Colorectal cancer screening use among insured adults: Is out-of-pocket cost a barrier to routine screening?

AIM To describe the characteristics of adults who needed to see a doctor in the past year but could not due to the extra cost and assess the impact of limited financial resources on the receipt of routine fecal occult blood test, sigmoidoscopy, or colonoscopy for colon cancer screening among insured patients. METHODS Data obtained from the 2012 Behavioral Risk Factor Surveillance System included 215436 insured adults age 50-75 years. We computed frequencies, adjusted odds ratios(a ORs), and 95%CIs using SAS v9.3 software. RESULTS Nine percent of the study population needed to see a doctor in the past year but could not because of cost. The numbers were significantly higher among those aged 50-64(P 0.0001), Non-Hispanic Whites(P 0.0001), and those with a primary care physician(P 0.0001) among other factors. Adjusting for possible confounders, a ORs for not seeing the doctor in the past year because of cost were: stool occult blood test within last year a OR = 0.88; 95%CI: 0.76-1.02, sigmoidoscopy within last year a OR = 0.72; 95%CI: 0.48-1.07, colonoscopy within the last year a OR = 0.91; 95%CI: 0.81-1.02. CONCLUSION We found that the limited financial resources within the past 12 mo were significantly associated with colorectal cancer(CRC) non-screening. Patients with risk factors identified in this study should adhere to CRC guidelines and should receive financial help if needed.     

Point‐of‐care Doppler ultrasound in the management of hyponatremia: Another string to nephrologists' Bow

Objective assessment of fluid status is vital for the appropriate management of patients with hyponatremia. Conventional physical examination suffers from several limitations in this regard, and point‐of‐care Doppler ultrasonography can be used as an adjunct to clinical and laboratory data in evaluating these patients.     

Nephrologist‐performed portal vein Doppler to monitor response to diuretic therapy

Conventional parameters for assessment of fluid status suffer from several limitations. IVC maybe chronically dilated in patients with pulmonary hypertension. Portal vein Doppler offers an additional data point to assess the severity of venous congestion as well as monitor the efficacy of decongestive therapy.     

Point of care ultrasonography in onco-nephrology: A stride toward better physical examination

Onco-Nephrology is an emerging subspecialty of Nephrology that focuses on a broad spectrum of renal disorders that can arise in patients with cancer. It encompasses acute kidney injury (AKI), complex fluid, electrolyte, and acid-base disorders, as well as chronic kidney disease caused or exacerbated by cancer and/or its treatment. In many such scenarios including AKI and hyponatremia, objective evaluation of hemodynamics is vital for appropriate management. Point of care ultrasonography (POCUS) is a limited ultrasound exam performed at the bedside and interpreted by the treating physician intended to answer focused clinical questions and guide therapy. Compared to conventional physical examination, POCUS offers substantially higher diagnostic accuracy for various structural and hemodynamic derangements. In this narrative review, we provide an overview of the utility of POCUS enhanced physical examination for the Onconephrologist supported by the current evidence and our experience-based opinion.     

Point-of-care ultrasound in diagnosis and management of congestive nephropathy

Congestive nephropathy is kidney dysfunction caused by the impact of elevated venous pressures on renal hemodynamics. As a part of cardiorenal syndrome, the diagnosis is usually made based on history and physical examination, with findings such as jugular venous distension, a third heart sound, and vital signs as supporting findings. More recently, however, these once though objective measures have come under scrutiny for their accuracy. At the same time, bedside ultrasound has increased in popularity and is routinely being used by clinicians to take some of the guess work out of making the diagnosis of volume overload and venous congestion. In this mini-review, we will discuss some of the traditional methods used to measure venous congestion, describe the role of point-of-care ultrasound and how it can ameliorate a clinician’s evaluation, and offer a description of venous excess ultrasound score, a relatively novel scoring technique used to objectively quantify congestion. While there is a paucity of published large scale clinical trials evaluating the potential benefit of ultrasonography in venous congestion compared to gold standard invasive measurements, more study is underway to solidify the role of this objective measure in daily clinical practice.