Abstract This paper discusses the business potential of Angel Medical and their portable dialysis device. It describes a background to the product and the advantages of using this product as opposed to similar products. The paper then examines marketing aspects for the device and potential business and technical risks that may exist. Finally, the paper presents the writer's personal opinion of the business proposition.
Table of Contents:
Executive Summary
The U.S. Dialysis Market
Background: Patient Switching Between Peritoneal Dialysis and Hemodialysis
Description of the Portable Dialysis Device Product Line
Advantages of the Portable Dialysis Device, vs. Hemodialysis
Manufacturing Costs, Product Pricing, and Medicare Reimbursement
Marketing
Competitive Outlook
Potential Business Risks
Potential Technical Risks
Potential Risks During Use
Product Development for an Animal Study
Company Milestones
Patents
Author's Opinion of this Business Proposal
From the Paper "Baxter Healthcare (headquartered in Deerfield, IL) currently has 90% of the U.S. peritoneal dialysis market. They derive most of their peritoneal dialysis revenue from selling bags of dialysate and from leasing APD cyclers, so any significant market penetration by Angel Medical would most likely be seen as a threat. While Baxter has a large U.S. and international sales presence, they are notoriously weak in R&D. Nearly all of their products and technologies were purchased, rather than developed internally. Baxter attempted to create a Portable Dialysis Device in 2000, but gave up after insufficient progress was made in the allotted time. Baxter is also the most likely suitor for Angel Medical, after the device has achieved some market penetration."
The paper is a marketing plan for Fresenius Medical Care, a company specializing in the manufacture of dialysis equipment and the operation of dialysis facilities.
Abstract Fresenius Medical Care is a German company based in Frankfurt that specializes in kidney services. The company runs some 2200 dialysis clinics worldwide, with over 70% of those being in North America. They also manufacture dialysis and other kidney treatment equipment, and market this to some of their competitors. The paper is a marketing plan that examines the company in detail and attempts to suggest avenues for expansion whilst discussing potential advantages and disadvantages faced by the company.
Outline:
Introduction
SWOT
Conclusion
From the Paper "There are several opportunities for Fresenius. The first is to continue to expand their markets. The company is relatively new, and their operations are highly concentrated in the United States (almost 70% of clinics, for example). This leaves a large segment of the global market yet to be developed. Increased privatization in Canada, for example, will provide greater opportunities in that market. Emerging markets such as Thailand and India are becoming medical destinations for Western travelers, but also have rapidly increasing middle classes, as does China.
"Another opportunity is the development of new technologies. The industry is subject to rapid technological changes, and this allows for any firm to win market share through technological superiority. Fresenius has a history of technological leadership and with their size has the ability to finance new technology development to a degree that few of their competitors can match."
Abstract This paper examines the importance of nutrition in end stage renal failure disease versus non-diseased people. It begins by discussing the causes of end-stage renal disease and its recommended treatment. The paper then discusses nutrition in the pre-dialysis and dialysis patient. The paper specifically looks at the restrictions that must be placed on the diet of a patient undergoing dialysis.
Outline:
Causes
Treatment
Nutrition in the Pre-dialysis and Dialysis Patients
From the Paper "The definitive treatment of ESRD is the initiation of dialysis (peritoneal or hemodialysis) or renal transplantation with control or eradication of the cause of the kidney disease. However, nutritional support in the patient with end-stage renal disease must take into account the fragile electrolyte balance maintained by the remaining functional nephrons. Nutritional support in these patients most importantly takes into account the stage at which the patient is in. Protein restriction (0.6 g/kg/day) combined with a balanced, calorie-sufficient diet (35 kcal/kg/day) and phosphorus supplementation of up to 10 g/kg/day is the diet of choice for stage 3, 4 and 5CRD patients (Skorecki, Green & Brenner, 2005). Protein restriction is the most important component, which avoids the problem of urea nitrogen accumulation from the catabolism of the n-terminals of excess protein. Other organ system disorders are treated separately."
Abstract This paper is a literature review to investigate how the leadership of the manager nurse affects the clinical outcomes of dialysis patients especially as relating to medications given during dialysis and in monitoring lab values. The paper points out that the research indicates that staffing and resource adequacy is a problem in the dialysis units throughout the United States. The paper concludes that the leadership role of the nephrology nursing manager is vital in preventing the turnover of nurses in these units especially because the nurse's mental, physical and emotional state and effectiveness quite clearly impact the outcomes of their dialysis patients.
Table of Contents:
Introduction
Environmental Analysis of the Dialysis Unit
Organizational Characteristics That Promote Nursing Practice
Additional Findings
Summary and Conclusion
From the Paper "For the nephrology nurse who has the capacity to deal with the "bigger picture" this means overseeing sometimes multiple dialysis centers many hundreds of patients. Steib (2008) For others it may mean overseeing only one dialysis unit. Steib (2008) relates that patients who are involved in dialysis sometimes must go in three and four hours at a time and multiple days per week making treatment feel like a job to them."
Tags: career, total patient care, statistics, organizational characteristics, burnout
Abstract This paper explains that end-stage renal disease (ESRD) represents irreversible damage to the nephrons, the functioning filtration units of the kidney. The author points out that this stage is generally accepted clinically as the complete dependence of the patient on life-preserving dialysis or kidney transplantation for adequate waste filtration due to this irreversible damage. The paper relates that the definitive treatment of ESRD is the initiation of dialysis (peritoneal or hemodialysis) or renal transplantation with control or eradication of the cause of the kidney disease; however, nutritional support in the patient with end-stage renal disease must take into account the fragile electrolyte balance maintained by the remaining functional nephrons.
Table of Contents
Causes
Populations at Risk
Signs and Symptoms
Treatment
From the Paper "Signs and symptoms of ESRD are also seen in acute, chronic and acute renal failure superimposed on chronic renal failure. ESRD is seen in GFRs that approach zero; it is thus inferable that prolonged periods in between dialysis result in severe manifestations of electrolyte imbalance, especially urea and ammonia accumulation. Azotemia and uremia are associated with urea and ammonia accumulation secondary to diminished renal function are seen in rises in blood urea nitrogen."
Abstract This paper explains that end-stage kidney disease occurs immediately prior to chronic renal failure in which the kidney is no longer able to provide its necessary physiological functions. The author points out that patients in end-stage chronic renal failure typically are engaged to some degree in the dialysis process, but complete chronic renal failure will create a new series of lifestyle changes for the patient. The paper provides a comprehensive lesson plan for a patient who is undergoing end-stage chronic renal failure.
From the Paper "End-stage kidney disease occurs immediately prior to chronic renal failure, in which the kidney is no longer able to provide its necessary physiological functions. Patients in end-stage chronic renal failure typically are engaged in the dialysis process to some degree, but complete chronic renal failure will create a new series of lifestyle changes for the patient. This paper is designed to provide a brief yet comprehensive lesson plan for a patient who is undergoing end-stage chronic renal failure. Conditions of End-Stage Chronic Renal Failure The patient undergoing end-stage chronic renal failure has a new set of physiological burdens applied. The kidney is no longer able to effectively process the body's wastes or play its role as the foremost regulator of the body's blood supply."
Abstract The paper calls for a complete review of the endocrine system in the human body along with a description of kidney functioning. Once both systems are described, a presentation is made with respect to kidney failure and treatment by kidney dialysis. Each endocrine gland is described in detail along with the kidney ductless endocrine system. Comparisons are made between the two systems.
From the Paper "All the systems in the human body are vital to our survival and well-being and if one succumbs to failure the entire whole body will cease to work properly. The main systems of the human body are the nervous, endocrine, respiratory, circulatory, immune, digestive, excretory, skeletal, and muscular, (Jacob, 1). They all work together in harmony and unison to keep us alive in perfect synergy. In fact, a 17th dualist and intellectual rebel by the name of Rene Descartes delved into the depths of the human psyche and concluded that man is made up of two different kinds of substances, namely, the mind and the body. To Descartes the mind was representative of man's mental properties and the body representative of physical properties. As a medical expert Descartes proposed that the answer of the relationship between mind, body, and soul lies within the endocrine system."
Abstract This paper explains that the numerous factors of kidney disease can directly affect a sufferer's state of mind. Not only is there physical pain involved, but also there is the humiliation of having a catheter, the burden of dialysis, the stress of the potential of transplant surgery and the possibility of putting a loved one in danger if they become a donor. The author points out that diagnosis and appropriate treatment of a psychiatric problem related to chronic kidney disease depends on a rational assessment of numerous contributing factors and the strengths and weaknesses of the individual. The paper stresses that one of the most important roles the advanced practice nurse is early detection and intervention.
Table of Contents:
Introduction
Overview of Kidney Disease
Implications for Mental Health
Diagnosis and Treatment
Role of the Advanced Practice Nurse
From the Paper "Statistically, men and women over 55 face an increasing probability of acquiring some chronic disease (Birren & Sloane, 2001). A psychiatric symptom such as poor memory may be related to organic illness, for example, a brain disorder, or represent a psychological aspect of an illness, for example, depression. Depression is the most frequent incapacitating psychiatric problem throughout life. More than half the victims of a serious depression have their first episode after 60, and estimates are that careful clinical examination would confirm depression in 10 to 30 percent of those over 65."
Abstract In this article, the writer notes that kidneys are fist-sized, bean-shaped organs, which are located at the lowest part of the rib cage and the sides of the spine. Their major function is to remove waste products and excess fluids from the body in the form of urine. The writer points out that damage to the kidneys or reduced kidney functions can constitute chronic kidney disease or CKD. Chronic renal failure consists of a progressive loss of kidney function from disease or another cause. In addition, the writer explains that untreated CKD may lead to kidney or renal failure. The condition may need to be treated with dialysis or kidney transplantation. The writer discusses the symptoms, diagnosis and possible treatment of chronic kidney disease and renal failure.
Outline:
Psychosocial and Physiological Changes
Dietary Changes
Management and Implications
Diagnostic Strategy and Differential
From the Paper "Dialysis performs the function of the kidneys but does not cure the disease or prevent possible complications. It may even cause those complications and even reduce one's quality of life. Hemodialysis sends the blood through a dialyzer and goes back to the body after eliminating toxins and excess fluid. It is usually done thrice a week, each time for 3 to 5 hours or more. Common negative reactions are fluid and electrolyte imbalances, hypotension, light-headedness, leg cramps, nausea and vomiting. The other type is peritoneal dialysis, which uses the peritoneum to filter the blood without removing it from the body. It uses dialysate, which is later drained through a peritoneal catheter. Peritonitis is the most common complication. A study of 336 hemodialysis and 185 peritoneal dialysis patients undergoing both types found that peritoneal dialysis was a preference 1.5 times more. The quality of care, freedom of choice and cost are major reasons for their choice. Physicians, however, prefer hemodialysis because of reimbursement trends."
Abstract This paper explains that dialysis is a treatment for end-stage renal disease, in which a machine is used to act as the patient's healthy kidneys. The author describes two types of dialysis: hemodialysis and peritoneal dialysis. The paper recommends kidney transplantation where the patient receives a new kidney, either from a living or deceased donor. The author points out that kidney transplant patients have been shown to live as long as the average non-transplant patient without the burden of spending large amounts of time on dialysis. The paper relates that, while both treatments are covered eighty percent financially by the federal government end-stage renal disease program, the cost is higher for patients with dialysis than for transplantation. The paper states that no action is sometimes chosen by the patient who feel that the burdens of dialysis or transplantation outweigh the benefits.
From the Paper "Kidney transplantations come with some complications and stresses. Waiting for the transplant can cause stress in patients. The National Kidney Foundation says that over 73,000 people are on the waiting list, and twelve of those people die every day waiting for a kidney. Anti-rejection medications lower the immune system allowing for higher susceptibility to illness. Although severe transplant rejection occurs in less than twenty-five percent of patients, patients are required to take anti-rejection medication daily according to MedicineNet, Inc."
Abstract The prevalence of patients with End Stage Renal Disease (ESRD) has increased and efforts to control cost and meet managed care demands for lower reimbursements, have resulted in the increased use of unlicensed personnel in dialysis treatment centers. This paper compares the confidence and competence of licensed and unlicensed dialysis providers and identifies the differences between the two groups. The paper then focuses on ESRD literature investigating the prevalence and economics, the introduction of unlicensed personnel, the consequences of too few licensed personnel, future trends, differences found in personnel, and theoretical framework for this study. Finally, the paper discusses the methodology that was employed in the investigation between licensed and unlicensed personell and divides the discussion into five sections - Research Design, Subjects and Sampling, Instrumentation, Procedure and Data Analysis.
From the Paper "Be this as it may, there is such a shortage of nephrology nurses that it may ultimately mean rethinking the way non-licensed personnel are used, and may in fact require expanded roles for them (Robbins, 1999). Vogel (1999) reports there is an increased use of permanent catheters (tunneled cuffed catheters) in chronic dialysis units. As it stands now, California law prohibits dialysis technicians from accessing permanent catheters (Business and Professions Code Section: 1247-1247.9). There is a critical shortage of nephrologists and the technician's training programs have not kept up with the rapid developments in hemodialysis technology, which may have led to related safety problems (Nissenson & Rettig, 1999; Rolston (1993)."
Abstract This paper describes hemodialysis, which is used to treat patients suffering from renal failure. The paper begins by explaining renal failure. Next the paper discusses the need for dialysis, explains how it is preformed, and assesses its effects -- both positive and negative -- on the patient. The paper also investigates potential complications, particularly with regard to arteriovenous fistulas, which are essential for connecting the patient to the dialysis machine. The paper concludes by reviewing other side-effects of renal failure, such as anemia and high blood pressure, and their treatment.
From the Paper "When the kidneys are functioning normally, they regulate the chemical composition of the blood, particularly sodium, potassium, calcium and phosphorus. They also remove extra fluid to form urine, as well as drugs and toxins..."
From the Paper "DIALYSIS
Introduction
For the past 30 years, hemodialysis (HD) has been administered to patients with end-stage renal failure (1). Hemodialysis has evolved into a safe treatment and has been successful in preventing death in these patients (10). Peritoneal dialysis became popular as a treatment modality for end-stage renal disease (ESRD) after the development of ambulatory forms of the technique. Plastic bags of dialysis solution were introduced to the United States in 1979; this made application of the technique to the general dialysis population more feasible. By the end of 1992, approximately 70,000 people worldwide received continuous ambulatory peritoneal dialysis or continuous cycling peritoneal dialysis (chronic peritoneal.."
Abstract This paper examines the impact of hemodialysis on End Stage Renal Disease (ESRD) patients. The paper discusses the vital role played by the nurse, in hemodialysis treatments. The paper outlines the different treatments available to ESRD patients, and focuses on the option of hemodialysis. This treatment is explained in detail, including the praticalities of how it works and what it does, and the costs involved. The paper presents the option for ESRD patients, of undergoing the treatment in the hospital or at home. Statistics are provided regarding the patients choices as well as regarding the different costs.
Introduction
Hemodialysis as the Choice of Treatment
The Increasing Role of Hemodialysis Nurse
How Nurses Develop Themselves
Bibliography
From the Paper "It is a difficult condition of a kidney failure when one's kidney could no longer carry out the proper metabolism system to eliminate waste products. Kidney is the essential organ that is responsible in waste elimination, including others like detoxification process of drugs and toxic materials, also in controlling water balance, salt balance, blood pressures and secrete hormones (Crawford, 2002). When both kidneys fail to function, which comes to the End Stage Renal Disease, there is suddenly a loss of control to the fluid balance. The kidney cannot filter the fluid and therefore metabolism waste, toxic, salt and water accumulate in the blood, causing swell on the tissues, high blood pressure and heart disease. Until now, there is no medication offered to cure ESRD. The current treatments to this disease are hemodialysis, peritoneal dialysis, or kidney transplant."
Abstract This paper presents a colorful and detailed explanation of the function of the kidneys. The paper offers many diagrams to illustrate the material discussed. The paper also includes extensive research on acute and chronic renal failure. The paper examines acute renal failure by providing a case study on the subject.
Outline
Introduction
Mechanisms of Fluid Regulation
Acute Renal Failure Pathophysiology
Clinical Manifestations
Treatment
Diet
Drug Treatment
Case Study
References
From the Paper "The adrenal medulla functions as part of the autonomic nervous system. Stimulation of preganglionic sympathetic nerve fibers causes release of epinephrine and noreepinephrine. These regulate metabolic pathways to promote catabolism of stored fuels to meet caloric needs from endogenous sources. Epinephrine is the key player in the 'fight or flight' response. The adrenal cortex produces three steroid hormones. Glucocorticoids affect blood glucose levels using the negative feedback system. Mineralcorticoids exert their major efforts on electrolyte balance. Androgens effects are similar to male sex hormones."
