“Living Well on Dialysis”

HEP 454: Health Promotion Plan and Implementation

April 21, 2022

Table of Contents

Program Rationale…………………………………………………………………………………………3

Needs Assessment ………………………………………………………………………………………….5

Mission Statement, Goal, and Objectives for Living Well on Dialysis……………………………….. 8

Budget for Program: Living Well on Dialysis…………………………………………………………14

Intervention Design……………………………………………………………………………………….18

Marketing strategy………………………………………………………………………………………..22

Logic Model……………………………………………………………………………………………….27

Task timeline………………………………………………………………………………………………28

References…………………………………………………………………………………………………29

Program Rationale

More than seventy percent of dialysis patients have hypertension, and only around twenty percent of those with hypertension have sufficient management of their blood pressure (BP). Peritoneal dialysis (PD) patients are no different, and the reported prevalence of hypertension ranges from around 30 to more than 90 percent. Variability in the definitions and tools used to diagnose hypertension is largely to blame. Using various definitions of hypertension, epidemiological studies in Mississippi found that 72% to 88% of all individuals investigated had increased BP (Ashby et al., 2019). Patients with high blood pressure were more likely to be on antihypertensive medication, but only 30 to 50 percent of those patients had their blood pressure under control in those trials. When patients begin dialysis for kidney failure, they are almost universally on blood pressure-lowering medicines. Although many of them have too much fluid in their systems, frequent dialysis may help lower blood pressure if a patient has that fluid removed. Despite this, roughly 60 percent of hemodialysis patients and 30 percent of patients on peritoneal dialysis (PD) still require medication for high blood pressure.

Patients on hemodialysis often have three treatments a week. Before dialysis, the patient’s weight and extra fluid usually increase and decrease the following dialysis. Blood pressure is highest before hemodialysis and drops to its lowest after that, as you might expect (Heerspink et al., 2009). After hemodialysis, low blood pressure is a common symptom. The side effects are cramps, dizziness, lightheadedness, nausea, and vomiting. Hemodialysis patients who get treatment every day, like those who get hemodialysis at home, had less high blood pressure than those who didn’t (HHD). Most patients undergoing more frequent hemodialysis at home have normal blood pressure and do not require blood pressure medications.

To maintain healthy blood pressure, it is necessary to properly control a person’s fluid intake. Leg cramps, nausea, and lightheadedness are all signs that your body lacks fluid. Many signs of having too much fluid in your body are swollen ankles or a tight chest.

The priority population for Gulfport Quality Improvement Initiative is adults aged between 25 years and 40 years undergoing dialysis. Obesity is one of the reasons that causes high blood pressure in dialysis patients. It is advised that adults watch what they eat, the amount of salt intake, and eat healthy food.

People on hemodialysis can keep an eye on their blood pressure at home or while they are out and about. This is a better way to keep an eye on their blood pressure than to keep an eye on their dialysate blood pressure. Even though blood pressure is routinely measured in dialysis treatment facilities, some parts of the current measurement method may be deficient. Patients with chronic kidney disease (CKD) who have increased blood pressure (hypertension) can now use various new diagnostic and treatment options. A guideline for the dialysis population has not yet been developed to address this critical issue while the KIDGO recommendations are being reviewed.

The program to be developed will aim to better the lives of the patients. The benefits that the patients will get include dieticians’ benefits that will look upon what the patients eat and drink. Along with this there will be exercises that the patients will engage in to make sure that the blood flow is standard and within the acceptable ranges. There will also be transportation services which will facilitate the ferrying of patients to and from the hospital. Due to the financial constraints that are often associated with the dialysis treatment, the program should be a big success and a pioneer to similar programs especially for the priority population.

Needs Assessment

Health problem

Blood pressure taken before and after dialysis does not agree well with those reported outside the dialysis unit. Whether recordings obtained outside the dialysis unit are of better predictive value than blood pressure recorded right before and after dialysis remains incompletely known. More than seventy percent of dialysis patients have hypertension, and only around twenty percent of those with hypertension have sufficient management of their blood pressure (BP). Peritoneal dialysis (PD) patients are no different, and the reported prevalence of hypertension ranges from around 30 to more than 90 percent. Variability in the definitions and tools used to diagnose hypertension is essentially to blame. Using various definitions of hypertension, epidemiological studies in Mississippi found that 72% to 88% of all individuals investigated had increased BP (Ashby et al., 2019). Patients with high blood pressure were more likely to be on antihypertensive medication, but only 30 to 50 percent of those patients had their blood pressure under control in those trials. When patients begin dialysis for kidney failure, they are almost universally on blood pressure-lowering medicines. Although many of them have too much fluid in their systems, frequent dialysis may help lower blood pressure if a patient has that fluid removed. Despite this, roughly 60 percent of hemodialysis patients and 30 percent of patients on peritoneal dialysis (PD) still require medication for high blood pressure.

Patients on hemodialysis often have three treatments a week. Before dialysis, the patient’s weight and extra fluid usually increase and decrease the following dialysis. Blood pressure is highest before hemodialysis and drops to its lowest after that, as you might expect (Heerspink et al., 2009). After hemodialysis, low blood pressure is a common symptom. The side effects are cramps, dizziness, lightheadedness, nausea, and vomiting. Hemodialysis patients who get treatment every day, like those who get hemodialysis at home, had less high blood pressure than those who didn’t (HHD). Most patients undergoing more frequent hemodialysis at home have normal blood pressure and do not require blood pressure medications.

Risk factors

To maintain healthy blood pressure, it is necessary to control a person’s fluid intake properly. Leg cramps, nausea, and lightheadedness are all signs that your body lacks fluid, which can lower your blood pressure. There are many signs of having too much fluid in your body, such as swollen ankles or a tight chest. Each patient can benefit from establishing a goal weight for themselves each day. There may be an excess of fluid if the patient’s weight and blood pressure are high (Zhang et al., 2019). A lack of fluid can cause dehydration in underweight patients or have low blood pressure. Dextrose, a type of sugar, can be changed in PD dialysate exchanges with the help of a doctor and a nurse trained in peritoneal dialysis. Keeping fluids out and blood pressure down can be accomplished by limiting your daily salt and beverage intake.

Hypertension affects a large percentage of people undergoing peritoneal dialysis. It is possible to have both high and low blood pressure, and both of these conditions can lead to heart disease, strokes, and early death. Using peritoneal dialysis regularly makes it possible to maintain a healthy blood pressure level without using other medications (Müller et al., 2020). With correct hydration management and appropriate remedies, blood pressure can be kept under control.

Priority population

The priority population for Living Well on Dialysis are newly diagnosed dialysis patients at Memorial Hospital Gulfport. According to the national kidney foundation, patients in stages 4-5 need more care and treatment because the stage is critical and should be handled carefully to help the patient cope with the situation (Stern et al., 2014). The majority of the patients suffering from high blood pressure are between 25 and 30. Patients in this age bracket take many things for granted and do not follow the correct procedure for dialysis to avoid having high blood pressure issues. It is advised that adults watch what they eat, the amount of salt intake, and eat healthy food to avoid becoming obese. Obesity is one of the reasons that causes high blood pressure in dialysis patients. If they eat healthily and follow the procedure for the treatment, it is easy to manage the high blood pressure that affects them.

People on hemodialysis can watch their blood pressure at home or while they are out and about. This is a better way to keep an eye on their blood pressure than to keep an eye on their dialysate blood pressure. Even though blood pressure is routinely measured in dialysis treatment facilities, some parts of the current measurement method may be deficient. Patients with chronic kidney disease (CKD) who have increased blood pressure (hypertension) can now use various new diagnostic and treatment options. A guideline for the dialysis population has not yet been developed to address this critical issue while the KIDGO recommendations are being reviewed.

Other similar programs

As part of the National Institutes of Health, the National Heart, Lung, and Blood Institute (NHLBI) recommends that persons with CKD utilize whatever therapy is necessary to keep their blood pressure under 130/80.

 To lower blood pressure, the NHLBI suggests five dietary and lifestyle modifications. Those with high blood pressure, whether prehypertension or hypertension, need.

 Maintain a healthy body weight close to that of a typical person.

 Eat enough fresh fruits and vegetables, whole grains, and low-fat dairy products as part of your daily diet to achieve optimal health.

 They should keep their daily sodium consumption to no more than 2,000 mg.

 They should reduce their use of frozen meals and fast-food establishments and instead eat more fresh foods.

 They should look at nutrition labels on packaged items to see how much sodium is in a serving. You may keep track of your sodium intake by keeping a sodium diary.

 Maintain a regular exercise schedule, aiming for 30 minutes of brisk activity five days a week (walking, bicycling, or swimming).

 Don’t overindulge in alcoholic beverages. As far as men are concerned, they should limit themselves to no more than two alcoholic beverages every day.

 Women should consume only one serving a day since they are more sensitive to the effects of alcohol due to the differences in the breakdown of food in the body.

Mission Statement, Goal, and Objectives for Living Well on Dialysis

Mission Statement: The mission of the “Living Well on Dialysis” program is to educate and prepare dialysis patients for long-term success during their treatment through a holistic approach to their care which encompasses dietary recommendations, case management, behavioural health services, and other social services as needed at Gulfport Memorial Hospital.

Program Goal: Prevent complications for patients on dialysis and promote long-term healthy habits for patients that have been admitted to Gulfport Memorial Hospital.

Process Objectives:

Specific: What, how, and where the behaviour will be done. List the Priority Population. Free nursing, counselling, and Social Work services will be offered to various patients. The Social Workers will be responsible for the arrival of patients to and from the hospital, while Dieticians will help educate patients on healthy eating habits and fluid intake. The Dieticians will educate the patients on what foods they should avoid and give them a list of healthy food options. New patients diagnosed with ESRD at Memorial hospital will be given top priority. Counselling services will be provided bi-weekly to follow up on the well-being of the patients for their 1st year of treatment.

Measurable: How much, how many, or how often will the behaviour be done One hundred fifty newly diagnosed ESRD patients on dialysis will be the priority population at Memorial Hospital Gulfport.

Attainable: Set a realistic goal, high enough to be a challenge but low enough to be reachable There are 150 patients in this 1-year Program which. One hundred fifty patients are attainable in the time frame.

Relevant: Does this Objective relate to the program goal? The Objective relates to the program goal of preventing complications for patients on dialysis and promoting healthy habits long term for patients that have been admitted to Gulfport Memorial Hospital

Time-bound: When will this Objective be achieved? Use a specific date. This Program will be implemented on August 1, 2022, and the completion date will be August 1, 2023

How might this Objective be measured and evaluated?

(brainstorm, it does not need to be added to your Objective) Patients' Medical records will host all information. The Medical Team will document everything in the HER Electronic Health Record.

Process Objective Statement: By August 2023, 150 newly diagnosed ESRD patients will be set up for long-term success on dialysis at Memorial Hospital Gulfport.

Specific: What, how, and where the behavior will be done. List the Priority Population. The Case Manager will distribute pamphlets.

Newly diagnosed ESRD patients on dialysis will be the priority population at Memorial Hospital Gulfport.

Measurable: How much, how many, or how often will the behavior be done 2,500 pamphlets

Attainable: Set a realistic goal, high enough to be a challenge but low enough to be reachable Two thousand five hundred pamphlets are attainable, given the Program is only hosting 150 newly diagnosed ESRD patients on dialysis in a 1-year time frame.

Relevant: Does this Objective relate to the program goal? This Objective relates to the Program’s

intervention strategy of health

Communication. The pamphlets educate on healthy lifestyles and long-term success in dialysis.

Time-bound: When will this Objective be achieved? Use a specific date. Completed by July 2022

How might this Objective be measured and evaluated?

(brainstorm, it does not need to be added into your Objective) The Case Manager will keep a daily inventory of how many pamphlets are printed and distributed

Process Objective Statement: By July 2022, The Case Manager will distribute 2500 pamphlets on healthy lifestyle and long-term success to 150 newly diagnosed ESRD patients at Memorial Hospital Gulfport.

Impact Objectives:

Specific: What, how, and where the behavior will be done. List the Priority Population. Group Therapy with a counselor

There will be six classes of 25 patients

Newly diagnosed ESRD patients on dialysis at Memorial Hospital Gulfport will be the priority population.

Measurable: How much, how many, or how often will the behavior be done 150 newly diagnosed ESRD patients on dialysis

Attainable: Set a realistic goal, high enough to be a challenge but low enough to be reachable Six counselors will be on hand to provide counseling services to 6 groups of 25 patients. This will be ongoing once a month while this 1-year Program is in place. Each patient will have attended 12 groups sessions by the completion of the Program. This is attainable by the deadline.

Relevant: Does this Objective relate back to the program goal? This Objective relates to the Program’s

intervention strategy of health education and health promotion for the Living Well on Dialysis Program

Time-bound: When will this Objective be achieved? Use a specific date. Completed by August 2023

How might this Objective be measured and evaluated?

(brainstorm, does not need to be added into your Objective) There will be a sign-in sheet for each patient to sign in upon arrival at the group counseling session. There will be an anonymous drop-off box for patients to drop a note or letter to share if this group session was impactful.

Impact Objective Statement: By August 2023, 150 newly diagnosed ESRD patients on dialysis will have completed 12 group counseling sessions at Memorial Hospital Gulfport.

Outcome Objectives:

Specific: What, how, and where the behavior will be done. List the Priority Population. They are preventing complications for patients on dialysis while promoting healthy long-term habits. One hundred fifty newly diagnosed ESRD patients on dialysis are the priority population.

Measurable: How much, how many, or how often will the behavior be done There will be an 80% increase in patient success on dialysis at Memorial Hospital Gulfport.

Attainable: Set a realistic goal, high enough to be a challenge but low enough to be reachable 80% is an attainable goal for the first three years of program implementation. That’s a success rate of 120 patients out of 150

Relevant: Does this Objective relate back to the program goal? educate and prepare dialysis patients for long-term success during their treatment through a holistic approach

Time-bound: When will this Objective be achieved? Use a specific date. Two years after program implementation, August 2025

How might this Objective be measured and evaluated?

(brainstorm, does not need to be added into your Objective) Primary data was collected from Memorial Hospital Gulfport

Outcome Objectives Statement: Five years after the program implementation, patient success on dialysis at Memorial Hospital Gulfport will increase by 80%.

Additional Impact Objectives:

• At the end of the educational workshop, all 150 patients will be able to list three foods high in potassium and three foods low in potassium.

• After completing 12 months of group counseling sessions, 95% of the patients will be able to list four coping techniques verbally.

Category Item How Much How Many Total Cost

Personnel: Charge Nurse $119,781.00 / year 1 $119,781.00

Floor Nurse $62,500/ year 3 $150,000.00

Patient Advocate $52,173.00/year 1 $52,173.00

Social worker $60,618.00/ year 3 $181,854.00

Dietician $76,144.00/ year 1 $76,144

Therapist $69,169.00 year 5 $345,845

CHES 64,395.00/ year 1 64,395.00

Curriculum & Instructional Resources Textbooks 7.79 150 $1168.50

Space/Transportation 15 Passenger Van $30,000.00 5 $150,000.00

Advertisement Radio $25.00 24 $600.00

Social Media $200.00 12 posts $2,400.00

Flyers .03 5,000 $150.00

Health Education Materials Pamphlets $60 2500 $4000

Equipment & Supplies

Heated blankets

Beds

Journals

Gas

Amazon Fire Tablet

$30.00

$100.00

$40.00

$200.00

$39.99.00 150

150

$20

12months for 5 cars

150 $4,500.00

$6000

$800

$12,000.00

$5,998.50

Donations Program flyers

Face Mask

Water

Incentives BP Cuffs $20.00 50 $1000.00

Glucose Monitors $15.00 100 $1,500.00

Gift Cards $20.00 150 $3,000.00

Fringe Benefits for Staff:

Health Insurance 25% of salary 20 $217,997,75

Total Cost for Program $1,401,306.75

Number of Program Participants 150

Cost per Participant $5,000.00

Budget Narrative:

The budget for the Dialysis Care Program is based on the now population of dialysis care patients within Memorial Hospital Gulfport. Implementation of the Program will be centered on the left wing of the hospital where the dialysis patient is located and spread over 12 months. The budget will see patients not having to use their means while coming to the hospital, and also, while within the hospital, they will have supplies, which the hospital will provide. While patients are admitted, texts books will be offered to the patients who are against screen time to ensure everyone’s needs are accommodated. Additional beds will be purchased to ensure they are the most comfortable, especially for the priority population, to ensure the quickest recovery.

This Program is grant-funded, and most salaries will be covered through the grants. The American Kidney Foundation will secure additional grants. Most dialysis patients have Medicare insurance. Medicare is a federally funded health insurance program for Americans over age 65 and people who have been deemed disabled. In 1972, people requiring dialysis became newly entitled to this health benefit. The law was amended to provide coverage to people who may have forgone treatment due to the high costs of dialysis treatment. Today, if you have chronic kidney disease (CKD) and need dialysis, you may be eligible for Medicare insurance. (DaVita 2004-20222)

This Program will bill the patient’s insurance to help cover their time in the Program if the patient’s insurance cannot cover the entire price of the Program. We can either bill their secondary insurance and have them apply for assistance through the American Kidney Foundation or self-pay.

The Patient Advocates, alongside the Dietician, will provide different learning activities for the patients—one dealing with fluid intake and healthy food choices. The Patient Advocate will also be required to offer different exercise options while ensuring that there is a reward system for the patients who push through their exercise routines.

This Program involves some sense of sensitivity. The patients will go through a lot during these 12 months, so we offer support groups twice a month and single counseling sessions if needed. The patients will be vulnerable at this stage in their life, and they must have the support needed to push them and hold them accountable. This is all covered through the Federal Grant that we used to help implement the Program.

Resources used to calculate this budget

Budget Resources:

Resources:

U-Line

Sharp Assure

Walmart

Amazon

Best Buy

Staples

RTG Medical Supplies

Glassdoor Salary for Gulfport, MS

Thrifts books and Print Place

Intervention Design

Intervention

strategy HBM

construct Program

Activities

Health Communication Perceived susceptibility

Perceived severity

Cues to action • Pamphlets will be provided – tailored to healthy lifestyles and long-term success on dialysis.

Priority population.

• Various health practitioners will carry out health surveys.

• Group meeting to share experiences, healthy recipes, aspirations, and smart goals. During this time, we will allow for questions

Health Education Perceived susceptibility

Perceived benefits

Self-efficacy • Monthly group therapy meetings to connect and vent about their experiences on dialysis. During this time, we will encourage patients.

• WebEx gatherings will be conveyed three times each week to associate with people and talk about progress, battles, or answer questions.

• During exercises sessions, the population can be taught various stretches to incorporate into their daily sessions.

• Various educational podcasts will be played via Bluetooth in the car while the patients are taken to the hospital.

• Skill-building activity: Patients will practice cannulating a model Fistula/graft

• Skill-building Activity: Patients will be shown four eight-ounce cups filled with fluid and then a one 32-ounce cup filled with fluid to reference how much fluid a dialysis patient can have daily.

• Patients will journal their daily experiences to reflect on after the Program

Environmental Change Cues to Action

Perceived Barriers/Benefits • Patients will be limited to four eight-ounce cups of water daily

• Installing signs that promote healthy walking and breathing exercises as a reminder.

• Increasing the availability of fresh, healthy food options

Behavior-modification Cues to Action

Perceived Barriers/Benefits • During their journaling time, patients will be asked to look deep and see what behavior they would like changed and develop a solution to change that behavior.

Health-Related Community Service Perceived barriers

Perceived severity

Perceived susceptibility • Health Screenings for the community

• BP and glucose readings will be done

• The Patient Advocate will be there to help educate the community on how important it is to get labs done regularly

• There will be a community hiking event to educate the masses about the effects of kidney failure.

Marketing strategy

4ps Program Application

Product -Gaining additional knowledge on how to be on dialysis and still be healthy and maintain a healthy lifestyle.

-Improved health

-Increased levels of assessments.

-Reducing the risk of one having complications while undergoing dialysis.

-Providing yoga and stretching exercises to various patients.

-Increased need for one to take care of their body and eating habits.

-Reduce the risk of stress while under dialysis treatment.

-Access to the hospital gym to maintain a fit body mainly for the athletic patients or ones who engage in sports.

-Access to transport facilities while visiting the hospital for dialysis treatment.

-Access to the services of a therapist to be at par with the mental health of a patient.

-Within reach of nursing services.

-Blood pressure within the ordinary, acceptable healthy ranges

-Proper feeding.

Price -No program charges

-Time commitment of three hours every Monday Wednesday and Friday for the entity of the program, which is 52 weeks.

-Time responsibility and work to take on better way of life propensities that are separated into more modest absorbable pieces during the classes and furthermore exhibited with opportunities to perform them also.

Place -Memorial Hospital Gulfport

-The left-wing of the hospital will be solely where the dialysis will take place.

-The rooftop will be where the yoga will primarily occur because of the sufficient aeration while the patients are working out.

-The therapy sessions will be next to the psychiatric facilities.

-Education and interactions will be next to the nurse’s cafeteria because of the vast space and seating facilities.

Promotion -Advertisements in the weekly South Mississippi Living magazine.

- An article will be composed by a student, which will then be printed in the Nation newspaper and will be distributed to 6000 families in the nearby regions

-An announcement will be made in between a favored radio program.

-Podcasters will be approached and convinced to announce the Program during their Program.

-Pamphlets may also be employed in various work places within the region

To reach the masses and take advantage of the growing podcast world, there will be a podcast ad seeking to capture new listeners and inform them of the Program. The yoga and healthy stretches will help the patients combat various ailments that the patients may be combating from staying at home. The exercise will also make sure that the blood pressure is exercised and that while the patient is gaining weight, his health won’t be at risk.

Inputs (Resources) Outputs

Outcomes – Impact

Activities Participation Short Medium Long

One Charge Nurse

Three Floor Nurses

Patient Advocate

Three Social worker

One Dietician

Five Therapist

CHES

Textbooks

(5) 15 Passenger Vans

Social Media influencers

Flyers

Pamphlets

Heated blankets

Beds

Journals

Gas

Amazon Fire Tablet

Program flyers

Face Mask

Water

BP Cuffs

Glucose Monitors

Gift Cards

Health Insurance

Training Social media influencers will post about the program details.

Various adverts will be aired through the radio channel between favorite program sessions.

A van will be collecting the patients to and from their places of residence and the hospital.

Participants will be educated on the benefits of healthy eating, after which various texts will be given to them for more information.

A dietician will educate the participants on the benefits of healthy eating and eating in general.

The floor nurses will monitor the participants' progress and directly report to the charge nurse to evaluate their overall work.

A patient advocate will be the one who will overlook the nurse’s duties and will be available in case of any legal technicalities. 150 participants. There will be increased awareness, and participants will avail themselves.

The participants will know what foods they can or cannot have

The nurses will be educated on additional practices they can partake in to help the patients better.

The participant’s notions that one only needs rest when sick will have to be revised, and therefore the participants will finally agree that exercise is essential.

The participants will save more money considering that they will be taken to the hospital and dropped back to their residences after the dialysis and additional treatments.

The participant’s diet will improve, considering the Dietician’s advice. The participants will restock their pantries and fridges with quality food.

The participant’s beliefs about medication and exercise will be alleviated completely.

The hospital facilities will eventually make the halls provide a permanent area for dialysis patients.

Participants will continue to practice positive self-assessment.

Participants will identify the negative blood pressure triggers

Participants will be able to get into a workout routine.

The Program will be able to get known widely due to the vast promotion done.

There will be an increase in participants acknowledging that some habits can lead to negative blood pressure.

Participants will have a very positive body image.

Very few deaths will occur due to patients suffering from high blood pressures.

Participants will express their gratitude and promise to in future donate towards the cause of improving the well-being of patients.

Participants will be able to live well while on dialysis.

Participants will be able to manage their emotions better.

Participants will be able to identify 32oz of water and know how much fluid they should take on a day to day basis.

Participants will be able to identify foods high and low in potassium

Task Timeline

Tasks Year 1 J F M A M J J A S O N D

Develop Program Rationale 

Conduct Needs Assessment   

Develop Goal and Objectives 

Create Intervention   

Conduct Formative Evaluation 

Hire and train program facilitators  

Assemble Resources 

Pilot test program  

Market and promote the Program 

Prepare for program kick-off 

Full implementation   

Evaluate Program 

Write final report 

=planned time

References

Davita inc. (n.d.). Medicare and chronic kidney disease. DaVita. Retrieved April 14, 2022, from https://www.davita.com/treatment-services/insurance-financial-management/medicare-and-chronic-kidney-disease

Salary: Registered nurse in Gulfport, MS | glassdoor. (n.d.). Retrieved April 15, 2022, from https://www.glassdoor.com/Salaries/gulfport-registered-nurse-salary-SRCH_IL.0,8_IM361_KO9,25.htm

Salary: RN case manager in Gulfport, MS - glassdoor. (n.d.). Retrieved April 15, 2022, from https://www.glassdoor.com/Salaries/gulfport-rn-case-manager-salary-SRCH_IL.0,8_IM361_KO9,24.htm

Salary: Patient Access Representative in Gulfport, MS … (n.d.). Retrieved April 15, 2022, from https://www.glassdoor.com/Salaries/gulfport-patient-access-representative-salary-SRCH_IL.0,8_IM361_KO9,38.htm

Salary: Social Worker in Mississippi, US - glassdoor. (n.d.). Retrieved April 15, 2022, from https://www.glassdoor.com/Salaries/mississippi-social-worker-salary-SRCH_IL.0,11_IS1553_KO12,25.htm

\\ Dietitian jobs in Gulfport, MS | glassdoor. (n.d.). Retrieved April 15, 2022, from https://www.glassdoor.com/Job/gulfport-dietitian-jobs-SRCH_IL.0,8_IC1141323_KO9,18.htm

Salary: Health Education Specialist (April, 2022) - glassdoor. (n.d.). Retrieved April 15, 2022, from https://www.glassdoor.com/Salaries/health-education-specialist-salary-SRCH_KO0,27.htm

Salary: Therapist in Gulfport, MS | glassdoor. (n.d.). Retrieved April 15, 2022, from https://www.glassdoor.com/Salaries/gulfport-therapist-salary-SRCH_IL.0,8_IM361_KO9,18.htm

Ashby, D., Borman, N., Burton, J., Corbett, R., Davenport, A., Farrington, K., Flowers, K., Fotheringham, J., Andrea Fox, R. N., Franklin, G., Gardiner, C., Martin Gerrish, R. N., Greenwood, S., Hothi, D., Khares, A., Koufaki, P., Levy, J., Lindley, E., MacDonald, J., … Wilkie, M. (2019). Renal Association Clinical Practice Guideline on Haemodialysis. In BMC Nephrology (Vol. 20, Issue 1). https://doi.org/10.1186/s12882-019-1527-3

Heerspink, H. J. L., Ninomiya, T., Zoungas, S., de Zeeuw, D., Grobbee, D. E., Jardine, M. J., Gallagher, M., Roberts, M. A., Cass, A., Neal, B., & Perkovic, V. (2009). Effect of lowering blood pressure on cardiovascular events and mortality in patients on dialysis: a systematic review and meta-analysis of randomised controlled trials. The Lancet, 373(9668). https://doi.org/10.1016/S0140-6736(09)60212-9

Müller, M., Schönfeld, C. L., Grammer, T., Krane, V., Drechsler, C., Genser, B., Kohnen, T., Wanner, C., & März, W. (2020). Risk factors for retinopathy in hemodialysis patients with type 2 diabetes mellitus. Scientific Reports, 10(1). https://doi.org/10.1038/s41598-020-70998-9

Stern, A., Sachdeva, S., Kapoor, R., Singh, J., & Sachdeva, S. (2014). High blood pressure in dialysis patients: Cause, pathophysiology, influence on morbidity, mortality and management. In Journal of Clinical and Diagnostic Research (Vol. 8, Issue 6). https://doi.org/10.7860/JCDR/2014/8253.4471

Zhang, L., Wang, Y., Xiong, L., Luo, Y., Huang, Z., & Yi, B. (2019). Exercise therapy improves eGFR, and reduces blood pressure and BMI in non-dialysis CKD patients: Evidence from a meta-analysis. BMC Nephrology, 20(1). https://doi.org/10.1186/s12882-019-1586-5

Ashby, D., Borman, N., Burton, J., Corbett, R., Davenport, A., Farrington, K., Flowers, K., Fotheringham, J., Andrea Fox, R. N., Franklin, G., Gardiner, C., Martin Gerrish, R. N., Greenwood, S., Hothi, D., Khares, A., Koufaki, P., Levy, J., Lindley, E., MacDonald, J., … Wilkie, M. (2019). Renal Association Clinical Practice Guideline on Haemodialysis. In BMC Nephrology (Vol. 20, Issue 1). https://doi.org/10.1186/s12882-019-1527-3

Heerspink, H. J. L., Ninomiya, T., Zoungas, S., de Zeeuw, D., Grobbee, D. E., Jardine, M. J., Gallagher, M., Roberts, M. A., Cass, A., Neal, B., & Perkovic, V. (2009). Effect of lowering blood pressure on cardiovascular events and mortality in patients on dialysis: a systematic review and meta-analysis of randomised controlled trials. The Lancet, 373(9668). https://doi.org/10.1016/S0140-6736(09)60212-9

Müller, M., Schönfeld, C. L., Grammer, T., Krane, V., Drechsler, C., Genser, B., Kohnen, T., Wanner, C., & März, W. (2020). Risk factors for retinopathy in hemodialysis patients with type 2 diabetes mellitus. Scientific Reports, 10(1). https://doi.org/10.1038/s41598-020-70998-9

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