bluuebunny/crossref_metadata_2025 huggingface dataset:
EUROPEAN PRACTICE DATABASE: COMPARATIVE RESULTS OF THE YEAR 1 PILOT PROJECT
Authors:   EDTNA/ERCA Research Board., Elseviers Monique , De Vos Jean‐Yves , Pancírová Jitka , Zampieron Alessandra , Lindley Elizabeth , Green Diane , Maurice Harrington National EPD Co‐ordinators
Published: July 2012

The European Practice Database (EPD) project, developed by the Research Board (RB) of EDTNA/ERCA, intended to collect data on renal practice at centre level in different European countries. During the pilot phase of the project (2002–2003), Czech Republic, Italy (North East) and England (North) participated with two thirds of all their eligible dialysis centres. Comparative results presented in this paper focus on centre size and patient characteristics, peritoneal and haemodialysis techniques, transplantation, infection control and the employment of technicians, dietitians and social workers in dialysis centres. At centre level, EPD results will enable in‐depth evaluation of personal practice. International comparison of the results will stimulate further research and the development of new guidelines.
EUROPEAN STUDY ON EPIDEMIOLOGY AND THE MANAGEMENT OF HCV IN THE HAEMODIALYSIS POPULATION. PART 1: CENTRE POLICY
Authors: Zampieron Alessandra , Jayasekera Heather , Elseviers Monique , Lindley Elizabeth , DeVos Jean‐Yves , Visser Ronald , Harrington Maurice
Published: July 2012

Haemodialysis patients are known to be at risk of infection of Hepatitis C Virus (HCV) through nosocomial spread. This paper presents the first part of a study on epidemiology and management of HCV, in a haemodialysis population, conducted by the EDTNA/ERCA Research Board. Data on HCV management and infection control procedures was collected from 136 European centres using an electronic questionnaire. The study identifies a number of possible risk factors for transmission of the virus: failing to disinfect devices between patients, sharing of single‐use vials to prepare drugs or infusions for different patients, inadequate sterilisation or cleaning of machines between dialysis sessions, unsatisfactory environmental cleaning and distance less than one metre between chairs.
POST INSERTION CATHETER CARE IN PERITONEAL DIALYSIS (PD) CENTRES ACROSS EUROPE. PART 2: COMPLICATION RATES AND INDIVIDUAL PATIENT OUTCOMES
Authors:   EDTNA/ERCA Research Board, Vijt Denise , Castro Maria José , Endall Gerry , Lindley Elizabeth , Elseviers Monique
Published: July 2012

The first part of this report, which looked at centre policy, showed that there was no consensus on the best way to manage a patient in the rest period between PD catheter insertion and the first use of the catheter for dialysis. This paper intends to investigate if the differences in policy had any effect on complication rate and individual patient outcomes.

Data were included from 298 patients of 49 participating centres. The results revealed a high rate of catheter related complications, with half of the patients having been treated for complications including leakage (29%), malfunction (23%) or infection (10%), and a quarter of patients having been hospitalised for catheter problems. Leakage was more frequently observed in lean and obese patients and if the catheter was only immobilized for a short time period. Diabetes, having constipation at first use and having rested for less than 6 hours after catheter insertion were significant risk factors for malfunction. Infection seemed to be related to the type of catheter used and hygienic precautions (not significant) and showed a significant relationship with the frequency of dressing changes. There is still an important lack of evidence on which to develop an optimal protocol for PD catheter insertion and care before first use.
EDTNA/ERCA VASCULAR ACCESS RECOMMENDATIONS FOR NEPHROLOGY NURSES
Authors:   Research Board of EDTNA/ERCA, Van Waeleghem Jean‐Pierre , Elseviers Monique , De Vos Jean‐Yves
Published: July 2012

In 1989, SJ. Schwab stated that providing satisfactory vascular access for haemodialysis remains one of the most challenging problems confronting the nephrology team (1). Successful long‐term haemodialysis in patients with end‐stage renal failure depends to a large extent upon a trouble‐free vascular access. Unfortunately, the creation as well as the use, maintenance and the treatment of vascular access complications nowadays still remain a serious clinical problem despite pharmacological and technical advances during the last decade (2). Even today, vascular access failure and complications form a major cause of morbidity leading to a high percentage (20 to 30 %) of hospitalization in the dialysis population (3).

Moreover, we are confronted all over the world with a clinically complicated patient population, such as diabetics, patients with advanced atherosclerosis, cardiac and peripheral vascular diseases. Also the increased blood viscosity due to the systematic use of erythropoietin and the use of high blood flows in modern dialysis therapy necessitates a vascular access of excellent quality.
CARE AND MANAGEMENT OF DIABETIC NEPHROPATHY (MODERATE TO ADVANCED RENAL INVOLVEMENT)
Authors: Thomas N.
Published: July 2012

This paper describes the possible risk factors in the development of renal disease in diabetes mellitus. The aim of this paper is to identify and evaluate the care and management of patients with moderate renal impairment and to make recommendations for optimal renal referral.
AN INTEGRATED VASCULAR MANAGEMENT PROGRAMME
Authors: Shemesh David , Olsha Oded , Berelowitz Daniel , Zigelman Charles
Published: July 2012

This paper discusses the development of an integrated approach for the creation and maintenance of arteriovenous access (AVA), under the direction of a dedicated vascular access surgeon in close cooperation with the haemodialysis staff, involving pre‐operative imaging, anaesthetic and surgical techniques together with a post‐operative graft surveillance programme, in order to maximize autogenous arteriovenous access (AAVA) construction (the preferred access for haemodialysis patients with end‐stage renal disease), and to improve patency rates for AAVA and prosthetic arteriovenous access (PAVA).
A DESCRIPTIVE ANALYSIS OF SLEEP DISTURBANCES IN PATIENTS WITH END‐STAGE RENAL DISEASE UNDERGOING HAEMODIALYSIS
Authors: De Barbieri Ilaria , Zampieron Alessandra
Published: July 2012

Many studies reveal the presence of sleep disturbances in patients with end‐stage renal disease (ESRD) undergoing haemodialysis. The objective of this study was to identify the incidence of sleep disturbances in a sample of 112 patients, being treated by a dialysis centre. Patients who fulfilled the inclusion criteria, were interviewed by means of a questionnaire. The average age was 63.97, 79 male (70.5%) and 33 female (29.4%). The principal pathology underlying subjects' ESRD was hypertension (27.6%) and cardiovascular pathologies were the accompanying pathologies most suffered (75.8%).

Sleep disturbances were noted in 54 patients (48.2%). These findings confirm the results of the literature, but less daytime sleepiness and nighttime waking occurred with this study group.
NURSING CARE FOR DIALYSIS PATIENTS IN JAPAN
Authors: Nakahara N. , Morita N. , Uchida M. , Kishimoto T. , Miura K.
Published: July 2012

In Japan, the number of chronic renal failure patients requiring dialysis treatment is increasing by approximately 10,000 patients a year, totalling 229,538 or 1,801.2 patients per one million population at the end of December, 2002 according to the survey conducted by the Japanese Society for Dialysis Therapy (1). The primary disease is diabetic nephropathy (28.1% of patients), and with greater numbers of long‐term and elderly patients, the incidence and severity of complications continue to increase. Dialysis units provide more diversified care, but budget cuts in health care make it difficult to secure sufficient personnel, and the workload on nurses has intensified. In this study, a survey of 157 out of 300 randomly selected dialysis facilities in Japan was made regarding nursing systems and nurses' concerns for medical care of dialysis patients.
LATE SOMATIC AND PSYCHO‐SOCIAL CONSEQUENCES OF RENAL INSUFFICIENCY IN CHILDREN
Authors: Groothoff J.W.
Published: July 2012

The aim of the project was to establish the somatic and psycho‐social consequences in adulthood of paediatric end‐stage renal disease (ESRD). A long term follow up study of all Dutch patients who started renal replacement therapy at age 0–15 years between 1972 and 1992 and who were born before 1979 was undertaken. The study was performed between 1998 and 2000. About 25% of patients had died at time of investigation. Cardiovascular abnormalities were prominent in both transplanted and dialysis patients and cardiovascular disease was also found to be the most prominent cause of death. Skeletal disorders as a result of metabolic bone disease accounted for most frequent occurring disabilities. The risk for malignancies was 10‐fold that of the normal population. Mean IQ and educational attainment were low as compared to the normal population. The overall quality of life was good, despite the co‐morbidity and disabilities. Adverse outcomes were in nearly all cases related to a prolonged period of dialysis in the past and to (current) hypertension, not to the state of dialysis at time of investigation.
IMPLEMENTING NURSE PRESCRIBING WITHIN THE HAEMODIALYSIS UNIT
Authors: Gerrish M.
Published: July 2012

Patients within satellite haemodialysis units do not always have access to a medical practitioner. This may cause problems when prescriptions are required. Amendments to UK law to allow the introduction of supplementary prescribing came into force in 2003 allowing nurses with the appropriate experience, training and qualification to prescribe for their patients.

Within a 14‐station satellite unit a prescribing partnership has been successfully established. Clinical Management Plans have been implemented for haemodialysis patients. These include areas such as dialysis adequacy, access management, anti‐coagulation, anaemia management, MRSA treatment and prophylaxis, antihypertensive therapy, calcium and phosphate control and exit site or line infection.

100% of patients within the unit have consented to the nurse prescribing for them under the Clinical Management Plan.

Supplementary prescribing enhances nursing practice by empowering those who are best placed to make decisions regarding care and treatment for their patients. Patients appear confident in the ability of the nurse within the haemodialysis unit to prescribe competently.

Nurse prescribing is of benefit to patient care, meeting the demands of an expanding patient population. It is recognition of the skill and experience required of haemodialysis nurses.
COMPLIANCE IN HYPERTENSION
Authors: Burnier M.
Published: July 2012

Despite improvements in the management of hypertension in the past several years, nearly 70% of patients with hypertension are not adequately controlled. Today's physician treating hypertension is armed with numerous efficacious antihypertensive agents. Thus, one of the major contributors to the large number of uncontrolled hypertensive patients appears to be non‐compliance with prescribed regimens. Non‐compliance is a universal characteristic and can affect all patients. However, the major problem of non‐compliance is that it remains largely unrecognised in clinical practice. Several types of non‐compliance exist with the ‘drug holiday’ being the most common. Good communication with the patient and the entire health care team is critical in increasing patient compliance. Long‐acting medications that provide good blood pressure control beyond the 24‐hour dosing period should be considered drugs of choice in non‐compliant hypertensive patients. This article will discuss different types of compliance, methods to measure compliance, and clinical consequences of non‐compliance in hypertension.
MANAGEMENT OF VASCULAR ACCESS: MONITORING AND SURVEILLANCE
Authors: Lopot F. , Švára F. , Polakovic V.
Published: July 2012

This article reviews vascular access (VA) assessment methods and procedures. It gives an overview of the existing methods for bed‐side VA assessment by means of pressures, recirculation and access flow measurement. Pros and cons of the methods are discussed and additional benefits of a combined recirculation and access flow measurement are explained. Present vascular access care guidelines are discussed, namely the K/DOQI and EVAS documents. Practical setup of a vascular access monitoring and surveillance system is illustrated with data from the authors' own unit where such a system has been in use since 1999. The issue of adequate target setting is analysed in view of published works on clinical impact of access surveillance system introduction (timely detection of access stenosis and access patency). Critical re‐evaluation is needed especially in current QVA threshold and intervention timing.
IS POTENTIAL EQUALISATION IN HD TREATMENTS NECESSARY?
Authors: Wictor P.‐O. , Svensson R.
Published: July 2012

In some cases in haemodialysis blood access is established with a special type of central venous catheter (CVC), sometimes called a central dialysis catheter (CDC), instead of an AV fistula or graft. This central venous catheter tip is placed very close to the heart, increasing the probability of a leakage of electrical current passing through the heart. This may cause arrhythmia or ventricular fibrillation. This current is generally referred to as patient leakage current and has to be kept very low for patient safety. All staff involved in CVC treatments, nursing staff as well as technicians, should be aware of this particular risk to the patient.

The purpose of this article is to discuss the background of the above‐mentioned safety issue and suggest precautionary measures for minimising this risk. Precautions discussed include potential equalisation, use of separating transformers, periodic maintenance (normally performed by a service technician) and physical placement of the equipment used in the vicinity of the patient (normally the responsibility of the nursing staff).
QUALITY OF LIFE IN CHRONIC KIDNEY DISEASE
Authors: Pugh‐Clarke K. , Naish P.F. , Mercer T.M.
Published: July 2012

Background — Quality of life (QOL) is suboptimal in end‐stage renal disease. However, studies indicate that QOL is already impaired prior to the initiation of renal replacement therapy, implying that the initial decline originates in the chronic kidney disease (CKD) phase of the renal disease trajectory. Given the significance of QOL as a clinical outcome, there is a paucity of QOL research in CKD.

Aims — To measure QOL at three distinct phases (based on creatinine clearance — Ccr) of the disease trajectory in CKD: normal renal function (NRF) with underlying renal disease, moderate CKD, and advanced CKD (Ccr ≥75, 40–60, and ≤30 ml/minute, respectively), and to establish if QOL is different between these groups.

Methods — Data was collected from 25 patients from each of the Ccr bands (N=75). We measured self‐reported QOL (Schedule for the Evaluation of Individual Quality of Life — SEIQOL), uraemic symptoms (Leicester Uraemic Symptom Scale — LUSS), and laboratory variables.

Results — SEIQOL was significantly lower (p<0.001), and symptom number, frequency, and intrusiveness significantly higher (all p<0.001) in the advanced CKD group when compared to the NRF group. Although SEIQOL and symptom intrusiveness did not differ between the advanced and moderate CKD groups, SEIQOL was significantly lower (p<0.05) and symptom intrusiveness significantly higher (p<0.05) in the moderate CKD group when compared to the NRF group.

Conclusion — QOL is already impaired in moderate CKD. The significant difference in QOL and symptom intrusiveness between the moderate CKD and NRF groups may denote a causal relationship between symptom intrusiveness and QOL early in CKD.
ENHANCING LIFESTYLE THROUGH HOME HAEMODIALYSIS
Authors: Blogg A. , Hyde C.
Published: July 2012

The Sydney Dialysis Centre (SDC) supports 150 patients who dialyze in the home environment. Since its inception SDC has been assisting patients to modify their dialysis regime according to individual needs. In 2003–2004 a postal survey was sent to SDC patients who had changed their dialysis regime to ascertain the effect of this change on lifestyle. This article will present the results of the survey with regard to patients who dialyze nocturnally (LND) and for longer hours (LH). The patients experience will be presented in relation to their reason for modifying treatment, resultant changes in diet and medication prescription and their subjective experience of wellbeing. Findings indicate that patients who dialyse nocturnally and for longer hours experience improved sense of wellbeing, diet control and increased energy levels. While nocturnal dialysis does not suit all patients, the respondents in this survey reported benefits such as: increased opportunity for employment; less restrictions on free time; improved blood results and better lifestyle.
CARING FOR PEOPLE WHO ARE DYING ON RENAL WARDS: A RETROSPECTIVE STUDY
Authors: Noble H. , Rees K.
Published: July 2012

Unfortunately, there is still a high mortality rate among patients with end‐stage renal disease (ESRD). If the decision is made to activate non‐dialytic management of the patient with ESRD, it should be made jointly by the patient and responsible consultant nephrologist after consultation with relatives, the family doctor and other relevant members of the caring team. This paper discusses the establishment of a new renal supportive care service for patients opting not to have dialysis and focuses on the results of a ‘death audit’ carried out on this patient population. Recommendations for practice resulting from analysis of the audit results include, the use of advance directives, identification and prompt treatment of symptoms, increased staff education, timely referral to the palliative care team and expansion and further integration of the renal supportive care team.
EARTHQUAKE IN PAKISTAN — THE RENAL DISASTER RELIEF TASK FORCE IN ACTION
Authors: Van Dam R.
Published: July 2012

Following an earthquake, an International stream of help is launched. Teams of nephrologists, renal nurses and technicians from many European countries are ready as volunteers to come into action when needed. Basic help is necessary but what is the benefit of nephrologists and renal nurses, as the Renal Disaster Relief Task Force comes into action? The scouting team assesses the situation in the disaster area. Treatment of acute renal failure, hyperkalemia and Crush Syndrome can be life saving. The ability to accommodate dialysis treatment is investigated, in collaboration with local nephrologists.

Belgian, French, Irish and Turkish colleagues who made up two teams, with Médecins sans Frontières (MsF) left for Pakistan following the devastating earthquake in October 2005. This is a report from one of the volunteers from the first team explaining the individual contribution that his mission made to the disaster.
Merits and limitations of continuous blood volume monitoring during haemodialysis: Summary of the EDTNA|ERCA Journal Club discussion: winter 2005
Authors: Lindley Elizabeth J , Ward Richard , Pearson Chris , Harrington Maurice , O'Kane Frankie , Belot Bertrand , Shaldon Stanley , De Vos Jean‐Yves , Lopot Franta , Nikman Anahita , Curtis Jim , Schneditz Danny , Gerrish Martin , Roy Thomas , Tattersall James , Dasselaar Judith
Published: July 2012

The discussion explored and expanded on the issues raised by Dasselaar et al in their review of the measurement of relative blood volume (RBV) changes during dialysis (NDT 2005). Dialysis machines incorporating blood volume monitoring and control are widely available in Europe. The use of continuous blood volume monitoring (CBVM) to help establish dry weight; problems with CBVM due to connection and use of single needle dialysis; the physiological processes that cause RBV changes during eating, exercise and posture changes; and the application of blood volume based biofeedback control were discussed by participants from ten countries. The ‘take‐home’ messages from the discussion were that CBVM can assist in setting target weight, but must be used together with traditional measures and experience. Biofeedback control may help to achieve symptom‐free dialysis, but staff should be prepared to monitor patients systematically for several weeks to obtain individualised settings. Users of CBVM should be aware of factors that can alter the central haematocrit leading to apparent changes in RBV. Practical guidelines should be developed to help staff interpret CBVM data effectively.
AN EXPLORATORY STUDY OF PATIENT'S FEELINGS ABOUT ASKING HEALTHCARE PROFESSIONALS TO WASH THEIR HANDS
Authors: Duncan C.
Published: July 2012

The purpose of this study was to explore patient opinion about asking healthcare professionals to wash their hands prior to a clinical procedure and to explore if MRSA status and access to patient information about infection control would influence anxiety about asking.

A descriptive survey was undertaken using a semi‐structured questionnaire. The questionnaire was distributed to a randomised convenience sample of 185 in‐patients across all departments of an acute NHS Trust hospital (response rate 59.4%).

Spearman's rank order and Kendall Tau‐b tests were used to analyse specific correlations.

Respondents were more confident than anxious to be involved in a campaign that asked patients to ask staff to wash their hands. Patients were more anxious to ask if previous admission episodes were fewer, if their knowledge of MRSA was high and if there was less information about infection control available. Less anxiety was associated with patients who had MRSA in the past and the suggestion that staff wore badges saying ‘It's OK to ask’.
RELATIVE BLOOD VOLUME BASED BIOFEEDBACK DURING HAEMODIALYSIS
Authors: Dasselaar J.J.
Published: July 2012

Intra‐dialytic hypotension is the most frequently occurring complication during haemodialysis and can lead to serious complications. Devices that continuously and non‐invasively monitor relative blood volume (RBV) changes during HD are being advocated as a tool to maintain an adequate volume of the intravascular compartment in order to avoid dialysis hypotension. Nowadays, most manufacturers have incorporated a RBV monitor in their dialysis apparatus and two manufacturers have designed biofeedback devices that control intra‐dialytic RBV changes. The goal of RBV based biofeedback systems is to prevent a severe or abrupt decrease in blood volume in order to prevent the development of dialysis hypotension. Biofeedback technologies can diminish the severity and/or frequency of dialysis hypotension. At present, however, a completely symptom‐free HD is not a reality. The major reasons for this are patient characteristics such as cardiovascular co‐morbidity and high UF rates and a lack of understanding of the relation between RBV changes and blood pressure/ cardiovascular stability.
SELECTION OF DONOR AND ORGAN VIABILITY CRITERIA: EXPANDING DONATION CRITERIA
Authors: Gutiérrez E. , Andrés A.
Published: July 2012

Donation criteria have been becoming more flexible over the years. Currently, the only absolute exclusion criteria are human immunodeficiency virus infection (HIV), uncontrolled tumor disease and bacterial or viral infections. Clinical conditions dictate organ viability criteria: biochemical, morphological and functional, that must be fulfilled by the donors and their organs in order to focus the decision on which donor organs can be used. These criteria attempt to assure that the transplanted organs function after the extraction, transformation, implantation and reperfusion process without transmitting any infectious or tumour disease. In recent years, the gross and microscopic appearance has become one of the fundamental criteria for selection of potentially viable organs. At present, there is no age limit for hepatic and renal donation; the principal contra‐indication is chronic organ damage. The use of each organ must be decided individually after a profound analysis of all the viability criteria, weighing the advantages and disadvantages of the implant of a certain organ for the recipient.
BOOK REVIEW: HANDBOOK OF DIALYSIS 4TH EDITION
Authors: Thomas Nicola
Published: July 2012

Book reviewed in this article:

DAUGIRDAS J, BLAKE P AND ING T (2007) HANDBOOK OF DIALYSIS. LIPPINCOTT, WILLIAMS AND WILKINS PHILADELPHIA.
SHOULD WE PROVIDE ULTRAPURE DIALYSIS FLUID? Summary of the EDTNA|ERCA Journal Club discussion Winter 2006
Authors: Murcutt Gareth , Shaldon Stanley , De Vos Jean‐Yves , Lindley Elizabeth , Greening Robert , Hansen Susan K , Stragier André , James Ray , Hoenich Nic , Brooke Simon , Mahalko John , Ledebo Ingrid ,   An EDTNA/ERCA Journal Club (Winter 2006) discussion based on “Ultrapure dialysis fluid — how pure is it and do we need it” by Dr Ingrid Ledebo PhD of Gambro Corporate Research, Sweden.
Published: July 2012

The paper discussed during winter 2006 was an editorial in Nephrology, Dialysis and Transplantation (NDT) entitled “Ultrapure dialysis fluid — how pure is it and do we need it” by Dr Ingrid Ledebo PhD of Gambro Corporate Research, Sweden. Thirteen people from seven different countries contributed to the wide‐ranging discussion whose topics ranged from the most cost effective way of producing ultrapure dialysis fluid (UPDF) to the environmental impact of heat sanitisation and the industrial‐scale bleeding of the Limulus horseshoe crab. Different methods of disinfection such as heat and UV light were discussed as well as the requirement and funding for microbial detection assays and their various sensitivities.

Participants concluded that the available evidence supported the use of UPDF as standard, but identified financial pressures, via differing reimbursement systems, as the main barrier to its universal introduction.
RENAL ANAEMIA: RECENT DEVELOPMENTS AND FUTURE DIRECTIONS FOR IMPROVED MANAGEMENT
Authors: Mahon A. , Bennett L.
Published: July 2012

The global burden of chronic kidney disease (CKD) and associated anaemia is substantial. With the increasing numbers of patients that are likely to be affected in the future, approaches are required to improve anaemia management without increasing the workload of renal units. Advocating early treatment may improve patient outcomes and nurses are in an ideal position to identify and manage anaemia at an early stage in patients with CKD. In addition, adopting a multidisciplinary approach, alongside nephrologists, diabetologists, cardiologists, social workers, nutritionists and pharmacists, may allow nurses to detect and treat anaemia earlier in patients with CKD. Maintaining awareness of factors associated with decreased erythropoiesis‐stimulating agents (ESAs) efficacy (e.g. iron deficiency or poor nutritional status) is also important. To reduce the burden on healthcare providers, anaemia management could be simplified by extending the administration interval of ESAs.

Recent studies have explored the clinical efficacy of administration of currently available agents at intervals of up to once monthly in highly selected, stable patients. The use of an ESA that can control anaemia while maintaining haemoglobin levels within guideline ranges with extended administration intervals in all patients without the need for additional screening or stepwise dose adjustments with attendant monitoring may help improve patient care while reducing the workload of healthcare providers.
HYPERKALAEMIA AND HAEMODIALYSIS PATIENTS: ELECTROCARDIOGRAPHIC CHANGES
Authors: Sánchez José Luis Cobo , Camarero Ana Rosa Alconero , Pérez María Casaus , Sota Maza Ma Ángeles , Llamazares Camino Villa , Roldán Carmen Higuera , Viadero Raquel Menezo , Nates Rosa Alonso
Published: July 2012

Background — Patients with end‐stage renal disease (ESRD) present hydro‐electrolytic alterations due to the lack of adequate regulation of the internal medium. Of these alterations hyperkalaemia is frequent and produce neuromuscular symptoms, electrocardiographic changes and arrhythmias. Literature affirms that patients with ESRD present less prominent hyperkalaemia‐related electrocardiographic changes than those patients with normal renal function.

Objectives — To evaluate electrocardiographic alterations related with potassium in our ESRD patients and to compare the obtained results with those previously reported.

Methods — Descriptive, cross‐sectional and prospective study in hospital haemodialysis (HD) patients. Pre‐ and post‐HD serum potassium and other electrolyte concentrations were measured, and simultaneous 12‐lead electrocardiogram (ECG) obtained at the first session of the week. An expert evaluated all ECG's.

Results − 39 patients were included in the study, 58.9% were women and 41.1% men, with a mean age 67.35 years (24–89). Serum potassium pre‐HD range was 2.8 to 7.4 mEq/l (mean 5.07 mEq/L), 29.4% of the sample presented levels ≥5.5 mEq/l and the most frequent alteration in the ECG was high and peaked T waves in leads V2 to V4. In the hyperkalaemia cases, the mean elevation of T wave was 7mm. In 2 hyperkalaemia patients there was no elevation of T wave: one T wave was negative (K+ = 6 mEq/L) and another one stayed normal (K+ =5.6 mEq/L).

Conclusions — The ECG continues to be a good tool of early hyperkalaemia detection, contributing to estimating severity. Patients with ESRD present electrocardiographic alterations similar to the healthy population.
EDUCATIONAL NEEDS FOR BLOOD PRESSURE CONTROL IN CHRONIC KIDNEY DISEASE
Authors: Mason Jo , Stone Margaret , Khunti Kamlesh , Farooqi Azhar , Carr Sue
Published: July 2012

Strict blood pressure control reduces the risk of adverse outcomes in chronic kidney disease but is difficult to achieve. To inform the design of an educational intervention for patients with chronic kidney disease and hypertension, we used focus groups to identify key patient issues, from both patient and healthcare professional perspectives. Framework methodology was used to analyse data and patient confusion emerged as the core concept. This was both an effect and, in some cases, a cause of the six key themes identified: lack of basic knowledge; conflicting advice; nature of diagnosis; changes in evidence‐based practice; views on patient empowerment and views on the patient‐health professional relationship. Educational needs identified involved addressing confusion by increasing both knowledge and motivation. In people with chronic kidney disease, confusion can lead to a lack of motivation and negative views that need to be addressed through appropriate education and support.
CAN INCREASED DIETARY FIBRE REDUCE LAXATIVE REQUIREMENT IN PERITONEAL DIALYSIS PATIENTS?
Authors: Sutton Debbie , Dumbleton Susan , Allaway Claire
Published: July 2012

Constipation is an important cause of technique failure and poor dialysis efficiency in Peritoneal Dialysis (PD) patients. A review of patient notes on our unit revealed 43% reported difficulties associated with constipation. A stool and laxative recording diary was sent to 126 PD patients. 46 patients reported using laxatives. All respondents using laxatives were invited to use a soluble dietary fibre supplement for 4 weeks, followed by dietary advice to see if they could achieve the same effect using high fibre foods.

23 patients entered the intervention stage of the study. 17 succeeded in replacing prescribed laxatives with the fibre supplement. 16 tried to increase their intake of high fibre foods, with 8 of these succeeding in improving their dietary intake of fibre; however only 2 were able to reduce their intake of fibre supplement. The results of the study suggest that a fibre supplement can be as effective as current laxative treatment in preventing constipation, as well as being the preferred choice of patients as many felt it improved bowel habits while not having the side effects of stimulant laxatives.
GUARDING AGAINST HIDDEN HAEMOLYSIS DURING DIALYSIS: AN OVERVIEW Summary of the EDTNA|ERCA Journal Club discussion Spring 2007
Authors: Murcutt Gareth , De Vos Jean‐Yves , Pilley Ken , Lindley Elizabeth , Lopot Franta , Hansen Susan K , Polaschegg Hans‐Dietrich , Chamney Melissa , Hoenich Nic , Venkatraman Narayan , Shaldon Stanley , Monros Anna Marti i , Gajaria Mukesh , Küntzle Waltraud , Harman Elisabeth , Dutka Paula ,   A discussion based on “Hemolysis: A Hidden Danger” by Elisabeth Harman RN, CNN, Clinical Coordinator, Central Valley Dialysis, Salt Lake City, Utah, USA and Paula Dutka, RN, MSN, CNN, Director Education/Research Nephrology Network, Winthrop University Hospital, New York, USA. The paper was published in The Nephrology Nursing Journal, the official publication of the American Nephrology Nurses' Association.
Published: July 2012

The paper discussed during spring 2007 was a case study report entitled “Haemolysis: A Hidden Danger” published in The Nephrology Nursing Journal. The authors, Elisabeth Harman and Paula Dutka, agreed to follow the discussion and respond to points raised. Sixteen contributors from ten different countries provided insights into the potential causes, symptoms and effects of both acute and hidden haemolysis during dialysis, as well as discussing some of the safety systems that can be used to try and minimise occurrences. The use of blood volume monitoring as a potential method of ‘seeing’ hidden haemolysis was explored as well as some reporting mechanisms and organisational safeguards that are used to manage the risks.
The existence and diversity of myxobacteria in lake mud – a previously unexplored myxobacteria habitat
Authors: Li Shu‐guang , Zhou Xiu‐wen , Li Peng‐fei , Han Kui , Li Wei , Li Zhi‐feng , Wu Zhi‐hong , Li Yue‐zhong
Published: July 2012

Myxobacteria are widely distributed in soil and oceanic sediment with a phylogeographic separation at high levels of classification. However, it is unclear whether freshwater environments, from which there has been no isolation report of myxobacteria since 1981, are habitats for myxobacteria. In this study, we investigated the presence of myxobacteria in lake mud using a two‐step strategy. First, we constructed two universal bacterial libraries from the V3–V4 (V34) and V6–V8 (V678) hypervariable regions of 16S rRNA gene sequences. High‐throughput 454 pyrosequencing revealed that myxobacteria were one of the major bacterial groups in the lake mud. They accounted for 5.77% of the total sequences and 7.52% of the total operational taxonomic units (OTUs) at a phylogenetic distance of 0.03. The community composition and taxonomic structure of the mud myxobacterial community were further analysed using myxobacteria‐enriched libraries targeting the V34 and V678 regions, which were amplified with Cystobacterineae‐ and Sorangineae‐specific primer pairs respectively. Phylogenetic analysis showed that the limnetic myxobacteria exhibited closer relationships to their soil than their marine relatives, but there were also exclusive taxa of limnetic myxobacteria detected. These results, together with a survey on available GenBank data, indicate that lake mud is a primary habitat for myxobacteria.
Aminophylline, administered at usual doses for rodents in pharmacological studies, induces hippocampal neuronal cell injury under low tidal volume hypoxic conditions in guinea-pigs
Authors: Somekawa-Kondo Tomoko , Yamaguchi Keitaro , Ishitsuka Yoichi , Ito Sachiko , Tanaka Kaori , Irikura Mitsuru , Moriuchi Hiroshi , Takahama Kazuo , Ando Yukio , Yamazaki Toshio , Irie Tetsumi
Published: July 2012

Objectives

To establish whether aminophylline, administered at usual doses for rodents in pharmacological studies, induces brain injury in systemic hypoxaemia in guinea-pigs.

Methods

A hypoxaemia (partial oxygen tension of arterial blood (PaO2) = 40–60 mmHg) model was developed by low tidal volume mechanical ventilation in guinea-pigs.

Key findings

Under hypoxic conditions, aminophylline significantly increased the concentration of brain-specific creatine kinase in the serum in a dose- and time-dependent manner. A reduced number of hippocampal neuronal cells in the CA1 region, an increase in the concentration of neuron-specific enolase (NSE) in cerebrospinal fluid (CSF), an increase in lipid hydroperoxides and a decrease in the ratio of glutathione to glutathione disulfide in the brain tissues were also observed. These effects were not observed when aminophylline at the same doses was administered under normoxic conditions (PaO2 = 80–100 mmHg). There was no difference in either serum or CSF concentrations of theophylline between normoxic and hypoxic conditions. Another methylxanthine, caffeine, did not increase the concentration of NSE in CSF.

Conclusions

Aminophylline potentially induces brain damage under hypoxic conditions. We suggest that aminophylline treatment has adverse effects in patients with hypoxaemia subsequent to respiratory disorders such as asthma.
Constitutive Modeling of Multistage Creep Damage in Isotropic and Transversely Isotropic Alloys With Elastic Damage
Authors: Stewart Calvin M. , Gordon Ali P.
Published: July 2012

In the pressure vessel and piping and power industries, creep deformation has continued to be an important design consideration. Directionally solidified components have become commonplace. Creep deformation and damage is a common source of component failure. A considerable effort has gone into the study and development of constitutive models to account for such behavior. Creep deformation can be separated into three distinct regimes: primary, secondary, and tertiary. Most creep damage constitutive models are designed to model only one or two of these regimes. In this paper, a multistage creep damage constitutive model is developed and designed to model all three regimes of creep for isotropic materials. A rupture and critical damage prediction method follows. This constitutive model is then extended for transversely isotropic materials. In all cases, the influence of creep damage on general elasticity (elastic damage) is included. Methods to determine material constants from experimental data are detailed. Finally, the isotropic material model is exercised on tough pitch copper tube and the anisotropic model on a Ni-based superalloy.
Improved Ease of Use Designs for Rapid Heart Cooling
Authors: Merrill Thomas L. , Merrill Denise R. , Akers Jennifer E.
Published: July 2012

Mild hypothermia has been shown to reduce heart tissue damage resulting from acute myocardial infarction (AMI). In previous work we developed a trilumen cooling catheter to deliver cooled blood rapidly to the heart during emergency angioplasty. This paper describes two alternative designs that seek to maintain tissue cooling capability and improve “ease of use.” The first design was an autoperfusion design that uses the natural pressure difference between the aorta and the coronary arteries to move blood through the trilumen catheter. The second design used an external cooling system, where blood was cooled externally before being pumped to the heart through a commercially available guide catheter. Heat transfer and pressure drop analyses were performed on each design. Both designs were fabricated and tested in both in vitro and in vivo settings. The autoperfusion design did not meet a cooling capacity target of 20 W. Animal tests, using swine with healthy hearts, showed that the available pressure difference to move blood through the trilumen catheter was approximately 5–10 mmHg. This differential pressure was too low to motivate sufficient blood flow rates and achieve the required cooling capacity. The external cooling system, however, had sufficient cooling capacity and reasonable scalability. Cooling capacity values varied from 14 to 56 W over a flow range of 30–90 ml/min. 20 W and 30 W were achieved at 38 ml/min and 50 ml/min, respectively. Animal testing showed that a cooling capacity of 30 W delivered to the left anterior descending (LAD) and left circumflex arteries (LCX) of a healthy 70 kg swine can reduce heart tissue temperatures rapidly, approximately 3 °C in 5 min in some locations. Core temperatures dropped by less than 0.5 °C during this cooling period. An autoperfusion design was unable to meet the target cooling capacity of 20 W. An external cooling design met the target cooling capacity, providing rapid (1 °C/min) localized heart tissue cooling in a large swine model. Future animal testing work, involving a heart attack model, will investigate if this external cooling design can save heart tissue.
Designing Controllable Porosity for Multifunctional Deformable Tissue Scaffolds
Authors: Khoda AKM Bashirul , Koc Bahattin
Published: July 2012

Reconstructing or repairing a damaged tissue with porous scaffolds to restore the mechanical, biological, and chemical functions is one of the major tissue engineering and wound healing strategies. Recent developments in three-dimensional bioprinting techniques and improvements in the biomaterial properties have made fabrication of controlled and interconnected porous scaffold structures possible. Especially, for wound healing or soft tissue engineering, membranes/scaffolds made out of visco-elastic hydrogels, or other soft biomaterials with regular porous structures are commonly used. When the visco-elastic structures are applied onto a wound or damaged area, various forces might act upon these structures. The applied forces caused by bandage or occlusive dressings, contraction, and/or the self-weight could deform the fabricated scaffolds. As a result, the geometry and the designed porosity changes which eventually alters the desired choreographed functionality. To remedy this problem, a denser scaffold providing higher material concentration could be developed. However, denser scaffolds might have a negative impact on cell proliferation and also could block pathways for nutrient and waste transportation. In this work, a novel multifunctional visco-elastic scaffold modeling has been proposed to control the effective porosity of scaffolds. The designed scaffolds are optimized to provide spatial functionality and controlled material concentration under deformed conditions. The proposed methodology has been implemented and illustrative examples are provided in this paper. Effective porosity between the traditional and the proposed scaffold design have been compared by applying both models on the same free-form surface mimicking a wound.
Unsteady Pressure Analysis of a Swirling Flow With Vortex Rope and Axial Water Injection in a Discharge Cone
Authors: Bosioc Alin Ilie , Susan-Resiga Romeo , Muntean Sebastian , Tanasa Constantin
Published: July 2012

The variable demand of the energy market requires that hydraulic turbines operate at variable conditions, which includes regimes far from the best efficiency point. The vortex rope developed at partial discharges in the conical diffuser is responsible for large pressure pulsations, runner blades breakdowns and may lead to power swing phenomena. A novel method introduced by Resiga et al. (2006, “Jet Control of the Draft Tube in Francis Turbines at Partial Discharge,” Proceedings of the 23rd IAHR Symposium on Hydraulic Machinery and Systems, Yokohama, Japan, Paper No. F192) injects an axial water jet from the runner crown downstream in the draft tube cone to mitigate the vortex rope and its consequences. A special test rig was developed at “Politehnica” University of Timisoara in order to investigate different flow control techniques. Consequently, a vortex rope similar to the one developed in a Francis turbine cone at 70% partial discharge is generated in the rig’s test section. In order to investigate the new jet control method an auxiliary hydraulic circuit was designed in order to supply the jet. The experimental investigations presented in this paper are concerned with pressure measurements at the wall of the conical diffuser. The pressure fluctuations’ Fourier spectra are analyzed in order to assess how the amplitude and dominating frequency are modified by the water injection. It is shown that the water jet injection significantly reduces both the amplitude and the frequency of pressure fluctuations, while improving the pressure recovery in the conical diffuser.
A Robotic Biopsy Device for Capsule Endoscopy
Authors: Kong Kyoungchul , Yim Sehyuk , Choi Sunhee , Jeon Doyoung
Published: July 2012

This paper introduces a robotic biopsy device for capsule endoscopes. The proposed device consists of three modules for the complete process of biopsy, which includes monitoring the intestinal wall by a tissue monitoring module (TMM), aligning onto a polyp by an anchor module (AM), and sampling of the polyp tissue by a biopsy module (BM). The TMM utilizes a trigonal mirror as well as an on-board camera; since the TMM continuously takes images through lateral apertures, an operator such as a medical doctor is able to anchor the capsule endoscope onto the polyp and biopsy it with the visual feedback in real-time. When the operator finds a polyp using the TMM and the frontal camera of a capsule endoscope, then the AM is used to approach the polyp for biopsy. When the AM is in use, outriggers are extruded by shape-memory-alloy (SMA) springs, which results in the swelling of capsule endoscope body. In addition, an alignment module, which is a part of the AM, rotates the body of the capsule endoscope such that the biopsy razor can be aligned onto the polyp. Then, the BM excises a part of the polyp and seals the aperture, and the capsule endoscope continues exploring the intestine. The concept and working principles of the proposed device are introduced in this paper and are verified by a prototype that successfully integrates the three modules.
An uncommon shape of epiglottis misleading as acute epiglottitis: Figure 1
Authors: Sasaki Toru , Nomura Yasuyuki , Tsunoda Koichi
Published: July 2012

We report a case of a 31-year-old Japanese woman with an uncommon shape of epiglottis misleading as acute epiglottitis. She presented with high fever, arthralgia, general fatigue and strong throat pain. Laryngeal fiberscopy showed a markedly swollen epiglottis suggestive of acute epiglottitis, though she had no signs of asphyxia. A careful observation and detailed medical history ruled out acute epiglottitis. However, without clinical discretion, it might have been misinterpreted as acute epiglottitis. She was diagnosed later with Behçet's disease, which is reported to present pharyngeal stenosis. Two years later, a repeat laryngeal fiberscopy showed exactly the same appearance of the epiglottis, suggesting its shape to be permanent. The cause of this misleading shape of the epiglottis in this patient is yet unknown. For similar cases, a possibility of this kind of epiglottis should be considered before diagnosing as acute epiglottitis.
Stage IV malignant melanoma of unknown primary site in a young man
Authors: Christopoulos Petros , Doulias Triantafyllos , Koutelidakis Ioannis , Papaziogas Bassileios
Published: July 2012

Metastatic melanoma of unknown primary is a rare entity with low life expectancy. Inoperable metastatic malignant melanoma in lungs has a survival rate of <6%. Regression of the primary lesion is a well-documented theory in the literature, since melanoma is one of the tumours that can undergo regression. We present a case of a young man with metastatic malignant melanoma in lungs, whose survival duration is longer than expected even without metastasectomy.
Homeopathic vaccine
Authors: Whiting Martin
Published: July 2012

An owner presents a litter of 15‐week‐old puppies and their mother. The puppies are collapsed and have severe diarrhoea. You strongly suspect this to be caused by parvovirus, as you have seen several cases in the past three months. The owner says they were vaccinated by a neighbouring practice using a homeopathic nosode vaccine, but she has now lost all faith in the practice and wants to move to your practice. What legal and ethical elements should be considered when proceeding?
Protecting your practice's reputation online
Authors: Samuel Susie
Published: July 2012

Encouraging people to leave review comments about your practice online will make it easier for you to identify where improvements could be made, increase traffic to your website and maximise conversion rates. It can also help to dilute the impact of any negative comments. Susie Samuel explains how to monitor online mentions, deal with negative comments and participate in social media for the benefit of the practice.