bluuebunny/crossref_metadata_2025 huggingface dataset:
Blood recirculation in malfunctioning catheters for haemodialysis
Authors: Crespo R. , Rivero M.F. , Contreras M.D. , Martínez A. , Labrador A. , Jurado M.J. , Casas R.
Published: July 2012

Venous catheters are increasingly used for chronic haemodialysis, with dual lumen catheters being the most commonly used as blood recirculation (REC%) is relatively low. The aim of this study was therefore to evaluate blood recirculation in dual lumen catheters, both well‐functioning and malfunctioning, with reversed lumens. In our study, blood recirculation in well‐functioning catheters with standard lumens is similar to that found in previous studies. However, when lumens are reversed, blood recirculation increases significantly (6.7 ± 4 vs 19 ± 11 %, p<0.001). REC% in malfunctioning catheters (10.8 ± 2%) was higher than normal function (p<0.05) but lower than reversed flow in normal catheters (p<0.01) Therefore, inadvertent reversal of lumens in a well‐functioning catheter increases REC% in a significant manner, thus worsening haemodialysis efficiency. We conclude that, in inflow failure catheters, lumens can be reversed because REC% is acceptable. However, inadvertent reversal of lumens in a well‐functioning catheter increases REC% to a level which may compromise the adequacy of haemodialysis.
Rediscovering home haemodialysis. Returning choice to patients
Authors: Lunts P.
Published: July 2012

Increased demand for haemodialysis and the stresses on existing units have led to a crisis in renal replacement therapy around the world. Allied to this is a realisation that dialysis needs to be viewed increasingly as a long‐term option for patients. New approaches to treating people with dialysis need to be developed to reflect this. By adopting a modern approach, home haemodialysis can be a viable, indeed an optimal, treatment for many patients.
Evolution and development of a renal recipient transplant co‐ordinator for the Asian community
Authors: Jain Ms. N.
Published: July 2012

The aim of this paper is to share with colleagues the development of this innovative role and the unprecedented experience in addressing issues of transplantation for a large Asian population. The author is the named transplant co‐ordinator for all Asian patients who account for 30% of the total waiting list. During the first six months of the post the author has undertaken home visits, nurse‐led clinics and liaison with dialysis units. This continuous direct rapport is unique, and facilitates the living donor programme. The author has been involved in developing specific educational material relevant and appropriate to this patient population. Patients and families comments and responses have been favourable and positive. Audit and evaluation of the role is on‐going and the author feels privileged to be central to this process of providing holistic care equitably to all patients in a multicultural society.
Exercising to fitness on dialysis
Authors: Death C.
Published: July 2012

Exercise tolerance is a recognised consequence of chronic renal failure. Physical de‐conditioning is an integral factor in preventing the achievement of an otherwise very acceptable quality of life which can be accomplished by good dialysis therapy. This paper reports on the implementation of an exercise programme in an ESRD setting with a patient population of over 1,100. Patients aged between 20 and 65 years were identified for phase one of the programme. All patients had an in‐depth medical assessment to eliminate potential risks. The programme encompasses stretching, strengthening and aerobic exercises and a individualised exercise prescription was compiled for each participant. Twelve months after the initiation of this programme there is evidence of increased exercise tolerance, increased feelings of well‐being and enhanced stability on dialysis.
The influence of hygienic practices to the exit site/tunnel on peritoneal catheter infections
Authors: Gruart P. , Andreu L. , Gil A.
Published: July 2012

In Peritoneal Dialysis (PD), correct handling of the equipment and especially of the catheter exit site are essential. The PD nurse is responsible for preparing the patient to be able to carry out self care. As there are no universally accepted procedures for catheter care, we evaluated the procedure recommended in our unit, to identify the level of achievement by our patients and compare it with the infection incidences of exit site/tunnel (ES/T). 31 patients were surveyed on aspects related with hygiene, care and support of the catheter. This was complemented with a direct observation of the way of fixing and protecting the catheter and exit site, relating these facts with the incidence of infection. The results show the incidence of the infection is similar to data from other centres. It seems that the non compliance with the recommendations is due to either a misunderstanding on the patients' part or difficulty to adapt these recommendations to their particular way of life.
Communication as a teamwork tool in peritoneal dialysis
Authors: Rivetti M. , Barrile P. , Borgata M. , Cerruti G. , Battu S.
Published: July 2012

The growing complexity of the problems which have to be faced in providing a peritoneal dialysis service, such as giving assistance over a territory, consideration of the needs of the individual and the greater emphasis on the prevention of complications, makes multidisciplinary teamwork necessary, with the interaction of various skills. In order to succeed, teamwork requires the identification of clear objectives which are shared by all the members of the team. The various skills can best be exploited by defining roles and agreeing common aims and objectives so that the team can provide the patient with holistic treatment, which recognises the needs of the individual rather than the needs of the illness. Active cohesion between the various components is only possible through a defined communication strategy and an on‐going transfer of knowledge.
Focus charting in renal nursing: a quality issue
Authors: Nickerson S.
Published: July 2012

The paper explores how to minimise charting time, yet ensure that relevant information is documented in a concise manner in locations that are easy to access. This type of charting lends itself to review and data collection which is useful for quality improvement incentives. Patient centred documentation leads to quality improvements which ultimately results on cost savings.
Basic tools to integration in management and continuous quality improvement: protocols and procedures
Authors: Geatti S. , Pegoraro M.
Published: July 2012

In order to support interested colleagues with the concepts of Continuous Quality Improvement (CQI) and Clinical Standards for Nephrology Practice, a package of education support has been set up. We enhance the use of procedures, protocols, working plans, guidelines and nursing care plans as instruments of organisational integration. For the nursing care of renal patients in HD and PD we believe that all the procedures and protocols (P&P) above could have an important impact in the renal nursing practice. We propose that group members run a programme which is presented and implemented as a modular package including, theoretical knowledge, setting up working groups involved in literature revision, evaluation of defined P&P after a period of implementation, final implementation & periodic evaluation.
Do anaemia co‐ordinators have to be nurses?
Authors: Sanders D. , Hibbert D. , Ackrill P. , Clinkard S. , Cooke J. , Cottrell N.
Published: July 2012

The role of the anaemia co‐ordinator has developed subsequent to the introduction of erythropoietin therapy for renal anaemia, and posts have been established at an increasing number of hospitals in the UK. While co‐ordinators have previously tended to come from a nursing background, the post at our hospital has been held jointly by a pharmacist and a clinical nurse specialist since July 1997. This paper presents an informal evaluation of our experience of joint working, and has drawn on diary entries to outline the components of the service provided. The main focus is on the boundary negotiated between pharmacist and nurse responsibilities and expertise, involving as it does areas of potential conflict and complementarity. Through a critical examination of the assumptions and expectations associated with ‘generic’ pharmacist and nurse roles, we begin to clarify the respective contributions which the disciplines make to anaemia management.
Nursing implications of a Vancomycin resistant Enterococcus outbreak in a renal unit
Authors: Taylor J. , Stevenson G.
Published: July 2012

Vancomycin Resitant Enterococcusis a difficult organism to treat and is becoming more prevalent world‐wide. When it was identified in a busy renal unit, radical and expensive measures were taken to try and control the outbreak. Although these had costs to both patients and staff, the organism was eradicated from the unit.
Caring for renal patients during loss and bereavement
Authors: Binkley L.
Published: July 2012

Many of us are not prepared in assisting patients through the final phase of the life cycle. Recognising physical manifestations of stress, understanding why patients experience loss with kidney disease, and realising the supportive role that staff play for a patient undergoing this process, are key to assisting the patient to cope with loss and bereavement. The renal caregiver can assist the patient to view the ESRD life from another perspective as they journey through the life cycle to death. In so doing, the renal caregiver can recognise the needs of the family during this period, thus making them feel they fulfil a valuable role in the patient's final care. Being with a patient and family at the time of death is extremely rewarding as it helps the staff bring closure to the nurse patient relationship.
Provision of counselling for the dying patient
Authors: Hine J.
Published: July 2012

The majority of doctors and nurses clearly recognise their responsibility to provide palliative care to the dying patient, and also the need for effective communication, counselling and support for this group of patients. This paper explores some of the issues preventing patient and significant others from being referred to the counselling service at this stage, and demonstrates that the nursing staff feel both inadequate and ill prepared to deliver quality care to the dying patient and use avoidance as a coping mechanism.
Self perception affecting adherence to drug regimen following renal transplantation
Authors: Trevitt R. , Whittaker C. , Ball E.A.
Published: July 2012

The patient, a chronic cannabis user, found it increasingly difficult to tolerate the side effects of the medication on her appearance. Rejection in the early post‐transplant period meant that immunosuppression could not be further reduced. We were able to avoid a catastrophic self‐initiated cut in immunosuppression, and withdrawal of steroids was carried out according to a schedule supervised by the clinic. Cellular rejection resulted and was treated with IV methyl prednisolone and conversion from cyclosporin micro‐emulsion (Neoral®, Novartis) to tacrolimus (Prograf®, Fujisawa) and from azathioprine to mycophenolate mofetil (CellCept®, Roche).
Adherence to treatment and personality in renal failure
Authors: Vives T. , Pujolar N. , Junyent E. , Flores I. , Cordovilla L. , Izquierdo R.
Published: July 2012

Adherence of individual treatment and personality dimension of locus of control was analysed. Evidence suggests that locus of control and other personality dimensions can influence adherence behaviour to treatment. The aim of this study was to examine the impact of social‐clinical factors over personality dimensions and to provide empirical evidence of the relationship between internal locus of control experience and higher level of the compliance to treatment and diet. The results have shown the low level of adherence of patients to treatment and we found a tendency to correlate the dimension locus of internal control with adherence to treatment.
Assessment of problems: which study design?
Authors: Elseviers M.
Published: July 2012

Evidence‐based medicine has gained recognition in recent years, necessitating a large amount of conclusive results derived from a large number of experimental and epidemiological studies. Renal nurses are preferable investigators in this field because of their close relationship with the renal patient. Apart from clinical studies, with an experimental study design varying a single factor between two groups of patients, epidemiological studies are needed to assess actual problems. Epidemiological studies are purely based on observation, without altering any factor. The choice of study design will depend on the available knowledge about the problem and available resources.
Stay•safe®. A new PVC free system in long‐term CAPD treatment
Authors: Lambert M.C. , Lage C. , Kirchgessner J.
Published: July 2012

Stay·safe® is a new PVC free double bag PD system that was introduced two years ago for CAPD. The system has been evaluated by three target groups, patients, nurses and physicians in 2 different studies. In the pilot study stay·safe® was compared to the previous system and in the multi centre study, new patients judged stay·safe® over a longer period of time. The pilot study showed better handling and function judgement by experienced patients of the new system compared to previous. In the multi centre study the overall satisfaction with the new system including use with disabled patients was very good and this high valuation was maintained over time.
Results of a national epidemiological investigation of HCV infection in dialysis patients
Authors:   Italian Branch of the EDTNA/ERCA, Lombardi M. , Cerrai T. , Geatti S. , Negroni S. , Pertusini L. , Pegoraro M. , Di Lullo G.
Published: July 2012

The Italian Branch of EDTNA/ERCA organised a national, epidemiological, retrospective study to collect data and implement preventative measures for the spread of HCV infection in dialysis units. A questionnaire was sent to staff in 830 dialysis centres to collect information relating to 1996. Data are presented on incidence/prevalence of HCV infection, antibodies, viraemia and mortality, and comparison of the management of HCV between centres. At variance with the recommendations of the Official Health Organisations, dedicated machines and separate rooms are used in many centres and this paper concludes with recommendations for units, in particular those units with a low prevalence of antiHCV positive patients.
Nephrology nursing practice: more than technical expertise
Authors: Ran K. Jung , Hyde C.
Published: July 2012

This paper argues that the role of the nephrology nurse goes far beyond the generally accepted parameters of technical expert to include the roles of care giver, advocate, educator, facilitator, mentor and referral agent. Patients with End Stage Renal Disease, who require long term dialysis, experience many stressors which they must cope with in order to achieve an acceptable quality of life. Nephrology nurses who understand the stress of living with dialysis, and who are familiar with the coping strategies a patient may use, are ideally placed to facilitate the process of adaptation from the patient and their families perspective.
Malaria. A challenge for the haemodialysis and intensive care nurse
Authors: Uys H. , Nel E.
Published: July 2012

Malaria is the world's most important tropical parasitic disease. In many developing countries, and Africa in particular, malaria exacts an enormous toll in lives, medical costs, and days of lost labour. Through the use of case studies, this paper explores the effects of malaria and the patient management by the haemodialysis and intensive care nurse. All malaria cases admitted to an intensive care unit, and treated by means of haemodialysis or continuous‐veno‐veno‐haemodiafiltration were analysed. Specific problems identified were impaired fluid and biochemical control, acid‐base imbalance, disseminated intra vascular coagulation, adult respiratory distress syndrome, and haemodynamic instability. Guidelines were compiled for the nursing management of these complicated malaria cases.
Algorithmic nursing protocol to provide optimum care post combined kidney/pancreas transplantation
Authors: Henderson A. , Prendergast E.
Published: July 2012

This paper explains the development of protocols to aid in the care of patients following a combined kidney / pancreas transplant. With adequate planning of care, medical and nursing problems can be detected at an early stage thus ensuring immediate and appropriated action. We have found protocols to be invaluable in the care of these patients and the one which we developed on fluids and electrolytes is outlined in this paper.
Relation between response to illness and compliance in haemodialysis patients
Authors: Saounatsou M.
Published: July 2012

The treatment schedule of the haemodialysis patients has many restrictions and the long‐term haemodialysis patient's response to illness is characterised by various emotional reactions Compliance with their medical regimens remains a significant problem which influences the progress of health and by extension quality of life. The preconceived idea that a patient's response to illness may influence his adherence to medical regimen led to this study. The main variables examined were the relationship between the patient's response to illness and compliance and the relationship between compliance and age, education and the length of time on haemodialysis.
Stress, coping and quality of life among chronic haemodialysis patients
Authors: Cristóvão F.
Published: July 2012

This study identifies the most significant stressors perceived by individuals undergoing haemodialysis due to chronic renal failure, the coping methods used most often by patients, and their quality of life. 75 patients aged 18–65 years old, and on regular haemodialysis for at least for one year were studied. Results showed that patients perceived high levels of stress, and that psychosocial stressors are as problematic as the physiological ones. Patients used problem‐oriented coping methods more often than affective‐oriented methods. Although their quality of life was satisfactory, patients were dissatisfied about their physical well being.
Improving adequacy improves haemodialysis outcome
Authors: Charra B.
Published: July 2012

Our goal of maintenance dialysis for the coming millennium is optimal rather than just adequate dialysis. Delivering a large amount of dialysis expressed in terms of urea Kt/V is a necessary but insufficient measure to improve clinical outcome. Cardiovascular morbidity and mortality remain very high in haemodialysis. This is due in great part to the insufficient control of extra cellular volume and blood pressure. Ours, as well as published data, indicate that up to now, only increasing dialysis time either by prolonging the session or increasing its frequency has proven value in overcoming this critical issue.
One haemodialysis unit's experience of hepatitis B
Authors: Balshaw A , Casey J
Published: July 2012

Haemodialysis patients are at high risk of contracting Hepatitis B Virus (HBV). This blood borne virus has been responsible for many critical incidents within haemodialysis units around the world. This paper seeks to explore one such outbreak and at the same time look more closely at HBV and connected issues. The incident discussed occurred within a haemodialysis unit situated in the Northwest of England. This paper is presented as a case study. When HBV was detected in a previously HBV negative patient a crisis management team moved quickly to contain any possible outbreak and sought to discover the origin of the infection. An outline of the personal and financial cost to the organisation, what lessons have been learnt and why recommendations have been made to immunise the local dialysis population again HBV will be presented.
Heparinisation in chronic haemodialysis treatment: bolus injection or continuous homogenous infusion?
Authors: De Vos J.Y. , Marzoughi H. , Hombrouckx R.
Published: July 2012

After several incidents where patients either bled after dialysis or suffered severe anaphylactic reactions caused by intravenous heparin injections, we decided to administer heparin as a continuous homogenous intravenous infusion. This had been usual practice in our unit in the past. Following the shocking experience of the death of a patient due to an anaphylactic reaction during his first dialysis, we wanted to warn colleagues for the potential dangers of administering intravenous heparin as a bolus injection.
Evaluation of potential transplant recipients and living donors
Authors: Trevitt R. , Whittaker C. , Ball E.A.
Published: July 2012

The transplant waiting list needs to be actively managed by the transplant centre in a systematic way to achieve any degree of efficiency and effectiveness. This paper describes the key role of the transplant nurse in a large centre with over 300 people on the transplant waiting list. It focuses on the way patients are assessed, how the list is updated and the benefit of nurse involvement in the work‐up of potential live donors.
Pathogenesis and treatment of diabetic nephropathy
Authors: Lameire Norbert
Published: July 2012

Diabetic nephorpathy is a major cause of renal disease, but clinically evident diabetic nephropathy may be reduced by better glycaemic control. Patients with type 1 and type 2 diabetes should be screened yearly for microalbuminuria and treatment commenced with angiotensin converting enzyme inhibitors if indicated.
How can we help chronic patients not to abandon hope?
Authors: Dörner Klaus
Published: July 2012

Patients with kidney disease need appropriate psychological care. Complete assessment of the patient must take place and an active part played by doctors and nurses. These patients require companionship for their despair to gradually turn into grief and for some eventual sense to be made of their situation.
Dialysis visitation project: testing professional quality
Authors: Mutsaers R.
Published: July 2012

In many hospitals the professional aspects of the functioning of dialysis centres are tested by separate associations of professionals and the organizational aspects by associations of professionals or by government authorities, such as the ‘National Health Care Inspectorate’. In countries where the government's interference is declining, associations of professionals, patients and health care providers are stimulated to take responsibility for further improvement in quality of dialysis treatment. This article demonstrates how the quality of renal replacement therapy can be made clear, and most importantly testable.
Compliance of haemodialysis patients with prescribed medication
Authors: Gago C. , Gónzalez S. , Marco B. , Fernández J. , Jarriz A. , Martinez S. , Gónzalez A. , Gálvez C. , Andrea C. , Hernando P. , Hernández J. , Gruss E.
Published: July 2012

summary

This study was designed to monitor the compliance of haemodialysis patients with their prescribed medicines and to analyse factors associated with non‐compliance. We conducted a transversal and descriptive study of 121 haemodialysis patients. The patient compliance to prescribed medicines was evaluated according to the percentage of tablets prescribed and taken. Gender, duration of dialysis treatment, knowledge about prescribed medicines, and family status were not related to patient compliance. However the compliance of patients younger than 65 years was 90.4% vs. 84.6% in patients over 65 years (p < 0.06) and the compliance of patients with academic knowledge was 89.6% vs. 83.7% in patients without it (p < 0.06). The most frequent cause of non‐compliance was the wrong interpretation of treatment (33.9%).
Provision of dietary advice in selected centres across Europe
Authors:   For the EDTNA/ERCA Collaborative Research Programme, Nevett G , Nagel C , Elseviers MM , Lindley EJ
Published: July 2012

summary

The EDTNA/ERCA survey of the provision of dietary advice in renal care was the second project organised through the Collaborative Research Programme (CRP). Data was collected from 51 participating centres in 19 countries. Advice on nutrition was provided by a multidisciplinary team, normally led by a specialist renal dietitian or a medical doctor, in 90% of participating centres. There was a general consensus on the type of advice that should be provided, in that most patients routinely received advice on intake of protein, energy and minerals in over 70% of centres. There was also good agreement on daily protein requirements expressed as g/kg, but considerable variation in the calculation of the body weight that determines the dietary intake for an individual patient. This could lead to significant differences in the advice offered and suggests that guidelines on assessment and use of ideal body weight should be included in the new EDTNA/ERCA Nutrition Guidelines.
Management of vascular access in Europe. Part 1 ‐ A study of centre based policies
Authors:   For the EDTNA/ERCA Collaborative Research Programme, van Waeleghem JP , Elseviers MM , Lindley EJ
Published: July 2012

summary

The EDTNA/ERCA survey of the management of vascular access was the first project organised through the Collaborative Research Programme. This paper reports in the first part, on the current policies for management of vascular access which were studied using centre‐based data collected with a computer based questionnaire. The survey included 103 European centres treating a total of 13,800 chronic haemodialysis patients. 75% of patients in the participating centres were dialysed using a native arteriovenous fistula, 10% had a synthetic graft and 15% had a catheter. In most centres, well‐established hygienic precautions were used. When handling catheters, hygiene was even better. We observed that many aspects of access management varied significantly from region to region as well as between centres. The second part of this paper will relate the large differences observed in centre policies of vascular access management to individual patients' outcome parameters.
Statement for special Journal Edition 4/2000
Authors: Elfrichm Ulla
Published: July 2012

The Education Board (EB) is responsible for the development and implementation of Education policy within EDTNA/ERCA. Although the EB has seen many changes in volunteer positions in the last year, the enthusiasm of the new group will certainly continue to bring innovative educational activities for EDTNA/ERCA members. In the coming year the EB will consider further educational initiatives which may benefit members and the group aims to improve liaison with the Research Board.
A decade review: Methods to improve adherence to the treatment regimen among haemodialysis patients
Authors: Morgan Lois
Published: July 2012

Haemodialysis patients are asked to adhere to a very difficult treatment regimen consisting of fluid and diet restrictions, many daily medications, and usually 3 or 4 hour haemodialysis sessions three times each week. Many haemodialysis patients fail to adhere to their prescribed treatment and although this regimen is difficult, it is necessary for patients to adhere for optimal health and well‐being. It is important for nephrology nurses to know what interventions help patients overcome the barriers that keep them from adhering to prescribed treatment The purpose of this paper is to review the literature to examine the research that has been published on methods to improve adherence among haemodialysis patients. Behavioural approaches, education, and primary nursing are interventions that have been researched More research has been reported on the demographics of noncompliant haemodialysis patients than on effective methods that help patients improve adherence to the treatment regimen. Demographic characteristics do not consistently predict compliance for individual patients. Each patient is unique. Research supports the idea that the nephrology nurse should spend time with the patient on a regular basis in order to understand the factors that hinder the individual patient from adhering to the treatment regimen. The nurse who knows the patient well is empowered to develop individualised interventions aimed at reducing barriers that interfere with the patient's ability to adhere to treatment.
Vascular access monitoring evaluated from automated recirculation measurement
Authors: Lopot F. , Nejedly B. , Svárová B. , Sulková S. , Málek V. , Bodláková B. , Svára F.
Published: July 2012

Vascular access quality monitoring by means of vascular access blood flow (QVA) evaluated from automated thermodilutional measurement of recirculation with reverse needle position is described. This method provides significant advantages over conventional methods based on simple monitoring of pressures in the extracorporeal circuit and/or measurement of recirculation with normal needle position.

AQVA evaluation protocol was developed and introduced into the system of primary nursing. The QVA values were found independent of the extracorporeal blood flow used during the recirculation measurement. QVA values from below 200 ml/min to over 2 l/min were seen. In general, lower values were found in diabetics compared to non‐diabetics and in females compared to males. While blood flow below 600 ml/min is considered risky for synthetic vascular grafts, native AV‐fistulae seem to remain stable and patent at a flow of 400 ml/min or even below.

The method is able to detect erroneous needle placement in looped grafts, stenosis between needles, and is also well suited for effective evaluation of success/failure of interventions on access.
Internet use by patients ‐ A shift in power?
Authors: Trevitt R. , Smitherman R. , Fitzgerald L. , Whittaker C. , Ball E.A.
Published: July 2012

Traditionally, the patient has relied on health care professionals for advice and knowledge. The unprecedented access to information offered by the Internet may challenge this relationship. To investigate this, a questionnaire was sent to 640 transplant patients. 24 responded positively and were interviewed to see if the information they found on the net had been useful, in negotiating a change in treatment or as support. Internet use was associated with younger males who had access to the net at work. 22 had found useful information although only 1 patient had negotiated a change in treatment as a result. As the Internet becomes universally available, patients will be empowered to have a larger role in maintaining their health, and support groups will be better able to help patients. To prepare to deal with this avalanche of information we need to develop a system of accreditation of Internet sites, to create our own sites and to collaborate with patient support groups.
Haemodialysis and H.I.V. infection ‐ therapeutic management
Authors: Chamton N. , Tellier E. , Zins B. , Dubreuil‐Lemaire  , Zazempa Virginie
Published: July 2012

The prevalence of human immunodeficiency virus among haemodialysis patients is of interest and this article discusses the management of 25 patients between 1985 and 1998 in Paris.
EDTNA/ERCA Dialysis Technology Journal Cub 2000/3 summary
Authors: Stragier André
Published: July 2012

Two hundred and eighty nine colleagues participated in the August 2000 Journal Club. The selected discussion paper was entitled: “Why and how to monitor bacterial contamination of dialysate” by Dr Rafael Péz‐Garcia et al. from Madrid, Spain, published in Nephrology Dialysis Transplantation (2000) 15: 760–764.

The authors present the rationale and discuss the methods to monitor dialysate bacterial and endotoxin levels. They offer a better insight into the complex relationship between bacterial contamination of dialysate, endotoxin and cytokines. Eventually they stress the need for complete guidelines regarding dialysate fluid quality monitoring. Please find below a condensed summary of this discussion paper, the full summary being available on the EDTNA/ERCA web site, where free on‐line subscription to this Journal Club is available.
Advanced nursing practice in renal medicine
Authors: Casey J.
Published: July 2012

Renal Nursing presents many challenges for nurses seeking to work at advanced level. The ever‐changing political climate and increasing service demands make it vital for nurses to grasp the opportunities that advanced practice offers. Theorists have suggested that the over‐specialisation of nursing could lead to a fragmented nursing service and an undervaluing of the registered nurse. September 1999 saw the appointment of two such Advanced Nurse Practitioners within the renal unit. This article takes a personal look at the implementation of an Advanced Nurse Practitioner service over the first 12 months and suggests that such a role does have a lot to offer particularly in a renal setting.
Clinical impact of residual renal function on patients starting dialysis treatment
Authors: Taratufolo A. , Egidi S. , Grassotti A. , Pedullá F. , Satriani M. , Galeotti P , Carofei O.
Published: July 2012

We describe our clinical experience of monitoring residual renal function of patients on regular dialysis treatment as residual renal function can play an important role in the management of patients undergoing regular dialysis. With active residual renal function it is possible to delay the start of haemodialytic programmes. In managing dialysis treatments, it is important to maintain residual renal function by preventing hypotensive events. It is known that in acute renal failure intradialytic hypotension is able to reduce the recovery of renal function. Out patient follow‐up plays an important role for these patients. This paper will also discuss the use of biocompatible membranes during dialysis. The outcome is that they are not associated with better maintenance of residual renal function.
Percutaneous interventions for vascular dialysis access
Authors: Roč;ek M. , Peregrin J.
Published: July 2012

A prerequisite for the long‐term patency of vascular access is early detection of a failing shunt, i.e., at the stage of stenosis. Fistulography performed to locate the lesion is followed by percutaneous transluminal angioplasty using a balloon catheter. The procedure takes 30–60 minutes to complete; the clinical success rate varies between 85% and 98%. A more serious condition of failled vascular access is its occlusion secondary to thrombosis. The high costs of hospitalisation and treatment of thrombosed shunts require effective yet less invasive outpatient procedures. Recent years have seen an explosion in the development of mechanical devices on the principle of mechanical dissolution, fragmentation, and aspiration of the clot. Post‐procedural dialysis can be performed immediately thus reducing the need for a central venous catheter. The procedure, particularly in the treatment of native fistula occlusion, is more complicated and about twice as time consuming as treatment of stenosis. The clinical success rate is usually between 71% and 100%. The incidence of serious complications of percutaneous treatment is low.
Drop‐out rate during living donor selection
Authors: Trevitt R. , Whittaker C. , Ball E.A. , FitzGerald L.
Published: July 2012

This unit carried out 29 live donor transplants over a 3‐year period. Many potential donors did not proceed to transplant. For those who had an acceptable tissue type, were blood group compatible and lymphocytotoxic crossmatch negative, we looked at the reasons for cancelling the donor work up. The reasons were impaired renal function (5 potential donors), cardiac/hypertension (4 potential donors), renovascular (1 potential donor), cancer (1 potential donor), crossmatch positive at a late stage (3 potential donors), failure to attend at clinic/change of mind (6 potential donors) and hepatitis (2 potential donors). Improvements carried out following the audit include a list of tests which potential donors living away from this unit ‐ especially those abroad ‐ are asked to do before travelling here. An information leaflet has also been produced for potential donors.
Japanese patients not seeking kidney transplants
Authors: Nakahara N. , Nakatani T. , Takemoto Y. , Kishimoto T.
Published: July 2012

In Japan, the number of patients seeking kidney transplants has declined in recent years. To investigate the reasons for this decline, a questionnaire was given to 73 haemodialysis patients treated at the Tokiwa‐Tatsumi Clinic. The resulting data showed the percentage of patients seeking transplants declined from 61% in 1992 to 19.2% in 1999. The reasons given for not seeking transplants were the improvements of physical condition and resultant quality of life (QOL) due to progress in dialysis therapy, upgraded social welfare support, uncertainties of transplant medicine, loss of expectations due to limited availability of transplant kidneys and aging of patients. Meanwhile, the number of patients on dialysis continues to increase by approximately 10,000 a year, and the mean age of patients rises. To reduce this number, greater effort must be directed toward preventive medical care as well as educating the public regarding transplant medicine.
The UK's Asian population: Solving the transplant crisis
Authors: Randhawa G.
Published: July 2012

The United Kingdom Transplant Authority has recently re‐introduced a policy to identify the ethnicity of patients. This is in response to the realisation by Transplant Co‐ordinators and other health professionals in the field that a number of disparities existed between Asian residents and the indigenous population. The limited data that exists highlights that the Asian population are in a disproportionately greater need of kidney transplants. The situation is clear, there needs to be a greater number of donors coming forward from the Asian communities to increase the pool of suitable organs. However, this may only be achieved if we understand the reasons for the current lack of supply. Very little empirical research has been devoted to this subject and those studies, which have been carried out, highlight the need for greater attention to this life‐threatening problem.
Dialysis fluid contamination of pathways and life of microbes
Authors: PhD R. Nystrand
Published: July 2012

The fluid systems of a dialysis clinic are reviewed from a microbiological standpoint. Water, concentrate and dialysis fluid are the main fluids in the clinic. The quality of these fluids cannot be dealt with, without at the same time reviewing the systems delivering these fluids. The handling of fluids must be seen in a system perspective where every part is important. In the pretreatment of water before reverse osmosis, the incoming water determines the quality. After reverse osmosis, the maintenance in form of disinfection activities is decisive for the microbiological quality in the water system.

The dialysis fluid quality is dependant on the water quality as it is produced at the end of the water system. It must be noted that it is not only the number of microorganisms that is of importance but also what the microorganisms do in the fluid systems.

Microbiological analysis is not normally able to tell the complete microbiological quality of the fluid systems, as the inner surfaces where the microbial growth takes place are not sent to any laboratory. Consequently, what is seen in samples is only what can come off the surface. The only action that can prevent growth of microorganisms is disinfection but disinfection only is not the solution, it must also be performed regularly. Additionally, all areas of the fluid system must be disinfected.

The principle of Quality Assurance including equipment, education and maintenance must be applied in order to ensure microbiological quality.
The social climate in chronic haemodialysis units as perceived by patients and nurses
Authors: Vitri N. , Attias M. , Banayahu M. , Elharrat K. , Hener T.
Published: July 2012

The purpose of this research was to check if there was a correlation between how patients perceived the atmosphere in dialysis units compared to the nurses' perception. The intention was to examine commonality and differences between the two groups. This would serve as a basis to change the behaviour of the nurses and/or to develop or create settings that are more suitable.

Sixteen haemodialysis units in Israel participated in this study, a total of 190 participants of which ninety‐three were nurses and ninety‐seven were patients. Patients and nurses gave their consent in writing and answered anonymously.

The Moos Ward Atmosphere Scale was used using 100 true and false questions. These questions were condensed into six main categories. Our results showed that the patients and staff had significantly different perceptions in the following categories:

Openness and sensitivity,

Staff attitude,

Order and organization,

Mutual support,

New treatment approaches.

The greatest degree of agreement between the two groups was found in only one category: that of the “doctor's attitude” or behaviour.

Three studies have been found that have investigated the unit atmosphere as perceived by patients and staff — two in Israel in an oncology and a psychiatric unit. Rhodes did the third study in a haemodialysis unit in the Unites States and his results are compared with the results in this study.

The differences found between nurses and patients show that there is a communication problem. It is recommended that interpersonal communication be improved to close the gap in perceptions, thereby improving the unit atmosphere. New strategies should be developed for coping and helping the patient to adjust.
– The grown‐up patient — The new customer in dialysis or — how to handle the demanding and emancipated dialysis patient
Authors: Hippold I.
Published: July 2012

The treatment of dialysis patients is under pressure. As a result of strict budgeting and increased administrative work, enhancement and the further development of the dialysis health care system is needed. An essential element of that development is a radical change in the patient/nurse relationship. Customer relationship management assumes that the patient is seen as a client, is encouraged to make decisions on their treatment and also emphasises the professionalism of nursing.
Subjective global assessment of nutrition a useful diagnostic tool for nurses?
Authors: Julien J.P. , Combe C. , Lasseur C.
Published: July 2012

Malnutrition in maintenance haemodialysis (HD) patients is closely related with morbidity and mortality in this population.

Aim of the study: To evaluate feasibility, performance and information given by SGA (subjective global assessment), a semi‐quantitative method of nutritional evaluation (based on a medical questionnaire and a simple clinical examination) carried out by a group of 12 nurses.

Method: In March 1999, a feasibility study was organised to evaluate 9 patients during HD. Since July 1999, a nutritional evaluation of all the patients meeting the required parameters (e.g. duration of HD > 6 months, day sessions) has been set up every 4 months.

Results: In March 1999, preliminary results demonstrated an average learning time per SGA of 15′. In July 1999, 32 patients were evaluated, albuminemia (μmol/l) and pre‐albuminemia (g/l) were analysed according to the SGA classification (A = good nutrition, B= light to moderate malnutrition, C= severe malnutrition). The albuminemia and the pre‐albuminemia of patients A (respectively 541±45 and 0.37±0.10) were higher than those of patients B (482±41 and 0.31±0.01), and those of patients C (381±54 and 0.19±0.1), by variance analysis (p < 0.0001).

The information drawn from the SGA reveal a severe malnutrition, a light to moderate malnutrition, and good nutrition in respectively 13%, 63% and 25% of the patients, and a noticeable muscular atrophy (moderate to severe) in 43% of cases. Anorexia and major gastro‐intestinal symptom (nausea, vomiting, and diarrhoea) are found in 14% of cases.

Conclusion: Beside traditional methods of screening and evaluation of malnutrition in HD patients, the use of SGA by a nursing team uncovers useful information on nutritional status of patients, especially in areas lacking facilities such as a laboratory, dietetic department or permanent presence of doctors.
The nurses knowledge, awareness and acceptance of tissue‐organ donation
Authors: Ozdag N. , Bal C.
Published: July 2012

Background: Organ donation and transplantation, although widely accepted as a successful medical procedure, is one of the new consepts in nursing. Organ donation does not occur as often as needed and the reasons for acceptance or refusal are not clear. To meet this demand more organs and tissues need to be recovered from potential donors. Nurses working on transplantation units are given in‐service training and gain knowledge through experience. Nurses are in a position to inform, and to ask families to donate organs, and also to inform potantial donors on their ward to the units.

Methods: A prospective, descriptive and semi‐analytic study was designed. Data were collected using 25 structured and semi‐structured questionnaires, over a week in April 2000. 3 general and 2 midwifery hospitals were visited and the purpose of the study explained. Staff were asked to participate assuring anonymity. A conference on the issue was offered on completion of the questionnaire if desired. The questionnaire came with an explaination of the purpose of the study, and thanked staff for their participation. They were given to the nurses in charge on each ward, and collected 3 days later by the researchers. The respond rate was 65.6%.

Results: Of the nurses, 87.7% had positive thoughts about the organ donation, but only 10.8% knew the donation law, 68.8% would consider donating organs of their own, 58.7% would consider signing a consent card, and only 36.7% would donate organs from their family members. Although, the majority had positive views about the issue only 34.4% showed willingness to talk to families and ask for donations, 84.0% would inform potential donors in the unit. Adequate knowledge and level of education were the factors effecting acceptance and willingness to be involved in organ harvesting efforts (p < 0.001 and p < 0.05).

Conclusions: The only significant predictors of their acceptence and willingness were education (X2 = 6.45, p < 0.05), and to have adequate knowledge (X2 = 21.90, p < 0.001). Nurses were found in need of education about all aspects of brain death and organ donation including how and when to approach families to inform and ask for organs, and how to support families throughout the process. A brochure should be prepared in detail to guide them on this task. More research should be done to clarify the reasons for refusal of organ donation.
Education of patients and use of insulin pumps in diabetic treatment
Authors: Dijkhuizen‐Overes A. M.
Published: July 2012

Diabetes Mellitus is a chronic disease well known for its fatal complications. Therefore, an international call for measures was declared to keep complications of diabetes to a minimum in order to reduce the costs of treating these complications (St. Vincent Declaration). The common international guidelines for treatment of patients with Type 1 Diabetes Mellitus are the Diabetes Control and Complications Trial (DCCT). The United Kingdom Prospective Diabetes Study (UKPDS) investigated the use of tight glycaemic control in those with Type 2 Diabetes Mellitus.

This paper will explain the importance of intensive insulin treatment for diabetic patients, even when they are dialysing, to prevent diabetic complications. There's always a possibility of reducing diabetic complications to ensure a better quality of life. It will also discuss the different treatment options available including Continuos Subcutaneous Insulin Infusion, which has been demonstrated as the most effective mode of treatment.