bluuebunny/crossref_metadata_2025_split huggingface dataset:
The access flowmonitor: A great step forward
Authors: van Loon M. 
Published: July 2012

summaryAccess to the circulation is of vital importance to haemodialysis patients. Proper care and monitoring of fistulas therefore has a positive effect on their quality of life. The dialysis nurse has an important role in the care and monitoring of access. With little effort and means she or he can obtain information on the functioning of fistulas. Others cannot ignore this information, and each coagulated fistula can be considered a missed opportunity. In the monitoring of fistulas the access flowmonitor is a valuable tool: it measures in a direct way how much blood flows through the fistula and that is exactly the information that is necessary to determine the functioning of the fistula. This instrument therefore deserves a solid embedding in the integrated care of fistulas.
Post‐implantation events of swan‐neck catheters for PD
Authors: Picó‐Vicent L. , Cases JM. , Picó‐Mira L. , Contreras JP. 
Published: July 2012

summaryThe first step in PD is the implantation of a peritoneal catheter, a technique that is subject to different possible incidences. We have studied the non‐infectious events or incidences (pericatheter leakage, blood tinged dialysate, catheter displacement, omental wrapping and extra‐peritoneal placement) registered in our unit during a five‐year period (1992–1996) after the implantation of 144 swan‐neck curled catheters in 100 peritoneal dialysis patients, 49 males and 51 females. 70 catheters (48.61 %) were implanted using the blind puncture method and 74 (51.39 %) with the surgical method. All the incidence rates were compared between the two methods to analyse the possible influence of the implantation technique. 21 pericatheter leaks, 19 episodes of blood tinged dialysate, 10 displacements, 7 cases of omental wrapping and 4 extra‐peritoneal placements (all of them after blind punctures carried out by young assistant doctors) were registered, with a total number of 61 incidences (0.42 per catheter). Statistically significant differences were not found either globally or for each type of event when comparing the incidence rates between the two implantation techniques, although extra‐peritoneal placement was close to significant (p = 0.053). None of the incidences were severe. 25 catheters (17.4%) had to be replaced with the removal rates being similar for both techniques. In conclusion, in our experience neither technique shows a clear advantage over the other. Experienced staff members should implant PD catheters.
An adequacy improves adequacy of dialysis
Authors: Thomson T. 
Published: July 2012

summaryThe role of the Adequacy Nurse is concerned with the adequacy of dialysis and nutritional status in both haemodialysis and peritoneal dialysis patients. This relatively new and unique post incorporates diverse roles, including that of practitioner, educator, researcher and change agent. The purpose of this work is to educate both staff and patients about the importance of Urea Kinetic Modelling, to enable them to participate in the process, to ensure that standards set are research based and to act as a change agent when necessary. The creation of this post has resulted in improved communication amongst nurses and the multidisciplinary team and with this increased knowledge a higher standard of care has been observed.
Treatment of water for dialysis ‐ A European survey
Authors:   For the EDTNA/ERCA Collaborative Research Programme, Lindley EJ , Lopot F , Harrington M , Elseviers MM 
Published: July 2012

summaryThe EDTNA/ERCA survey of the treatment of water for dialysis was the third project organised through the Collaborative Research Programme (CRP). Data was collected from 69 haemodialysis facilities in 14 countries. Water quality in European dialysis units was mainly self‐regulated. The majority of centres aimed to meet the requirements of the European Pharmacopoeia, but only 50% carried out tests to check compliance. All facilities used reverse osmosis to treat water for dialysis, most also used softening and carbon adsorption. There was a wide variation in policies for the maintenance of carbon filters, and for the control and monitoring of contamination in the distribution system. Endotoxin tests carried out in 27 facilities showed that higher levels of contamination are associated with systems that are infrequently disinfected, and also with older system designs. The survey indicated that guidelines for water treatment are urgently needed. EDTNA/ERCA guidelines for microbiological monitoring are now being drafted, additional guidelines are under consideration.
Using and developing your EDTNA/ERCA Professional Portfolio
Authors: Thomas N. 
Published: July 2012

summaryA Portfolio is an instrument for continuing professional development, which can be used by all members of the multidisciplinary team. This paper describes the development of the EDTNA/ERCA Professional Portfolio and discusses how health care professionals are able to complete and utilise the Portfolio in everyday practice. A discussion on reflective practice is presented and a short example of reflective writing is given. The paper concludes with an evaluation of possible Portfolio use in teaching and management and plans for future development.
Quality assessment in nephrology nursing
Authors: van Waeleghem J.P. , Elseviers M.M. , de Vos J.Y. , van Malderen P. 
Published: July 2012

summaryIn order to evaluate the quality of nephrology nursing in Flanders, three quality indicators (anaemia, dialysis dose and patient satisfaction) were studied in 11 Flemish dialysis centres, including 521 haemodialysis patients. Median haematocrit (Hct) was 33.7 with 42% of patients not reaching the target level of 33. Median percentage removal of urea (PRU) was 64.8 with 52% of patients showing values below the target level of 65. PRU levels were significantly influenced by needle technique, type of vascular access, sex, duration of dialysis and diabetes The patient satisfaction questionnaire showed that most patients particularly appreciated the professional skills of the health care workers. On completing this study, we ex perienced that the regular use of well‐established indicators to assess the quality of nephrology nursing, is mandatory.
The influence of staff‐patient interactions on adherence behaviours
Authors: Zrinyi M. 
Published: July 2012

SummaryThe research assessed the influence of staff‐patient interactions on adherence to a dietary regimen in dialysis patients. A random sample of 147 subjects provided data on clinical, psychosocial, and demographic measures. Results indicated that staff‐patient interactions determine and predict adherence behaviours. However, the lack of association between the laboratory data and either individual adherence behaviours or staff‐patient interactions raised questions about the validity of these proxy measures of adherence. To better understand the nature of these determinant variables of adherence, more extensive research is suggested.
Investigation: Basis for nursing practice
Authors: Barrio A. Cuñado , López F. García 
Published: July 2012

SummaryThe term evidence based nursing signifies a systematic process of search, assessment and application of the most up‐to‐date investigation for decision taking. In practice the process can be applied in four steps: formulation of the question, a search of the bibliography, a critical analysis of the validity of the results, and putting the obtained findings into practice.Nursing practise must be based on the best available scientific results. Professional nurses are more accustomed to acting according to tradition with scarce scientific rigour. It is necessary to introduce investigation as an instrument to allow resolution of problems with practice and to offer the best possible care alternative.The evidence contributed by investigation is evaluated according to criteria of validity and utility. There are several scales to assess the methodological rigour of investigation studies as well as to recommend a practice or technique as appropriate, or not, according to the scientific evidence available.
Quantity versus quality: Ethics and provision of renal replacement therapy
Authors: Ashwanden Cordelia 
Published: July 2012

Summary50 years ago if one had renal failure the prognosis was certain death within a short timeframe. Now if one receives renal replacement therapy the prognosis has dramatically changed. But in this time of economic constraints and ever decreasing human resources are we now to be faced with the necessity to make choices about who receives replacement therapy?This paper looks at the ethics of providing treatment for large numbers but at the risk of 2nd class treatment, or selection of a few to receive the best treatment possible. The author asks what is the point of choice for the provision of therapy; before treatment has begun or having started who has the right to stop treatment and should there be criteria for discontinuing this treatment? The paper examines the ethical issues facing all the health care team especially those caring for the chronically ill. The financial benefits of one kind of therapy over the other are examined and again the author puts the question, is it economics that governs the treatment prescribed, or a real choice made with knowledge? The author has found that “hands on” health care teams are still aiming to treat the ever increasing workload but at what cost? How long can we continue to accept patients for treatment when we may be putting at risk other patients and the very people who are providing the care?
Pre‐training assessment tool (JPAT) ‐ A pilot study
Authors: Chow J. , Bennett L. 
Published: July 2012

SummaryA tool for assessing the suitability of candidates for home dialysis (Jo‐Pre‐training Assessment Tool ‐ JPAT) was developed. JPAT acts as a screening instrument to identify suitable candidates for the home dialysis programme, and therefore increases a patient's chance of learning to manage the programme. JPAT is in the form of an interview questionnaire consisting of 38 assessment items in six domains: physical stability, nutritional status, communication, ability to maintain self‐care, psychological suitability and social support. A pilot study was conducted (n = 20, 1996–1997) using a descriptive study design, with subjects randomly selected from an existing dialysis programme. Pearson correlation and 2‐tailed tests were employed to explore the relationship between the assessment outcome (i.e. the initial JPAT scores) and the follow up data (i.e. data collected within the seven days following the initial JPAT assessment). Many of the variables attained statistical significance (p < 0.05). The inter‐rater reliability was calculated at an average Kappa value of 0.909. Overall, results suggest that JPAT is sufficiently reliable to be used as a tool for assessing patients who suffer from ESRD.
Restless Legs Syndrome: A review for the Renal Care Professionals
Authors: Wetter Thomas C. 
Published: July 2012

SummaryRestless legs syndrome is a common neurological disorder with an estimated prevalence between 2 and 10 %. It is characterised by an imperative desire to move the extremities associated with paraesthesias, motor restlessness, worsening of symptoms at rest with at least partial relief by activity, and worsening of symptoms in the evening or at night. As a consequence, patients suffer from severe sleep disturbances and, less frequently, from daytime sleepiness. The cause of restless legs syndrome remains unknown. It has been divided into idiopathic and symptomatic (secondary, e.g. uraemic restless legs syndrome) forms. Based on pharmacological, neurophysiological and imaging studies it is suggested that it is a disease of the subcortical central nervous system with involvement of the brainstem and spinal chord. Dopaminergic agents are regarded as the first choice of treatment; however, the development of augmentation of symptoms especially under levodopa therapy may be a major problem. Alternative medications are opioids and benzodiazepines.In secondary restless legs syndrome the underlying illness should be treated first, but dopaminergic drugs may also be helpful.
The Pre‐dialysis Experience ‐ Are individual needs being met?
Authors: Andrew J. 
Published: July 2012

SummaryThe pre‐dialysis experience is a time of change. Individuals and their families are able to adapt to this change and altered lifestyle if their specific needs are met. This qualitative study aims to gain an understanding of the patient's perspective and identify how they manage the pre‐dialysis experience. This knowledge will enable renal unit teams to plan effective holistic programmes, which meet the needs of the individual. The emergent theory identified that predialysis patient's and their families have to accept a different view of life before they can move forward and make a decision regarding treatment. The adoption of a model for good practice aids the transition.
21st Century Home Haemodialysis: A new approach to an old treatment
Authors: Lunts P. 
Published: July 2012

SummaryHome therapies are increasingly being demonstrated to be the best treatments for the early stages of the dialysis lifecycle. Although home haemodialysis has declined dramatically over the last 20 years from 41% in 1983 (1) to 3.2% in 1998 in the UK alone (2), many studies have suggested that it offers the optimum dialysis in terms of outcomes (3,4,5). Evidence from a 1998 survey of UK dialysis staff indicates that the major perceived drawbacks of home haemodialysis were lack of suitable patients, family stress, cost of machines and training time (6). The study also strongly indicated that a lack of familiarity with the treatment was a major cause of its decline in many units.We set out to redesign our approach to home haemodialysis to make it suitable for many more patients.
Maintaining an optimum haemocatheter exit site
Authors: Wittich E. 
Published: July 2012

SummaryAs a result of crusty growths over some haemocatheter exit sites, it was decided to explore why these crusty scabs occur and how they could be eradicated. It is concluded that a haemocatheter exit site requires a dressing, which will maintain an optimum environment, and avoid contamination from Staphylococcus aureus. Inadine (Johnson & Johnson) a povidine iodine product, applied before the final dressing of Tielle (Johnson & Johnson Medical), a hydropolymer adhesive dressing creates an ideal environment for healing. The haemocatheter exit site can also be inspected at each dialysis session, but can in fact be left insitu for seven days.
Nutritional status, delaying progression and risks associated with protein restriction
Authors: Hartley G. H. 
Published: July 2012

SummaryLow protein diets (LPD), providing ≥ 0.6 g protein/kg body weight daily, have traditionally been used in the nutritional management of chronic renal failure (CRF). Initially they were advocated when dialysis availability was limited. More recently LPD have been proposed as a means of delaying the rate of CRF progression. Despite much research in this area, the value of protein restriction remains contentious. A major concern over their use is that they may induce malnutrition. This is of critical importance since mortality rates are significantly increased in individuals who are malnourished when dialysis is initiated. Other approaches to the nutritional management of CRF may be more appropriate. The primary goal of any nutritional therapy should be to optimise the patient's nutritional status.In the UK LPD are used in a minority of units. An alternative approach to the use of these diets is to view the prevention of malnutrition as being of paramount importance. For uraemic patients, dialysis is the best treatment.
Bye bye chemical desinfection with canisters
Authors: Pancíř;ová J. 
Published: July 2012

SummaryThis paper describes and evaluates disinfection techniques of dialysis monitors available in our dialysis unit. We demonstrate disinfection techniques with regards to the risk of human error. To achieve a high hygienic standard and to support the safety and efficiency of each disinfection procedure, we emphasise the use of single‐use‐disinfection cartridges.
Self‐monitoring of microbiological levels in dialysis fluids
Authors: Träger H. 
Published: July 2012

SummarySelf monitoring of dialysis fluids is important. The dialysis technician has experience of the microbiological situation of the fluid systems and can make more tests for personnel safety. The tests are not expensive and are very easy to learn. It seems that the cells, which generate endotoxins, cannot be determined by the plate count system. No tanks or permanent water flow UV sterilisation in the pipeline to the dialysis machines can prevent the build up of biofilms and higher endotoxin amounts in water.
Containers for waste causing peritonitis in CAPD patients
Authors: Alscher DM. , Pfinder‐Nohe E. , Rumpf D. , Pauli‐Magnus C. , Knabbe C. , Kuhlmann U. , Mettang T. , Krankenhaus Robert‐Bosch 
Published: July 2012

SummaryFungal infection is a rare cause of peritonitis in patients on chronic peritoneal dialysis. In this population, fungi are found in less than 2 percent of all cases of primary episodes of peritonitis (1). More often, a primary bacterial peritonitis treated with antibiotic therapy leads to secondary fungal infection (2). Candida species cause 74.5% of the episodes of fungal peritonitis (2). The fungi invade the peritoneal cavity from the skin peri‐ or intraluminally through the catheter (3). Filamentous fungi are rare (4,5). Treatment of fungal peritonitis commonly consists of removal of catheter and antifungal drugs (3). Here we describe two cases of fungal peritonitis caused by mycelial fungi, where the source of the micro‐organismn could be special containers used for biological waste, which are popular in Germany.
Job‐related stress among nursing personnel in Greek dialysis units
Authors: Brokalaki H. , Matziou V. , Thanou J. , Zirogiannis P. , Dafni U. , Papadatou D. 
Published: July 2012

SummaryThe purpose of this study was to describe specific work‐related factors that contribute to increased levels of stress experienced by nursing personnel, and to compare their impact on nurses and assistant nurses who work in Dialysis Units (DU) to those who work in Peritoneal Dialysis Units (PDU) in Greece. The sample of the study consisted of 682 members of nursing personnel working in DU and in PDU in Greek Hospitals. The collection of data was done by means of a questionnaire. The latter included questions about the motivation of nursing personnel for having chosen to work in these units along with questions about the stress factors related to the patients and their care, the role of the nurse in the unit, and the working conditions. According to the results of the study, the percentage of nursing personnel working in DU or PDU by their own choice was 71% and 8.3% respectively, whereas the rest of the staff were placed there irrespective of their preferences, by the Administrators. Among nursing personnel who had chosen to work in DU, the reported motives that contributed to their decision were the absence of a night shift (27.8%), and working in a closed unit. The main motive that incited nursing personnel to work in PDU was the acquisition and the application of specialized knowledge. The percentage of nursing personnel working in DU that expected high levels of job satisfaction was 77%, whereas the corresponding percentage for nursing personnel working in PDU was 65%. However, only 44% and 37% of the nursing personnel working in DU and PDU reported high levels of job satisfaction. The most important stressors related:
To the patient: were the risk of contamination (79% DU, 84% PDU) and the death of a patient (77% DU, 80% PDU).
To the role of nursing personnel in the unit: were increased responsibilities (65% DU, 37% PDU), low involvement of the nursing personnel in decision making (58% DU, 54% PDU), and low professional status of nursing personnel.
To the working conditions: were the shortage of nursing personnel (74% DU, 99% PDU), limited material (74% DU, 57% PDU), the closed environment (75% DU, 64% PDU) and the daily work routine (78% DU, 61% PDU).
In conclusion, we can say that working in DU and PDU provokes increased stress in nursing personnel, even though the implicated stress factors differ between these units.
The relationship between interdialytic weight gain and patient compliance. A single centred cohort study (n=21)
Authors: Casey J. , Johnson V. , McClelland P. 
Published: July 2012

SummaryHaemodialysis patients are subject to many restrictions and face a lifetime attempting to adhere to various regimes. This small study was designed to explore the relationship between fluid gain, compliance and staff reinforcement. This was achieved by measuring dietetic and nursing educational input using interdialytic weight gain as a barometer of patient compliance. This study suggests renal nurses, dietitians and other members of the multi‐disciplinary team may have less influence than previously assumed.
Continuous venovenous haemodialysis: A study of 84 cases
Authors: Ureña Galipienzo T. 
Published: July 2012

SummarySlow continuous therapies are the choice treatment in critically ill patients with acute renal failure (ARF). Over 4 years (1994‐97) we retrospectively studied 84 intensive‐care unit patients suffering from ARF and multiple organ failure, and treated with continuous venonenous haemodialysis (CVV‐HD). The main cause of ARF was sepsis (59.3%). The global mortality was 88% and the patients who died were older than the survivors (p = 0.004). The main cause of dialyser change was the ratio FUN/BUN ≤ 0.8 (61.6%); this ratio was calculated from the quotient filtrate urea nitrogen / blood urea nitrogen (urea nitrogen = urea / 2.14). Most patients (94.8%) treated with initial replacement fluid infusion didn't show falls in blood pressure (BP).Conclusions: 1. The mortality was higher in elderly patients. 2. In most cases the monitoring FUN/BUN ratio allowed recovery of the patient's blood before clotting in the extracorporeal circuit. 3. The replacement fluid infusion at the beginning of the CVV‐HD procedure contributes to patient's haemodynamic stability, because BP usually falls due to excessive ultrafiltration.