bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vascular Access: A role for a renal nurse clinician
Authors: Waterhouse D. 
Published: July 2012

SummaryThe team approach to the delivery of healthcare is important and has become more so since the boundaries between professional groups have become blurred. Renal replacement therapy requires that patients have adequate access. This could be in the form of an arterio‐venous fistula, a graft, or a vascular catheter. Doctors have historically always provided access for patients. Placement of vascular access is a lengthy process often causing long delays and anxiety. Due to the reduction in junior doctors hours and the further demands on senior medical staff, a nurse was nominated and developed the role of vascular access specialist and clinician.Before the development of the nurse clinicians' role, the situation in this centre regarding venous access for haemodialysis was based on an ad hoc arrangement between junior doctors. Historically surgeons and medical staff have always provided vascular access for haemodialysis. However, it was felt that a suitably educated renal nurse would be more suitable to develop this role, and a relevant course, (MSc in Advanced Nursing Practice) had been developed at a nearby university.The access role included the insertion of both short and long‐term vascular access catheters. An access referral pathway is now in place, giving a streamlined service. A designated access specialist nurse now inserts vascular access, providing focused individualised care specifically targeted at the renal patients' needs.Because of the success of this role, four more nurses are being supported to undertake the clinical MSc. The aim is to develop other areas of renal provision and to provide a nurse led specialist individualised service in line with the future National Service Framework. The role has also provided scope for nursing career development, giving motivation to experienced clinical nurses who wish to remain clinically involved, improve the care for patients and progress their career.
The Renal Diabetic Nurse Specialist… A luxury or an essential player?
Authors: Marchant K. 
Published: July 2012

SummaryDiabetic Nephropathy is the single largest cause of Chronic Renal Failure. As the number of patients referred to a nephrologist increase, the needs of many diabetic nephropaths are not being met.The post of Renal Diabetes Nurse Specialist (DNS) was instituted in September 1999 to organise the management of and to meet all aspects of need of this group of patients.The role currently incorporates a daily ward round with the aim of reviewing all patients at least once during every admission to hospital. Ward‐based teaching with the patients occurs and six nurse‐led clinics covering all modalities are now in place and run alongside the Nephrologist. Patients are either referred directly to the nurse‐led clinic or are approached by the renal DNS whilst the patient is in the nephrology clinic.71.4% of our diabetic patients have an improvement in their HbA1c after 21 months of working closely with the Renal DNS and multidisciplinary team. The average HbA1c at the beginning was 9.7%; the average is now 8%.It is clear that the role is being continuously stretched to its absolute limit. Our aim is to develop a broader service over time and we will, in the near future be employing a renal nurse with an interest in diabetes to work alongside the DNS for six months to particularly learn about the needs of our in‐patients.
A practical approach to the molecular biology of kidney diseases: From basic science to bed side
Authors: Garrido P. , Vélez E. , Izquierdo A. , Matthews J. , Gutiérrez‐Tarrés Ma. A. , Luna P. López , Bover J. , Bosch R. J. 
Published: July 2012

SummaryNowadays, the term “Molecular Biology”(MB) is generally applied to the biochemical processes that involve genes and the expression of proteins for which specific genes code. In recent years, astonishing advances have occurred in this field. Currently, there are many important powerful techniques allowing scientists to study the molecular mechanisms involved in many human genetic diseases. Furthermore, it is important to underline that the possibilities are not limited to the diagnosis and study of these genetic diseases. Indeed, by studying gene expression, MB also allows the molecular study of many acquired diseases such as viral hepatitis and cancer. Therefore, these major advances in the knowledge of gene biology are facilitating the arrival of a new era of gene therapy.This article will describe the most important techniques currently used in MB. Firstly, techniques involved in recombinant DNA technology will be discussed and these will include the study of DNA and the possibility of identifying the expression of abnormal genes, e.g. to identify individuals for paternity. Secondly, a description of techniques designed to study the expression of genes and their regulation will follow and they involve the study of RNA. Thirdly, the impact of genetic molecular studies as tools for medical diagnosis will be discussed and analysed. Finally, a discussion concerning the rational basis for gene therapy and its future perspectives is included.In this article, we have focused on technical or diagnostic aspects of Molecular Biology. Although Ethics are also an interesting issue to deal with, theseissues are far beyond the scope of this review.
Chemical additives in new RO systems
Authors: Gietman H. 
Published: July 2012

SummaryRecent analysis of water and dialysate samples shows that due to new RO systems chemical substances can migrate into the osmotic water. A large number of tests have shown that there are no additives in drinking and softened water, but that the problem arises after the RO system. For the tests, samples were taken in the drinking water, after the softener and after the RO system. When the problem was located there were also samples taken from a similar water treatment system, and further samples were taken from two identical RO systems from another supplier. Instead of an RO system that removes all kind of substances, we're now confronted with systems that add volatile aromatic carbon hydrogens. Further tests have shown that dialysate contains the same level of these carbon hydrogens. It seems that even after having primed the artificial kidney in the blood compartment carbon hydrogens are present.The effects of these substances can be alarming because levels have been found equal to limits that are being proposed for drinking water under new European legislation.Is this the moment to look at our RO water quality level, and state new limits for new additives, should we work out new prescriptions for water quality or should we let the rules remain as they are?
The influence of bacteria in dialysis water on its endotoxin level
Authors: Träger H. 
Published: July 2012

SummaryThe influence of bacteria in dialysis water and its endotoxin level is one of the main important issues of purified water for haemodialysis. The current methods, assessing the number of water bacteria, are insufficient; due to their large diversity, only a small fraction of them grow on our used culture agars. Bacterial cells are classified into three categories: the A cells represent cultivable cells, B cells are living though not cultivable whereas the C cells are dead cells. Methods assessing these different cell categories are discussed. Endotoxin is only released from the C‐type cells and is removed by the Reverse Osmosis membranes. It is our task to ensure that we keep the A‐cell level low after the Reverse Osmosis. The purified water must not remain very long in the pipe system and the use of Permeate tanks should be avoided.
Patient flow analysis and referrals — how 1,137 ESRD patients started dialysis during 1998–1999
Authors: Paris V. , Ballerini L. 
Published: July 2012

SummaryThe study consisted in collecting and analysing data from 15 dialysis centres on referral modalities of 1,137 patients with end‐stage renal failure starting renal replacement therapy. All the centres in question had implemented PFA Patient Flow Analysis®, a management programme for pre‐dialysis care from Baxter designed to help improve the collection of data on dialysis patients, from the first visit to a centre through to the start of renal replacement therapy.The aims of the study were threefold:
describe patient referral modalities and the eligibility of patients for renal replacement treatment;
determine how many early referrals (ERs)* and late referrals (LRs)* have a permanent PD (Peritoneal Dialysis) or HD (Haemodialysis) access at the first treatment;
for the main outcomes (permanent access at the first treatment and permanent dialysis treatment), compare the performance of centres that offer enhanced education with those that do not.
The main characteristics (sex and age) of ERs (54%) are comparable to those of LRs. However, ERs generally have greater access to PD or the opportunity to choose the dialysis treatment. The vast majority (86%) have permanent access at the first dialysis treatment and a large number (44%) have PD as permanent dialysis treatment. Centres with structured pre‐dialysis educational programmes experience a larger number of ERs, therefore ensuring better outcomes. For example, 66.3% of patients at centres with structured pre‐dialysis educational programmes (compared to 48.2% at centres without enhanced education) start the dialysis treatment with permanent access; and more patients (40% vs. 22%) receive permanent PD.
Evaluation of blood recirculation in catheters for haemodialysis and its relation to blood circuit pressures
Authors: Montero R. Crespo , Cuesta R. Casas , Muñoz Navarro Ma.C. , Contreras Ma.D. , Garrido I. Alguacil , Bermúdez E. López 
Published: July 2012

SummaryThe objectives of this study were to evaluate the degree of blood recirculation (REC) in venous catheters for dual lumen haemodialysis, and its relation to the drop in arterial line pressure and return venous pressure during haemodialysis. A total of 25 catheters were evaluated (15 temporary 15 cm catheters, and 10 permanent tunnelled 32 cm catheters). REC was calculated using a blood temperature monitor. With blood flow stabilised at 250 ml/min, the session was initiated and the following was determined: real blood flow, drop in arterial line pressure (pre‐pump pressure), positive pressure and blood recirculation.Mean blood recirculation in the total of catheters was 6.4 ± 3%, mean real blood flow was 230 ± 9 ml/min. Mean blood pressure was −146 ± 52 mmHG. Mean positive pressure was 127 ± 47 mmHG. A strong correlation was found between real flow and arterial pressure (r = 0.79, p < 0.01), and between arterial pressure and blood recirculation (r = −0.57, p < 0.01). Comparing the variables studied, a lower degree of REC (5.2±2 vs. 8.5±3, p < 0.01), a higher real blood flow (234 ± 7 vs. 223 ± 7, p < 0.01) and a lower drop in arterial pressure (–127 ± 49 vs. −180 ± 40, p < 0.05) were found in temporary catheters than in permanent catheters. No differences were observed in positive pressure.As a conclusion, these results suggest that blood recirculation is lower in temporary catheters than in permanent tunnelled catheters. This is related to a lower drop in pre‐pump blood pressure and a higher real blood flow. However, positive pressure does not seem to influence the degree of blood recirculation in venous dual lumen catheters for haemodialysis.
Causes of late leaks in peritoneal dialysis patients
Authors: Albaz M. , Kantarcı G. , Tuglular S. , Tercüman N. , Tetik G. , Özener C. 
Published: July 2012

SummaryBackground/Aims: Late dialysis leakage is an important complication of peritoneal dialysis. The aim of our study was to investigate the causes of late leaks in patients on peritoneal dialysis.Methods: 25 patients (19 F: 6 M; mean age: 56 ± 14) with and 25 patients (10 F: 15 M; mean age: 57 ± 12) without dialysis leakage on maintenance peritoneal dialysis treatment were included in the study. Data on demographic characteristics including age, sex, body mass index, body surface area, primary renal disease and peritoneal dialysis characteristics including implantation technique of the catheter, site of the catheter, time from catheter implantation to initiation of peritoneal dialysis, daily total filling volumes, use of hypertonic solutions, membrane transport properties and total and peritoneal creatinine clearances were retrospectively collected for both groups.Results: The number of female vs. male patients (76% vs. 40%, p < 0.05) and patients on CAPD vs. APD (68% vs. 56%, p < 0.05) were significantly higher in the group with dialysis leakage. Patients with leakage also had lower average transport properties (p < 0.05) and lower total creatinine clearances (p < 0.05). Other demographic and peritoneal dialysis characteristics were similar in both groups.Conclusions: Female gender and CAPD as opposed to male gender and APD are the risk factors involved in the development of late dialysis leaks. Peritoneal membrane transport characteristics as well as total creatinine clearance also seems to influence the development of complications.
Continuing CAPD after herniotomy
Authors: Tast C. , Kuhlmann U. , Stölzing H. , Alscher D. , Mettang T. 
Published: July 2012

SummaryThere is still controversy as to whether PD‐treatment can be safely continued after herniotomy (HT). Many nephrologists withhold PD‐treatment for several weeks after HT in fear of dialysate leakage and/or hernia recurrence.We report on 12 patients (2 women, 10 men) in whom HT was performed either for umbilical (n = 6), inguinal (n = 6) or open processus vaginalis (n = 3). Surgery was performed according to the Lichtenstein method with insertion of a Marlex‐mesh and ligation of the hernia sac. In all patients PD treatment was paused for the day of surgery and 1 to 3 days postoperatively, depending on RRF. Low volume (1.0 to 1.5 l) and high frequency exchanges (6 exchanges per day) were started for several days with a gradual reinstitution of the former PD‐regimen within the next 2 to 4 weeks.All patients did well rapidly with no uraemia‐or dialysis‐related complications. No leakage and no hernia recurrence could be observed 3 months thereafter. None of the patients had to be haemodialysed intercurrently. In conclusion, continuing a modified regimen of PD‐treatment after HT seems to be safe and comfortable for the patient.
Anticoagulation therapy in acute renal failure extracorporeal treated patients
Authors: De Vos J‐Y. 
Published: July 2012

SummaryIn extracorporeal techniques, as used for Acute Renal Failure (ARF) treatments, blood is constantly exposed to foreign surfaces. These foreign surfaces include the catheter(s), blood tubings, the dialyser membrane and all artificial materials used for such techniques in general.Blood begins to clot as soon as it strikes a foreign surface. The foreign surface initiates the clotting process. The extracorporeal circuit is prone to clotting during acute treatments unless some form of anticoagulation is employed. On the other hand, this specific group of patients is often at increased risk of bleeding (cfr. Post‐operative patients and post‐renal‐transplant patients, patients with Multiple Organ Failure (MOF) often including liver disturbances). It should be kept in mind that patients with renal failure have a defect in platelet function resulting in altered platelet‐vessel wall interaction. Over time, as the extracorporeal treatment progresses, the platelets become more adhesive or sticky. The blood becomes more likely to clot.Performing effective therapy with low bleeding risk in ARF patients is a challenge requiring knowledge, skills and experience.
Ethical aspects of withdrawing/withholding renal replacement therapies on patients in acute renal failure in an intensive care unit
Authors: Draper H. 
Published: July 2012

SummaryThe majority of patients being treated for acute renal failure in intensive care units have multiple medical problems. Accordingly, the withdrawal of renal replacement therapies should be considered as part of a general decision about whether to initiate or continue with treatment per se. Several guidelines on withdrawing and withholding therapy have been produced and some common themes emerge: concerns to avoid euthanasia, potential for benefit, patient consent (shared decision‐making), team consensus/decision‐making, and the provision of appropriate palliative care and resource implications. Each of these is considered in turn, although the word limit for this paper does not permit detailed exposition.
Nutritional aspects of Acute Renal Failure
Authors: Hoogerwerf M. 
Published: July 2012

SummaryThe patient with acute renal failure is a very ill patient suffering from high urea levels causing poor appetite, nausea and vomiting. These patients are usually treated with a low sodium, low protein and, if the potassium in the blood is high, with a low potassium diet (1). This paper discusses whether or not this is the correct treatment.The symptoms of high urea levels in the blood together with increased needs for energy and protein makes it very hard to prevent the patient becoming malnourished. Often energy‐enriched drinks are necessary to achieve recommendations and it is prudent to let the patient eat and drink what they desire. By calculating the energy and protein needs and comparing these with the intake and the state of illness and by following the patient's body weight over time we can obtain information about the state of nourishment. When we alter the food that's offered we achieve better intake and reduce the risk of malnourishment.
RISING TO THE CHALLENGE OF EFFECTIVE LEADERSHIP
Authors: Maclean M. 
Published: July 2012

SUMMARYTaking on the role of Senior Sister within a rapidly developing haemodialysis unit has been an inspiring challenge. The role inherited minimal numbers of staff, many of who were overworked and disgruntled with no clear direction. The increase in patient activity and the growing demand for renal replacement therapy had the potential to effect the quality of patient care. The need to provide effective leadership for staff, whilst maintaining a ‘hands‐on’ clinical influence within the role had become evident.A transformational leadership style as described by Bass (1) was adopted. Bass believed that transformational leaders envisage organisational goals in order to motivate followers to do their best and perform beyond their own expectation. The inspiration of a shared vision was paramount in order to build a nursing team enthused, uplifted and enabled to rise to the challenge of local reform. The role boundaries of the senior nursing staff were reviewed with a focus on supporting the development and clarification of the role of Team Leader.A strategy was successfully implemented to strengthen leadership. Through providing a support network for all grades of staff, a team culture has been fostered, improving morale and job satisfaction.Without effective leadership, support and encouragement, nurses could potentially withdraw from the emotional demands of the patients and loose sight of the intellectual challenges of everyday practice. Furthermore, this strategy has been a useful tool to encourage recruitment of staff, whilst providing a structure to develop today's skills in preparation for tomorrow's leaders.
PITY? WHAT CHRONICALLY ILL CHILDREN REALLY NEED
Authors: Rauch‐Elnekave H. , Gabbai N. , Spitz M. , Weissman I. 
Published: July 2012

SUMMARYIt is difficult not to ‘pity’ children who suffer from a chronic illness. It is, indeed, heartbreaking to see an innocent child suffer. What motivates this almost universal response? Is it useful and/or helpful? In this paper we propose that ‘pitying’ chronically ill children — i.e., lowering expectations, reducing reasonable demands, excessive gift‐giving, etc. — serve primarily to assuage adults' feelings of helplessness and guilt and result in children who are unhappy and have difficulty living up to their true potential. To illustrate our point, we present three examples of children with end‐stage renal disease (ESRD), two whom pity weakened and one whom lack of pity strengthened.The children we discuss below are patients in the Division of Paediatric Nephrology at Western Galilee Hospital in Nahariya, Israel where a collaborative project was established to meet the psychosocial needs of children on dialysis, children who have undergone transplantation and their families. The project, whose goal is to improve children's quality of life and to help them to grow up to be productive adults, provides psychological consultation to children, families and staff as well as social work interventions within medical settings and in the community (1).
THE EFFECT OF PROFILING DIALYSATE SODIUM AND ULTRAFILTRATION ON PATIENT COMFORT AND CARDIOVASCULAR STABILITY DURING HAEMODIALYSIS
Authors: Gerrish M. , Little J. 
Published: July 2012

SUMMARYThe aim of this study was to investigate what affect profiling dialysate sodium and ultrafiltration rate had on cardiovascular stability during haemodialysis, and if there was any effect on patients' fluid balance, thirst, serum sodium levels, blood pressure, or comfort and tolerance.The past decade has seen major advances in haemodialysis machine technology. Parallel developments have included profiling dialysate sodium levels and fluid removal during dialysis. However, some dialysis centres do not use profiling due to fears of long‐term detrimental effects, especially with regard to hypertension and fluid control. Within my own workplace, approximately 30% of haemodialysis treatments utilise either sodium or ultrafiltration profiling, or a combination of both. Anecdotally, we have seen an increase in cardiovascular stability and haemodialysis tolerance. The aim of this study was to identify the effects of profiling haemodialysis, to ensure that the treatment we offer patients is safe and effective.
SHOULD DIALYSIS MACHINES BE DISINFECTED BETWEEN PATIENTS' SHIFTS?
Authors: Stragier A. , Jadoul M. 
Published: July 2012

SUMMARYThe disinfection of dialysis machines is performed after each session in some units but only at the end of the day in other ones. In a multicentre study, in 15 units (five with and ten without disinfection after each session), the incidence of sero‐conversion for HCV was reduced to zero, after reinforcement of general hygiene precautions only, without changing the above‐mentioned machine disinfection policies. Recently reported episodes of blood contamination of dialysis machines beyond pressure transducers demonstrate that pressure isolator inspection and care should be added to the general hygiene precautions. In a second investigation, no difference was found in dialysate bacterial and endotoxin characteristics between dialysis machines, disinfected after each dialysis (n = 2) and those disinfected at the end of the day only (n = 2). In conclusion, the systematic disinfection of all dialysis machines after each session does not appear to help prevent HCV infection nor to have a detectable impact on optimal dialysate bacterial and endotoxin characteristics.