bluuebunny/crossref_metadata_2025_split huggingface dataset:
Home training experience in peritoneal dialysis patients
Authors: José Castro M. , Celadilla O. , Muñoz I. , Martínez V. , Mínguez M. , Bajo M. Auxiliadora , del Peso G. 
Published: July 2012

SummaryThe objective of nursing is to increase health and well being, prevent morbidity and obtain the best physical and social rehabilitation. The nurse's role in Peritoneal Dialysis (PD) consists of promoting and supporting patients to perform self‐care.In the ‘Text Book of Peritoneal Dialysis’, published in 2000, the chapter dedicated to the nurses' role says: “Regular home visits are an important part of follow‐up care, as the family and patient need to realize that continuing support is available… It is advisable that the first exchange after discharge from hospital is in the presence of a nurse… Early recognition and management of problems will assist in keeping the patient healthy and well rehabilitated, and will hopefully reduce hospital visits and inpatient stays” (1).Home care in Hospital Universitario La Paz has been developed with varying dedication over the years. Firstly, it was offered if significant problems appeared (1979–1990), later, home visits were started for some new PD patients (1990–1994) and follow up visits then ensued (1995–1996). In 1997, a project was undertaken which included home training for the first time in our unit, as well as periodic follow up visits. This project was shown to the Hospital Nurse Direction, and approved immediately. It started during the first term of 1997.There were several reasons which led us to undertake this project including the importance of providing PD at home and making it lifelong and it was felt that the hospital was an unfriendly environment in which to learn PD. The main objective was to establish early on, the patient's social environment and psychological status, and to assess how these influenced aspects of learning and adapting to PD.Most patients expressed a very good opinion about the home training. Only one patient rejected the presence of the nurse at home. The nursing team was very satisfied because early knowledge about the patient's psychosocial conditions and family environment was established. The incidence of peritonitis decreased.
Compliance with automated peritoneal dialysis
Authors: Rivetti M. , Battú S. , Barrile P. , Benotto S. , Berruto L. , Bosio A. , d'Auria L. , Tortone C. 
Published: July 2012

SummaryCompliance in peritoneal dialysis is reported as being a significant problem. In CAPD, the percentage of non‐compliant patients varies between 10 and 40%. In APD the phenomenon seems to be more limited, at 15% −20%. We considered 23 patients who had been on APD for more than 3 months. The dialytic treatment was performed using the Home Choice Pro device to record all the parameters of the dialysis session.The last 30 days of treatment were considered in the assessment of compliance, evaluating differences in daytime and night‐time volumes between the prescription and the actual treatment, the length of the night‐time session, and the days of treatment. As regards volume and duration, no differences were found compared to the dialytic prescriptions. For the days of treatment, a difference was only found in 3 patients:2 self‐administered patients missed 1 day of therapy out of 30, and in both cases the missed tretment was ageed with the Centre; non‐compliance was only found in 1 patient (4,3%), whose treatment was performed by the family, and who missed 4 days out of 30.
Organ donation: Attitude and knowledge of nurses in South Africa
Authors: Naude A. , Nel E. , Uys H. 
Published: July 2012

SummaryVarious factors influence the process of organ donation. As a result, there is a shortage of organs for transplant. Poor communication and cooperation between transplant coordinators and intensive care nursing staff can lead to the non‐referral of potential organ donors, which is detrimental to the process. The purpose of this research was to ascertain the attitude and knowledge of the transplant coordinators and intensive care nursing staff that work in intensive care units during organ donation. Contextual descriptive research was carried out by compiling literature‐based questionnaires, one each for the transplant coordinators and intensive care nursing staff, and then analysing responses. The indications are that problem areas exist between the role players in the organ transplant process. Guidelines were drawn up for the improvement of communication and cooperation between them in order to promote organ donation.
Information and counselling for patients approaching end‐stage renal failure in selected centres across Europe
Authors:   For the EDTNA/ERCA Collaborative Research Programme, Da Silva‐Gane Maria , Goovaerts Tony , M. Elseviers Monique , J. Lindley Elizabeth 
Published: July 2012

SummaryThe EDTNA/ERCA survey of the provision of pre‐ESRF information, education and counselling in renal care was the third project organised through the Collaborative Research Programme (CRP). Data was collected from 35 participating centres in 10 countries. The majority of participating centres had a structured pre‐ESRF programme. Advice and education received by patients in these centres was usually provided by a multidisciplinary team and was coordinated by nurses in half of the centres. Programmes in all countries had similar content in that normal kidney function, medication, diet, haemodialysis, peritoneal dialysis and transplantation were routinely discussed and that issues such as employment, importance of leisure activities, holidays and Kidney Patient Associations were also on the agenda for discussion. Educational material produced by companies was widely used.Policy differences did emerge in attitudes to discussing the “no‐treatment” option with patients accepted for dialysis and in the treatment that would be offered to patients with specific co‐morbidities and life‐style.
Self adhesive dressing pouch for the protection of catheters
Authors: Martínez María Teresa de la Cruz , Hernández María José 
Published: July 2012

SummaryThis paper is about a new model of dressing, used for the protection of all types of temporary and permanent catheters. Those who developed this dressing realised the practical difficulties during the placement and removal of traditional dressings, used in haemodialysis units. They also realised that it this was unpleasant for the patients, and there was a risk to the catheters when removing the dressings because of the use of scissors and other cutting instruments.This new dressing solves these previously mentioned problems and at the same time contributes to the comfort of the patients.The model has been registered as a standard using model, and therefore it is protected by law and its copyright (Intellectual Property).
The SF‐36: An instrument for measuring quality of life in ESRD patients
Authors: Terada I. , Hyde C. 
Published: July 2012

SummaryThis paper provides a review of four studies, which use the generic Medical Outcome Study Questionnaire 36‐Item Short Form Survey (SF‐36) to investigate the quality of life of patients with end‐stage renal disease. Both English and translated versions of this instrument have been demonstrated to be valid. It is difficult however, to compare results from western and eastern populations as cultural differences may influence how people rate their quality of life.The SF‐36 has been demonstrated to be a valid instrument when used to measure the quality of life of ESRD patients. Research findings from Europe and the United Kingdom demonstrate that patients who are treated with a successful renal transplant can experience a QOL which, is superior to that achieved with any dialysis modality and which is very close to the QOL scores of the general population.It is acknowledged that while the studies cited in this article all used the SF‐36 the research design employed in each instance is not exactly comparable, and any conclusions drawn here require further testing.
Unstable diabetes and peritoneal dialysis — what are the challenges?
Authors: Thomas N. , Mahon A. 
Published: July 2012

SummaryThis case study outlines the care of a young woman undergoing peritoneal dialysis (PD) who has Type 1 diabetes mellitus as the underlying cause of her renal disease. Although she is able to manage the practical aspects of her fluid exchanges and exit‐site care, she has difficulty with managing her fluid balance. This necessitates the use of two 3.86% glucose bags per day, which in turn sometimes leads to high, unstable, blood glucose levels.This study will outline the nursing challenges and interventions and will evaluate the nursing management.
Management of a pregnant woman dependent on haemodialysis
Authors: Walsh Anna‐Marie 
Published: July 2012

SummaryThis is a case study of a woman who became pregnant whilst receiving haemodialysis in a London teaching hospital. She courageously disregarded the doctors' advise to abort the fetus. The doctors advised her to wait until she had a kidney transplant to become pregnant again, rather than increase maternal and fetal risk on dialysis. She was due to have a live‐related transplant from her father in the spring.The case study describes a practical account in detailed measure to equip nurses with the knowledge to provide specialised care to high‐risk dialysis expecting mothers. The main problems in this case study were trying to manage the mother's dialysis regime, control her anaemia, ensure good nutritional levels and gain accurate daily weights.
Endotoxin and ‘on line’ production of substitution fluid in haemodiafiltration and haemofiltration
Authors: Nystrand Rolf 
Published: July 2012

SummaryIn dialysis, machines intended for use in the treatment modes haemodiafiltration (HDF) and haemofiltration (HF) have been on the market about 10 years. These machines are equipped to be able to produce the substitution fluid to be used for direct infusion. In principle, this is done by using the reverse osmosis water of the clinic and mixing in concentrates as usual to form dialysis fluid. The dialysis fluid is then filtered in order to prepare it for use as substitution fluid.The volumes used when the substitution fluid is prepared on‐line are usually 20–50 litres in HDF mode and 70–150 litres in HF mode. This means that a patient treated 3 times a week is exposed to a total volume of substitution fluid ranging from 3,000 litres to a maximum 23,000 litres a year. Where else in medicine do we see something coming close to this? Because of these large infusion volumes, the issue of endotoxin levels becomes as important as the issue of sterility.
Routine disinfection of the total dialysis fluid system
Authors: Gorke A. , Kittel J. 
Published: July 2012

SummaryThe importance of bacteria and endotoxin free, sterile dialysis fluid for long term, high quality haemodialysis treatment is obvious and very much demanded (1,2). Dead spaces and connections between units (segments) of fluid production and delivery in elder systems are a continuous source for bacteria growth, biofilm generation and endotoxin release (3).After varying success with routine disinfection of system components showing partly fast recovery and growth of bacteria (i.e. < 48 hours) we changed to routine disinfection of the entire fluid production and distribution system. We call this ‘system disinfection’.We report the methods and results from observation of practice over 28 months of disinfection. The fluid system is composed of a soft water tank, reverse osmosis (double RO), RO fluid loop, central bicarbonate production and delivery system and dialysis stations with and without ultrafilter and citric‐thermal disinfection before and after each haemodialysis.The system disinfection is carried out bimonthly with peracetic acid 3.5% in < 0.1% solution at a mean temperature of > 15 °C and at a minimum of 60 minutes of disinfection time.Samples for microbiological testing and endotoxin measurement were assessed 3–4 monthly at 7 measurement points. The tests were carried out 7 times on the 11th day (mean value [MV]) after routine system disinfection. The result was in 0.2 CFU/ml (MV) in 40 tests.The endotoxin levels (IU/L) were all < 0.25 except one at 0.325 in RO water. Endotoxin was assessed 5 times in 26 tests over 28 months. Samples were taken at 10.5 (MV) days after system disinfection. The Gel Clot or turbometric method was used.Efficient and preventive routine system disinfection of an entire dialysis fluid production and distribution system — as standard in modern equipment — can support sufficient quality in dialysis fluid produced and distributed by elder and composed systems.
Hand decontamination: What interventions improve compliance?
Authors: Hinkin J. 
Published: July 2012

SummaryBackground: Haemodialysis units have traditionally been classified as high‐risk areas in relation to infection control. Hand decontamination is the fundamental infection control practice, although this is not always performed optimally. Deficiencies in the technique, frequency and appropriateness of this vital practice are frequently reported in health care journals. A literature search was carried out to determine what interventions improve compliance with hand decontamination practice.Method: A literature search was carried out of electronic databases from 1988–2000. Forty articles matched the key search words. When inclusion/exclusion criteria had been applied, seven primary research articles were found to be suitable. Appropriate tools were used to critically analyse the research. The findings were then synthesised into similar themes.Findings: The interventions used in the seven articles utilised a combination of staff and patient education, feedback and motivational interventions to improve compliance. The evidence showed that these interventions met with different degrees of success. Multiple interventions were generally more successful than individual efforts. The improvement in hand decontamination practice often fell back to base line measurements after the intervention had ceased.Implications for practice: The findings can cautiously be used to improve practice. A combination of continuous, innovative education and motivation should improve and maintain this important skill.
The Role of the Renal Specialist Nurse in Prevention of Renal Failure
Authors: Hurst J. 
Published: July 2012

SummaryThis article will investigate the care required for those with reduced renal function before renal replacement therapy (RRT) commences. Renal nurses are often involved with the technical, monitoring and evaluative aspects of RRT for those with end stage renal failure. However, many patients may experience reduced renal function many years before reaching the stage of needing RRT. Renal nurses are already involved in the preparation of patients for RRT, but are not presently exercising their specialist skills in the period before this time by contributing to the prevention of end stage renal failure (ESRF). Screening programmes carried out in various parts of the world demonstrate that many members of the population have undetected renal insufficiency, and may benefit from intervention from the nephrology team to prevent further renal dysfunction. It is for this group of patients that this article will consider the potential for the renal nurse to expand their scope of practice.
Dialysis — A family matter. A personal tribute to the relatives of kidney patients
Authors: Auer J. 
Published: July 2012

SummaryThe patient and his or her treatment is the main focus of the multidisciplinary team in the Renal Unit, yet the most important part of the patient's life is that spent at home, outside the hospital. It is important to recognise the contribution to care of the patient's family, especially the spouse. It is also important to understand the carer's needs. Carers experience many of the stresses associated with End Stage Renal Failure, while being relatively unsupported and unappreciated by hospital staff. This paper focuses on the need for imagination and understanding of the carer's predicament, and suggests ways in which carer's needs can be met.
Belgian peer review experience on the Achille's Heel in haemodialysis care: Vascular access
Authors: Theelen B. , Rorive G. , Krzesinski J.M. , Collart F. 
Published: July 2012

SummaryAims: In order to improve the supervision and to evaluate the quality of care in dialysis units, a national project was promoted as a Peer Review. It consisted of systematic, continuous and critical evaluation of the care and the application of international guidelines and compared the reality of care with standards.Method: The first chart consisted of the evaluation of infectious episodes of vascular access. This point is particularly relevant since infection represents the second cause of mortality in haemodialysis.A questionnaire concerning each patient was designed. Questions concerned the description of vascular access and the related infectious events. Each questionnaire included 21 items. The project involved 29 dialysis centres, 1644 patients and 1775 vascular accesses. The database included 90,525 data.Results: Among the 29 centres, the native arteriovenous fistula (AVF) is the first choice (67.5%) in vascular access, but the proportion of AVF decreases with age contrary to the catheter, which is more frequently chosen, in older patients. Independent of age, 20% of hospitalisations are among patients with catheters and only 7% among patients with AVF. The RR (relative risk) of being hospitalised (any complication of vascular access) is 1.68 for patients with catheters compared to patients with AVF. The rate of infections does not increase with age but is higher for patients with catheters (RR = 2.26). The number of infections appears to be dependent on the staphylococcus aureus carriage in the year.Conclusions: This first step allows each centre to compare itself to others in an anonymous way. This approach should lead to specific recommendations to improve the quality of care in dialysis units.
Do demographic variables affect the timing of referral to the nephrologist?
Authors: Steel J. , Ellis P. 
Published: July 2012

SummaryThe consequences of late referrals for nephrological care include: increased morbidity, poorer quality of life on dialysis and probably increased mortality. Few studies look at the socio‐demographic factors which influence referral to the nephrologist. There is good evidence from studies in other areas of health care that socio‐demographic and economic factors influence access to health care. It is important that the nephrology community understand whom the individuals are who likely to be referred late so that we can address any inequality in access to services. We studied all of the patients who started renal replacement therapy in our unit over a five‐year period, 1st January 1996 to 31st December 2000 (n = 494). We collected data on gender, age at referral, ethnicity, the date that the individual started dialysis as well as the date they were first seen by a nephrologist.We analysed the data to see if age, gender or ethnicity was associated with timing of referral. If an individual had seen a nephrologist more than three months prior to starting dialysis, they were termed ‘early referred’, if not they were termed ‘late referred’. Since this was a sociologically driven research project, we set statistical significance at the 10% (0.1) level. Our data showed that gender did not affect the timing of referral (p = ns), ethnicity affected referral in so much as whites were more likely to be referred late than blacks (p = 0.08) but no more so than non‐whites (p = ns). People under the age of 30 were statistically more likely to be referred late than people over the age of 30 years (p = 0.027) as were people under the age of 40 (p = 0.047). We interpret these finding as demonstrating that health care professionals are referring older people and people from the black community in good time and that, in contrast to other studies of inequalities in health, these findings demonstrate that the elderly and ethnic minorities are not being disadvantaged.
Effects of different doses in continuous veno‐venous haemofiltration on outcomes of acute renal failure: A prospective randomised trial
Authors: Ronco C. , Belomo R. , Homel P. , Brendolan A. , Dan M. , Piccinni P. , La Greca G. 
Published: July 2012

SummaryBackground: Continuous veno‐venous haemofiltration is increasingly used to treat acute renal failure in critically ill patients, but a clear definition of an adequate treatment dose has not been established. We undertook a prospective randomised study of the impact of different ultrafiltration doses in continuous renal replacement therapy on survival.Methods: We enrolled 425 patients, with a mean age of 61 years, in intensive care who had acute renal failure. Patients were randomly assigned ultrafiltration at 20 ml/h−1/kg−1 (group 1, n = 146), 35 ml/h−1/kg−1 (group 2, n = 139), or 45 ml/h−1/kg−1 (group 3, n = 140). The primary endpoint was survival at 15 days after stopping haemofiltration. We also assessed recovery of renal function and frequency of complications during treatment. Analysis was by intention to treat.Results: Survival in group 1 was significantly lower than in groups 2 (p = 0.0007) and 3 (p = 0.0013). Survival in groups 2 and 3 did not differ significantly (p = 0.87). Adjustment for possible confounding factors did not change the pattern of differences among the groups. Survivors in all groups had lower concentrations of blood urea nitrogen before continuous haemofiltration was started than non‐survivors. 95%, 92% and 90% of survivors in groups 1, 2 and 3, respectively, had full recovery of renal function. The frequency of complications was similarly low in all groups.Interpretation: Mortality among these critically ill patients was high, but increase in the rate of ultrafiltration improved survival significantly. We recommend that ultrafiltration should be prescribed according to patient's bodyweight and should reach at least 35 ml/h−1/kg−1.
Importance of increased ultrafiltration volume and impact on mortality: Sepsis and cytokine story and the role for CVVH
Authors: Ronco C. , Ricci Z. , Bellomo R. 
Published: July 2012

SummaryThere is growing interest in extracorporeal blood purification therapies (EBPT) as adjuvants in the complex therapy of sepsis and multiple organ dysfunction syndrome (MODS). Nowadays the only routinely used purification technique is ‘renal replacement therapy’ (RRT) during acute renal failure (ARF), one of the almost inevitable and deadly components of MODS. RRT has been the first and still is the most utilised and effective type of EBPT. Evidence is growing about its ability to maintain homeostatic balance in critically ill patients, and specifically in septic patients with MODS. Clinical trials have been recently designed to modify or improve these therapies. In detail, the following issues have been currently addressed: effects on blood purification provided by different therapies, adequacy of prescription and delivery of therapy, toxins and solutes to be removed with these techniques. Based on these speculations we will briefly review the current understanding of these issues and the rationale for application of RRT in the intensive care unit (ICU). In particular, we will focus on the importance of increased ultrafiltration volume and its impact on mortality in the general ICU population and in septic patients.