bluuebunny/crossref_metadata_2025_split huggingface dataset:
Advanced nursing practice in renal medicine
Authors: Casey J. 
Published: July 2012

SummaryRenal 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

SummaryWe 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

SummaryA 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

SummaryThis 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

SummaryIn 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

SummaryThe 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

SummaryThe 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

SummaryThe 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

SummaryThe 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

SummaryMalnutrition 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

SummaryBackground: 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

SummaryDiabetes 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.
Quality monitoring of care: Ask the patient
Authors: De Vos J‐Y. , Leleu L. , Geenens M. , Hombrouckx R. 
Published: July 2012

SummaryIn 1998 and 1999, we organised a questionnaire to be filled out by chronic haemodialysis patients. The first part dealt with general information data on the specific patient and the second part dealt with quality assessment data given as experienced by the individual patient. This second part included a ranking of preference by the patients and aspects patients wanted to see improved in the future.As we implemented the EDTNA/ERCA Clinical Standards and Core Curriculum, the monitoring tool, as described in this paper, was developed in order to monitor the effect of implementation.As a result of this two‐year monitoring process of quality of care, we can follow up the care provided by our multidisciplinary team.It has proven a very useful tool to find out what is to stay as it is and what is to be improved. Simply closing the loop!
Improving care and efficiency: Appointment times in a haemodialysis unit
Authors: Lunts P. 
Published: July 2012

SummaryShortage of nurses and dialysis spaces and the desire to improve patient care are the two main driving forces in the dialysis field today. This paper suggests that these issues can be addressed by organisational change. We describe a simple, dramatically effective but rarely used example — the effect on a haemodialysis unit of the introduction of patient appointment times.This paper will demonstrate that appointment times can be highly effective in reducing waiting times for patients and in utilizing staff and resources more efficiently, as long as there is commitment from key staff to implement and maintain them effectively.
Chronic Renal Failure, nursing diagnoses and interventions
Authors: Yürügen B. 
Published: July 2012

SummaryChronic renal failure (CRF) is a clinical condition resulting from a multitude of pathologic processes which lead to derangement and insufficiency of renal excretory and regulatory functions (uraemia). There are normally two million glomeruli in both the kidneys of an adult, which filter an average amount of 120 ml of blood per minute. This filtration is called glomerular filtration rate (GFR). In the case of damaged parenchyma tissues due to renal disease, the filtration rate goes down to 20–30 ml per minute. This is when findings and symptoms of renal failure come about. In the case of a filtration rate less than 10 ml (GFR< 10 ml/min), a patient is understood to have reached the final stage of renal failure. At this stage, fluid and electrolyte balance is disturbed, azotemia increases and systemic manifestations (uraemia) occur (1,2).Renal failure is a condition in which the kidneys cannot fulfil their function of discharging metabolic waste and of maintaining the fluid and electrolyte balance. It can be divided into two groups: acute and chronic.This paper discusses the etiology, pathophysiology and signs and symptoms. of CRF as well as the diagnosis and interventions required by nurses. Deficit, nursing priority and intervention are discussed in relation to patient problems.
Daily use of the physio dialysis system: Long‐term experience
Authors: Pastore C. , Ruggieri G. , Pastore A. , Siliberto P. , Cristofaro V. 
Published: July 2012

SummaryBackground: Hypovolaemia has been implicated as a major causal factor of morbidity during haemodialysis (HD). In order to avoid the appearance of destabilising hypovolaemia a biofeedback control system for intra‐HD blood volume (BV) change modelling has been developed (Hemocontrol™, Hospal Italy). It is based on an adaptive controller incorporated into a HD machine (Integra™, Hospal Italy). The Hemocontrol™ biofeedback system (HBS) monitors BV contraction during HD with an optical device; furthermore, HBS modulates BV contraction rates (by adjusting the ultrafiltration rate — UFR) and the refilling rate (by adjusting dialysate conductivity — DC) in order to obtain the desired pre‐determined BV trajectories.Methods: Nineteen patients prone to hypotension (7 males, 12 females, mean age 64.5 ± 3.0 SEM years, on maintenance HD for 80.5 ± 13.2 months) volunteered for the prospective study which aimed to compare the efficacy and safety of bicarbonate HD treatment equipped with HBS, as a whole (HBS), with the gold standard, bicarbonate treatment, equipped with a constant UFR and DC (BD). The study included one period of 6 months of BD always preceding a follow‐up period of HBS treatment ranging from 14 to 30 months (mean 24.0 ± 1.6).Results: The overall occurrence of symptomatic hypotension and muscle cramps was significantly less in HBS treatment. Self‐evaluation of intra‐ and inter‐HD symptoms (the worst score was 0 and the best one 10) did reveal a statistically significant difference, as far as post‐HD fatigue is concerned (6.2 ± 0.2 in HBS vs. 4.3 ± 0.1 in BD treatment, p < 0.0001). No difference between the two treatments was observed when comparing pre‐ and post‐HD lying blood pressure, heart rate, body weights and body weight changes.Conclusions: HBS is an effective treatment. Hypovolaemia‐associated morbidity occurs less in BD treatment than HBS. Furthermore, HBS is a safe treatment in the medium‐term because these results are achieved without potentially harmful changes in blood pressure, body weight and serum sodium concentration.
Personality dimensions of haemodialysis patients related to initial renal disease
Authors: Koutsopoulou V. , Theodosopoulou E. , Vantsi E. , Kotrotsiou E. , Kostandinou V. , Dounousi E. 
Published: July 2012

SummaryObjective: The aim of the study was to investigate personality dimensions in uraemic patients undergoing haemodialysis (HD. The relationship between the disease that led to renal failure (and the subsequent need for haemodialysis) and the personality of the haemodialysis patients in question were investigated.Methods: In the present study, which was conducted in three Greek hospitals, 103 patients were analysed and compared to 138 control patients matching the groups according to their age, sex and place of residence. The investigation was conducted using the Eysenck Personality Questionnaire (EPQ), a reliable method for clinical studies that measures three dimensions of personality: neuroticism, psychoticism and introverted/extroverted.Results: The results from the EPQ were compared to the three disease categories that cause renal failure: glomerulonephritis, polycystic disease, and vascular disease. It was concluded that haemodialysis systematically affected all three scales of personality disorders in the patients. Male patients scored higher in neuroticism, while female patients appeared to score higher in psychoticism. Renal disease, the responsible factor for renal failure and the need for haemodialysis, significantly affected personality disorders.Conclusion: The findings show that dialysis modality influences the personalities of patients, and that initial renal disease must be strongly considered in the psychosocial evaluation and care of these patients.
Effect of integrated education on nurses' knowledge of haemodialysis vascular access
Authors: Gelmez M. , Akçaoglu T. , Utkucu Ü. 
Published: July 2012

SummaryThe success of haemodialysis depends on access to the circulation. Preservation of the access site should be a primary goal of patient care. Little research on nursing interventions related to vascular access exists. Access care varies from centre to centre and there are often no written protocols for guidance. The aim of the study was to determine the effect of integrated education on nurses' knowledge.The fundamental principles of vascular access should be used to help train future dialysis staff members in order to improve quality of care. We must continue to gain knowledge in this important area through nursing research and education.This research demonstrates that integrated education improves the knowledge of nurses working in a renal unit.