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Seminars in Dialysis

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https://www.readbyqxmd.com/read/29336064/home-hemodialysis-education-during-postdoctoral-training-challenges-and-innovations
#1
Joel D Glickman, Rebecca Kurnik Seshasai
Inadequate education in home hemodialysis (HHD) fellowship training might contribute to underutilization of this modality in the United States. Most graduates of nephrology fellowships do not grade themselves as competent in HHD suggesting that fellowship training in HHD is inadequate. An essential component for fellow education is at least one faculty member with expertise in HHD who is passionate about promoting the use of this modality. At a minimum, fellow training should utilize a curriculum that includes both lectures about HHD and outpatient clinical exposure to this modality over a period of at least 6-12 months...
January 15, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29336060/what-the-non-nephrologist-needs-to-know-about-dialysis
#2
Matt Foy, C John Sperati
The End-Stage Renal Disease (ESRD) program now serves approximately 675,000 individuals in the United States at a cost of $26.1 billion to the Medicare system. Given the size of this population, healthcare providers from all disciplines will deliver care to patients on dialysis. Mortality remains high among patients on chronic dialysis, with 42.3% surviving 5 years. As this is a vulnerable population, it is important in the care of ESRD patients that non-nephrologists have a working knowledge of issues germane to dialysis...
January 15, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29333675/sharing-innovations-to-enhance-renal-fellow-education-in-dialysis
#3
Laura J Maursetter, Lisa K Prince, Christina M Yuan, James F Simon
Dialysis care is an integral part of the practice of nephrology. Despite this, education of fellows in providing dialysis often remains rudimentary, relying on a combination of didactics and learning through experience. This runs the risk of training nephrologists who can provide dialysis care without truly being experts on the subject. In this article, a collection of novel or innovative teaching methods is presented that are meant to provide training programs with additional tools with which to improve the training of their fellows in dialysis...
January 14, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29333659/acute-renal-replacement-therapy-during-hospitalization-is-training-adequate
#4
Paul M Palevsky
Acute renal replacement therapy is one of the most common interventions provided by nephrologists, however, data on the quality of training provided to nephrology fellows is limited. Extensive curricula for acute renal replacement therapy and the management of poisonings and intoxications have been published, but personal experience suggests that there are significant opportunities to improve training. Particular areas to be considered include the use of novel technologies for assessment of volume status, greater emphasis on the dosing of medications during acute renal replacement therapy, greater training in assessing and tailoring treatment to the goals of care of the individual patient, incorporation of continuous quality improvement tools into the management of acute renal replacement therapy programs and development of robust simulation training to augment training...
January 14, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29333620/in-center-hemodialysis-education-challenges-and-innovations-in-training-of-fellows-in-nephrology
#5
Louise M Moist, Robert M Lindsay
The in-center dialysis unit and practice of dialysis, in the current multi-team approach, requires knowledge and skills in all the domains including medical expert, communicator, collaborator, scholar, health advocate, and leader. We are tasked as a community, to embrace and incentivize new innovations and technology to address these needs for our post graduate trainees. These innovations must address the basic principles of dialysis, quality improvement, technical and procedural skills as well as leadership and administration skills...
January 14, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29315834/medical-safety-in-the-care-of-the-person-with-end-stage-kidney-disease
#6
John V Duronville, Clarissa J Diamantidis
Much is written about medical safety as it pertains to patients with chronic kidney disease, yet the transition to end-stage kidney disease and processes inherent to the receipt of dialysis present unique safety challenges in this population. Educational efforts in medical safety need to focus on the areas of greatest threat and where intervention can provide the greatest benefit. This study addresses such safety topics in the dialysis population and identifies potential strategies that may aid in harm reduction...
January 7, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29315798/end-stage-renal-disease-treatment-options-education-what-matters-most-to-patients-and-families
#7
Jennifer St Clair Russell, L Ebony Boulware
Treatment modality education can offer many important benefits to patients and their families. Evidence suggests such education can increase use of home dialysis, reduce catheter use, decrease 90-day mortality, and increase transplantation. While these benefits are encouraging, not all patients are offered options education and when they are, it may not be presented in a way that is immediately applicable to them and their lives. Furthermore, little is known regarding specific characteristics (e.g. format such as group or individual or in-person or online, duration, teaching methods, location, content) of educational programs that are most successful...
January 7, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29314253/peritoneal-dialysis-education-challenges-and-innovation
#8
Rajnish Mehrotra
Peritoneal dialysis is the most common modality for home dialysis and to ensure patients have access to dialysis at home, training programs have to ensure that the fellows attain clinical competency in the care of such patients. The limited data available however are sobering; about 10 years ago, 44% of nephrologists reported that they did not feel competent in the care of patients undergoing peritoneal dialysis. There are recognizable challenges in ensuring clinical competency of trainees that may need creative solutions...
January 4, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29314304/role-of-telehealth-in-renal-replacement-therapy-education
#9
Anna Malkina, Delphine S Tuot
The prevalence of end-stage renal disease is rising in the United States, which bears high financial and public health burden. The most common modality of renal replacement therapy (RRT) in the United States is in-center hemodialysis. Many patients report lack of comprehensive and timely education about their treatment options, which may preclude them from participating in home-based dialysis therapies and kidney transplantation evaluation. While RRT education has traditionally been provided in-person, the rise of telehealth has afforded new opportunities to improve upon the status quo...
January 3, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29314264/a-practical-guide-for-the-care-of-patients-with-end-stage-renal-disease-near-the-end-of-life
#10
Amar D Bansal, Jane O Schell
Most patients who rely on dialysis for treatment of end-stage renal disease (ESRD) never receive a kidney transplant. Therefore, it is important for nephrology providers to feel comfortable discussing the role of dialysis near the end of life (EOL). Advance care planning (ACP) is an ongoing process of learning patient values and goals in an effort to outline preferences for current and future care. This review presents a framework for how to incorporate ACP in the care of dialysis patients throughout the kidney disease course and at the EOL...
January 3, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29314256/point-of-care-ultrasound-education-to-improve-care-of-dialysis-patients
#11
Surekha Mullangi, Stephen M Sozio, Paul Segal, Steven Menez, Carol Martire, Tariq Shafi
Point-of-care ultrasound (POCUS) is rapidly emerging as a bedside diagnostic tool that can enhance physical diagnosis and facilitate clinical decision making. Although ultrasound is widely used by nephrologists for vascular access and kidney imaging, diagnostic POCUS skills in other anatomic areas are not part of routine nephrology training. In this narrative review, we will provide an overview of selected POCUS techniques, highlight potential uses of POCUS in routine nephrology practice, and describe a new curriculum implemented at Johns Hopkins University School of Medicine to teach diagnostic POCUS skills to nephrology fellows...
January 3, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29314241/dialysis-access-procedure-training-for-the-nephrologist
#12
Sana Waheed, Laura Maursetter, Alexander Yevzlin
Historically, the placement and maintenance of dialysis access has been an integral part of nephrology training. However, in recent years, a big debate has ensued regarding whether this should be limited to trainees' understanding and counseling the patients regarding indications, alternatives, risks and possible complications of these procedures or should it actually involve more of a hands-on experience for the trainees. Some of the barriers in making these procedures a requirement across the board are the lack of standardization of procedural training across various training programs and the absence of consensus on what achieving competency in these procedures looks like...
January 3, 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29265477/there-s-no-place-like-home-35-year-patient-survival-on-home-hemodialysis
#13
Jerry Z Yu, Connie M Rhee, Antoney Ferrey, Alex Li, Anna Jin, Yongen Chang, Uttam Reddy, Wei Ling Lau, Jason Chou, Jula Inrig, Kamyar Kalantar-Zadeh
The vast majority of maintenance dialysis patients suffer from poor long-term survival rates and lower levels of health-related quality of life. However, home hemodialysis is a historically significant dialysis modality that has been associated with favorable outcomes as well as greater patient autonomy and control, yet only represents a small minority of the total dialysis performed in the United States. Some potential disadvantages of home hemodialysis include vascular access complications, infection-related hospitalizations, patient fatigue, and attrition...
December 18, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/29178510/the-pathogenesis-of-hemodialysis-vascular-access-failure-and-systemic-therapies-for-its-prevention-optimism-unfulfilled
#14
REVIEW
Andrea K Viecelli, Trevor A Mori, Prabir Roy-Chaudhury, Kevan R Polkinghorne, Carmel M Hawley, David W Johnson, Elaine M Pascoe, Ashley B Irish
In patients receiving hemodialysis, the provision of safe and effective vascular access using an arteriovenous fistula or graft is regarded as a critical priority by patients and health professionals. Vascular access failure is associated with morbidity and mortality, such that strategies to prevent these outcomes are essential. Inadequate vascular remodeling and neointimal hyperplasia resulting in stenosis and frequently thrombosis are critical to the pathogenesis of access failure. Systemic medical therapies with pleiotropic effects including antiplatelet agents, omega-3 polyunsaturated fatty acids (fish oils), statins, and inhibitors of the renin-angiotensin-aldosterone system (RAAS) may reduce vascular access failure by promoting vascular access maturation and reducing stenosis and thrombosis through antiproliferative, antiaggregatory, anti-inflammatory and vasodilatory effects...
November 26, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/29148094/acid-base-alterations-in-esrd-and-effects-of-hemodialysis
#15
REVIEW
Qi Qian
Acid-base alterations in patients with kidney failure and on hemodialysis (HD) treatment contribute to (1) intradialytic hypercapnia and hypoxia, (2) hemodynamic instability and cardiac arrhythmia, (3) systemic inflammation, and (4) a number of associated electrolyte alterations including potentiating effects of hypokalemia, hypocalcemia and, chronically, soft-tissue and vascular calcification, imparting poor prognosis and mortality. This paper discusses acid-base regulation and pathogenesis of dysregulation in patients with kidney failure...
November 16, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/29105839/hemodialysis-in-neonates-and-infants-a-systematic-review
#16
REVIEW
Rupesh Raina, Prashanth Vijayaraghavan, Gaurav Kapur, Sidharth Kumar Sethi, Vinod Krishnappa, Deepak Kumar, Timothy E Bunchman, Shari D Bolen, Deepa Chand
Hemodialysis (HD) in neonates and infants poses unique challenges due to high risks of mortality attributable to obligatory small blood flow volumes. Although HD is often necessary in neonates, its effectiveness and feasibility are poorly understood. The aim of this review is to describe in detail the few studies reporting on HD in neonates and infants (<12 months old) and then dissertate more broadly on the subject with an emphasis on recent innovations with potential to overcome traditional barriers for effective HD in this population...
November 5, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/29098724/improving-wellbeing-in-patients-undergoing-dialysis-can-meditation-help
#17
REVIEW
Paul N Bennett, Trey Ngo, Christine Kalife, Brigitte Schiller
Coping with the stress and anxiety caused by end stage kidney disease (ESKD) symptoms, treatment, restrictions, and social, financial and family stressors, consumes many afflicted with kidney disease. Meditation has been shown to decrease anxiety and stress, and improve wellbeing and quality of life of people with chronic disease. However, the clinical uptake of meditation is low in the ESKD dialysis population. This review describes what meditation and mindful meditation are and how they have been used for people with ESKD...
November 2, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/29098715/central-venous-catheters-for-chronic-hemodialysis-is-last-choice-never-the-right-choice
#18
EDITORIAL
Chance S Dumaine, Robert S Brown, Jennifer M MacRae, Matthew J Oliver, Pietro Ravani, Robert R Quinn
Since the publication of the first vascular access clinical practice guidelines in 1997, the global nephrology community has dedicated significant time and resources toward increasing the prevalence of arteriovenous fistulas and decreasing the prevalence of central venous catheters for hemodialysis. These efforts have been bolstered by observational studies showing an association between catheter use and increased patient morbidity and mortality. To date, however, no randomized comparisons of the outcomes of different forms of vascular access have been conducted...
January 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/29063671/magnesium-supplementation-a-consideration-in-dialysis-patients
#19
EDITORIAL
Mugurel Apetrii, Adrian Covic, Ziad A Massy
Even though disorders of magnesium (Mg) balance are common in dialyzed patients, this cation is often neglected. Many factors interfere with serum magnesium including diet, medications (eg, antacids or phosphate binders), and the dialysis prescription. Mg supplementation may help reduce serum phosphate concentration, PTH, and interfere with vascular calcification and bone mineralization. It could also decrease the all-cause and cardiovascular mortalities, although the results of current studies are conflicting...
January 2018: Seminars in Dialysis
https://www.readbyqxmd.com/read/28833520/introduction-to-intradialytic-hypotension-perspectives-in-contemporary-practice
#20
EDITORIAL
Steven Brunelli
No abstract text is available yet for this article.
November 2017: Seminars in Dialysis
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