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Nephrology Education

Pierre Antoine Brown, Swapnil Hiremath, Edward G Clark, Edmund S H Kwok, Christopher McCudden, Ayub Akbari
BACKGROUND: Morbidity and Mortality Conferences (M&MCs) have for generations been part of the education of physicians, yet their effectiveness remains questionable. The Ottawa M&M Model (OM3) was developed to provide a structured approach to M&MCs in order to maximize the quality improvement impact of such rounds. STUDY DESIGN: We conducted a retrospective assessment of the impact of implementing nephrology-specific M&MCs using the OM3. SETTING AND PARTICIPANTS: All physicians, residents and fellows from the division of nephrology at a large academic medical center were invited to participate...
March 12, 2018: International Urology and Nephrology
Chadi Y Saad, Joshua Fogel, Sofia Rubinstein
OBJECTIVES: Errors in drug dosing lead to poor patient outcomes and are common in patients with chronic kidney disease (CKD). Because the majority of patients with CKD are being treated by physicians specializing in internal medicine, we studied the awareness and knowledge that internal medicine resident trainees (IMRTs) have regarding the correct dosage of commonly used analgesic and neuropsychotropic medications for patients with CKD. METHODS: We surveyed 353 IMRTs about their awareness of whether a medication needs dose adjustment in patients with CKD and knowledge for medication adjustment by level of glomerular filtration rate...
March 2018: Southern Medical Journal
Esmeralda Molina-Robles, Marta Colomer-Codinachs, Marta Roquet-Bohils, Emilia Chirveches-Pérez, Pep Ortiz-Jurado, Mireia Subirana-Casacuberta
OBJECTIVE: To describe the impact of a standard hospital educational intervention including active physical exercises on personal well-being, functional capacity and knowledge of the benefits of prescribed physical activity for patients undergoing haemodialysis. METHOD: An uncontrolled, quasi-experimental, before-and-after study with repeated measures of response variables at 4, 8 and 12 weeks after participating in an educational and physical exercise hospital intervention...
March 1, 2018: Enfermería Clínica
Varun Agrawal, Kenar D Jhaveri, Hitesh H Shah
Interest in nephrology careers continues to remain low in the USA. Educational innovations that enhance interest in nephrology among medical trainees are being actively studied. While internal medicine (IM) residency programs commonly offer the inpatient nephrology elective to the resident, outpatient nephrology experience is lacking. Understanding the provision of care in outpatient and home dialysis and management of patients with glomerular diseases, chronic kidney disease and kidney transplantation are vital components of an outpatient nephrology rotation...
August 2017: Clinical Kidney Journal
Carmine Zoccali, Francesca Mallamaci
Intention-to-treat and per-protocol analyses provide complementary information about the usefulness of therapies. While intention-to-treat analyses of trials that tested low-protein diets remain debated, per-protocol analyses of the same trials show that low protein intake actually reduces the risk of kidney failure. Per-protocol analyses are notoriously open to bias but intention-to-treat analyses are less immaculate than commonly realized because they critically depend on adherence to the treatment being tested and therefore may not be directly relevant for informing clinical decisions when different degrees of adherence to therapy occur...
February 19, 2018: Nephrology, Dialysis, Transplantation
Anne Dufey Teso, Pascale Lefuel, Sophie de Seigneux, Aline Lassere-Moutet, Pierre-Yves Martin, Alain Golay
Chronic kidney disease (CKD) usually goes unrecognized for patients until late symptomatic stages. In preterminal CKD, extrarenal substitution methods are usually presented to patients. This is felt like a breakdown, implying major modifications of everyday life. Acquisition of health literacy is necessary for patients with CKD to become autonomous and increase their empowerment toward the disease. Therapeutic education in nephrology plays a major role in improving the care of CKD patients.
February 21, 2018: Revue Médicale Suisse
Joanne Reid, Helen R Noble, Gary Adamson, Andrew Davenport, Ken Farrington, Denis Fouque, Kamyar Kalantar-Zadeh, John Mallett, C McKeaveney, S Porter, David S Seres, Joanne Shields, Adrian Slee, Miles D Witham, Alexander P Maxwell
BACKGROUND: Surveys using traditional measures of nutritional status indicate that muscle wasting is common among persons with end-stage kidney disease (ESKD). Up to 75% of adults undergoing maintenance dialysis show some evidence of muscle wasting. ESKD is associated with an increase in inflammatory cytokines and can result in cachexia, with the loss of muscle and fat stores. At present, only limited data are available on the classification of wasting experienced by persons with ESKD...
February 13, 2018: BMC Nephrology
David Y Gaitonde, David L Cook, Ian M Rivera
Chronic kidney disease affects 47 million people in the United States and is associated with significant health care costs, morbidity, and mortality. Because this disease can silently progress to advanced stages, early detection is critical for initiating timely interventions. Multiple guidelines recommend at least annual screening with serum creatinine, urine albumin/creatinine ratio, and urinalysis for patients with risk factors, particularly diabetes mellitus, hypertension, and a history of cardiovascular disease...
December 15, 2017: American Family Physician
Patricia Quintana-Bárcena, Anne Lord, Annie Lizotte, Djamal Berbiche, Lyne Lalonde
BACKGROUND: Drug-related problems (DRPs) are prevalent among chronic kidney disease (CKD) patients. However, little is known about their severity and management by community pharmacists. OBJECTIVES: To (a) describe the prevalence of DRPs by severity level in CKD patients and (b) assess the effect of a training-and-communication network program in nephrology (ProFiL) on these DRPs. METHODS: This is a secondary analysis of a cluster randomized controlled trial evaluating the effect of the ProFiL-program...
February 2018: Journal of Managed Care & Specialty Pharmacy
Radhika Devraj, Matthew E Borrego, A Mary Vilay, Junvie Pailden, Bruce Horowitz
AIM: To determine the relationship between chronic kidney disease (CKD) awareness (CKD-A), self-management behaviors (CKD-SMB) knowledge, performance of CKD-SMBs, health literacy (HL) and kidney function. METHODS: Participants were eligible patients attending an outpatient nephrology clinic. Participants were administered: Newest Vital Sign to measure HL, CKD self-management knowledge tool (CKD-SMKT) to assess knowledge, past performance of CKD-SMB, CKD-A. Estimated GFR (eGFR) was determined using the MDRD-4 equation...
January 6, 2018: World Journal of Nephrology
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
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
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
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
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
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
Pi-Chih Yang, Yu-Ying Lu
The purposes of this study were to identify the level of fatigue and to examine the predictors of fatigue in female patients on hemodialysis. The subjects for this study were 130 female patients at one hemodialysis unit in northern Taiwan. On univariate analyses, patients with higher levels of fatigue were more likely to be older, and have less education, lower serum albumin levels, sleep disturbances, and perceived higher level of hemodialysis stressors. The findings of this study can help nephrology nurses recognize fatigue as an important nursing issue for female patients on hemodialysis...
November 2017: Nephrology Nursing Journal: Journal of the American Nephrology Nurses' Association
Wim Van Biesen, Raymond Vanholder, Thomas Ernandez, Daniel Drewniak, Valerie Luyckx
With the number of migrants and refugees increasing globally, the nephrology community is increasingly confronted with issues relating to the management of end-stage kidney disease in this population, including medical, logistical, financial, and moral-ethical questions. Beginning with data for the state of affairs regarding refugees in Europe and grounded in moral reasoning theory, this Policy Forum Perspective contends that to improve care for this specific population, there is a need for: (1) clear demarcations of responsibilities across the societal (macro), local (meso), and individual (micro) levels, such that individual providers are aware of available resources and able to provide essential medical care while societies and local communities determine the general approach to dialysis care for refugees; (2) additional data and evidence to facilitate decision making based on facts rather than emotions; and (3) better information and education in a broad sense (cultural sensitivity, legal rights and obligations, and medical knowledge) to address specific needs in this population...
December 20, 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Shree G Sharma, John M Arthur, Stephen M Bonsib, Kevin D Phelan, Manisha Singh, Nithin Karakala, Kelly W Bulloch, Vandana Dua Niyyar, Juan Carlos Q Velez
BACKGROUND: Medical practice trends and limitations in trainees' duty hours have diminished the interest and exposure of nephrology fellows to percutaneous kidney biopsy (PKB). We hypothesized that an integrated nephrology-pathology-led simulation may be an effective educational tool. MATERIALS AND METHODS: A 4-hour PKB simulation workshop (KBSW), led by two ultrasonography (US)-trained nephrologists and two nephropathologists, consisted of 6 stations: 1) diagnostic kidney US with live patients, 2) kidney pathology with plasticine models of embedded torso cross-sections, 3) US-based PKB with mannequin (Blue Phantom™), 4) kidney pathology with dissected cadavers, 5) US-based PKB in lightly-embalmed cadavers, and 6) tissue retrieval adequacy examination by microscope...
December 18, 2017: Clinical Nephrology
José Ibeas, Ramon Roca-Tey, Joaquín Vallespín, Teresa Moreno, Guillermo Moñux, Anna Martí-Monrós, José Luis Del Pozo, Enrique Gruss, Manel Ramírez de Arellano, Néstor Fontseré, María Dolores Arenas, José Luis Merino, José García-Revillo, Pilar Caro, Cristina López-Espada, Antonio Giménez-Gaibar, Milagros Fernández-Lucas, Pablo Valdés, Fidel Fernández-Quesada, Natalia de la Fuente, David Hernán, Patricia Arribas, María Dolores Sánchez de la Nieta, María Teresa Martínez, Ángel Barba
Vascular access for haemodialysis is key in renal patients both due to its associated morbidity and mortality and due to its impact on quality of life. The process, from the creation and maintenance of vascular access to the treatment of its complications, represents a challenge when it comes to decision-making, due to the complexity of the existing disease and the diversity of the specialities involved. With a view to finding a common approach, the Spanish Multidisciplinary Group on Vascular Access (GEMAV), which includes experts from the five scientific societies involved (nephrology [S...
November 2017: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
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