43 research outputs found

    Exploring the Experiences and Expectations of Trainee Representatives in Medical Specialities:A Qualitative Study in the West Midlands, UK

    Get PDF
    Introduction: Despite its importance, there is a paucity of evidence describing the role and responsibilities of trainee representatives.Aim: This study explored key stakeholders' experiences and expectations of the trainee representative role.Method: All eligible individuals in the West Midlands Deanery's School of Medicine were invited to participate in an interview exploring their experiences and expectations of the trainee representative role. Recurring themes were identified through thematic analysis using NVivo12 software.Results: Five themes—Support for trainee representatives, Deanery events for trainee representatives, Roles and responsibilities of trainee representatives, Representation and recruitment, and Benefits of being a trainee representative—were identified. Formalising appointments to such roles and providing induction and information on key responsibilities were highlighted as steps to minimise the gap.Conclusion: Trainee representative positions allow trainees to explore leadership roles; however, further work is needed to improve the resources to support the professional development of trainee representatives

    The prevalence of mild to moderate distress in patients with end stage renal disease:results from a patient survey using the emotion thermometers in four hospital Trusts in the West Midlands, UK

    Get PDF
    Objectives To assess the prevalence of mild-To-moderate distress in patients with end-stage renal disease (ESRD) and determine the association between distress and patient characteristics. Design Cross-sectional survey using emotion thermometer and distress thermometer problem list. Setting Renal units in four hospital Trusts in the West Midlands, UK. Participants Adult patients with stage 5 chronic kidney disease who were: (1) On prerenal replacement therapy. (2) On dialysis for less than 2 years. (3) On dialysis for 2 years or more (4) With a functioning transplant. Outcomes The prevalence of mild-To-moderate distress, and the incidence of distress thermometer problems and patient support needs. Results In total, 1040/3730 surveys were returned (27.9%). A third of survey respondents met the criteria for mild-To-moderate distress (n=346; 33.3%). Prevalence was highest in patients on dialysis for 2 years or more (n=109/300; 36.3%) and lowest in transplant patients (n=118/404; 29.2%). Prevalence was significantly higher in younger versus older patients (χ 2 =14.33; p=0.0008), in women versus men (χ 2 =6.63; p=0.01) and in black and minority ethnic patients versus patients of white ethnicity (χ 2 =10.36; p=0.013). Over 40% of patients (n=141) reported needing support. More than 95% of patients reported physical problems and 91.9% reported at least one emotional problem. Conclusions Mild-To-moderate distress is common in patients with ESRD, and there may be substantial unmet support needs. Regular screening could help identify patients whose distress may otherwise remain undetected. Further research into differences in distress prevalence over time and at specific transitional points across the renal disease pathway is needed, as is work to determine how best to support patients requiring help.</p

    Do we practice what we preach? Dialysis modality choice among healthcare workers in the United Kingdom

    Get PDF
    Background: In the United Kingdom, over 80% of end‐stage kidney disease patients receive in‐center hemodialysis. We conducted a survey of UK renal healthcare workers on their preferred dialysis modality if they needed dialysis themselves. Methods: An anonymized online survey was disseminated to all renal healthcare workers in the United Kingdom. We asked “Assume you are an otherwise well 40‐year‐old (and, separately, 75‐year‐old) person approaching end stage kidney disease, you have no living kidney donor options at present. There are no contraindications to any dialysis options. Which dialysis therapy would you choose?” We also asked about factors influencing their choice. Results: 858 individuals with a median age of 44.3 years responded. 70.2% were female, 37.4% doctors, and 31.1% were senior nurses. There was a preference for peritoneal dialysis over in‐center hemodialysis (50.47% v. 6.18%; p < 0.001 for 40‐year‐old and 49.18% v. 17.83%; p < 0.001 for 75‐year‐old assumption) and home hemodialysis (50.47% v. 39.28%; p < 0.001 for 40‐year‐old and 49.18% v. 18.41% for 75‐year‐old assumption). There was a preference for home hemodialysis over in‐center hemodialysis for 40‐year‐old (39.28% v. 6.18%; p < 0.001) but not for 75‐year‐old. On logistic regression, senior doctors were more likely to opt for PD when compared to nurses. Nurses, allied healthcare professionals, and those of Asian/British Asian ethnicity were more likely to choose in‐center hemodialysis. Conclusions: Most healthcare workers in renal medicine would choose home‐based treatment for themselves although the majority of end‐stage kidney disease patients receive in‐center hemodialysis in the United Kingdom; the reasons for the discrepancy need to be explored

    Survival rate in acute kidney injury superimposed COVID-19 patients: a systematic review and meta-analysis

    Get PDF
    Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155406/1/Yessayan_Survival_Rate.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155406/4/COVID YESSAYAN DeepBluepermissions_agreement-CCBYandCCBY-NC_ORCID.docxDescription of Yessayan_Survival_Rate.pdf : ArticleDescription of COVID YESSAYAN DeepBluepermissions_agreement-CCBYandCCBY-NC_ORCID.docx : Deep Blue Sharing Agreemen

    Focal Segmental Glomerulosclerosis Complicating Therapy With Inotersen, an Antisense Oligonucleotide Inhibitor: A Case Report

    Get PDF
    Inotersen is an antisense oligonucleotide inhibitor licensed for the treatment of polyneuropathy complicating hereditary transthyretin amyloidosis (ATTRv). Nephrotoxicity has been reported with inotersen, including progression to end stage renal disease. We describe the first reported case of inotersen-associated nephrotic syndrome secondary to focal segmental glomerulosclerosis (FSGS) and review the literature concerning inotersen-induced nephrotoxicity. We report a woman in her early 30s with ATTRv associated with the (p.V50M) transthyretin (TTR) variant, who presented with nephrotic syndrome 7 months after commencement of inotersen. Renal histology demonstrated focal segmental glomerulosclerosis and scanty glomerular amyloid deposition. Discontinuation of inotersen alone resulted in complete clinical and biochemical resolution of nephrotic syndrome. Inotersen is associated with significant nephrotoxicity. In the phase III NEURO-TTR clinical trial, 3% of patients in the treatment arm developed a crescentic glomerulonephritis. All affected patients carried the (p.V50M) TTR variant which is known to be associated with renal amyloid deposition. This case adds to spectrum of renal disease associated with inotersen and indicates that discontinuation of the drug alone may result in resolution of renal complications without additional immunosuppression. Monitoring of renal function is essential in patients with ATTRv receiving inotersen, particularly if there is evidence of existing renal amyloid

    Evaluation of the effect of Cooled HaEmodialysis on Cognitive function in patients suffering with end-stage KidnEy Disease (E-CHECKED): feasibility randomised control trial protocol

    Get PDF
    BACKGROUND: Cognitive impairment is common in haemodialysis (HD) patients and is associated independently with depression and mortality. This association is poorly understood, and no intervention is proven to slow cognitive decline. There is evidence that cooler dialysis fluid (dialysate) may slow white matter changes in the brain, but no study has investigated the effect of cooler dialysate on cognition. This study addresses whether cooler dialysate can prevent the decline in cognition and improve quality of life (QOL) in HD patients. METHODS: This is a multi-site prospective randomised, double-blinded feasibility trial. SETTING: Four HD units in the UK. PARTICIPANTS AND INTERVENTIONS: Ninety HD patients randomised (1:1) to standard care (dialysate temperature 36.5 °C) or intervention (dialysate temperature 35 °C) for 12 months. PRIMARY OUTCOME MEASURE: Change in cognition using the Montreal Cognitive Assessment (MoCA). SECONDARY OUTCOME MEASURES: Recruitment and attrition rates, reasons for non-recruitment, frequency of intradialytic hypotension, depressive symptom scores, patient and carers burden, a detailed computerised cognitive test and QOL assessments. ANALYSIS: mixed method approach, utilising measurement of cognition, questionnaires, physiological measurements and semi-structured interviews. DISCUSSION: The results of this feasibility trial will inform the design of a future adequately powered substantive trial investigating the effect of dialysate cooling on prevention and/or slowing in cognitive decline in patients undergoing haemodialysis using a computerised battery of neuro-cognitive tests. The main hypothesis that would be tested in this future trial is that patients treated with regular conventional haemodialysis will have a lesser decline in cognitive function and a better quality of life over 1 year by using cooler dialysis fluid at 35 °C, versus a standard dialysis fluid temperature of 36.5 °C. This also should reflect in improvements in their abilities for activities of daily living and therefore reduce carers' burden. If successful, the treatment could be universally applied at no extra cost. TRIAL REGISTRATION: ClinicalTrials.gov NCT03645733 . Registered retrospectively on 24 August 2018

    The acute kidney outreach to prevent deterioration and death – a large pilot study for a cluster randomised trial

    Get PDF
    Background and objectives: The Acute Kidney Outreach to Reduce Deterioration and Death (AKORDD) trial was a large pilot study for a cluster randomised trial of AKI Outreach. Design, Setting, Participants, and Measurements: An observational Control (Before) phase was conducted in two teaching hospitals (9 miles apart) and their respective catchment areas. In the Intervention (After) phase, a working hours AKI outreach service operated for the intervention hospital/area for 20 weeks, with the other site acting as a control. All AKI alerts in both hospital and community patients were screened for inclusion. Major exclusion criteria were patients who were end of life, or unlikely to benefit from Outreach, or lacking mental capacity, or already referred to the Renal team. The intervention arm included a model of escalation of renal care to AKI patients, depending on AKI stage. The 30-day primary outcome was a combination of death, or deterioration, as shown by any need for dialysis or progression in AKI stage. 1762 adult patients were recruited; 744 at the Intervention site during the After phase. Results: A median of 3.0 non-medication recommendations and 0.5 medication related recommendations per patient were made by the Outreach team, a median of 15.7 hours after the AKI alert. Relatively low rates of the primary outcomes of death within 30 days (11-15%), or requirement for dialysis (0.4 – 3.7%) were seen across all four groups. In an exploratory analysis, at the Intervention hospital during the After phase the was an odds ratio for the combined primary outcome of 0.73 (95% CI 0.42, 1.26, p = 0.26). Conclusions: An AKI outreach service can provide standardised specialist care to those with AKI across a healthcare economy. Trials assessing AKI outreach may benefit from focusing on those patients with "mid-range" prognosis, where nephrological intervention could have the most impact

    Peritoneal dialysis patients - the forgotten group in the coronavirus pandemic.

    No full text
    While all patients with chronic disease have undoubtedly been affected by the ongoing SARS-CoV-2 (COVID-19) pandemic, individuals with end-stage renal failure have suffered significant excess morbidity and mortality. Patients on haemodialysis have received extensive research and media attention into their vulnerability to the disease; however, those receiving peritoneal dialysis (PD) have been much less visible. We surveyed a selection of patients from a cohort receiving PD at a tertiary renal unit in Birmingham, UK. We devised a questionnaire looking at patients' experience of shielding, accessing both dialysis and general medical care during the pandemic, and their thoughts about the pandemic and the future. Concerning findings were apparent from this. Attending hospital was the most commonly cited reason for being unable to shield, and multiple patients experienced difficulties accessing care while unwell during this period. Worryingly, 58% of respondents indicated that they feel negatively, or feel ambivalent, about the future. Patients receiving PD have suffered significantly during the COVID-19 pandemic and face ongoing difficulties and risks while accessing medical care. It is vital that this cohort is not forgotten in the planning of renal services during the pandemic, and that special attention is paid to both their physical and mental health

    End-of-life decision making: withdrawing from dialysis: a 12-year retrospective single centre experience from the UK.

    No full text
    AIM Withdrawal from dialysis is a common mode of death in patients undergoing dialysis. Anecdotally most patients have a physician-directed dialysis withdrawal (DW) following an acute medical precipitant, rather than a patient-narrated planned withdrawal as part of a collaborative end-of-life care plan. We report a 12-year retrospective experience of patients undergoing dialysis who died following DW, and suggest clinical parameters which can be used to identify patients who are able to direct their end-of-life care process. METHODS Retrospective 12-year review of inhouse electronic and paper records. RESULTS 867 patients undergoing dialysis died during the study period. 93 patients died from DW. 9 (10%) patients electively withdrew in the absence of an acute medical precipitant and 84(90%) withdrew from dialysis for medical reasons. Patients who chose to withdraw were 10 years younger at dialysis initiation and withdrawal, had greater reported sessional difficulties/intolerances (p<0.05), greater general deterioration in terms of comorbidity and physical dependency during the course of dialysis (p<0.05), were more likely to rehabilitate following an acute medical precipitant, and were more likely to reside in their own home on DW (p<0.05). All had decision-making capacity compared with 35(42%) patients who had dialysis withdrawn for medical reasons (p<0.05). CONCLUSIONS Comorbidity, physical dependence, dialysis tolerance, cognitive decline, rehabilitation post an acute medical precipitant and, place of residence are parameters which differentiate between patients who choose to withdraw from dialysis and those who have dialysis withdrawn for medical reasons. These parameters can be used to identify terminal patients on dialysis who are able to be directive in their end-of-life advanced care planning

    Meralgia paraesthetica: an unusual complication in peritoneal dialysis.

    Get PDF
    A 53-year-old woman with a history of end-stage renal disease on peritoneal dialysis (PD) presented with a 3-month history of intermittent numbness and paraesthesia over the anterior aspect of the right thigh. The patient noticed the pain was worse on walking and related to dialysis sessions. An examination revealed no neurovascular abnormalities or abdominal masses. However, there was subjective paraesthesia in the distribution of the right lateral cutaneous nerve. Subsequent nerve conduction studies revealed the cause of the patient's symptoms. She was diagnosed with meralgia paraesthetica. Her symptoms resolved when the dialysis regime was modified
    corecore