High-dose intravenous immunoglobulin pulse therapy in patients with progressive immunoglobulin A nephropathy: a long-term follow-up

In progressive immunoglobulin A nephropathy (IgAN), intravenous immunoglobulin (IVIg) treatment has been used to delay disease progression, but the long-term efficacy is largely unknown. We report the clinical outcomes after IVIg therapy in six male patients with progressive IgAN [median glomerular filtration rate (GFR) 31 ml/min per 1.73 m(2)] followed for a median observation period of 8 years. In this single-arm, non-randomized study, IVIg was given monthly at a dose of 2 g/kg body weight for 6 months. The course of renal function was assessed by linear regression analysis of GFR and proteinuria, and was compared to eight patients with IgAN (median GFR 29 ml/min per 1.73 m(2)) without IVIg as a contemporaneous control group. IgAN disease progression was delayed after IVIg therapy on average for 3 years. The mean loss of renal function decreased from -1.05 ml/min per month to -0.15 ml/min per month (P = 0.024) and proteinuria decreased from 2.4 g/l to 1.0 g/l (P = 0.015). The primary end-point (GFR < 10 ml/min or relapse) occurred 5.2 years (median; range 0.4-8.8) after the first IVIg pulse, and after 1.3 years (median; range 0.8-2.4) in the control group (P = 0.043). In Kaplan-Meier analysis, the median renal survival time with IVIg was prolonged by 3.5 years (IVIg 4.7 years versus control 1.2 years; P = 0.006). IVIg pulse therapy may be considered as a treatment option to reduce the loss of renal function and improve proteinuria in patients with progressive IgAN

Dimensions of informal care in Greece: the family's contribution to the care of patients hospitalized in an oncology hospital

Aims and objectives. This study aims to explore the kind and frequency of care provided to hospitalized cancer patients by relatives and the reasons for providing this care. Background. Informal care is a common phenomenon across many countries. In Greece, informal caring activities occur in most hospitals. Patients' relatives stay by their bedside for long hours and assist with care. This phenomenon is highly correlated with the nursing staff shortage. Method. This study was carried out in a Greek oncology hospital. The sample consisted of 150 informal caregivers. We used a 37-item questionnaire called In-Hospital Informal Care Questionnaire Acute Care. Results. The participants provide substantial help to their patients daily. On average, they stay by their bedside for 20·23 hours in a 24-hour period. Additionally, 104 participants stated that they hire a privately paid patient's helper. The relatives stay by their patients' bedside for various reasons such as: (1) severity of the condition; (2) providing psychological support; (3) family tradition; (4) because they do not believe their patients are safe in the hospital without their supervision; or (5) the nursing staff shortage. Conclusions. The participants offer informal care that reflects specific nursing duties. We could argue that Greek hospitals 'use' relatives as unpaid labour to compensate for the nursing shortage. It is disquieting that usually someone from the hospital staff suggests to the relatives to stay at the patient's bedside even after visiting hours or to hire a private paid patient's helper. This implies that the staff considers such contribution necessary. Relevance to clinical practice. The findings show that relatives perform daily tasks that nurses should be performing. They indicate that the hospital should introduce specific staffing policies for reducing families' burden. Our findings could influence future staffing plans of nursing managers, policy makers or health authorities