Journal of nephrology
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Journal of nephrology · Sep 2011
What causes an improved safety climate among the staff of a dialysis unit? Report of an evaluation in a large network.
Clinical staff's safety perception is considered an important indicator of the implementation level of safety climate and safety culture. For this purpose, the Safety Climate Survey Questionnaire was submitted to the dialysis clinics staff of the Fresenius Medical Care (FME) network in Italy. Moreover, to explore how standard procedures implementation influences staff opinion of safety levels, the Universal Hygiene Precautions Questionnaire was also submitted. ⋯ A relatively high value for Safety Climate was evaluated within the FME network of Italian dialysis clinics. Management showed higher Safety Climate scores than frontline staff. Fostering communication and implementation of training programs are considered valid tools to improve safety.
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From Hippocratic medicine through the modern theory of Melzack and Wall, the concept and physiopathology of pain has been developed over the course of time, assuming in some instances a religious or philosophical view and in others a more scientific meaning. People have developed very different words to express pain. The Arabic language has hundreds of words to express pain, while European languages are more limited. ⋯ The Cartesian model gave rise to the notion of a "hard-wired system." European physicians did their best to relieve their patients' pain, often through the judicious use of opium and, after 1680, laudanum, the mixture of opium in sherry introduced by Thomas Sydenham. In 1803, Sertürner discovered a substance from isolated crystals of a powerful analgesic agent, derived from crude opium, that he named morphine, after Morpheus, the Greek god of dreams. The introduction of surgical anesthesia represented one of the most important advances of modern medicine, although initially it was not accepted by the medical community, for ethical reasons.
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Journal of nephrology · Sep 2010
ReviewBack to the future: extended dialysis for treatment of acute kidney injury in the intensive care unit.
On September 11, 1945, Maria Schafstaat was the first patient who successfully underwent a dialysis treatment for acute kidney injury (AKI). The ingenious design of the first dialysis machine, made of cellophane tubing wrapped around a cylinder that rotated in a bath of fluid, together with the brave determination to treat patients with AKI, enabled the Dutch physician W. J. ⋯ Furthermore, we report on logistic and economic advantages of this method. We share our view on how extended dialysis offers ample opportunity for a collaborative interaction between nephrologists and intensivists as the nephrology staff, enabling optimal treatment of complex critically ill patients by using the skill and knowledge of 2 indispensable specialties in the ICU. Lastly, we address the problem of ED intensity, which does not seem to have an impact on survival at higher doses, a finding that might be caused by the fact that we still adhere to dosing guidelines for antibiotics which are at best ineffectual but might also lead to potentially dangerous underdosing of these life-saving drugs.
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Journal of nephrology · Mar 2010
Randomized Controlled Trial Comparative StudySodium bicarbonate in preventing contrast nephropathy in patients at risk for volume overload: a randomized controlled trial.
Sodium bicarbonate has been recently proposed as a prophylactic measure for the prevention of contrast-induced nephropathy (CIN). We aimed to compare the efficacy of the combination of sodium bicarbonate with half saline, and half saline alone in preventing CIN in patients having uncontrolled hypertension, compensated severe heart failure or a history of pulmonary edema. ⋯ The combination therapy of sodium bicarbonate plus half saline does not offer additional benefits over hydration with half saline alone in the prevention of CIN.
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Journal of nephrology · Mar 2010
ReviewEvaluation of glomerular filtration rate and of albuminuria/proteinuria.
Kidney function should be evaluated by procedures including the calculation of glomerular filtration rate (GFR) estimates and the assessment of albuminuria or proteinuria as creatinine-normalized urinary ratios for albumin or total protein. GFR estimates are an approximation of true GFR, which circumvent the limitations of serum creatinine and creatinine clearance without increasing costs and time of diagnostic work-up. Estimates by Cockcroft-Gault equation tend to be higher than true GFR and estimates by other equations, because this equation predicts creatinine clearance, hence true GFR plus creatinine excretion via tubular secretion. ⋯ The urinary ratio of albumin (or total protein) to creatinine is measurable in untimed spot urine and reflects the urinary excretion rate of albumin (or total protein). Low muscle mass could imply borderline elevation in the ratio merely because of low urinary creatinine. Vice versa, high muscle mass could imply normal ratios even in the presence of high urinary albumin, because of high urinary creatinine due to high creatinine generation.