EDTNA/ERCA journal (English ed.)
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There is growing interest in extracorporeal blood purification therapies (EBPT) as adjuvants in the complex therapy of sepsis and multiple organ dysfunction syndrome (MODS). Nowadays the only routinely used purification technique is 'renal replacement therapy' (RRT) during acute renal failure (ARF), one of the almost inevitable and deadly components of MODS. RRT has been the first and still is the most utilised and effective type of EBPT. ⋯ In detail, the following issues have been currently addressed: effects on blood purification provided by different therapies, adequacy of prescription and delivery of therapy, toxins and solutes to be removed with these techniques. Based on these speculations we will briefly review the current understanding of these issues and the rationale for application of RRT in the intensive care unit (ICU). In particular, we will focus on the importance of increased ultrafiltration volume and its impact on mortality in the general ICU population and in septic patients.
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Organ donation and transplantation, although widely accepted as a successful medical procedure, is one of the new concepts in nursing. Organ donation does not occur as often as needed and the reasons for acceptance or refusal are not clear. To meet this demand more organs and tissues need to be recovered from potential donors. Nurses working on transplantation units are given in-service training and gain knowledge through experience. Nurses are in a position to inform, and to ask families to donate organs, and also to inform potential donors on their ward to the units. ⋯ The only significant predictors of their acceptance and willingness were education (chi2 = 6.45, p < 0.05), and to have adequate knowledge (chi2 = 21.90, p < 0.001). Nurses were found in need of education about all aspects of brain death and organ donation including how and when to approach families to inform and ask for organs, and how to support families throughout the process. A brochure should be prepared in detail to guide them on this task. More research should be done to clarify the reasons for refusal of organ donation.
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The treatment schedule of the haemodialysis patient has many restrictions and the long-term haemodialysis patient's response to illness is characterised by various emotional reactions. Compliance with their medical regimens remains a significant problem which influences the progress of health and by extension quality of life. The preconceived idea that a patient's response to illness may influence his adherence to medical regimen led to this study. The main variables examined were the relationship between the patient's response to illness and compliance and the relationship between compliance and age, education and the length of time on haemodialysis.
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Haemodialysis in acute renal failure differs from chronic uraemia. We describe our clinical experience comparing tolerance to dialysis and dialysis efficacy of bicarbonate haemodialysis in comparison to haemofiltration. ⋯ Clinical outcome was the same in both groups, in particular the overall survival was satisfactory at about 70%. These results are likely to reflect close control of these patients by nursing staff committed to haemodialysis in acute renal failure.
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The majority of doctors and nurses clearly recognise their responsibility to provide palliative care to the dying patient, and also the need for effective communication, counselling and support for this group of patients. This paper explores some of the issues preventing patient and significant others from being referred to the counselling service at this stage, and demonstrates that the nursing staff feel both inadequate and ill prepared to deliver quality care to the dying patient and use avoidance as a coping mechanism.