Le Journal CANNT = CANNT journal : the journal of the Canadian Association of Nephrology Nurses and Technicians最新文献

In August 1995, the Ontario Ministry of Health (MOH) issued a request for proposal (RFP) for the establishment of new and expanded dialysis services. London Health Sciences Centre (LHSC) was successful in expanding its integrated dialysis delivery network with satellites in Stratford, Woodstock and Owen Sound. This achievement required collaboration of LHSC and host hospital staff to meet the challenging RFP requirements. With final approval received in January 1997, efforts were required to establish an operational model supporting self-care and full-care patients, to train satellite staff and patients, and to manage the resulting clinical impact. A balanced scorecard (Kaplan & Norton, 1992) evaluation model was developed. Initial outcome data indicate that full-care patients in satellites require more fallback support to London units, experience more hypotensive episodes during dialysis and, in some cases, demonstrate lower levels of dialysis adequacy and nutritional status when compared to satellite self-care patients. Findings from these data will assist in revising patient inclusion criteria and processes to optimize community-based dialysis.

Pregnancy in the dialysis patient is a rare occurrence. When pregnancy does occur, the risk of spontaneous abortion, stillbirth and neonatal complications such as prematurity and growth retardation are fairly high. This paper discusses issues surrounding pregnancy and the dialysis patient. It also follows the pregnancy of one hemodialysis patient at The Toronto Hospital. Guidelines for the care of pregnant dialysis patients are reviewed.

The objectives for the predialysis clinic were to help patients and their families cope with chronic renal failure and to provide information so that patients could choose the method of dialysis that best suited their lifestyle. The clinic was started on April 26, 1995. The patients' visits were divided into three phases. Phase one consisted of three visits to complete a biophysical, psychosocial assessment. A multidisciplinary team provided information to assist the patient and family understand renal disease as well as the options available for dialysis. The patients learned about continuous ambulatory peritoneal dialysis (CAPD), self-care hemodialysis, and in-centre hemodialysis. Criteria to start this phase one were chronic renal failure with a creatinine clearance rate of 20 ml/min. Phase one usually lasted two to three weeks.

Personal experience suggests that sleep pattern disturbance (SPD) is a serious problem for the patients we serve. The purpose of this study was to identify the scope of sleep problems among all willing patients in a medium-sized hemodialysis unit in a university teaching centre. This descriptive study examined SPD through the use of a sleep diary that subjects were asked to complete each morning for a week. Subjects were asked to describe sleep latency, sleep quantity, number of arousals, whether they awoke feeling rested, factors that interfered with sleep the night before, and sleep inducers employed the night before. They were also asked to record their dialysis schedule. Each subject's chart was reviewed with respect to medications and evidence of other medical problems that interfered with sleep. Findings were benchmarked with results from the literature. Information regarding facilitators and barriers to sleep has provided some basis for an interdisciplinary plan of care to address this distressing problem.

Writing for publication requires special skills and understanding. The aim of this workshop held by the co-editors of the CANNT Journal was to help participants identify the first steps needed to initiate the process of writing for publication. During the workshop, the attendees were invited to join small groups with a facilitator for each group. The individual groups identified what they considered to be their first five steps to writing for publication. This information from each group was shared with all the attendees. At the end of the session, helpful tools to aid potential authors were identified and thoughts on future writing workshops were discussed.

The hemodialysis unit at The Toronto Hospital routinely vaccinates its patients against hepatitis B using Engerix B Hepatitis B Vaccine (Recombinant). A new positive hepatitis B surface antigen (HBsAg) was flagged by the lab, but upon investigation it was discovered that the patient had received hepatitis vaccine two days earlier. The infectious diseases service was consulted and the case was referred to the microbiologist. Subsequent testing showed a conversion to negative antigen. We decided to test other patients who had just been vaccinated to see if we could replicate our results. Seven other patients were selected, and we found the incidence of false positive HBsAg to be 50%. The duration of the vaccine-induced positive HBsAg lasted no more than two weeks. Our results are compatible with the results found in the current literature.

In October of 1995 the dialysis program at Oshawa General Hospital initiated a survey that was sent out to all dialysis units across Canada listed in the 1995 Canadian Organ Replacement Registry. The survey was designed to gather a broad range of information on dialysis programs across the country. The overall response rate was a positive 54%. The results are broken down into general information, clinical practice, education, support services and technological issues, with further division into hemodialysis and peritoneal dialysis where appropriate. The survey revealed wide variations in practice across the country with little standardization even within individual regions.