Comment: Climate and health: a weather warning
John Bradley
pp 91-91
The NHS is entering winter under pressure from increased demand and worsening finances. Emergency admissions from A&E departments, which usually peak in winter, continue to increase. In September 2016 there were 476,000 emergency admissions from A&E departments, 2.6% higher than the same month in 2015. Of more concern is the delay in discharging patients; 134,300 days of acute care in the NHS were lost because of delays in the transfer of care in September 2016. This is the highest number since monthly figures were first captured in 2010, and an increase of nearly 40% from September 2015, when there sector. The majority of delays were due to patients awaiting further non-acute NHS care or social care packages in their homes.
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The value of advanced nurse practitioners in nephrology
Andrew Stott
pp 92-94
The nursing profession is dynamic and constantly changing to accommodate an ever-changing NHS. Advanced-level practice encompasses aspects of education, research and management, but is also firmly grounded in direct care provision and clinical work with patients, families and populations. Nurses who are working and practising at an advanced level are at the forefront of their area of practice and expertise. Such nurses have a track record of innovative practice and service development; for example, by taking a lead in designing and delivering new care pathways and services, or in the development and implementation of policy, standards, guidelines and protocols. The expectation for nurses working at an advanced level is extensive clinical practice experience and completion of a master’s degree.
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Dual paraneoplastic syndromes in metastatic small cell lung carcinoma
Igor Sunjic, Antony Nguyen, Jacques Durr and Claude Bassil
pp 95-97
Tumours have the ability to secrete a variety of substances, which in turn cause several systemic presentations, collectively known as paraneoplastic syndromes. Paraneoplastic syndromes may affect a number of organ systems, including the kidneys. In this case report we describe a rare occurrence of dual paraneoplastic syndromes resulting from small cell lung carcinoma.
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Autosomal dominant polycystic kidney disease: discussing treatment options with your patients
Elizabeth Houghton, Peter Hill and Sadaf Arshad
pp 100-103
Autosomal dominant polycystic kidney disease is a genetic condition that causes gradual loss of function of the kidneys, eventually resulting in renal failure. Receiving this diagnosis can leave patients worried about the potential impact on their own and their family’s life. Having a care team who can help them navigate their treatment options and choices can be invaluable. In this article, we share how we explain to our patients the treatment options and lifestyle modifications available to manage this condition and its associated complications, in order to maintain their quality of life and preserve kidney function for as long as possible.
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Fellows Day in Cambridge draws the crowds
Kidney Research UK
pp 104-104
The Kidney Research UK Fellows Day conference took place at Murray Edwards College at the University of Cambridge in September. The annual conference brought together researchers funded by the charity, who shared their work with their peers, patients, industry and charity staff.
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Partnerships to improve the detection and management of kidney disease globally
Alison Craik, Ulla Hemmila, Mwayi Mtekateka, Zuze Kawale, Olive Kalata, Lusungu Manda, Veronica Kamwenda, Gavin Dreyer and Rhys D R Evans
pp 107-111
In 2011, a partnership was established between Barts Health NHS Trust and the Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi, by a Barts nephrology trainee (Gavin Dreyer) who subsequently spent 3.5 years developing the renal service at QECH. This partnership has been formalised and supported by both institutions, as well as the International Society of Nephrology Sister Renal Centres Program. The ultimate aim of the partnership is that renal services at QECH are delivered by Malawian medical, nursing and associated clinical staff. To date, we have conducted ten bidirectional training visits, delivered Malawi’s first ever acute kidney injury continuing medical education event, and expanded our training and research portfolio to ensure that our partners in Malawi have the relevant skill set to provide a high-quality, independent service for patients with all degrees of kidney disease. Our structure is similar to many other partnerships for kidney disease globally, and represents a reproducible platform that could foster new teaching and training partnerships between high- and low-income settings and, thus, improve the quality of healthcare and outcomes for patients with kidney disease in low- and middle-income countries.
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Scale and pace
Donal J O’Donoghue
pp 112-113
Hands up those who would like to work in a renal service where transplantation before the need for dialysis was the norm, where time and space for patients to consider their options was available and their choices supported, and where harmful variation was a historical curiosity rather than a current quality concern? The word utopia was coined by Sir Thomas More as the title of the witty tale he wrote in 1516 while in Antwerp on a royal trade mission. The book described a distant and seemingly perfect island called Utopia; by co- incidence it had 54 cities, which is also the number of renal services in England. Thankfully, the reliable provision of high-quality, evidence-based care doesn’t require such perfection, but it does require a dedicated workforce, skilled in quality improve- ment and working within a collaborative healthcare system, where leadership is recognised across the multiprofessional team and with clear, measurable, ambition. The regional quality improvement programme led by Dr Graham Lipkin, Clinical Vice President of the Renal Association, isn’t planned for Utopia, its planned for the UK. The programme is coming next year to a town near you, with local data and resources for your unit to make changes at scale and pace, in order to help you deliver on the above ambitions.
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The Kidney Quality Improvement Partnership
The Renal Association
pp 114-114
The renal community, through the Renal Association, has a proud history of innovative developments in renal service delivery, including the UK Renal Registry (UKRR), PatientView and National Institute for Health and Care Excellence-approved clinical practice guidelines. We have worked together with patients to define our joint ambitions for future care, documented in Kidney Health: Delivering Excellence. Despite the dedication of the renal community, major unwarranted variation in key outcomes of care persists in the UKRR and NHS Blood and Transplant annual reports. The Kidney Quality Improvement Partnership is the vehicle by which we will deliver the next innovations, focusing on embedding quality improvement in the day-to-day working of renal units and their partners, including industry.
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Seasonal variability of arteriovenous fistula thrombosis
Andrew J Jackson, Emma L Aitken, Peter Thomson and David B Kingsmore
pp 115-118
Arteriovenous fistula thrombosis incurs significant morbidity to haemodialysis patients. It is one of the leading causes of hospitalisation, requiring surgical or endovascular intervention to maintain vascular access. In some cases the fistula cannot be preserved after an episode of thrombosis, frequently leading to a period of dialysis through a tunnelled central venous catheter (with the concordant increase in risk of infective episodes), while alternative autologous access is created.
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