A writing workshop for the CANNT Journal.

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.

Care of the hemodialysis patient with a new permanent vascular access: review of assessment and teaching.

Problems related to vascular access are the main reasons for admission to hospitals for hemodialysis patients today. Some patients develop vascular access problems prior to use and many require repeated surgery. This article addresses some of the key aspects of patient assessment and monitoring in the immediate preoperative/postoperative period. The focus is on the prevention of early vascular access failure. Approaches for patient teaching are included, as are strategies that should be part of a vascular access management program.

A comparison of two methods of measuring fatigue in patients on chronic haemodialysis: visual analogue vs Likert scale.

The study compared level of fatigue measured by two self-report instruments in 43 patients on chronic haemodialysis. The two fatigue measures were the multi-item fatigue subscale of the Profile of Mood States (POMS) and a single-item visual analogue scale (VAS). There was a significant relationship between the two measures (r = 0.80); however, the shared variance was only 64%. Males and females, as well as subjects of different ages, responded to the two scales in different ways. Nurses need to know that different tools may give different results, even when the same concept, that is fatigue, is being measured in the same subjects at the same time.

Designing dialysis prescriptions.

Our objective was to determine the adequacy of dialysis in our patients currently on home peritoneal dialysis and develop a program of surveillance aimed at maintaining tKt/V (Kt/V calculated from peritoneal clearance and residual renal function) greater than 2.0 as recommended by the CANUSA study. Eighty-nine patients were entered into our study between September, 1993 and September, 1995. Initial dialysate volumes used during the training period were determined by using a patient-specific protocol. Two weeks after discharge a standard peritoneal equilibration test was performed to determine total Kt/V using a computer program, and dialysis prescriptions were changed to achieve a tKt/V > 2.0 in those patients who had tKt/V < 2.0, and those with tKt/V > 2.0 were followed without further intervention. Of the patients who had initial assessments, 33.7% had tKt/V of 1.65 and 66.3% had tKt/V of 2.46, and the difference was mainly due to residual renal function. Forty-four patients were started on continuous ambulatory peritoneal dialysis (CAPD), of whom 34% had tKt/V < 2.0 and 66% had tKt/V > 2.0, and of the 36 patients on continuous cycling peritoneal dialysis (CCPD), 30.5% had tKt/V < 2.0 and 69.5% had tKt/V > 2.0. The cost of changing dialysis prescriptions is less with CCPD than with CAPD, and a 0.8-1.0 L increase in dialysate volume will increase peritoneal Kt/V (dKt/V) by 0.1 on average. Patients weighing less than 53 kg can achieve a dKt/V > 2.0 even in the absence of residual renal function, but as body weight increases there is greater dependence on residual renal function to achieve adequate dialysis. We have been able to maintain patients on adequate dialysis (tKt/V > 2.0) by checking peritoneal clearance and residual renal function initially and on a regular basis. Whether a tKt/V > 2.0 will be sufficient to maintain health and well-being of our patients will require a longer period of observation.

The use of community nurses for home peritoneal dialysis: is it cost-effective?

In the late 1970s, continuous ambulatory peritoneal dialysis was first introduced as a mode of treatment for patients with end-stage renal disease. Since that time many patients, themselves or with the help of family members, have routinely performed the therapy at home. There are now 2935 home peritoneal dialysis patients in Canada (36% of the total dialysis population). Today, however, the average patient on dialysis is likely to be older and have other complicating illnesses; moreover, patients may live alone, or have family members who are working. Over the past three years, through the use of innovative assistive devices and strong educational links with community nursing agencies, we have been able to manage peritoneal dialysis patients with complex needs in the home. We performed a retrospective analysis of 18 patients, with severe comorbid conditions, who were managed in the home with the help of community nurses. We will show that this is an economic, efficient, and effective method of caring for home dialysis patients with severe disabilities. Home care agencies need our support so that they can continue to help us manage the complex peritoneal dialysis patient in the 1990s.

Peritonitis in patients on peritoneal dialysis: a review of pathophysiology and treatment.

The incidence of peritonitis has decreased in peritoneal dialysis patients because of new delivery systems and connecting devices; however, peritonitis is still of major concern. Peritonitis remains the most common reason for admission to hospitals and is still a primary reason for failure of this method of dialysis. Nephrology nurses need a clear understanding of peritonitis etiology, recommended treatment regimens, side effects of treatment, and complications. This should enable nephrology nurses to provide a higher level of care, and, thus, improve patient well-being.

What do nurses know and believe about patients with pain? Results of a hospital survey.

Nurses in every area of clinical practice are confronted with the challenge of caring for patients in pain. The purpose of this study was to determine nurses' knowledge and attitudes regarding pain in the acute and long-term care settings of a large Canadian teaching hospital. This paper reports the results of a pain survey completed by 514 nurses using the Nurses' Knowledge and Attitudes Survey (Ferrell and Leek, 1990). The mean percent score was 41. Nurses with a university education scored significantly higher (P < 0.0001) than those nurses who were not university prepared. Nurses who had attended educational sessions on pain management within the last year also scored significantly higher (P < 0.0001) than those who had not attended. Results indicated that nurses lacked knowledge and understanding of basic pain management principles, opioid usage, and acute and chronic pain. These results supported the value of advanced educational preparation and continuing education sessions for nurses, and the need and direction for pain management programs at this hospital.

Calcium/phosphate imbalances, aluminum toxicity, and renal osteodystrophy.

Bone disease is one of the major long-term complications of end stage renal disease (ESRD). Loss of renal function upsets normal homeostasis of the two minerals stored in the bones, calcium, and phosphate. It affects the two hormones, vitamin D and parathyroid hormone (PTH) that help maintain healthy bones, and may result in excess aluminum being deposited in bones. Treatments of these imbalances in the past had an adverse effect on bones; present-day treatments are not without complications. New understanding of the pathogenesis of the two classifications of osteodystrophy, high turnover versus low turnover, have important implications for prevention and treatment of the disease.

The impact of home dialysis on the family: literature review.

This critique of 48 research and anecdotal reports published since 1967 summarizes current understanding about the effects on family members assisting with home dialysis. Psychological perspectives have provided descriptions of how these family assistants cope with the stresses associated with dialysis. However, important societal, gender, and economic factors affecting people with end stage renal disease (ESRD) and their families have been overlooked. More comprehensive perspectives would illuminate the range of effects home dialysis has on "the family"--especially female assistants.

The influence of physical activity on fatigue in patients with ESRD on hemodialysis.

This study examined the relative influence of anemia, nonspecific symptoms and physical activity on fatigue in 43 patients with end stage renal disease on chronic hemodialysis. We found that low levels of physical activity and frequent symptoms were related to high levels of fatigue. Degree of anemia was not related to level of fatigue. Inactivity contributed to fatigue scores more than symptoms.

An update on the pathogenesis, pathology and treatment of the anemia of chronic renal failure.

In the past, the focus of the treatment of the anemia of chronic renal failure was on improving methods of dialysis and minimizing blood loss, combined with the use of anabolic steroids, blood transfusions when necessary, and chelating agents. It is only recently that the underlying pathology for the anemia of chronic renal failure has been addressed. Now there is the potential to correct this anemia, in most cases completely, through replacement of the hormone erythropoietin by therapy with recombinant human erythropoietin.

[Urethroplasty using a free full thickness skin graft for stenosis of the bulbar or bulbo-membranous urethra]. / Urétroplastie par greffe libre de peau totale pour sténose de l'urètre bulbaire ou bulbo-membraneux.

Nineteen patients with urethral stricture involving the bulbar urethra were treated by a one-stage free full-thickness skin graft urethroplasty. Results with one year follow-up: excellent: 16--fair: 1--poor: 2. These results are slightly altered with 5 years follow-up: excellent: 12--fair: 3--poor: 3. An urethrotomy was necessary for three patients.

Appraising and monitoring a life on dialysis.

I feel that the adaptation theories proposed by Nerenz and Leventhal (1983) and by Taylor (1983), although offering insights into how chronically sick individuals may interpret and manage their illness, do not capture completely the complexities of how D.R. has successfully learned over the years to live with renal disease and dialysis. I find it interesting that Lazarus and Folkman's theory of stress, adaptation and coping, which is based more on the belief that everyone experiences stress every day and, thereby, does not single out chronically ill people as being different, has more to offer in interpreting D.R.'s own perceptions on how he monitors his health than the illness-based models of Nerenz/Leventhal and Taylor. After eight years of continuous appraisal and reappraisal, D.R. has taught himself, through his own perceptions and interactions with those close to him, how he can live successfully with renal failure. The recording of his insights has helped me appreciate more deeply what an endless challenge a life lived on dialysis is.

[A critical study of the prognosis of renal adenocarcinoma and an attempted classification. Apropos of a series of 322 cases]. / Etude critique du pronostic de l'adénocarcinome rénal et essai de classification. A propos d'une série de 322 dossiers.

The prognosis of adult renal adenocarcinoma was evaluated by analyzing 322 cases treated by extensive nephrectomy (1979-1988). Five-year actuarial survival curves showed that prognosis was closely correlated with anatomic spread: no clear prognostic significance could be ascribed to venous invasion but involvement of retroperitoneal lymph nodes proved to be nearly as negative a prognostic factor as metastatic disease. The grade of malignancy also had a major impact on prognosis. Because the TNM classification, although accurate, is difficult to use and relies solely on descriptive data, a simple five-stage classification is proposed but remains to be validated. The classification system advocated by Robson groups stages with very different outcomes and consequently seems unhelpful.

[Renal autotransplantation. An exceptional solution for salvage of the kidney following failure of surgery of bilateral megaureter]. / L'auto-transplantation rénale. Solution exceptionnelle de sauvetage du rein après éche de la chirurgie d'un méga-uretère bilatéral.

The authors report the case of a patient with primary bilateral mega-ureter presenting with recurrent pyelonephritis due to reflux occurring after 3 successive reimplantations. Transposition of the right kidney into the homolateral iliac fossa allowed correct anti-reflux with a good clinical, radiological and bacteriological result with a follow-up of 3 years. Renal auto-transplantation represents a last resort solution in certain extreme situations when other simpler procedures are impossible and when preservation of the kidney is essential (solitary kidney or bilateral lesions).

[Oncocytic tumors of the kidney. 11 cases (1978-1987)]. / Tumeurs rénales oncocytaires. Onze cas (1978-1987).

Analysis of this series of cases reveals the following points: complementary investigations (computed tomography, magnetic resonance imaging) sometimes suggest the diagnosis, the oncocytic nature is often a surprise pathological finding, it is difficult to determine whether the lesion is a pure oncocytoma and the exact grade cannot be determined on frozen section, the choice between radical surgery and conservative surgery is made even more difficult, the study of the course of the disease raises the question of whether the term of oncocytoma should not be reserved to low grade tumours.