Results of the 2012 third survey on Nephrology resident training.

The second survey for tutors and the third for residents of the Spanish Society of Nephrology and the Spanish National Commission of Nephrology in 2012 compared with those of 2004 and 2007. 64% of tutors but only 24.6% of resident physicians participated. Tutors: improvement in educational infrastructure. Improvement in teaching organisation and in resident activity reporting. Clear improvement in teaching and in resident assessment. They believe that there should be a five year training period and a compulsory examination at the end of the residency. Resident physicians: improved satisfaction with teaching received with respect to previous surveys, except with regard to renal biopsies and pathological sessions. Improvement in formal training; experience in transplantation (only poor in 7%); experience in peritoneal dialysis (still poor in 21%); level of tutoring (poor in 20%); performance and quality of clinical sessions; scientific activity; quality of training of your service: good/very good in 66% in 2012 versus 26% (2004) and 46% (2007).

Análisis del acuerdo entre la valoración que hacen los pacientes en hemodiálisis de su Calidad de Vida Relacionada con la Salud (CVRS) y la valoración que de ellos hace el personal de enfermería. Premio de Investigación en Enfermería Nefrológica Janssen-Cilag / Analysis of the agreement between the evaluation by patients undergoing haemodialysis of their Health-Related Quality of Life (HRQL) and the evaluation of these patients by nursing staff

Introducción: Los profesionales de la salud tienden a asumir que la valoración que realizan del estado de salud y de la Calidad de Vida de los pacientes a su cargo es congruente con la de los propios pacientes. Sin embargo diversos estudios indican que existen discrepancias que podrían repercutir sobre la percepción de los cuidados y la satisfacción del paciente. Objetivos: Evaluar el acuerdo entre la valoración que hacen los pacientes en hemodiálisis de su Calidad de Vida Relacionada con la Salud (CVRS) y la valoración que de ellos hace el personal de enfermería. Material y método: Todos los pacientes (N=57) fueron entrevistados por una psicóloga del servicio con el cuestionario EUROQOL, que mide las limitaciones en Movilidad, Cuidado Personal, Actividades Cotidianas, Dolor/Malestar y Ansiedad/Depresión. Cada cuestión se contesta de 1-no tiene problemas, 2-tiene problemas moderados, 3-tiene muchos problemas. En la misma semana, y desconociendo las respuestas que dieron los pacientes, las enfermeras los valoraron con ese mismo cuestionario. Resultados: El acuerdo absoluto osciló desde el 56% en Dolor/Malestar y el 60% en Ansiedad/ Depresión hasta el 68% en Movilidad y Actividades Cotidianas y 74% en Cuidado Personal. Se encontró que la menor comorbilidad, el menor número de fármacos diarios, y unas mayores puntuaciones en las Escalas de Karnofsky y de Barthel se asocian al acuerdo paciente-enfermera de un modo estadísticamente signifi cativo. Conclusiones. Las enfermeras parecen coincidir mejor con la valoración que hace el paciente de su propia CVRS cuando se evalúan aspectos más observables, y cuando los pacientes presentan estados de salud más favorables (AU)

Introduction. Healthcare professionals tend to assume that their evaluation of their patients’ state of health and Quality of Life is consistent with the evaluation done by the patients themselves. However, several studies show that there are discrepancies that could affect the perception of patient care and satisfaction. Objectives. To assess the agreement between the evaluation by patients on haemodialysis of their Health- Related Quality of Life (HRQL) and the evaluation of these patients by nursing staff. Material and method. All the patients (N=57) were interviewed by a psychologist of the service using the EUROQOL questionnaire, which measures limitations in Mobility, Personal Care, Daily Activities, Pain/Discomfort and Anxiety/ Depression. Every question is answered by marking 1-no problems, 2-moderate problems, 3-many problems. In the same week, unaware of the responses given by the patients, the nurses evaluated them with the same questionnaire. Results. Absolute agreement oscillated from 56% in Pain/Discomfort and 60% in Anxiety/Depression up to 68% in Mobility and Activities of Daily Living and 74% in Personal Care. It was found that lower comorbility, fewer daily medicines, and higher scores in the Karnofsky and Barthel scales are associated to patient-nurse agreement in a statistically signifi cant way. Conclusions. Nurses seem to match patients’ evaluation of their own HRQL more closely when more observable aspects are evaluated, and when the patients present more favourable states of health (AU)

Cell-free DNA as a noninvasive acute rejection marker in renal transplantation.

BACKGROUND: Acute rejection (AR) is a key conditioning factor for long-term graft function and survival in renal transplantation patients. The standard care with creatinine measurements and biopsy upon allograft dysfunction implies that AR is usually detected at advanced stages. Rapid noninvasive biomarkers of rejection are needed to improve the management of these patients. We assessed whether total cell-free DNA (tCF-DNA) and donor-derived cell-free DNA (ddCF-DNA) were useful markers for this purpose, both in plasma and in urine. METHODS: Plasma and urine samples from 100 renal transplant recipients were obtained during the first 3 months after transplantation. tCF-DNA and ddCF-DNA were analyzed by quantitative PCR for the HBB (hemoglobin, beta) and the TSPY1 (testis specific protein, Y-linked 1) genes, respectively. We observed 19 episodes of AR, as well as other complications, such as acute tubular necrosis, nephrotoxicity, and infections. RESULTS: Plasma tCF-DNA concentrations increased markedly during AR episodes, often before clinical diagnosis, and returned to reference values after antirejection treatment. A cutoff plasma tCF-DNA concentration of 12 000 genome equivalents/mL correctly classified AR and non-AR episodes in 86% of posttransplantation complications (diagnostic sensitivity, 89%; specificity, 85%). Although similar increases were observed during severe posttransplantation infections, use of the combination of plasma tCF-DNA and procalcitonin (PCT), a specific marker of sepsis, significantly improved the diagnostic specificity (to 98%; 95% CI, 92%-100%), with 97% of the episodes being correctly classified. Use of transrenal DNA and ddCF-DNA concentrations did not add relevant information. CONCLUSIONS: Given that renal biopsy is the gold standard for detecting AR, analysis of both plasma tCF-DNA and PCT could permit a more selective use of this invasive procedure.

Variables asociadas a la satisfacción del pacienteen una unidad de hemodiálisis / Variables associated to patient satisfaction in a haemodialysis unit

Introducción. Todos los planes de calidad en el ámbito hospitalario tienen en cuenta la satisfacción del paciente como uno de los principales objetivos a conseguir. Las medidas de los resultados obtenidos de las opiniones de los pacientes permiten tomar decisiones que mejoran la calidad de los cuidados. Objetivos. Evaluar la Satisfacción de los pacientes de una Unidad de Hemodiálisis, y analizar los aspectos, tanto del paciente como de la enfermedad, que pudieran condicionarla. Material y métodos. Los pacientes fueron entrevistados con el Cuestionario SERVQHOS modificado para hemodiálisis, que evalúa la Satisfacción con veinte atributos de la Unidad y con el cuestionario de Calidad de Vida Relacionada con la Salud, EUROQOL. También se recogieron las respuestas a cuestiones que podrían condicionar la satisfacción, variables clínicas y sociodemográficas. Resultados. Completaron la entrevista 50 pacientes y los niveles de satisfacción fueron altos y similares a los de otras unidades en España. Menores niveles de satisfacción se asociaron a percibir más Dolor, más limitación para las Actividades Cotidianas, más Ansiedad/Depresión, llevar más tiempo en diálisis, más horas de sesión, dializarse por catéter, haber estado trasplantado y tener menor edad (p<0,05). Por el contrario, menor nivel de estudios, actividades laborales menos cualificadas, ir en ambulancia, haber elegido modalidad de diálisis, y considerar que su opinión es tenida en cuenta, aumentaban la satisfacción (p<0,05).Conclusiones. Identificar los factores que modulan la satisfacción es tan importante como evaluarla, además deben de tenerse en cuenta las variables inherentes del paciente, que están condicionando la satisfacción percibida (AU)

Introduction. All quality plans in hospitals take patient satisfaction into account as one of the main goals to achieve. The measurements of the results obtained from patients’ opinions allow decisions to be made that improve the quality of care. Objectives. To evaluate the satisfaction of patients of a haemodialysis unit, and analyse the aspects, both of the patient and of the disease, that could be conditioning factors. Material and methods. Patients were interviewed with the SERVQHOS questionnaire modified for haemodialysis, which evaluates satisfaction with twenty attributes of the unit and with the EUROQOL health-related quality of life questionnaire. The replies to questions that could affect satisfaction, clinical and sociodemographic variables were also noted. Results. The interview was completed by 50 patients and the levels of satisfaction were high, and similar to those of other units in Spain. Lower levels of satisfaction were associated with feeling more pain, more limitations for daily activities, more anxiety/depression, having been on dialysis longer, longer sessions, receiving dialysis using a catheter, having had a transplant and being younger(p<0.05). On the other hand, a lower level of qualifications, less qualified work, travelling by ambulance, having chosen the form of dialysis and considering that their opinion is taken into accounts increased satisfaction (p<0.05). Conclusions. Identifying the factors that modulate satisfaction is as important as evaluating it. The inherent variable of the patient must also be taken into consideration, as they condition the perceived satisfaction (AU)

Análisis de la ciclosporina en sangre mediante la concentración a las 2 h de administrar la dosis / Blood cyclosporine analysis through the concentration 2 h after dosis administration

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