Comment: Young minds
John Bradley
pp 3-3
Functional neuroimaging studies are unravelling the complexities of the human mind. They provide insights into activities in the brain that influence human behaviour, demonstrating how these processes change as we age, and how they are affected by both genes and the environment.
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The best therapy for acute kidney injury
Nigel Suren Kanagasundaram
pp 4-7
Acute kidney injury (AKI), formerly known as acute renal failure, is common, affecting around 7% of inpatients and up to 25% of critical care patients. It is also dangerous, with even mild disease affecting survival. Mortality rates increase sharply as AKI worsens, and may reach over 50% in those with multi-organ failure. Evidence also suggests that patients are not dying simply with AKI as a ‘fellow passenger’, but as a result of the condition.
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Emerging technology for home haemodialysis
Nicholas A Hoenich
pp 8-10
Home haemodialysis (HHD) was pioneered in the UK and USA during the early 1960s, and by 1971, 58.8% of patients on dialysis in the UK and 32.2% in the USA received dialysis in their home – mostly overnight, three times a week. A decline followed, arising from the advent of continuous ambulatory peritoneal dialysis (a therapy that could be undertaken at home without the need for home conversion or a prolonged training period), the emergence of satellite haemodialysis units, and pre-emptive and living donor transplantation.
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Adding value: the National Kidney Care QIPP Framework
Donal J O'Donoghue
pp 11-11
It is now over eight years since the National Service Framework for Renal Services was drawn up, and we have come a long way. Chronic kidney disease is seen as common and treatable, and acute kidney injury is on the map. Kidney care is leading the way from the 20th-century ‘cure’ paradigm to a 21st-century model of care. This is cause for celebration; the shift has expanded our focus from the kidney to the person, and to carers and families. Patients are working with healthcare teams as equal partners, reaching shared decisions – both as a local team and national community.
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Moving on – young people’s experiences of transition within renal services
Karina L Hannigan and Neil Turner
pp 12-14
As the number of children with chronic renal disease who survive to adulthood increases, it has become clear that these young people are a group with distinct needs, who present distinct challenges for health services. For young people with chronic renal disease, and especially for those undergoing renal transplant, adolescence appears to be a time of increased risk.
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What I tell my patients about skin cancer and sun protection
Carol Coley
pp 15-18
Skin cancer is the most common cancer in the UK, and its incidence has risen rapidly over the last 20 years. Everyone needs to be aware of the dangers of sun exposure and the need to practice ‘sun-safe’ behaviour. Skin cancer, particularly malignant melanoma, is not just limited to the UK; it is a recognised health problem worldwide. However, there are more skin cancer deaths in the UK than in Australia, even though Australia has more cases of the disease. Around 2,560 people died from skin cancer in 2008 in the UK, and sun exposure is the main cause of the disease.
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Peritoneal dialysis: putting patients first
Tina Robinson and Jane Parker
pp 19-21
The peritoneal dialysis unit at Russells Hall Hospital in Dudley opened in 1987. The unit opening times are Monday to Saturday, 7:30 am until 9 pm, and Sundays 9 am to 5 pm. Outside of these times, an on-call service is provided for our patients; this operates 24 hours a day, seven days a week, 365 days a year.
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Home dialysis: addressing the needs of carers
Anthea Duquemin and Grace Sweeney
pp 22-25
When dialysis patients opt to dialyse at home they regain some ownership of their time, being freed from the regime of hospital dialysis. In 2010, a qualitative study by NHS Kidney Care of nine home dialysis patients found that the two benefits patients most valued were the increased flexibility to choose their own dialysis times, and the improvement to their health brought by more frequent dialysis.
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Preventing progression of chronic kidney disease: could baking soda be the holy grail?
Graham Warwick
pp 26-29
In July 2009, a Daily Mail headline proclaimed that a ‘daily dose of baking soda could stop kidney patients needing dialysis’. This was in response to a study published in the Journal of the American Society of Nephrology demonstrating that sodium bicarbonate supplementation reduced the rate of decline in glomerular filtration rate in patients with chronic kidney disease. The study received widespread media attention and generated a great deal of patient interest in this apparently simple, effective and cheap treatment.
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Value of a clinical library service to improved practice: one renal unit’s experience
Victoria Kirk, Jon Casey, Coral Oakley, Lauren Gould, Marie Bosworth, Debbie Mirrlees and Alex V Crowe
pp 30-31
In our renal unit, it was felt that staff would benefit from more immediate access to the best evidence and information. As part of the nephrology unit’s practice development, and in keeping with Lord Darzi’s three-role vision of clinician, leader and partner, it was decided to pilot a clinical library service or ‘library surgery’ within the renal unit.
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