Administration of erythropoiesis-stimulating agents in patients undergoing haemodialysis: A time and motion study.

BACKGROUND: International guidelines recommend treatment of anaemia due to chronic kidney disease (CKD) with erythropoiesis-stimulating agents (ESAs). OBJECTIVE: To document the time required and the cost in terms of nursing time to prepare and administer ESAs to patients on facility based haemodialysis (HD) with anaemia due to CKD before and after the introduction of long-acting ESAs. DESIGN: A time and motion study was implemented at four HD units in Australia to determine the time and costs associated with preparing and administering ESAs before and after the introduction of long-acting ESAs. PARTICIPANTS: This was a prospective, observational study of workplace practices at four HD units in Australia. MEASUREMENTS: Outcome data included the time taken to prepare, and administer ESAs. RESULTS: The time costs of preparation and administration per patient per year had a wide variability within each unit and ranged from Australian AUD$55.75 (38 euros) to AUD$90.49 (62 euros) before the introduction of long-acting ESAs. This dropped by 73-80% following the introduction of long-acting ESAs, representing an annual cost savings of between AUD$2,591 and AUD$5,914 if all patients on HD were switched to a long acting ESA. CONCLUSION: Switching from a short-acting to a long-acting ESA in HD units leads to a significant reduction in time costs of health professionals in preparation and administration of ESAs by up to 80%. Practical application: This time and motion study has added further evidence on reduction of human effort by taking advantages of new research development, such as the long acting ESAs.

Change process during synchronised conversion to a once-monthly erythropoiesis-stimulating agent (ESA) administration at a single satellite haemodialysis unit.

BACKGROUND: There are currently no published data on the impact of changes to practice caused by introducing coordinated once-monthly erythropoiesis-stimulating agent (ESA) administration. OBJECTIVE: This study aimed to measure staff satisfaction during and after ESA synchronisation within a single satellite haemodialysis unit. DESIGN: A quantitative survey using a Likert scale was distributed to dialysis nurses pre-synchronisation and during follow-up at three and nine months post-synchronisation. Secondary outcomes included monitoring of haemoglobin (Hb) levels. RESULTS: A total of 19 respondents completed the surveys. By nine months post-synchronisation, most nurses responded that ESA synchronisation was not a time-consuming task, did not increase their workload, had saved them time and was simpler for the unit. Additionally, most nurses reported that they had coped well with the change and that they wanted ESA synchronisation to be permanently introduced. At 8 months post-synchronisation, 53.3% of patients had an Hb level > 11 g/dl and < 12 g/dl. CONCLUSION: Changes to practice resulting from ESA synchronisation did not appear to negatively impact nurse workplace satisfaction.

Pyrexia of unknown origin (PUO) in a hemodialysis patient.

Patients with end stage renal disease (ESRD) are predisposed to malignancy. A patient who presented with a persisting fever, episodically above 38 degrees C, of unknown origin is described. The diagnosis of the illness remained elusive, over repeated hospital admissions and comprehensive investigations for over 11 weeks, until her last admission when the patient finally represented with features of acute liver cell failure and succumbed shortly afterwards. A liver biopsy revealed high grade lymphoma, an uncommon presentation for lymphoma. While malignancy is increased in dialysis patients, lymphoma is a relatively uncommon malignancy described. This case is a rare incidence of diffuse Non-Hodgkin's Lymphoma (NHL) isolated to the liver, causing fever, liver cell failure and death in a hemodialysis patient.

Total lung preservation following mainstem-bronchial resection for carcinoid tumor.

Carcinoid tumors of the trachea and bronchi account for approximately 2% of all lung tumors. Carcinoid tumors, especially those in the bronchi, often produce obstruction that can mimic foreign body aspiration or asthma and may lead to post-obstruction atelectasis and pneumonia. Management of carcinoid tumors of the bronchi has been by endoscopic resection, sleeve lobectomy with parenchymal sparing, and pneumonectomy. We present a case in which an obstructing bronchial carcinoid tumor was successfully managed by long-segment mainstem-bronchial resection with total lung preservation by re-implantation.