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Blood Purif ; 49(3): 259-264, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32235119


The World Health Organization has recognized the pandemic nature of the coronavirus disease 19 (COVID-19) outbreak. A large proportion of positive patients require hospitalization, while 5-6% of them may need more aggressive therapies in intensive care. Most governments have recommended social separation and severe measures of prevention of further spreading of the epidemic. Because hemodialysis (HD) patients need to access hospital and dialysis center facilities 3 times a week, this category of patients requires special attention. In this editorial, we tried to summarize the experience of our centers that hopefully may contribute to help other centers and colleagues that are facing the coming wave of the epidemic. Special algorithms for COVID-19 spreading in the dialysis population, recommendations for isolation and preventive measures in positive HD patients, and finally directions to manage logistics and personnel are reported. These recommendations should be considered neither universal nor absolute. Instead, they require local adjustments based on geographic location, cultural and social environments, and level of available resources.

Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Unidades Hospitalares de Hemodiálise/organização & administração , Nefropatias/terapia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Diálise Renal , Agendamento de Consultas , Infecções por Coronavirus/complicações , Infecções por Coronavirus/transmissão , Humanos , Nefropatias/complicações , Pneumonia Viral/complicações , Pneumonia Viral/transmissão
BMC Health Serv Res ; 19(1): 989, 2019 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-31870358


BACKGROUND: Lower-level emotional and psychological difficulties ('distress') in patients with end stage renal disease (ESRD), can lead to reduced quality of life and poor clinical outcomes. National guidelines mandate provision of emotional and psychological support for renal patients yet little is known about the support that patients may require, or the challenges that staff experience in identifying and responding to patient distress. METHODS: Mixed methods study in renal units at four NHS Trusts in the West Midlands, UK involving cross-sectional surveys of ESRD patients and renal unit staff and semi-structured interviews with 46 purposively-sampled patients and 31 renal unit staff. Interviews explored patients' experience of distress and personal coping strategies, staff attitudes towards patient distress and perceptions of their role, responsibility and capacity. RESULTS: Patient distress was widespread (346/1040; 33.3%), and emotional problems were frequently reported. Younger patients, females, those from black and minority ethnic (BME) groups and patients recently initiating dialysis reported particular support needs. Staff recognised the value of supporting distressed patients, yet support often depended on individual staff members' skills and personal approach. Staff reported difficulties with onward referral to formal counselling and psychology services and a lack of immediate access to less formalised options. There was also a substantial training/skills gap whereby many staff reported lacking the confidence to recognise and respond to patient distress. Staff fell broadly into three groups: 'Enthusiasts' who considered identifying and responding to patient distress as integral to their role; 'Equivocators' who thought that managing distress was part of their role, but who lacked skills and confidence to do this effectively, and 'Avoiders' who did not see managing distress as part of their role and actively avoided the issue with patients. CONCLUSIONS: Embedding the value of emotional support provision into renal unit culture is the key to 'normalising' discussions about distress. Immediately accessible, informal support options should be available, and all renal staff should be offered training to proactively identify and reactively manage patient distress. Emotional support for staff is important to ensure that a greater emphasis on managing patient distress is not associated with an increased incidence of staff burnout.

Unidades Hospitalares de Hemodiálise/organização & administração , Falência Renal Crônica/psicologia , Falência Renal Crônica/terapia , Angústia Psicológica , Adaptação Psicológica , Idoso , Atitude do Pessoal de Saúde , Aconselhamento , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cultura Organizacional , Pesquisa Qualitativa , Medicina Estatal , Reino Unido
Metas enferm ; 22(10): 22-27, dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185328


Objetivo: determinar el grado de satisfacción de los usuarios del servicio de hemodiálisis tras una innovación organizacional. Método: estudio descriptivo transversal realizado en usuarios del servicio de hemodiálisis del Hospital de la Santa Creu (Tarragona). Se administró el cuestionario SERVQHOS modificado para hemodiálisis y se comparó la satisfacción reportada previa y posterior al cambio. La comparación de medias se analizó mediante la t de Student para muestras relacionadas. Resultados: de 80 usuarios que cumplían los criterios de inclusión se obtuvieron 43 encuestas válidas. El perfil mayoritario del usuario que contestó fue el de un varón (76,2%), de 71,7 años, sin estudios o con estudios primarios (85,7%), pensionista o jubilado (90,5%). Aunque en la satisfacción global la opción "muy satisfecho" disminuyó un 7,5% después del cambio, el resultado no fue estadísticamente significativo, como tampoco fueron las diferencias de los 20 ítems del cuestionario. Conclusiones: el mantenimiento de la satisfacción obtenido refuerza el aumento de eficiencia alcanzado con el cambio organizativo y confirma factores de éxito en innovación, animando en la búsqueda de estrategias para reducir costes sin comprometer buenos resultados

Objective: to determine the level of satisfaction of the users of the Hemodialysis Unit after an organizational innovation. Method: a descriptive cross-sectional study conducted in users of the Hemodialysis Unit of the Hospital de la Santa Creu (Tarragona). The SERVQHOS questionnaire modified for hemodialysis was administered, and the satisfaction previously reported was compared with the satisfaction after the change. The comparison of means was analyzed through Student's t test for paired samples. Results: out of those 80 users who met the inclusion criteria, 43 valid surveys were obtained. The predominant profile of the user who answered the survey was: male (76.2%), 71.7-year-old, no formal education or primary school completed (85.7%), pensioner or retired (90.5%). Even though in Overall Satisfaction, there was a 7.5% reduction in the "Very Satisfied" option after the change, this result and the differences in the 20 questionnaire items were not statistically significant. Conclusions: the sustained satisfaction achieved reinforces the increase in efficiency reached with the organizational change, and confirms factors of success in innovation, encouraging the search for strategies in order to reduce costs without compromising good results

Humanos , Masculino , Feminino , Idoso , Adulto , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Satisfação do Paciente , Unidades Hospitalares de Hemodiálise/organização & administração , Inovação Organizacional , Estudos Transversais , Inquéritos e Questionários , Benchmarking
Indian J Public Health ; 63(2): 157-159, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31219068


Renal replacement therapy in India is predominantly a private health-care-driven initiative making it an expensive treatment option due to high out-of-pocket expenditures. Moreover, with the rapid increase in the number of chronic kidney disease patients requiring dialysis, hemodialysis units (HDUs) are getting saturated. Community "stand-alone" dialysis centers could be an important alternative to HDUs in meeting the growing demand in an affordable model. The aim of this study was to find hemodialysis (HD) delivery in "stand-alone" dialysis units (SAUs) with respect to expanding coverage, patient costs, and patient safety safeguards. The total number of HD sessions was collected at three points. The information regarding patient safety safeguards at SAUs and impact of SAUs on patient costs were collected by interviews and from hospital records. There was 11.5 times increase in HD sessions from 2008 to 2017, out of which 75.3% was provided at SAUs. Following objective clinical and safety measures, high-quality dialysis was delivered at SAUs and it significantly reduced the mean patient cost of treatment per session.

Diálise Renal , Terapia de Substituição Renal , Feminino , Unidades Hospitalares de Hemodiálise/organização & administração , Unidades Hospitalares de Hemodiálise/estatística & dados numéricos , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Diálise Renal/métodos , Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/terapia , Terapia de Substituição Renal/métodos
Enferm. nefrol ; 21(4): 386-392, oct.-dic. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-180185


Introducción: El tratamiento con inmunoadsorción no selectiva fue introducido en nuestra unidad de hemodiálisis hospitalaria con el objetivo de permitir la desensibilización previa a un trasplante renal con incompatibilidad de grupo sanguíneo y el tratamiento del rechazo mediado por anticuerpos. Objetivo: Analizar los resultados de la técnica de inmunoadsorción no selectiva, en una unidad de hemodiálisis hospitalaria. Material y Método: Estudio retrospectivo, descriptivo, de los primeros 18 pacientes tratados en nuestro centro con inmunoadsorción no selectiva (años 2012-2017) en las indicaciones de acondicionamiento del trasplante ABOi y tratamiento del rechazo humoral. Resultados: Durante un periodo de 5 años se analizaron un total de 128 sesiones de inmunoadsorción no selectiva. El 38,9% (n=7) de los casos para desensibilización previa al trasplante renal con incompatibilidad de grupo sanguíneo y el 61,1% (n=11) restante para el tratamiento del rechazo mediado por anticuerpos. En el primer caso, realizaron una media de 8±0,6 sesiones de inmunoadsorción previas al trasplante renal y el 57,1% se complementaron 2 sesiones posteriores. El tratamiento concomitante fue el protocolizado con Rituximab e inmunoglobulinas, requiriendo el 57,1% la realización de recambios plasmáticos. En el segundo caso, realizaron una media de 5,9±2 sesiones de inmunoadsorción. El tratamiento concomitante fue el mismo y el 27,3% realizaron recambios plasmáticos. Conclusiones: El trasplante renal de donante vivo ABOi tras la desensibilización fue posible en el 100% de los pacientes. El 72,7% de los pacientes tratados para el rechazo mediado por anticuerpos mantienen actualmente la funcionalidad del injerto

Introduction: The non-selective immunoadsorption treatment was introduced in our hospital hemodialysis unit with the aim of allowing desensitization prior to a kidney transplant with blood group incompatibility and the treatment of antibody-mediated rejection. Aim: To analyze the results of the non-selective immunoadsorption technique in a hospital hemodialysis unit. Material and methods: Retrospective descriptive study of the first 18 patients treated in our center with non-selective immunoadsorption (years 2012-2017) in the indications for ABOi transplant conditioning and treatment of humoral rejection. Results: During a period of 5 years, 128 non-selective immunoadsorption sessions were analyzed. 38.9% (n= 7) of cases for desensitization prior to renal transplantation with incompatibility of blood group and 61.1% (n=11) remaining for the treatment of antibody-mediated rejection. In the first case, an average of 8±0.6 sessions of immunoadsorption prior to kidney transplantation were performed and 57.1% were complemented by 2 subsequent sessions. The concomitant treatment was protocolled with rituximab and immunoglobulins, 57.1% requiring plasma exchanges. In the second case, an average of 5.9±2 immunoadsorption sessions were carried out. The concomitant treatment was the same and 27.3% performed plasma exchanges. Conclusions: Kidney transplantation from ABOi living donor after desensitization was possible in 100% of patients. 72.7% of patients treated for antibody-mediated rejection currently maintain graft functionality

Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Técnicas de Imunoadsorção/enfermagem , Transplante de Rim/métodos , Diálise Renal/métodos , Incompatibilidade de Grupos Sanguíneos/imunologia , Dessensibilização Imunológica/enfermagem , Estudos Retrospectivos , Imunologia de Transplantes , Unidades Hospitalares de Hemodiálise/organização & administração , Rejeição de Enxerto/prevenção & controle , Rituximab/uso terapêutico , Doadores Vivos
Semin Dial ; 31(2): 177-182, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29377277


Since the inception of the Medicare End Stage Renal Disease Program in 1972, the medical director has been an important leader in the dialysis unit. The initial duties of the medical director were focused on quality and safety but were gradually expanded over the decades to include the development and oversight of protocols to manage metabolic bone disease and anemia. As the total cost of ESRD care has escalated, there have been progressive attempts to control costs through additional bundling and the creation of alternative payment schemes. While we await the financial and clinical outcomes of these initiatives, the medical director's role continues to expand in scope and now includes an enhanced role for not only clinical outcomes but financial outcomes as well.

Unidades Hospitalares de Hemodiálise/organização & administração , Falência Renal Crônica/economia , Medicare/economia , Diretores Médicos , Garantia da Qualidade dos Cuidados de Saúde , Feminino , Humanos , Falência Renal Crônica/terapia , Masculino , Estados Unidos
Semin Dial ; 31(2): 102-106, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29333620


The in-center dialysis unit and practice of dialysis, in the current multi-team approach, requires knowledge and skills in all the domains including medical expert, communicator, collaborator, scholar, health advocate, and leader. We are tasked as a community, to embrace and incentivize new innovations and technology to address these needs for our post graduate trainees. These innovations must address the basic principles of dialysis, quality improvement, technical and procedural skills as well as leadership and administration skills. The teaching methods and innovations must also be challenged to demonstrate the translation into adoption and improvements in practice to demonstrate success. This article will review the current state of the training curriculum in Nephrology for in-center hemodialysis and address some of the recent innovations.

Competência Clínica , Bolsas de Estudo/métodos , Unidades Hospitalares de Hemodiálise/organização & administração , Nefrologia/educação , Diálise Renal/métodos , Currículo , Educação de Pós-Graduação em Medicina/métodos , Feminino , Humanos , Internato e Residência/métodos , Masculino , Melhoria de Qualidade , Estados Unidos
Semin Dial ; 31(2): 140-148, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29315834


Much is written about medical safety as it pertains to patients with chronic kidney disease, yet the transition to end-stage kidney disease and processes inherent to the receipt of dialysis present unique safety challenges in this population. Educational efforts in medical safety need to focus on the areas of greatest threat and where intervention can provide the greatest benefit. This study addresses such safety topics in the dialysis population and identifies potential strategies that may aid in harm reduction.

Unidades Hospitalares de Hemodiálise/organização & administração , Falência Renal Crônica/terapia , Segurança do Paciente , Diálise Renal/métodos , Gestão da Segurança/métodos , Administração Oral , Analgésicos/uso terapêutico , Antibacterianos/uso terapêutico , Anticoagulantes/uso terapêutico , Quimioterapia Combinada , Feminino , Humanos , Falência Renal Crônica/diagnóstico , Masculino , Equipe de Assistência ao Paciente/organização & administração , Diálise Renal/efeitos adversos
Nephrol Nurs J ; 44(3): 251-264, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29165957


Executive leaders of an acute care hospital performed a market and financial analysis, and created a business plan to establish an inpatient hemodialysis unit operated by the hospital to provide safe, high-quality, evidence-based care to the population of individuals experiencing end stage renal disease (ESRD) within the community. The business plan included a SWOT (Strengths - Weaknesses - Opportunities - Threats) analysis to assess advantages of the hospital providing inpatient hemodialysis services versus outsourcing the services with a contracted agency. The results of the project were a newly constructed tandem hemodialysis room and an operational plan with clearly defined key performance indicators, process improvement initiatives, and financial goals. This article provides an overview of essential components of a business plan to guide the establishment of an inpatient hemodialysis unit.

Unidades Hospitalares de Hemodiálise/organização & administração , Pacientes Internados , Falência Renal Crônica/terapia , Diálise Renal , Humanos
Rev Infirm ; 66(232): 24-26, 2017.
Artigo em Francês | MEDLINE | ID: mdl-28599722


In the archipelago of Saint-Pierre and Miquelon, the dialysis unit of François-Dunan hospital is managed by a nurse. During haemodialysis sessions, she is supported by telemedicine thanks to a partnership established between this unit and that of the ECHO association based in Le Mans. Real remote collaboration has developed over time between the nurse and the nephrologist despite the 4 000 km between them.

Comunicação Interdisciplinar , Colaboração Intersetorial , Relações Médico-Enfermeiro , Consulta Remota/organização & administração , Telemedicina/organização & administração , Competência Clínica , França , Unidades Hospitalares de Hemodiálise/organização & administração , Humanos , Nefrologia/organização & administração , Enfermeiras Clínicas/organização & administração , Autonomia Profissional , Diálise Renal/enfermagem
Rev. enferm. UERJ ; 24(6): e18237, nov.-dez. 2016. tab
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-960689


Objetivo: estimar e analisar a prevalência de eventos adversos relacionados ao tratamento hemodialítico. Método: estudo transversal, mediante análise documental de prontuários de 117 pacientes de uma unidade de hemodiálise de Goiás. A coleta de dados ocorreu, por meio da revisão dos prontuários de pacientes, atendidos entre janeiro a dezembro de 2012, utilizando um instrumento estruturado. A análise estatística foi realizada pelo programa SPSS versão 19.0. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa Médica Humana e Animal sob protocolo 064/2008. Resultados: nos 117 (100%) prontuários avaliados, foram identificados 1.272 eventos adversos, correspondendo à prevalência de 94 (80,3%) prontuários. O evento adverso mais prevalente foi o fluxo sanguíneo inadequado (41%). Quanto aos danos causados, 76,1% foram leves, 22,8% moderados, 0,9% graves e 0,08% óbito. Conclusão: a investigação identificou alta prevalência (80,3%) de eventos adversos, apontando a necessidade de revisar os processos assistenciais e desenvolver ações para diagnosticar e controlar situações de riscos do tratamento, garantindo a segurança do paciente.

Objective: to estimate and analyze the prevalence of adverse events related to hemodialysis treatment. Method: in this cross-sectional, documentary analysis study, data was collected using a structured instrument on records of 117 patients treated at a hemodialysis unit in Goiás State, between January and December 2012. Statistical analysis was performed using SPSS version 19.0. The study was approved by the Human and Animal Medical Research Ethics Committee (protocol 064/2008). Results: 1,272 adverse events were identified, and prevalence was 80.3%. The most prevalent adverse event was inadequate blood flow (40.6%). Of harm caused, 76.1% was classified as mild, 22.9% as moderate, 0.9% as severe, and 0.1% fatal. Conclusion: the study identified high prevalence (80.3%) of adverse events, pointing to a need to review the care processes and take action to diagnose and control treatment risk situations, so as to ensure patient safety.

Objetivo: estimar y analizar la prevalencia de eventos adversos relacionados con la hemodiálisis. Método: estudio transversal, median-te el análisis documental de los registros de 117 pacientes de una unidad de hemodiálisis de Goiás. La recolección de datos ocurrió mediante la revisión de los registros de pacientes tratados entre enero y diciembre de 2012, utilizando un instrumento estructurado. El análisis estadístico se realizó con el programa SPSS versión 19.0. El estudio fue aprobado por el Comité de Ética en Investigación Médica Humana y Animal bajo el protocolo 064/2008. Resultados: en los 117 (100%) registros evaluados, fueron identificados 1.272 eventos adversos, correspondiendo a la prevalencia de 94 (80,3%) registros. El evento adverso más prevalente fue el flujo sanguíneo inadecuado (41%). En cuanto a los daños causados, el 76,1% fue de daños leves, un 22,8% de moderados, el 0,9% de severos y un 0,8% de óbito. Conclusión: la investigación identificó una alta prevalencia (80,3%) de eventos adversos apuntando a la necesidad de revisar los procesos de atención y desarrollar acciones para diagnosticar y controlar las situaciones de riesgos del tratamiento, garantizando la seguridad del paciente

Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Qualidade da Assistência à Saúde , Diálise Renal/efeitos adversos , Segurança do Paciente , Dano ao Paciente , Unidades Hospitalares de Hemodiálise , Estudos Transversais , Diálise Renal , Diálise Renal/enfermagem , Insuficiência Renal , Insuficiência Renal Crônica , Unidades Hospitalares de Hemodiálise/organização & administração
G Ital Nefrol ; 33(5)2016.
Artigo em Italiano | MEDLINE | ID: mdl-27796026


BACKGROUND: Given the public health challenge and burden of chronic kidney disease, the Italian Society of Nephrology (SIN) promoted acensusof the renal and dialysis units to analyse structural and human resources, organizational aspects, activities and workload referring to theyear 2014. METHODS: An online questionnaire, including 64 items exploring structural and human resources, organization aspects, activities and epidemiological data referred to 2014, was sent to chiefs of any renal or dialysis unit. RESULTS: Renal and dialysis activity was performed by over 2718 physicians (45 pmp). The management of the acute renal failure was one of the most frequent activities in the public renal units (12,206 patients in ICU and 140.00 dialysis sessions). There were performed about 9000 AV fistulas and 1700 central vascular catheters insertions. In the census, there are a lot of data regarding organization, workforce and workload of the renal unit in Italy. The benchmark data derived from this census show interesting comparisons between centres, regions and groups of regions. These data realised the clinical management of renal disease in Italy.

Instituições de Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Censos , Unidades Hospitalares de Hemodiálise/organização & administração , Unidades Hospitalares de Hemodiálise/estatística & dados numéricos , Nefrologia/estatística & dados numéricos , Diálise Renal/estatística & dados numéricos , Insuficiência Renal/terapia , Carga de Trabalho , Humanos , Itália/epidemiologia , Prevalência , Registros , Insuficiência Renal/epidemiologia , Sociedades Médicas , Fatores de Tempo , Recursos Humanos
G Ital Nefrol ; 33(5)2016.
Artigo em Italiano | MEDLINE | ID: mdl-27796027


BACKGROUND: Given the public health challenge and burden of chronic kidney disease, the Italian Society of Nephrology (SIN) promoted a census of the renal and dialysis units to analyse structural and human resources, organizational aspects, activities and workload referring to the year 2014. METHODS: An online questionnaire, including 64 items exploring structural and human resources, organization aspects, activities and epidemiological data referred to 2014, was sent to chiefs of any renal or dialysis unit. RESULTS: 615 renal units were identified. From these 615 units, 332 were public renal centres (of which 318 centres answered to the census) and 283 were private dialysis centres (of which 113 centres answered to the census). The results show 6 public renal units pmp. Renal biopsies were 4624 (81 pmp). The nephrology beds are about 41 pmp. There are 7.304 nurses working in HD wards, 1.692 in the nephrology wards and only 613 for outpatients clinics. The benchmark data derived from this census show interesting comparisons between centres, regions and groups of regions. These data realised the clinical management of renal disease in Italy.

Instituições de Assistência Ambulatorial/organização & administração , Censos , Unidades Hospitalares de Hemodiálise/organização & administração , Nefrologia , Diálise Renal/estatística & dados numéricos , Insuficiência Renal/terapia , Humanos , Itália , Registros , Sociedades Médicas , Fatores de Tempo
Enferm. nefrol ; 19(2): 125-133, abr.-jun. 2016. tab
Artigo em Espanhol | IBECS | ID: ibc-154065


Introducción. En la calidad de cualquier servicio, intervienen elementos objetivos como las características de los materiales e instalaciones que se emplean, y elementos subjetivos como la satisfacción del usuario del servicio, entendida esta como la obtención de una respuesta satisfactoria a las expectativas que se había planteado. La relación paciente-sistema sanitario ha evolucionado hasta situar al paciente como eje del sistema, y su satisfacción se ha consolidado como un importante componente de calidad, al considerarse en sí misma una medida de resultado; y determinar los índices de satisfacción de forma periódica, se está consolidando como una herramienta imprescindible para valorar la evolución de la calidad del servicio. Objetivos. -Estado de instalaciones. -Tiempo de espera para ser atendido por un médico. Respecto a la pregunta abierta del cuestionario, 22 pacientes han sugerido alguna área de mejora. Al comparar los resultados entre los tres centros de la UGC, destaca que los pacientes en DP son los que muestran el mayor grado de satisfacción, encontrándose una ligera diferencia entre los pacientes de las dos unidades de HD, mostrándose más satisfechos los de la UH que los del CPD. Conclusiones. Con este estudio hemos constatado que los pacientes que reciben tratamiento de diálisis en nuestra UGC, se reconocen muy satisfechos con el servicio, con ligeras diferencias según la unidad en la reciben tratamiento, y además nos ha permitido conocer aspectos mejorables, que se están abordando para aumentar la satisfacción del paciente y por consiguiente la calidad asistencial. General: n Conocer el grado de satisfacción global de los pacientes con el servicio de Nefrología. Secundarios: n Determinar eventuales diferencias en la satisfacción entre las diferentes unidades que integran la unidad de gestión clínica (UGC). n Detectar aspectos mejorables en la atención a nuestros pacientes. Pacientes/Método. Estudio observacional descriptivo transversal sobre todos los pacientes atendidos en las tres unidades de diálisis de nuestra UGC. Utilizamos para la recogida de datos el cuestionario autoadministrado SERVQHOS, que fue distribuido a los pacientes por enfermeras ajenas a las unidades donde se estaban dializando, las cuales explicaron los objetivos del estudio, solicitaron el consentimiento verbal para su participación, y pidieron que una vez cumplimentado lo depositaran de forma anónima en un buzón colocado en cada unidad. Resultados. La muestra fue de 89 pacientes, con una edad media de 65,1±14.9 años (22-93), de los cuales (30%) mujeres y (70%) hombres. 29 pacientes (32%) se dializaban en la Unidad Hospitalaria (UH), 45 (49%) en el Centro Periférico de Diálisis (CPD) y 17 (19%) estaban en Diálisis Peritoneal (DP). Al comparar las variables sociodemográficas por centros, solo se observan ligeras diferencias en el nivel de estudios y en la situación laboral de los pacientes...(AU)

Introduction. The quality of any service involving objective factors such as the characteristics of the materials and facilities used, and subjective elements such as user satisfaction about the service, understood as obtaining a satisfactory response to the expectations that had been raised. The patient-health system relationship has evolved to place the patient at the heart of the system, and their satisfaction has become an important component of quality, considering itself an outcome; and determine satisfaction rates periodically, it is consolidating as an essential tool to assess the evolution of the quality of service. Objectives. General: n Know the overall satisfaction of patients in the nephrology unit. Secondary: n Determine any differences in satisfaction between different units within the clinical management unit (CMU). n Identify areas for improvement in the care of our patients. Patients / Method. Cross-sectional, observational study of all patients seen in the three dialysis units in our CMU. We used to collect data a self-administered questionnaire, SERVQHOS, which was distributed to patients by nurses not employees of the units where these patients were dialyzing. They explained the objectives of the study, requested verbal consent for participation, and asked that once completed, this must be deposited anonymously in a letterbox placed in each unit. Results. The sample was of 89 patients, with a mean age of 65.1 ± 14.9 years (22-93), of which 30% were women and 70% men. 29 patients (32%) were dialyzed in the Hospital Unit (HU), 45 (49%) at a non-Hospital Unit and 17 (19%) were on peritoneal dialysis (PD). When comparing the sociodemographic variables per centers were observed only slight differences in educational level and employment status of patients. Overall assessment of the questionnaires: - 98.8% of patients were satisfied or very satisfied with the service. - 97.7% say they would recommend the service without hesitation. Best rated aspects: -Transmitting -Security personnel. -Friendliness. -Interest In Patients. -Personalized. Worst rated aspects: -Punctuality of medical consultations. - State of facilities. - Time waiting to be seen by a doctor Regarding the open question of the questionnaire, 22 patients have suggested some area of improvement. When comparing the results between the three centers of the UGC, it emphasizes that PD patients are those that show the greatest degree of satisfaction, being a slight difference between patients in the two units of HD, showing more satisfied whose at the HU than those at the non-HU. Conclusions. With this study we have found that patients receiving dialysis treatment in our CMU, they are recognized very satisfied with the service, with slight differences depending on the unit where they receive treatment, and has also allowed us to know improvable aspects that are addressing to increase patient satisfaction and therefore the quality of care (AU)

Humanos , Masculino , Feminino , Satisfação do Paciente/estatística & dados numéricos , Unidades Hospitalares de Hemodiálise , Unidades Hospitalares de Hemodiálise/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Qualidade da Assistência à Saúde/normas , Enfermagem em Nefrologia/métodos , Enfermagem em Nefrologia/organização & administração , Enfermagem em Nefrologia/normas , Estudos Transversais/métodos , Estudos Transversais , Inquéritos e Questionários , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/normas , Nefrologia , Nefrologia/organização & administração
Perit Dial Int ; 36(5): 519-25, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27044794


UNLABELLED: ♦ INTRODUCTION: This study was carried out to investigate the center effect on the risk of peritoneal dialysis (PD) failure within the first 6 months of therapy using a multilevel approach. ♦ METHODS: This was a retrospective cohort study based on data from the French Language Peritoneal Dialysis Registry. We analyzed 5,406 incident patients starting PD between January 2008 and December 2012 in 128 PD centers. The end of the observation period was December 31, 2013. ♦ RESULTS: Of the 5,406 patients, 415 stopped PD within the first 6 months. There was a significant heterogeneity between centers (variance of the random effect: 0.10). Only 3% of the variance of the event of interest was attributable to differences between centers. At the individual level, only treatment before PD (odds ratio [OR]: 1.93 for hemodialysis and OR: 2.29 for renal transplantation) and underlying nephropathy (p < 0.01) were associated with early PD failure. At the center level, only center experience was associated (OR: 0.78) with the risk of PD failure. Center effect accounted for 52% of the disparities between centers. ♦ CONCLUSION: Center effect on early PD failure is significant. Center experience is associated with a lower risk of transfer to hemodialysis.

Unidades Hospitalares de Hemodiálise/organização & administração , Falência Renal Crônica/terapia , Diálise Peritoneal/efeitos adversos , Peritonite/epidemiologia , Sistema de Registros , Idoso , Estudos de Coortes , Intervalos de Confiança , Falha de Equipamento , Feminino , França , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Cooperação do Paciente/estatística & dados numéricos , Diálise Peritoneal/métodos , Peritonite/etiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Falha de Tratamento
Rev. Assoc. Paul. Cir. Dent ; 70(1): 30-36, jan.-mar. 2016. graf, tab
Artigo em Português | LILACS, BBO - Odontologia | ID: lil-797050


Objetivo: Avaliar as manifestações bucais e o uso de serviços odontológicos de indivíduos com Doença Renal Crônica (DRC) em tratamento hemodialítico. Materiais e Métodos: Participaram doestudo 130 indivíduos, de ambos os sexos e com idade superior a 18 anos em atendimento no Serviço de Hemodiálise de referência da cidade de João Pessoa-PB. Foram coletados dados socioeconômicos,saúde geral, higiene bucal, autopercepção dos problemas bucais e acesso ao serviço odontológico. Um único examinador realizou o exame clínico intrabucal. Resultados: A maioria dos participantes era do sexo masculino (60,8%), com baixos níveis de escolaridade (56,9%) e renda(61,5%). Houve o predomínio da hipertensão arterial sistêmica (86,2%) na doença de base. Em relação à autopercepção dos problemas bucais, os participantes relataram com maior frequência axerostomia (51,5%), seguida de mau hálito (30,0%). Dentre as manifestações bucais, a gengivite e a presença de cálculo dentário foram as mais prevalentes, com 66,2% e 56,2%, respectivamente.A maioria dos indivíduos buscava atendimento odontológico na rede pública de saúde e afirmava que o cirurgião-dentista não estava preparado para atender e explicar o tratamento que seria realizado. Conclusão: As principais alterações bucais identificadas foram xerostomia, mau hálito,cálculo dentário e gengivite, e que a maioria dos indivíduos tinha dificuldade no acesso ao serviço odontológico público de saúde.

Objective: To assess oral manifestations and use of dental care assistance by individuals with Chronic Kidney Disease (CKD) in hemodialysis treatment. Materials and Methods: Participated inthe study 130 individuals of both genders and aged over 18 years old attending the Hemodilalysis Reference Service in João Pessoa - PB. Data collection for socioeconomic status, oral hygiene, self--awareness of oral problems and access to dental care was carried out. A single examiner ran a clinical intraoral exam. Results: Most participants were male (60.8%) with low levels of education(56.9%) and income (61.5%). There was a predominance of systemic arterial hypertension (86.2%)as the underlying disease. In relation to the self-awareness of oral problems, participants reporteddry mouth most frequently (51.5%) followed by bad breath (30.0%). Among oral manifestations, gingivitis and the presence of tartar were the most prevalent, 66.2% and 56.2%, respectively. Mostindividuals sought dental care in the public health system and stated that the dental surgeon wasnot prepared to attend and explain the treatment to be provided. Conclusion: The main oral alterationsidentified were dry mouth, bad breath, tartar as well as gingivitis, and that most participantsfound it difficult to have access to dental care assistance in the public health system.

Humanos , Masculino , Feminino , Assistência Odontológica/efeitos adversos , Assistência Odontológica/organização & administração , Assistência Odontológica/tendências , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/prevenção & controle , Unidades Hospitalares de Hemodiálise/organização & administração
G Ital Nefrol ; 33(1)2016.
Artigo em Italiano | MEDLINE | ID: mdl-26913746


This paper reports a description of the characteristics of the Nephrology and Dialysis department of the Yangzhou Northern Peoples Hospital (Jiangsu province - China) observed by the Author in a two weeks stay. The most outstanding remark is that, in spite of the modern and highly developed structure and information technology of the hospital, the Chinese Health System, an insurance based system, doesnt cover all the care expenses, leaving the remaining cost to be payed by the patients (about 30%). This often induces an empirical method of treatment of nephropathy, because of the lack of a histologic diagnosis and a minimalistic approach for choosing drugs. Another important point is the discontinuity in the follow-up of the disease and the frequent development of uremic complications, especially hyperparathyroidism.

Unidades Hospitalares de Hemodiálise , Nefrologistas , Nefrologia , China , Unidades Hospitalares de Hemodiálise/organização & administração , Unidades Hospitalares de Hemodiálise/estatística & dados numéricos , Unidades Hospitalares/organização & administração , Unidades Hospitalares/estatística & dados numéricos , Humanos , Itália , Nefrologia/estatística & dados numéricos
Perit Dial Int ; 36(5): 509-18, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26764341


UNLABELLED: ♦ BACKGROUND: Previous studies have reported significant variation in peritonitis rates across dialysis centers. Limited evidence is available to explain this variability. The aim of this study was to assess center-level predictors of peritonitis and their relationship with peritonitis rate variations. ♦ METHODS: All incident peritoneal dialysis (PD) patients treated in Australia between October 2003 and December 2013 were included. Data were accessed through the Australia and New Zealand Dialysis and Transplant Registry. The primary outcome was peritonitis rate, evaluated in a mixed effects negative binomial regression model. Peritonitis-free survival was assessed as a secondary outcome in a Cox proportional hazards model. ♦ RESULTS: Overall, 8,711 incident PD patients from 51 dialysis centers were included in the study. Center-level predictors of lower peritonitis rates included smaller center size, high proportion of PD, low peritoneal equilibration test use at PD start, and low proportion of hospitalization for peritonitis. In contrast, a low proportion of automated PD exposure, high icodextrin exposure and low or high use of antifungal prophylaxis at the time of peritonitis were associated with a higher peritonitis rate. Similar results were obtained for peritonitis-free survival. Overall, accounting for center-level characteristics appreciably decreased peritonitis variability among dialysis centers (p = 0.02). ♦ CONCLUSION: This study identified specific center-level characteristics associated with the variation in peritonitis risk. Whether these factors are directly related to peritonitis risk or surrogate markers for other center characteristics is uncertain and should be validated in further studies.

Unidades Hospitalares de Hemodiálise/organização & administração , Falência Renal Crônica/terapia , Diálise Peritoneal/efeitos adversos , Peritonite/etiologia , Sistema de Registros , Idoso , Austrália , Feminino , Humanos , Incidência , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/mortalidade , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Diálise Peritoneal/métodos , Peritonite/epidemiologia , Peritonite/prevenção & controle , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Análise de Regressão , Estudos Retrospectivos , Medição de Risco , Taxa de Sobrevida , Fatores de Tempo