Cases reported "Kidney Failure, Chronic"

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1/15. Improvement of patient care through a collaborative approach to patient education and triage.

    Educating and triaging new patients into the End-Stage Renal disease care system are a challenge for all renal providers. This review describes the role of a renal patient educator, the goals of education, and ways in which an educator collaborates with multiple renal team members to assure optional treatment decision-making by patients and a smooth transition to treatments and care facilities. A case study is provided to show the collaborative role and benefits to both patients and facilities. Examples of team collaboration for delivery of education and care and requirements for successful teamwork and communication are provided. Results of this approach are improved continuity of care and coordination of patients, enhanced satisfaction of both patients and providers, and cost savings when appropriate financial and treatment decisions are in place.
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ranking = 1
keywords = communication
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2/15. Improving the nurse-patient relationship: a multi-faceted approach.

    AIM: A Corporate education Session was held to provide concrete strategies for overcoming several specific barriers in the daily nurse-patient relationship that negatively affect the patient, nurse, or both, and to provide the latest information about best practice as it affects nurses in renal care. METHODOLOGY: The session was led by a moderator who presented three video case studies to the audience. Communication strategies for recognising and overcoming nurse-patient communication barriers were presented. The audience expressed their views about each case study using voting pads, and a panel of experts addressed the comments of the audience and discussed guidelines for best practice in renal care. The panel comprised three experienced renal nurses, a senior nephrologist, and an expert in social interaction. CONCLUSIONS: Optimal treatment of patients with renal disease should include early treatment of anaemia, adequate levels of dialysis, and a multidisciplinary approach, responding to both the medical and the social needs of the patient.
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ranking = 1
keywords = communication
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3/15. palliative care for patients with end-stage renal failure: reflections from Central australia.

    This paper explores palliative care issues for Australian Aboriginal patients with end-stage renal failure. Renal disease is epidemic amongst Aboriginal Australians. The Central Australian palliative care Service, based in the remote town of Alice Springs, sees a high proportion of renal patients, with different demographic characteristics to those seen in urban palliative care services. A case history illustrates distinctive concerns for local service provision, including communication issues, cultural requirements for maximizing quality of life, and the need to provide care in remote locations. Palliation for end-stage renal failure (ESRF) patients should be based on standard principles, but modified in accordance with local practical requirements and community needs.
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ranking = 1
keywords = communication
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4/15. Aluminium intoxication in undialysed adults with chronic renal failure.

    The dialysis encephalopathy syndrome (DES) consists of altered mental status, communication difficulty, seizures and myoclonus. It has been attributed to elevated serum aluminium (A1) levels. Two undialysed patients with chronic renal failure who presented with the characteristic syndrome are reported. The first, a 48 year old female, had used A1 containing phosphate binders for two years. Her serum A1 level was 25.34 mumol/L. Despite treatment with desferoximine and dialysis, she died. Necropsy revealed elevated A1 levels in the cerebral cortex (19 mcg/gm) and spongioform change in the outer three cortical layers. The second patient, a 46 year old woman, had a serum A1 of 8.70 mumol/L. She had never taken A1 containing phosphate binders but had taken several grams/day of citrate for at least six months. Treatment with haemodialysis and discontinuation of the citrate produced a resolution of symptoms and return of the A1 level to normal. During two years of haemodialysis there has been no recurrence.
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ranking = 1
keywords = communication
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5/15. Peritoneo-scrotal communication: demonstration by 99mtechnetium sulphur colloid scintigraphy.

    Continuous ambulatory peritoneal dialysis is a widely used and convenient alternative to haemodialysis in patients with renal failure. Occasionally, a scrotal swelling may develop during this procedure because of fluid passing through a patent processus vaginalis. We present a case report to illustrate the diagnostic use of radionuclide scintigraphy in this group of patients.
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ranking = 4
keywords = communication
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6/15. Surgical treatment of massive hydrothorax complicating continuous ambulatory peritoneal dialysis.

    Acute hydrothorax is a well-recognized complication of continuous ambulatory peritoneal dialysis and is often regarded as a contraindication to its use. We report three cases treated by surgical closure of a communication between the peritoneal and pleural cavities enabling CAPD to continue successfully. This is a simple, safe and effective procedure which merits wider use as an alternative to transferring the patient to permanent hemodialysis.
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ranking = 1
keywords = communication
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7/15. A review of management of pleuroperitoneal communication in five CAPD patients.

    Development of massive hydrothorax is well known in CAPD patients. Five CAPD patients at one center have developed some form of pleuroperitoneal communication as evidenced by pleural effusion. Temporary discontinuation of CAPD, tetracycline instillation, and surgical patch grafting of the diaphragm have been used as treatments for the communication.
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ranking = 6
keywords = communication
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8/15. Tuberculous peritonitis complicating long-term peritoneal dialysis. Report of 5 cases and review of the literature.

    The characteristics of 5 patients who developed tuberculous peritonitis while receiving long-term peritoneal dialysis (PD) are presented. There were 2 males and 3 females. 3 patients were on intermittent and 2 were on continuous ambulatory peritoneal dialysis when tuberculous peritonitis was first diagnosed. None of the patients had recently received immunosuppression therapy or were diabetics. The clinical presentations were similar to other forms of peritonitis complicating PD except for a more insidious onset. As extraperitoneal involvement and peritoneal lymphocytosis were rarely present, the diagnosis was mainly dependent on the direct demonstration of mycobacterium tuberculosis with smear (1 patient) and culture (4 patients). In 1 patient with a pleuroperitoneal communication, the diagnosis was made by pleural biopsy and a positive response to antituberculous therapy. All patients responded to treatment with a combination of three antituberculous drugs which included streptomycin, isoniazid, rifampicin and pyrazinamide. Two patients were transferred to hemodialysis. In 3 patients, peritoneal dialysis was continued. Peritoneal clearance and ultrafiltration capacity were unchanged for up to 16 months after treatment in 2 patients who continued peritoneal dialysis but was reduced by 30 and 50%, respectively, in the remaining patient. Only 1 patient died, but her death was not directly related to tuberculous peritonitis. It was concluded that with a high index of suspicion and early institution of treatment, tuberculous peritonitis complicating PD can be successfully treated with low mortality and without compromising the dialysis capacity of the peritoneal membrane.
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ranking = 1
keywords = communication
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9/15. histoplasmosis with hypercalcemia, renal failure, and papillary necrosis. confusion with sarcoidosis..

    A 56-year-old man with a three-month history of fever, malaise, anorexia, mental confusion, and weight loss had hypercalcemia and azotemia. The chest roentgenogram was normal. biopsy material removed 2 1/2 years previously showed noncaseating granulomas. sarcoidosis was diagnosed, and prednisone was administered. fever persisted, and the patient died 49 days after admission. Postmortem examination showed evidence of extensive disseminated histoplasmosis, interstitial nephritis, and papillary necrosis. This communication emphasizes the difficulty in diagnosing the etiology of disseminated, noncaseating granulomatous disease.
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ranking = 1
keywords = communication
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10/15. Epoetin alfa--focus on patients who are hospitalized. Case study of the anemic patient.

    Maintaining continuity of care in dialysis patients who require hospitalization is an ongoing challenge for nephrology clinicians. One of the keys to improving continuity of care is establishing open lines of communication between the staffs of the dialysis center and local hospitals. This article examines the integral role nurses can play in this communication process and uses anemia management to illustrate how proactive planning can help improve continuity of care throughout the treatment continuum.
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ranking = 2
keywords = communication
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