The global pediatric nephrology workforce: a survey of the International Pediatric Nephrology Association.

PubMed

Glenn, Dorey; Ocegueda, Sophie; Nazareth, Meaghan; Zhong, Yi; Weinstein, Adam; Primack, William; Cochat, Pierre; Ferris, Maria

2016-07-15

The global pediatric nephrology workforce is poorly characterized. The objectives of our study were to assess pediatric nephrologists' perceptions of the adequacy of the pediatric nephrology workforce, and understand regional challenges to fellow recruitment and job acquisition. Perceptions regarding optimal length of training and research requirements were also queried. A 17-question web-based survey comprised of 14 close-ended and 3 open-ended questions was e-mailed to members of the International Pediatric Nephrology Association. Quantitative and qualitative analyses were performed. We received 341 responses from members of the International Pediatric Nephrology Association from 71 countries. There was a high degree of overall perceived workforce inadequacy with 67 % of all respondents reporting some degree of shortage. Perceived workforce shortage ranged from 20 % in Australia/New Zealand to 100 % in Africa. Respondents from Africa (25 %) and North America (22.4 %) reported the greatest difficulty recruiting fellows. Respondents from Australia/New Zealand (53.3 %) and Latin America (31.3 %) reported the greatest perceived difficulty finding jobs as pediatric nephrologists after training. Low trainee interest, low salary, lack of government or institutional support, and few available jobs in pediatric nephrology were the most frequently reported obstacles to fellow recruitment and job availability. Globally, there is a high level of perceived inadequacy in the pediatric nephrology workforce. Regional variability exists in perceived workforce adequacy, ease of recruitment, and job acquisition. Interventions to improve recruitment targeted to specific regional barriers are suggested.

The US pediatric nephrology workforce: a report commissioned by the American Academy of Pediatrics.

PubMed

Primack, William A; Meyers, Kevin E; Kirkwood, Suzanne J; Ruch-Ross, Holly S; Radabaugh, Carrie L; Greenbaum, Larry A

2015-07-01

The US pediatric nephrology workforce is poorly characterized. This report describes clinical and nonclinical activities, motivations and disincentives to a career in pediatric nephrology, future workforce needs, trainee recruitment, and possible explanations for personnel shortages. An e-mail survey was sent in 2013 to all identified US-trained or -practicing pediatric nephrologists. Of 504 respondents, 51% are men, 66% are US graduates, and 73% work in an academic setting. About 20% of trained pediatric nephrologists no longer practice pediatric nephrology. Among the 384 respondents practicing pediatric nephrology full or part-time in the United States, the mean work week was 56.1±14.3 hours, with time divided between patient care (59%), administration (13%), teaching (10%), clinical research (9%), basic research (6%), and other medical activities (3%). Most (>85%) care for dialysis and transplantation patients. The median number of weeks annually on call is 16, and 29% work with one or no partner. One-third of US pediatric nephrologists (n=126) plan to reduce or stop clinical nephrology practice in the next 5 years, and 53% plan to fully or partially retire. Almost half the division chiefs (47%) report inadequate physician staffing. Ongoing efforts to monitor and address pediatric nephrology workforce issues are needed. Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Results of a coordination and shared clinical information programme between primary care and nephrology.

PubMed

García García, Manuel; Valenzuela Mújica, Mari Pau; Martínez Ocaña, Juan Carlos; Otero López, María del Sol; Ponz Clemente, Esther; López Alba, Thaïs; Gálvez Hernández, Enrique

2011-01-01

The high prevalence of chronic kidney disease (CKD) in the general population has created a need to coordinate specialised nephrology care and primary care. Although several systems have been developed to coordinate this process, published results are scarce and contradictory. To present the results of the application of a coordinated programme between nephrology care and primary care through consultations and a system of shared clinical information to facilitate communication and improve the criteria for referring patients. Elaboration of a coordinated care programme by the primary care management team and the nephrology department, based on the SEN-SEMFYC consensus document and a protocol for the study and management of arterial hypertension (AHT). Explanation and implementation in primary health care units. A directory of specialists’ consultations was created, both in-person and via e-mail. A continuous training programme in kidney disease and arterial hypertension was implemented in the in-person consultation sessions. The programme was progressively implemented over a three-year period (2007-2010) in an area of 426,000 inhabitants with 230 general practitioners. Use of a clinical information system named Salut en Xarxa that allows access to clinical reports, diagnoses, prescriptions, test results and clinical progression. Improved referral criteria between primary care and specialised nephrology service. Improved prioritisation of visits. Progressive increase in referrals denied by specialists (28.5% in 2009), accompanied by an explanatory report including suggestions for patient management. Decrease in first nephrology outpatient visits that have been referred from primary care (15% in 2009). Family doctors were generally satisfied with the improvement in communication and the continuous training programme. The main causes for denying referral requests were: patients >70 years with stage 3 CKD (44.15%); patients <70 years with stage 3a CKD (19.15%); albumin/creatinine ratio <500 mg/g (12.23%); non-secondary, non-refractory, essential AHT (11.17%). The general practitioners included in the programme showed great interest and no complaints were registered. The consultations improve adequacy and prioritisation of nephrology visits, allow for better communication between different levels of the health system, and offer systematic training for general practitioners to improve the management of nephrology patients. This process allows for referring nephrology patients with the most complex profiles to nephrology outpatient clinics.

Results of the 2014-2015 Canadian Society of Nephrology workforce survey.

PubMed

Ward, David R; Manns, Braden; Gil, Sarah; Au, Flora; Kappel, Joanne E

2016-01-01

Nephrology was previously identified as a subspecialty with few Canadian employment opportunities, and in recent years, fewer trainees are choosing nephrology. The objective of this study is to better understand the current Canadian adult nephrology workforce and the expected workforce trends over the next 5 years. This is an online self-administered survey. This study is set in Canada. Survey participants are Canadian adult nephrologists, including self-identified division heads. The measurements of this study are demographics, training, current practice characteristics, work hours, and projected workforce needs. Survey questions were based on previous workforce surveys. Ethics approval was obtained through the University of Saskatchewan. The survey was piloted in both English and French and modified based on the feedback to ensure that responses accurately reflected the information desired. It was circulated to all identified Canadian nephrologists via an anonymous e-mail link for self-administration. Categorical data was aggregated, and free-text answers were thematically analyzed. Additional descriptive analysis was conducted by all authors. Five hundred ninety-two Canadian nephrologists were contacted and 48 % responded, with representation from all Canadian provinces. One third of the respondents were female, and the largest age cohort was 41-50 years. Most nephrologists are trained in Canada and 61 % completed additional training. The majority of the respondents (69.1 %) began working as a nephrologist immediately upon completion of fellowship training. Younger nephrologists reported more challenges in finding a job. Eighty percent of responding nephrologists were satisfied with their current work hours, 13.1 % will reduce work hours within 3 years, an additional 8.2 % will reduce work hours within 5 years, and a further 14.2 % will reduce work hours within 10 years. Nephrology division heads forecasted the number of clinical and academic nephrologists needed for the next 3 and 5 years. The response rate was 48 %. Forecasted workforce needs are not indicative of guaranteed future positions. This Canadian Society of Nephrology workforce survey demonstrated the current workforce demographics, individual nephrologist future workforce plans, and projected nephrology division requirements for the next 3 and 5 years. Further work will need to be done to refine Canadian nephrology workforce planning with the development of a robust strategy that encompasses both societal and nephrologists' needs with the realities of employment.

The global nephrology workforce: emerging threats and potential solutions!

PubMed

Sharif, Muhammad U; Elsayed, Mohamed E; Stack, Austin G

2016-02-01

Amidst the rising tide of chronic kidney disease (CKD) burden, the global nephrology workforce has failed to expand in order to meet the growing healthcare needs of this vulnerable patient population. In truth, this shortage of nephrologists is seen in many parts of the world, including North America, Europe, Australia, New Zealand, Asia and the African continent. Moreover, expert groups on workforce planning as well as national and international professional organizations predict further reductions in the nephrology workforce over the next decade, with potentially serious implications. Although the full impact of this has not been clearly articulated, what is clear is that the delivery of care to patients with CKD may be threatened in many parts of the world unless effective country-specific workforce strategies are put in place and implemented. Multiple factors are responsible for this apparent shortage in the nephrology workforce and the underpinning reasons may vary across health systems and countries. Potential contributors include the increasing burden of CKD, aging workforce, declining interest in nephrology among trainees, lack of exposure to nephrology among students and residents, rising cost of medical education and specialist training, increasing cultural and ethnic disparities between patients and care providers, increasing reliance on foreign medical graduates, inflexible work schedules, erosion of nephrology practice scope by other specialists, inadequate training, reduced focus on scholarship and research funds, increased demand to meet quality of care standards and the development of new care delivery models. It is apparent from this list that the solution is not simple and that a comprehensive evaluation is required. Consequently, there is an urgent need for all countries to develop a policy framework for the provision of kidney disease services within their health systems, a framework that is based on accurate projections of disease burden, a full understanding of the internal care delivery systems and a framework that is underpinned by robust health intelligence on current and expected workforce numbers required to support the delivery of kidney disease care. Given the expected increases in global disease burden and the equally important increase in many established kidney disease risk factors such as diabetes and hypertension, the organization of delivery and sustainability of kidney disease care should be enshrined in governmental policy and legislation. Effective nephrology workforce planning should be comprehensive and detailed, taking into consideration the structure and organization of the health system, existing care delivery models, nephrology workforce practices and the size, quality and success of internal nephrology training programmes. Effective training programmes at the undergraduate and postgraduate levels, adoption of novel recruitment strategies, flexible workforce practices, greater ownership of the traditional nephrology landscape and enhanced opportunities for research should be part of the implementation process. Given that many of the factors that impact on workforce capacity are generic across countries, cooperation at an international level would be desirable to strengthen efforts in workforce planning and ensure sustainable models of healthcare delivery.

The global nephrology workforce: emerging threats and potential solutions!

PubMed Central

Sharif, Muhammad U.; Elsayed, Mohamed E.; Stack, Austin G.

2016-01-01

Amidst the rising tide of chronic kidney disease (CKD) burden, the global nephrology workforce has failed to expand in order to meet the growing healthcare needs of this vulnerable patient population. In truth, this shortage of nephrologists is seen in many parts of the world, including North America, Europe, Australia, New Zealand, Asia and the African continent. Moreover, expert groups on workforce planning as well as national and international professional organizations predict further reductions in the nephrology workforce over the next decade, with potentially serious implications. Although the full impact of this has not been clearly articulated, what is clear is that the delivery of care to patients with CKD may be threatened in many parts of the world unless effective country-specific workforce strategies are put in place and implemented. Multiple factors are responsible for this apparent shortage in the nephrology workforce and the underpinning reasons may vary across health systems and countries. Potential contributors include the increasing burden of CKD, aging workforce, declining interest in nephrology among trainees, lack of exposure to nephrology among students and residents, rising cost of medical education and specialist training, increasing cultural and ethnic disparities between patients and care providers, increasing reliance on foreign medical graduates, inflexible work schedules, erosion of nephrology practice scope by other specialists, inadequate training, reduced focus on scholarship and research funds, increased demand to meet quality of care standards and the development of new care delivery models. It is apparent from this list that the solution is not simple and that a comprehensive evaluation is required. Consequently, there is an urgent need for all countries to develop a policy framework for the provision of kidney disease services within their health systems, a framework that is based on accurate projections of disease burden, a full understanding of the internal care delivery systems and a framework that is underpinned by robust health intelligence on current and expected workforce numbers required to support the delivery of kidney disease care. Given the expected increases in global disease burden and the equally important increase in many established kidney disease risk factors such as diabetes and hypertension, the organization of delivery and sustainability of kidney disease care should be enshrined in governmental policy and legislation. Effective nephrology workforce planning should be comprehensive and detailed, taking into consideration the structure and organization of the health system, existing care delivery models, nephrology workforce practices and the size, quality and success of internal nephrology training programmes. Effective training programmes at the undergraduate and postgraduate levels, adoption of novel recruitment strategies, flexible workforce practices, greater ownership of the traditional nephrology landscape and enhanced opportunities for research should be part of the implementation process. Given that many of the factors that impact on workforce capacity are generic across countries, cooperation at an international level would be desirable to strengthen efforts in workforce planning and ensure sustainable models of healthcare delivery. PMID:26798456

[Influence of physicians' subspecialty and training history on CKD management and medical cooperation: from the results of a nationwide questionnaire survey for primary care physicians].

PubMed

Naito, Takero; Ohtani, Haruhisa; Kobayashi, Kazuo; Miyazaki, Masanobu; Yamada, Kouji; Sugawara, Masahiro; Naka, Yoshikazu; Saruta, Takao

2013-01-01

The goal of this study was to elucidate how the subspecialty and training history of primary care physicians(PCPs) influence CKD management and medical cooperation in Japan. We conducted a nationwide questionnaire survey on CKD management for PCPs from December 2012 to March 2013. The questionnaire included 32 items about CKD management and medical cooperation. PCPs' subspecialties were categorized as follows: general internal medicine, nephrology, cardiology, diabetology/endocrinology, gastroenterology, pulmonology, neurology, neurosurgery, hematology, collagen disease/rheumatology, allergology. The PCPs' training history of nephrology was classified into three categories: none, experienced, active-nephrologist. Response distributions for each question were compared between the PCPs' subspecialties and the three categories of training history. 2,287 out of 28,200 PCPs (8.1%) of all 47 prefectures responded. The majority (86.5%) of responders were PCPs at clinics, and 90.9% were non-nephrologists. The PCPs' subspecialty influenced the response distributions in the following questions: utilization of the CKD guidebook, urinalysis at the first and follow-up examinations, frequency of blood testing, counselling with eGFR, self-monitoring of blood pressure, prescription and cessation of renin-angiotensin system (RAS) inhibitors, anemia treatment with erythropoiesis stimulating agents (ESA). The PCPs' training history of nephrology had a strong impact on various aspects of CKD management. The PCPs' subspecialties also influenced the responses regarding medical cooperation of CKD: relationship with nephrologists, utilization of critical path, criterion of patient referral, requests for nephrologists, discontent with the nephrologists' response. We elucidated that the PCPs' subspecialty and training history of nephrology substantially influenced CKD management and medical cooperation in Japan. Effective promotion activities to improve CKD management and medical cooperation should be proposed on the basis of these data.

The Kidney Disease Screening and Awareness Program (KDSAP): A Novel Translatable Model for Increasing Interest in Nephrology Careers

PubMed Central

Wu, Jingshing; Yeh, Albert C.; Shieh, Eric C.; Cui, Cheryl; Polding, Laura C.; Ahmed, Rayhnuma; Lim, Kenneth; Lu, Tzong-Shi; Rhee, Connie M.; Bonventre, Joseph V.

2014-01-01

Despite the increasing prevalence of CKD in the United States, there is a declining interest among United States medical graduates in nephrology as a career choice. Effective programs are needed to generate interest at early educational stages when career choices can be influenced. The Kidney Disease Screening and Awareness Program (KDSAP) is a novel program initiated at Harvard College that increases student knowledge of and interest in kidney health and disease, interest in nephrology career paths, and participation in kidney disease research. This model, built on physician mentoring, kidney screening of underserved populations, direct interactions with kidney patients, and opportunities to participate in kidney research, can be reproduced and translated to other workforce-challenged subspecialties. PMID:24876120

The Joint Society of Nephrology in Germany, Switzerland and Austria - Five Decades of Successful Activities.

PubMed

Heidland, August; Ritz, Eberhard; Lang, Florian

2016-02-01

The joint Society of Nephrology in Germany, Switzerland and Austria was founded on April 10th, 1961 in Wiesbaden. Board members were Hans Sarre, Kurt Kramer, Klaus Rother, Francois Reubi, Bruno Watschinger, Wolfgang Dutz, Ernst Wollheim and Karl Ullrich. The mission of the society was an intensive interaction between basic science of the kidney (anatomy, physiology, pathophysiology, biochemistry and molecular biology) and clinical research in nephrology and hypertension. Every year scientific symposia took place in different venues in one of the three countries, except in the years between 1963-1987, when the congresses of the International Society of Nephrology took place. Practical issues of clinical nephrology, in particular renal replacement therapy (dialysis and transplantation), were covered since 1971 by a specific Working Group. In 1994 the Advisory Board (Kuratorium) of the Society of Nephrology was founded as a result of an initiative of Peter Weidmann (Bern). Its main goals were Update Seminars in Nephrology and Hypertensionin Eastern Europe, in part together with the Joint Action of Nephrology and an Eastern European ScholarshipProgram. Despite the prosperous work of this European society within nearly five decades in Germany a national society was founded as well, which combined all activities of nephrology in one organization. The German Society of Nephrology was founded in 2009.

[Nurses and nephrology in Italy].

PubMed

De Pietro, Carlo

2010-01-01

An acceleration in the professionalization of Italian nurses has taken place in recent years. This pattern, together with the increasing prevalence of kidney diseases and the decreasing number of active nephrologists, makes a new collaborative structure between nurses and nephrologists both possible and welcome. This article describes the recent changes and future prospects of the Italian nursing profession. Observations about nephrology are based on interviews conducted with key opinion leaders of nursing in nephrology and dialysis. Italian nurses have recently acquired a status of professional autonomy. Nursing training is now fully integrated in the university system and nurses have obtained more responsibilities and a higher status within healthcare organizations. Future developments may be related to the internal articulation of the profession, supported by master courses and specialist training. Another possible evolution refers to the ongoing restructuring of the healthcare system with an emphasis on nursing activities and skills rather than medical specialties, which will lead to new and stronger managerial roles for nurses. The increase in the prevalence of kidney diseases and the declining number of nephrologists will result in a change in the distribution and utilization of nephrology services. The professionalization of nurses allows a new work division with a task shift from doctors to nurses. Italian nephrologists should seek a preferential relationship with the nursing profession, also considering the nursing shortage in several regions. Possible means to accomplish this preferential relationship could be, in addition to task shifting, nurses' involvement in research, and support for postgraduate training.

[Nephrology in Tunisia: From yesterday to now].

PubMed

Ben Maïz, Hédi

2010-06-01

Professor Hassouna Ben Ayed is the founder of Tunisian nephrology. He introduced in 1962 the first artificial kidney for the treatment of acute renal failure. In 1963, the first acute peritoneal dialysis was done. Renal biopsy started in 1967 with general pathologists. A special laboratory of renal pathology was set up in 1975 with Pr H. Ben Maïz. Epidemiology of glomerular diseases, when histologically proven, was published [8]. A comprehensive program of chronic hemodialysis was started in 1968 and was developed markedly since 1975 with Pr A. El Matri. An intermittent peritoneal dialysis programme was started in 1982 and CAPD in 1983 by Pr T. Ben Abdallah. The Tunisian renal failure patient association was created in 1982 and the Tunisian society of nephrology in November 1983. A national registry for ESRD treatment is available since 1986. Since this time, the number of patients initiating renal replacement therapy (RRT) for ESRD has increased dramatically due to the extension of acceptance criteria for RRT and the increase of the elderly population. The incidence was 13 pmp in 1986 and 133 pmp in 2008. The prevalence was 48.5 pmp in 1986 and 734 pmp in 2008. From 1971 up to 1986, locally dialysed patients have been transplanted abroad, especially in France. On 4 June 1986, the local transplantation program was started at Charles Nicolle Hospital in Tunis. A national center of organ transplantation was created on 12 June 1995. At the end of 2008, there were 106 nephrologists, 26 residents in nephrology and 253 doctors with a training in hemodialysis during 1 year. In university hospitals, the number of nephrology departments is five, with one unit in an army hospital and two units for pediatric nephrology. Five hospitals perform renal transplantation (Tunis: 2 - Sfax: 1 - Sousse: 1 - Monastir: 1). There are 138 centers of hemodialysis: 39 public, 99 private. Seven thousand and eighty patients were treated by HD, 127 patients underwent renal transplantation. The vast majority of these transplants have been performed using living related donors (103/127). The cost of renal replacement therapy (RRT) is taken in charge by the Ministry of Health and the national security boards. Legislation on HD was promulgated by the Tunisian government, setting rigorous and detailed rules for the implementation of new dialysis centers, as well as for the functioning of already active units (4 August 1986 - 4 April 1998). For transplantation, legislation was promulgated on 25 March 1991. Copyright 2010 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

[Assessment of a residency training program in endocrinology and nutrition by physicians: results of a survey].

PubMed

Moreno-Fernández, Jesús; Gutiérrez-Alcántara, Carmen; Palomares-Ortega, Rafael; García-Manzanares, Alvaro; Benito-López, Pedro

2011-12-01

The current training program for resident physicians in endocrinology and nutrition (EN) organizes their medical learning. Program evaluation by physicians was assessed using a survey. The survey asked about demographic variables, EN training methods, working time and center, and opinion on training program contents. Fifty-one members of Sociedad Castellano-Manchega de Endocrinología, Nutrición y Diabetes, and Sociedad Andaluza de Endocrinología y Nutrición completed the survey. Forty-percent of them disagreed with the compulsory nature of internal medicine, cardiology, nephrology and, especially, neurology rotations (60%); a majority (>50%) were against several recommended rotations included in the program. The fourth year of residence was considered by 37.8% of respondents as the optimum time for outpatient and inpatient control and monitoring without direct supervision. The recommended monthly number of on-call duties was 3.8±1.2. We detected a positive opinion about extension of residence duration to 4.4±0.5 years. Doctoral thesis development during the residence period was not considered convenient by 66.7% of physicians. Finally, 97.8% of resident physicians would recommend residency in EN to other colleagues. Endocrinologists surveyed disagreed with different training program aspects such as the rotation system, skill acquisition timing, and on-call duties. Therefore, an adaptation of the current training program in EN would be required. Copyright © 2011 SEEN. Published by Elsevier Espana. All rights reserved.

What Are We Doing? A Survey of United States Nephrology Fellowship Program Directors.

PubMed

Liebman, Scott E; Moore, Catherine A; Monk, Rebeca D; Rizvi, Mahrukh S

2017-03-07

Interest in nephrology has been declining in recent years. Long work hours and a poor work/life balance may be partially responsible, and may also affect a fellowship's educational mission. We surveyed nephrology program directors using a web-based survey in order to define current clinical and educational practice patterns and identify areas for improvement. Our survey explored fellowship program demographics, fellows' workload, call structure, and education. Program directors were asked to estimate the average and maximum number of patients on each of their inpatient services, the number of patients seen by fellows in clinic, and to provide details regarding their overnight and weekend call. In addition, we asked about number of and composition of didactic conferences. Sixty-eight out of 148 program directors responded to the survey (46%). The average number of fellows per program was approximately seven. The busiest inpatient services had a mean of 21.5±5.9 patients on average and 33.8±10.7 at their maximum. The second busiest services had an average and maximum of 15.6±6.0 and 24.5±10.8 patients, respectively. Transplant-only services had fewer patients than other service compositions. A minority of services (14.5%) employed physician extenders. Fellows most commonly see patients during a single weekly continuity clinic, with a typical fellow-to-faculty ratio of 2:1. The majority of programs do not alter outpatient responsibilities during inpatient service time. Most programs (approximately 75%) divided overnight and weekend call responsibilities equally between first year and more senior fellows. Educational practices varied widely between programs. Our survey underscores the large variety in workload, practice patterns, and didactics at different institutions and provides a framework to help improve the service/education balance in nephrology fellowships. Copyright © 2017 by the American Society of Nephrology.

Recovering activity and illusion: the nephrology day care unit.

PubMed

Remón Rodríguez, C; Quirós Ganga, P L; González-Outón, J; del Castillo Gámez, R; García Herrera, A L; Sánchez Márquez, M G

2011-01-01

Day Care Units are an alternative to hospital care that improves more efficiency. The Nephrology, by its technical characteristics, would be benefit greatly from further development of this care modality. The objectives of this study are to present the process we have developed the Nephrology Day Care Unit in the Puerto Real University Hospital (Cádiz, Spain). For this project we followed the Deming Management Method of Quality improvement, selecting opportunities, analyzing causes, select interventions, implement and monitor results. The intervention plan includes the following points: 1) Define the place of the Day Care Unit in the organization of our Clinical Department of Nephrology, 2) Define the Manual of organization, 3) Define the structural and equipment resources, 4) Define the Catalogue of services and procedures, 5) Standards of Care Processes. Protocols and Clinical Pathways; and 6) Information and Registration System. In the first 8 months we have been performed nearly 2000 procedures, which corresponds to an average of about 10 procedures per day, and essentially related to Hemodialysis in critical or acute patients, the Interventional Nephrology, the Clinical Nephrology and Peritoneal Dialysis. The development of the Nephrology Day Care Units can help to increase our autonomy, our presence in Hospitals, recover the progressive loss of clinical activity (diagnostic and therapeutic skills) in the past to the benefit of other Specialties. It also contributes to: Promote and develop the Diagnostic and Interventional Nephrology; improve the clinical management of patients with Primary Health Level, promote the Health Education and Investigation, collaborate in the Resources Management, and finally, to make more attractive and exciting our Specialty, both for nephrologists to training specialists.

Considering an integrated nephrology care delivery model: six principles for quality.

PubMed

Hamm, L Lee; Hostetter, Thomas H; Shaffer, Rachel N

2013-04-01

In 2012, 27 organizations will initiate participation in the Medicare Shared Savings Program as Accountable Care Organizations. This level of participation reflects the response of Centers for Medicare and Medicaid Services to criticism that the program as outlined in the proposed rule was overly burdensome, prescriptive, and too risky. Centers for Medicare and Medicaid Service made significant changes in the final rule, making the Accountable Care Organization program more attractive to these participants. However, none of these changes addressed the serious concerns raised by subspecialty societies-including the American Society of Nephrology-regarding care of patients with multiple chronic comorbidities and complex and end stage conditions. Virtually all of these concerns remain unaddressed, and consequently, Accountable Care Organizations will require guidance and partnership from the nephrology community to ensure that these patients are identified and receive the individualized care that they require. Although the final rule fell short of addressing the needs of patients with kidney disease, the Centers for Medicare and Medicaid Innovation presents an opportunity to test the potentially beneficial concepts of the Accountable Care Organization program within this patient population. The American Society of Nephrology Accountable Care Organization Task Force developed a set of principles that must be reflected in a possible pilot program or demonstration project of an integrated nephrology care delivery model. These principles include preserving a leadership role for nephrologists, encompassing care for patients with later-stage CKD and kidney transplants as well as ESRD, enabling the participation of a diversity of dialysis provider sizes and types, facilitating research, and establishing monitoring systems to identify and address preferential patient selection or changes in outcomes.

Assessing a nephrology-focused YouTube channel's potential to educate health care providers.

PubMed

Desai, Tejas; Sanghani, Vivek; Fang, Xiangming; Christiano, Cynthia; Ferris, Maria

2013-01-01

YouTube has emerged as a potential teaching tool. Studies of the teaching potential of YouTube videos have not addressed health care provider (HCP) satisfaction; a necessary prerequisite for any teaching tool. We conducted a 4-month investigation to determine HCP satisfaction with a nephrology-specific YouTube channel. The Nephrology On-Demand YouTube channel was analyzed from January 1 through April 30, 2011. Sixty-minute nephrology lectures at East Carolina University were compressed into 10-minute videos and uploaded to the channel. HCPs were asked to answer a 5-point Likert questionnaire regarding the accuracy, currency, objectivity and usefulness of the digital format of the teaching videos. Means, standard deviations and 2-sided chi-square testing were performed to analyze responses. Over 80% of HCPs considered the YouTube channel to be accurate, current and objective. A similar percentage considered the digital format useful despite the compression of videos and lack of audio. The nephrology-specific YouTube channel has the potential to educate HCPs of various training backgrounds. Additional studies are required to determine if such specialty-specific channels can improve knowledge acquisition and retention.

Four decades of kidney transplantation in Cuba.

PubMed

Alfonzo, Jorge P

2013-01-01

This article describes the background, beginnings, development, evolution and outcomes of kidney transplantation in Cuba. Nephrology as a medical specialty in Cuba began in 1962 and was formalized in 1966. Conditions were created to implement renal replacement therapy (including transplants), bring nephrology care to the entire country and train human resources who would assume this responsibility, making Cuba one of the first countries with a comprehensive program for renal patient care. After three unsuccessful cadaveric-donor kidney transplantations in 1968-69, the ensuing history of kidney transplantation can be summarized in the following three stages. 1970-1975: In January 1970, cadaveric-donor kidney transplantation began at the Nephrology Institute. That year, 17 kidney transplantations were performed; four of these patients lived with functional kidneys for 15-25 years; 10-year graft survival was 23.5% (Kaplan-Meier survival curve); HLA typing began in 1974. By December 1975, 170 grafts had been done in three hospitals. 1976-1985: Seven transplantation centers performed 893 grafts during this period. HLA-DR typing was introduced in 1976 and the National Histocompatibility Laboratory Network was founded in 1978. The first related living-donor kidney transplantation was done in 1979. 1986-2011: The National Kidney Transplantation Coordinating Center and the National Kidney Transplantation Program were created in 1986; the first combined kidney-pancreas transplantation was performed the same year. In 1990, cyclosporine and the Cuban monoclonal antibody IOR-T3 were introduced for immunosuppression to prevent rejection, as were other Cuban products (hepatitis B vaccine and recombinant human erythropoietin) for transplant patients. By December 2011, the cumulative number of transplants was 4636 (384 from related living donors). With over 40 years of experience, kidney transplantation is now well established in Cuba; it is free and universally accessible, on the basis of need and appropriateness.

Nephrologists between power and vulnerability in times of technology.

PubMed

Obregón, José Miguel Viscarra; Anjos, Marcio Fabri Dos

2018-05-03

The doctor-patient relationship is often discussed from the perspective of patient vulnerability. Little attention is given to the vulnerability of nephrologists in their professional practice, a reality often affected by profound cultural transformation arising from technological development. Nephrology is based on research and procedure instrumentalization, both permeated with technology. In addition, the relationship between nephrologists and institutions is governed by market rules. Recent data showed a shortage of new nephrologists and the need to improve the technical training of new professionals, foster the establishment of interventional nephrology, and attract more graduating physicians to this medical specialty. Bioethics offers a different perspective on the issue, since it takes the subjective concerns of medical doctors and the social environments they participate in into consideration in order to enhance their ethical autonomy. These ideas may be discussed as part of undergraduate or specialization programs, thus reinforcing the acknowledgement of vulnerability as a condition and of the relevance of adopting a reflective attitude toward the events of everyday life that interact with the morality of nephrologists, so that risks are adequately faced having bioethical parameters as a reference.

Protocols for treating patients with end-stage renal disease: a survey of nephrology fellowships.

PubMed

Perry, Maureen Munnelly; Howell, Scott; Patel, Nipa

2017-03-01

Approximately 14% of Americans are living with chronic kidney disease (CKD). The prevalence of end-stage renal disease (ESRD), the result of progressing CKD continues to rise by 21,000 per year. Currently, the only antibiotic prophylaxis guidelines for patients with ESRD undergoing dental treatment were published by the AHA in 2003. Presented in three parts, the first and second parts of this study found no consistent protocols amongst U.S. dental schools and U.S. GPRs and AEGDs, respectively. The goal of the third part of the project was to determine the current protocol being used to treat ESRD patients at U.S. nephrology fellowship programs. An 18 multiple-choice question survey was e-mailed to 130 directors of nephrology fellowships within the U.S. regarding renal treatment protocol details and antibiotic prophylaxis for patients with renal disease. Note that, 34.6% of respondents reported having an established renal treatment protocol. For programs with a protocol, 69% of programs reported following AHA guidelines. There is a lack of consistent, established protocols amongst U.S. nephrology fellowships. It is suggested that updated and evidence based guidelines for the safe treatment of patients be developed. © 2016 Special Care Dentistry Association and Wiley Periodicals, Inc.

Intra-dialytic exercise training: a pragmatic approach.

PubMed

Greenwood, Sharlene A; Naish, Patrick; Clark, Rachel; O'Connor, Ellen; Pursey, Victoria A; Macdougall, Iain C; Mercer, Thomas H; Koufaki, Pelagia

2014-09-01

This continuing education paper outlines the skills and knowledge required to plan, implement and evaluate a pragmatic approach to intra-dialytic exercise training. The aim of this continuing education article is to enable the nephrology multi-disciplinary team (MDT) to plan, implement and evaluate the provision of intra-dialytic exercise training for patients receiving haemodialysis therapy. After reading this article the reader should be able to: Appreciate the level of evidence base for the clinical effectiveness of renal exercise rehabilitation and locate credible sources of research and educational information Understand and consider the need for appropriate evaluation and assessment outcomes as part of a renal rehabilitation plan Understand the components of exercise programming and prescription as part of an integrated renal rehabilitation plan Develop a sustainable longer term exercise and physical activity plan. © 2014 The Authors Journal of Renal Care published by John Wiley & Sons Ltd on behalf of European Dialysis & Transplant Nurses Association/European Renal Care Association.

Incorporating Geriatric Assessment into a Nephrology Clinic: Preliminary Data from Two Models of Care.

PubMed

Hall, Rasheeda K; Haines, Carol; Gorbatkin, Steven M; Schlanger, Lynn; Shaban, Hesham; Schell, Jane O; Gurley, Susan B; Colón-Emeric, Cathleen S; Bowling, C Barrett

2016-10-01

Older adults with advanced chronic kidney disease (CKD) experience functional impairment that can complicate CKD management. Failure to recognize functional impairment may put these individuals at risk of further functional decline, nursing home placement, and missed opportunities for timely goals-of-care conversations. Routine geriatric assessment could be a useful tool for identifying older adults with CKD who are at risk of functional decline and provide contextual information to guide clinical decision-making. Two innovative programs were implemented in the Veterans Health Administration that incorporate geriatric assessment into a nephrology visit. In one program, a geriatrician embedded in a nephrology clinic used standardized geriatric assessment tools with individuals with CKD aged 70 and older (Comprehensive Geriatric Assessment for CKD) (CGA-4-CKD). In the second program, a nephrology clinic used comprehensive appointments for individuals aged 75 and older to conduct geriatric assessments and CKD care (Renal Silver). Data on 68 veterans who had geriatric assessments through these programs between November 2013 and May 2015 are reported. In CGA-4-CKD, difficulty with one or more activities of daily living (ADLs), history of falls, and cognitive impairment were each found in 27.3% of participants. ADL difficulty was found in 65.7%, falls in 28.6%, and cognitive impairment in 51.6% of participants in Renal Silver. Geriatric assessment guided care processes in 45.4% (n = 15) of veterans in the CGA-4-CKD program and 37.1% (n = 13) of those in Renal Silver. Findings suggest there is a significant burden of functional impairment in older adults with CKD. Knowledge of this impairment is applicable to CKD management. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

A comprehensive cooperative project for children with renal diseases in Nicaragua.

PubMed

Edefonti, A; Marra, G; Castellón Perez, M; Sandoval Díaz, M; Sereni, F

2010-11-01

In low-income countries renal diseases generally and chronic kidney disease (CKD) in particular represent a wide-spread and often underdiagnosed clinical problem. The aim of the cooperative project between the pediatric nephrology units of Milan, Italy, and Managua, Nicaragua was to improve the diagnosis and treatment of renal diseases and CKD in Nicaraguan children. When the project started, in 2000, there were many constraints in human and material resources in the Children's Hospital in Managua. Since 2001, a specialized Unit of Pediatric Nephrology and Urology has developed, offering free of charge basic clinical assistance to hospitalized children, and training abroad of the whole staff. Shared protocols, renovation of infrastructure and an information technology (IT) program were implemented. In 2003, renal replacement therapy (RRT) for selected children was initiated, along with a network of six department hospitals in 2005 and, in 2007, a CKD prevention program in the most peripheral Health Units, so that 61% of the Nicaraguan pediatric population is now covered by the project. To ensure implementation of the project, applications for funds to Italian private and public institutions were made and a Nicaraguan charity foundation was activated. The Nicaraguan Ministry of Health and the hospital directors were always involved in the plans of the development of the project and accepted the progressive transfer of the costs to the government, throughout the 9-year duration of the project. The IT program, inclusive of a database of children with kidney and other urinary tract (UT) diseases and a web connection between Milan and Managua, was crucial in monitoring the activities and providing epidemiological data, in order to better allocate resources. The clinical activities and the number of children managed in Managua in 2008 are similar to those of pediatric nephrology units worldwide and depict the level of clinical autonomy achieved. The sister-center model of cooperation and the top-down strategy we applied, along with the careful consideration of all the economic, logistic and political issues, were and are the key factors which explain the favorable results of this cooperative project.

How good are we at managing acute kidney injury in hospital?

PubMed

Meran, Soma; Wonnacott, Alexa; Amphlett, Bethan; Phillips, Aled

2014-04-01

Acute kidney injury (AKI) is a common clinical problem associated with adverse outcomes. This study identifies the incidence of AKI in two UK district general hospitals' without on-site renal services and assesses AKI management and level of nephrologist input. The AKIN classification was used to identify 1020 AKI patients over 6 months. Data were collated on patient demographics, AKI management and referral to nephrology and intensive care services. Short/long-term renal outcomes were investigated. Patients were followed up for 14 months post-discharge. Incidence of hospital-based AKI was 6.4%. Mean patient age was 73 years. There was 28.1% acute in-hospital mortality with a further 21.6% 14-month mortality. Only 8.3% of patients were referred to nephrology services for in-hospital review, and only 8.1% had outpatient nephrology follow-up. Compliance with the AKI National Confidential Enquiry into Patient Outcomes and Deaths (NCEPOD) recommendations was poor with 32.8% of patients having renal imaging and 15% of patients having acid-base status assessed. NCEPOD compliance improved with nephrology input. Patients referred to nephrology were likely to be younger with pre-existing CKD and severe AKI. 10.5% of AKI episodes were unrecognized. Forty percent of those with unrecognized AKI, (compared with 15% of recognized AKI) developed de novo or progression of pre-existing CKD. AKI in DGHs is mostly managed without nephrology input. There are significant shortcomings in AKI recognition and management in this setting. This is associated with poor mortality and long-term CKD. This study supports a need to improve the teaching and training of front-line medical staff in identifying AKI. Additionally, implementation of AKI e-alert systems may encourage early recognition and provide a prompt for renal referral.

Use of a national continuing medical education meeting to provide simulation-based training in temporary hemodialysis catheter insertion skills: a pre-test post-test study.

PubMed

Clark, Edward G; Paparello, James J; Wayne, Diane B; Edwards, Cedric; Hoar, Stephanie; McQuillan, Rory; Schachter, Michael E; Barsuk, Jeffrey H

2014-01-01

Simulation-based-mastery-learning (SBML) is an effective method to train nephrology fellows to competently insert temporary, non-tunneled hemodialysis catheters (NTHCs). Previous studies of SBML for NTHC-insertion have been conducted at a local level. Determine if SBML for NTHC-insertion can be effective when provided at a national continuing medical education (CME) meeting. Describe the correlation of demographic factors, prior experience with NTHC-insertion and procedural self-confidence with simulated performance of the procedure. Pre-test - post-test study. 2014 Canadian Society of Nephrology annual meeting. Nephrology fellows, internal medicine residents and medical students. Participants were surveyed regarding demographics, prior NTHC-insertion experience, procedural self-confidence and attitudes regarding the training they received. NTHC-insertion skills were assessed using a 28-item checklist. Participants underwent a pre-test of their NTHC-insertion skills at the internal jugular site using a realistic patient simulator and ultrasound machine. Participants then had a training session that included a didactic presentation and 2 hours of deliberate practice using the simulator. On the following day, trainees completed a post-test of their NTHC-insertion skills. All participants were required to meet or exceed a minimum passing score (MPS) previously set at 79%. Trainees who did not reach the MPS were required to perform more deliberate practice until the MPS was achieved. Twenty-two individuals participated in SBML training. None met or exceeded the MPS at baseline with a median checklist score of 20 (IQR, 7.25 to 21). Seventeen of 22 participants (77%) completed post-testing and improved their scores to a median of 27 (IQR, 26 to 28; p < 0.001). All met or exceeded the MPS on their first attempt. There were no significant correlations between demographics, prior experience or procedural self-confidence with pre-test performance. Small sample-size and self-selection of participants. Costs could limit the long-term feasibility of providing this type of training at a CME conference. Despite most participants reporting having previously inserted NTHCs in clinical practice, none met the MPS at baseline; this suggests their prior training may have been inadequate.

42 CFR 121.9 - Designated transplant program requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (vii) Makes available psychiatric and social support services for transplant candidates, transplant..., pediatrics, nephrology with dialysis capability, and pulmonary medicine with respiratory therapy support; (vi...

42 CFR 121.9 - Designated transplant program requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (vii) Makes available psychiatric and social support services for transplant candidates, transplant..., pediatrics, nephrology with dialysis capability, and pulmonary medicine with respiratory therapy support; (vi...

A call to arms: economic barriers to optimal dialysis care.

PubMed

McFarlane, P A; Mendelssohn, D C

2000-01-01

Epidemic growth rates and the enormous cost of dialysis pressure end-stage renal disease (ESRD) delivery systems around the world. Payers of dialysis services can constrain costs through (1) limiting access to dialysis, (2) reducing the quality of dialysis, and (3) placing constraints on modality distribution. In order to secure the necessary resources for ESRD care, we propose that the nephrology community consider the following suggestions: First, future leaders in dialysis should acquire additional advanced training in innovative pathways such as health care economics, business and health care administration, and health care policy. Second, the international nephrology community must strongly engage in ongoing advocacy for accessible, high quality, cost-effective care.Third, efforts should be made to better define and then implement optimal dialysis modality distributions that maximize patient outcomes but limit unnecessary costs. Fourth, industry should be encouraged to lower the unit cost of dialysis, allowing for improved access to dialysis, especially in developing countries. Fifth, research should be encouraged that seeks to identify measures that will reduce dialysis costs but will not impair quality of care. Finally, early referral of patients with progressive renal disease to nephrology clinics, empowerment of informed patient choice of dialysis modality, and proper and timely access creation should be encouraged and can be expected to help limit overall expenditures. Ongoing efforts in these areas by the nephrology community will be essential if we are to overcome the challenges of ESRD growth in this new decade.

[Assessment of epidemiological profile of patients and their difficulties for the first query in the screening ambulatory of Nephrology UNIFESP-EPM].

PubMed

Padovani, Cícera Sebastiana da Silva

2012-01-01

The aim of this study was to evaluate the epidemiologic profile of patients and difficulties of patients referred by basic health units (UBS) or other hospitals, outpatient screening of the Division of Nephrology, Hospital São Paulo (UNIFESP) for evaluation and treatment kidney disease. From February to September 2009, has been evaluated 341 patients referred from UBS in São Paulo and other parts of the Country. Of these patients, 26% (86/341) required for new tests to confirm the diagnosis doubtful for referrals, incomplete, or because of the waiting period for the care and exams, which ranged from one week to three years, and part of them did not bring any kind of examination for the evaluation, 12% (45/341) returned for follow-up at the unit location, 13% (46/341) were referred for treatment site closest to their residence, 47% (164/341) for our sub-specialty Clinics of Nephrology (HSP): 24% (82/341) uremia, 8% (27/341) with polycystic kidney disease, 7% (23/341) for hypertension, 4% (16/341) renal Lithiasis and 4% (16/341) nephritis. Our results suggest investments investment in infrastructure in the training of officials of UBS and HSP, reorganization of central references for better management and referral of patients, humanization of care and training of health professionals for outpatient care at UBS in preventive work and basic monitoring of patients, particularly those with diabetes mellitus and hypertension, which can lead to the development of chronic kidney disease (CKD).

[Artificial intelligence--the knowledge base applied to nephrology].

PubMed

Sancipriano, G P

2005-01-01

The idea that efficacy efficiency, and quality in medicine could not be reached without sorting the huge knowledge of medical and nursing science is very common. Engineers and computer scientists have developed medical software with great prospects for success, but currently these software applications are not so useful in clinical practice. The medical doctor and the trained nurse live the 'information age' in many daily activities, but the main benefits are not so widespread in working activities. Artificial intelligence and, particularly, export systems charm health staff because of their potential. The first part of this paper summarizes the characteristics of 'weak artificial intelligence' and of expert systems important in clinical practice. The second part discusses medical doctors' requirements and the current nephrologic knowledge bases available for artificial intelligence development.

Home hemodialysis education during postdoctoral training: Challenges and innovations.

PubMed

Glickman, Joel D; Seshasai, Rebecca Kurnik

2018-03-01

Inadequate education in home hemodialysis (HHD) fellowship training might contribute to underutilization of this modality in the United States. Most graduates of nephrology fellowships do not grade themselves as competent in HHD suggesting that fellowship training in HHD is inadequate. An essential component for fellow education is at least one faculty member with expertise in HHD who is passionate about promoting the use of this modality. At a minimum, fellow training should utilize a curriculum that includes both lectures about HHD and outpatient clinical exposure to this modality over a period of at least 6-12 months. Fellows benefit from the opportunity to transition at least three patients to a home modality to gain experience with modality education, access placement, initial prescriptions, and home dialysis training. They should spend time with HHD training nurses to learn more about modality education, observe nurse intake interviews with patients in order to learn the criteria for entrance into the home dialysis program as well as recognize how to identify potential barriers to successful home dialysis therapy. To expose fellows to problems that do not occur during clinic visits fellows are encouraged to take first call during the day for HHD patients. There are many opportunities to do research and quality improvement projects which might also propel some fellows into an academic career as a home dialysis nephrologist. © 2018 Wiley Periodicals, Inc.

Profile and scientific production of CNPq researchers in Nephrology and Urology.

PubMed

Oliveira, Eduardo A; Pécoits-Filho, Roberto; Quirino, Isabel G; Oliveira, Maria Christina; Martelli, Daniela Reis; Lima, Leonardo S; Martelli, Hercílio

2011-03-01

This study aimed at evaluating the profile and scientific production of researchers in Nephrology and Urology, receiving grants in the area of Clinical Medicine from the Brazilian National Research Council. The standardized online curriculum vitae (Curriculum Lattes) of 39 researchers in Medicine receiving grants in the 2006-2008 triennium were included in the analysis. The variables analyzed were: gender, affiliation, time from completion of the PhD program, scientific production, and supervision of undergraduate students, and master's and PhD programs. Males (74.4%) and category 2 grants (56.4%) predominated. The following three Brazilian states are responsible for 90% of the researchers: São Paulo (28; 71.8%); Rio Grande do Sul (4; 10.3%); and Minas Gerais (3; 7.7%). Four institutions are responsible for 70% of the researchers: UNIFESP (14; 36%); USP (8; 20.5%); UFMG (3, 7.7%); and UNICAMP (3; 7.7%). Considering the academic career, the assessed researchers published 3,195 articles in medical journals, with a median of 75 articles per researcher (QI = 52-100). The researchers received a total of 25,923 citations at the database Web of Science®, with a median of 452 citations per researcher (QI = 161-927). The average number of citations per article was 13.8 citations (SD = 11.6). The Southeastern region of Brazil concentrates researchers in Nephrology and Urology. Our study has shown an increase in the scientific production of most researchers in the last five years. By knowing the profile of researchers in Nephrology and Urology, more effective strategies to encourage the scientific production and the demand for resources to finance research projects can be defined.

[The future of the European nephrology belongs to the young: the Young Nephrologists' Platform].

PubMed

Bolignano, Davide

2014-01-01

Young people are the future of research, especially in nephrology. The prevalence of young nephrologists within the main scientific European societies varies from the 12% to 34% and the 20% of the ERA-EDTA members are less than 40 years old in 2013. Recently, the ERA-EDTA has launched a new platform, the Young Nephrologists Platform (YNP), which the aim is to become the first modern network of young nephrologists from Europe and beyond. YNP aims at promoting the aggregation of young people through modern communication channels such as social networks, blogs and through the construction of a database collecting information on attitudes and personal experiences of each young nephrologist. A mentorship program, focused and young-oriented clinical courses on hot topics and the direct involvement of young nephrologists in working groups and scientific studies are some of the other interesting initiatives driven by YNP. The future of nephrology belongs to the young and YNP could represent a good springboard for the professional growth of young nephrologists.

Electronic strategies for information and research: cyberNephrology/cyberMedicine in the emerging world.

PubMed

Solez, Kim; Hales, Michele; Katz, Sheila Moriber

2005-09-01

Communication and medicine have evolved together. Internet resources now provide an unprecedented opportunity to provide health assistance to the developing world. The International Society of Nephrology Informatics Commission and National Kidney Foundation cyberNephrology initiative (http://www.cybernephrology.org) have created e-mail discussion groups (e.g., NEPHROL, NEPHKIDS, and so forth) and online texts and web resources (e.g., the Schrier Atlas: http://www.kidneyatlas.org) that are, in many respects, ahead of other areas of medicine. On the other hand, nephrology is quite behind in its embrace of some specific communications initiatives that could benefit emerging nations: the Health InterNetwork Access to Research Initiative program, which provides free full-text access to medical journals and books in poorer countries; the Global Health Network Supercourse, which provides specially designed online lectures for the developing world; and Internet2/Abilene and similar research networks around the world, which provide reliable, guaranteed bandwidth for high-quality Internet videoconferencing as an alternative to face-to-face lectures and meetings. The intent of many educational ventures in nephrology, particularly in the clinical practice guideline realm (National Kidney Foundation Kidney Disease Outcomes Quality Initiative, Kidney Disease Improving Global Outcomes, and so forth), is not just to disseminate information but to change human behavior: physician practice and referral patterns, patient compliance, and so forth. Concepts from the worlds of marketing and entertainment, where the science of changing human behavior is highly evolved, can be used to create high-impact, educational offerings to promote health. They can also be highly beneficial to share Internet educational innovations and future vision across boundaries of medical specialties, which is part of the intent of the cyberMedicine joint venture (http://www.cyber-medicine.org).

International use of an academic nephrology World Wide Web site: from medical information resource to business tool.

PubMed

Abbott, Kevin C; Oliver, David K; Boal, Thomas R; Gadiyak, Grigorii; Boocks, Carl; Yuan, Christina M; Welch, Paul G; Poropatich, Ronald K

2002-04-01

Studies of the use of the World Wide Web to obtain medical knowledge have largely focused on patients. In particular, neither the international use of academic nephrology World Wide Web sites (websites) as primary information sources nor the use of search engines (and search strategies) to obtain medical information have been described. Visits ("hits") to the Walter Reed Army Medical Center (WRAMC) Nephrology Service website from April 30, 2000, to March 14, 2001, were analyzed for the location of originating source using Webtrends, and search engines (Google, Lycos, etc.) were analyzed manually for search strategies used. From April 30, 2000 to March 14, 2001, the WRAMC Nephrology Service website received 1,007,103 hits and 12,175 visits. These visits were from 33 different countries, and the most frequent regions were Western Europe, Asia, Australia, the Middle East, Pacific Islands, and South America. The most frequent organization using the site was the military Internet system, followed by America Online and automated search programs of online search engines, most commonly Google. The online lecture series was the most frequently visited section of the website. Search strategies used in search engines were extremely technical. The use of "robots" by standard Internet search engines to locate websites, which may be blocked by mandatory registration, has allowed users worldwide to access the WRAMC Nephrology Service website to answer very technical questions. This suggests that it is being used as an alternative to other primary sources of medical information and that the use of mandatory registration may hinder users from finding valuable sites. With current Internet technology, even a single service can become a worldwide information resource without sacrificing its primary customers.

Clinical integration of billing for a pediatric nephrology and transplant program.

PubMed

Tietjen, Andrea L; Orsini, Jenoveva; Mulgaonkar, Shamkant; Morgan, Debbie

2003-09-01

To develop and implement a billing process that fully integrates all activities of a pediatric nephrology and transplant program, by facilitating and coordinating data from patients, physicians, hospitals, and third-party billing services to maximize revenues. Financial operations were analyzed via a randomized audit of patient charts that focused on office procedures and revenue collection. Results based on monthly reports documenting revenue received and outstanding, procedures billed, and patient registration accuracy. The combination of improvements in patient registration, chart documentation, new billing sheets with procedure and diagnosis codes, physician in-service education, upgraded charges, and the recredentialing of all practice physicians realized an increase in revenue collections from 18% in 2000 to 89% in 2001. The need to integrate and coordinate information is vital for both billing accuracy and revenue collections. Integration of clinical services and billing procedures has maximized performance, profitability, and accuracy while decreasing administrative time and costs.

Nephrology in the Lancisi Medical Dictionary (1672-1720).

PubMed

Gazzaniga, Valentina; Marinozzi, Silvia

2006-01-01

Giovanni Maria Lancisi (1654-1720) shows a particular interest in urological and nephrological diseases, especially evident in a course of lectures held at Studium Urbis in 1696-97, which reflected his vast knowledge and familiarity with various important texts devoted to urology and nephrology. This interest is further documented in commentaries on articles on nephrological diseases in his Repertorium medicum (a sort of medical dictionary written between 1672 and his death). Lancisi's quoting medical authorities clarifies the clinical answers he gave in some of his unpublished Consulti concerning nephrological pathologies.

Efficacy and safety data of subsequent entry biologics pertinent to nephrology practice: a systematic review.

PubMed

Marin, Judith Genevieve; Leung, Marianna; Lo, Clifford; Tsao, Nicole W; Martinusen, Daniel J

2014-01-01

Subsequent entry biologics (SEBs) may soon be a reality in Canadian nephrology practice. Understanding the worldwide experience with these agents will be valuable to Canadian clinicians. To compare the efficacy and safety data between SEBs used in nephrology practice and their reference biologic. Systematic review. Ovid MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Database of Abstracts of Review of Effects, Cochrane Central Register of Controlled Trials. Adult patients with chronic kidney disease (CKD). Our systematic review follows the process outlined by Cochrane Reviews. For efficacy data, all randomized controlled trials (RCTs), quasi-RCTs and observational trials in nephrology practice were included. For safety data, case series, case reports, review articles in nephrology practice and pharmacovigilance programs were included as well. Only epoetin SEBs trials were published in the literature. Ten studies involving three different epoetin SEBs (epoetin zeta, HX575 and epoetin theta) were included. The mean epoetin dose used did not differ significantly between the SEBs and the reference product. For epoetin zeta and epoetin theta, the mean hemoglobin levels achieved in the studies were similar between the SEBs and the reference epoetin. The HX 575 studies reported a mean absolute change in hemoglobin within the predefined equivalence margin, when compared with the reference biologic. In terms of safety data, 2 cases of pure-red-cell aplasia were linked to the subcutaneous administration of HX 575. Otherwise, the rate of adverse drug reactions was similar when epoetin SEBs were compared with the reference biologic. Our analysis is limited by the paucity of information available on SEB use in nephrology with the exception of epoetin SEBs. Methodological flaw was found in one of the epoetin zeta studies which accounted for 45% of pooled results. Little clinical difference was found between epoetin SEBs and the reference product. Although not deemed clinically important, the financial implication of a possible dose difference between epoetin zeta and reference product should be considered in pharmacoeconomic studies. Ongoing trials are expected to address the risk of pure-red-cell aplasia with HX 575.

An Interactive Ambulatory Nephrology Curriculum for Internal Medicine Interns: Design, Implementation, and Participant Feedback.

PubMed

Gomez, Alexis C; Warburton, Karen M; Miller, Rachel K; Negoianu, Dan; Cohen, Jordana B

2017-09-01

While diminishing nephrology fellow recruitment is a known issue, more work is needed to evaluate possible interventions to reverse this trend. We designed and implemented a curriculum to increase exposure to ambulatory nephrology among internal medicine interns. The curriculum focused on key aspects of outpatient nephrology practice, including supervised clinic visits, formal themed didactic content, and an online interactive forum with assigned evidence-based readings and small-group responses to relevant cases. We obtained postcourse surveys from all participating interns. Of the 43 interns who took part in the first year of the ambulatory nephrology curriculum, 100% reported a positive didactic experience and 91% reported a positive interactive online experience. 77% reported an improvement in their familiarity with clinical nephrology practice (median 2-point increase in familiarity score on a 7-point scale, P<0.001 by signed rank testing). Qualitative feedback included praise for the high-yield topics covered by the lectures and energizing teachers. In conclusion, we successfully implemented an ambulatory nephrology curriculum using a framework that integrated formal didactics, interactive online learning, and key clinical components of outpatient nephrology care. Future investigation will evaluate whether early implementation of this curriculum is associated with increased pursuit of nephrology as a career. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

[Virtual teaching (e-learning) in Pediatric Urology. Master and expert course programme].

PubMed

Miguélez-Lago, Carlos; López-Pereira, Pedro; de la Fuente-Madero, José Luis; Caparrós-Cayuela, Aurora

2015-01-01

Currently there is a need for specific training and special dedication to pediatric urology (PU). Nevertheless, we lack of a continuous education program, which must be specific and multidisciplinary. To create a complementary training program in PU with the following differential characteristics: 1) University postgraduate, 2) internationally accredited, 3) multidisciplinary, 4) theoretical and practical, 5) through virtual teaching, 6) with on-site support, 7) academically directed and mentored, 8) based on individual and group self learning, 9) with international faculty and alumni 10) objectively evaluable. We developed two original projects of virtual training courses with practices in PU, Master and Expert following the International University of Andalucía (UNIA) regulations and with the support of the Medical College of Malaga. The Master has a general content one year duration and will be repeated yearly. The Expert course has monographic character, half-year duration and will be repeated yearly with different topics. They are credited 60 and 30 ECTS credits respectively. The course has 3 parts well differentiated in objectives and development: 1. Virtual training 2. On-site hospital practices and, 3. Final work. The alumni answered a questionnaire to evaluate the master at the midpoint. The UNIA has considered viable and approved all 3 projects presented: I PU MASTER (2014-2015), II PU MASTER (2015-2016) and Expert Course on pediatric incontinence (2015-2016)First PU MASTER data.- Registration applications: 60 alumni. Admitted alumni 40; mean age 37 years; 8 nationalities, 57% Spanish, 43% Foreigners. Specialities: Urology 14(35%), Pediatric Surgery 24 (60%), Pediatrics (Pediatric nephrology 1), General Medicine 1. Mid term Master evaluation by the alumni (0-100). Difficulty 60. Quality of the topics 92; complementary materials 90; faculty 90; UNIA virtual Campus 89. The demand of registrations demonstrates the need and interest of a pediatric Urology training program, through Master and Expert Courses. Virtual Training, e-learning, within the Virtual Campus of the UNIA is viable. This self-learning model is being highly valued by the international alumni. We offer an interesting supplement for continuous education in PU.

Rate of renal function decline, race and referral to nephrology in a large cohort of primary care patients.

PubMed

Koraishy, Farrukh M; Hooks-Anderson, Denise; Salas, Joanne; Scherrer, Jeffrey F

2017-08-01

Late nephrology referral is associated with adverse outcomes especially among minorities. Research on the association of the rate of chronic kidney disease (CKD) progression with nephrology referral in white versus black patients is lacking. Compute the odds of nephrology referral in primary care and their associations with race and the rate of CKD progression. Electronic health record data were obtained from 2170 patients in primary care clinics in the Saint Louis metropolitan area with at least two estimated glomerular filtration rate (eGFR) values over a 7-year observation period. Fast CKD progression was defined as a decline in eGFR of ≥5 ml/min/1.73 m2/year. Logistic regression models were computed to measure the associations between eGFR progression, race and nephrology referral before and after adjusting for potential confounding factors. Nephrology referrals were significantly more prevalent among those with fast compared to slow progression (5.6 versus 2.0%, P < 0.0001), however, a majority of fast progressors were not referred. Fast CKD progression and black race were associated with increased odds of nephrology referral (OR = 2.74; 95% CI: 1.60-4.72 and OR = 2.42; 95% CI: 1.28-4.56, respectively). The interaction of race and eGFR progression in nephrology referral was found to be non-significant. Nephrology referrals are more common in fast CKD progression, but referrals are underutilized. Nephrology referral is more common among blacks but its' association with rate of decline does not differ by race. Further studies are required to investigate the benefit of early referral of patients at risk of fast CKD progression. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

A prospective 2-site parallel intervention trial of a research-based film to increase exercise amongst older hemodialysis patients.

PubMed

Kontos, Pia; Alibhai, Shabbir M H; Miller, Karen-Lee; Brooks, Dina; Colobong, Romeo; Parsons, Trisha; Jassal, Sarbjit Vanita; Thomas, Alison; Binns, Malcolm; Naglie, Gary

2017-01-26

Evidence suggests that exercise training for hemodialysis patients positively improves morbidity and mortality outcomes, yet exercise programs remain rare and are not systematically incorporated into care. We developed a research-based film, Fit for Dialysis, designed to introduce, motivate, and sustain exercise for wellness amongst older hemodialysis patients, and exercise counseling and support by nephrologists, nurses, and family caregivers. The objective of this clinical trial is to determine whether and in what ways Fit for Dialysis improves outcomes and influences knowledge/attitudes regarding the importance of exercise for wellness in the context of end-stage renal disease. This 2-site parallel intervention trial will recruit 60 older hemodialysis patients from two urban hospitals. The trial will compare the film + a 16-week exercise program in one hospital, with a 16-week exercise-only program in another hospital. Physical fitness and activity measures will be performed at baseline, 8 and 16 weeks, and 12 weeks after the end of the program. These include the 2-min Walk Test, Grip Strength, Duke Activity Status Index, and the Timed Up-and-Go Test, as well as wearing a pedometer for one week. Throughout the 16-week exercise program, and at 12 weeks after, we will record patients' exercise using the Godin Leisure-time Exercise Questionnaire. Patients will also keep a diary of the exercise that they do at home on non-dialysis days. Qualitative interviews, conducted at baseline, 8, and 16 weeks, will explore the impact of Fit for Dialysis on the knowledge/attitudes of patients, family caregivers, and nephrology staff regarding exercise for wellness, and in what ways the film is effective in educating, motivating, or sustaining patient exercise during dialysis, at home, and in the community. This research will determine for whom Fit for Dialysis is effective, why, and under what conditions. If Fit for Dialysis is proven beneficial to patients, nephrology staff and family caregivers, research-based film as a model to support exercise promotion and adherence could be used to support the National Kidney Foundation's guideline recommendation (NKF-KDOQI) that exercise be incorporated into the care and treatment of dialysis patients. NCT02754271 (ClinicalTrials.gov), retroactively registered on April 21, 2016.

Nephrology nurses' perspectives on difficult ethical issues and practice guideline for shared decision making.

PubMed

Rabetoy, Christy Price; Bair, Bradley C

2007-01-01

Nephrologists and nephrology nurses have struggled with the technological, financial, and ethical concerns surrounding the life sustaining treatment of hemodialysis for as long as this treatment as been available. One of the overriding issues for the nephrology community has been appropriate utilization of this technology and the appropriate restraint for prescribing dialysis. Since the inception of dialysis, there has been discussion of guidelines for deciding who should receive and who should not receive this therapy. In 2000, a clinical guideline was developed to assist in directing the care of patients. The knowledge and acceptance of this guideline by nephrologists has been researched in the past. However, there is no data of knowledge and acceptance of the guideline by nephrology clinical nurses or nephrology nurse practitioners. A survey was conducted to begin to ascertain this information in order to better understand the perspectives of nephrology nurses.

Comparing mandated health care reforms: the Affordable Care Act, accountable care organizations, and the Medicare ESRD program.

PubMed

Watnick, Suzanne; Weiner, Daniel E; Shaffer, Rachel; Inrig, Jula; Moe, Sharon; Mehrotra, Rajnish

2012-09-01

In addition to extending health insurance coverage, the Affordable Care Act of 2010 aims to improve quality of care and contain costs. To this end, the act allowed introduction of bundled payments for a range of services, proposed the creation of accountable care organizations (ACOs), and established the Centers for Medicare and Medicaid Innovation to test new care delivery and payment models. The ACO program began April 1, 2012, along with demonstration projects for bundled payments for episodes of care in Medicaid. Yet even before many components of the Affordable Care Act are fully in place, the Medicare ESRD Program has instituted legislatively mandated changes for dialysis services that resemble many of these care delivery reform proposals. The ESRD program now operates under a fully bundled, case-mix adjusted prospective payment system and has implemented Medicare's first-ever mandatory pay-for-performance program: the ESRD Quality Incentive Program. As ACOs are developed, they may benefit from the nephrology community's experience with these relatively novel models of health care payment and delivery reform. Nephrologists are in a position to assure that the ACO development will benefit from the ESRD experience. This article reviews the new ESRD payment system and the Quality Incentive Program, comparing and contrasting them with ACOs. Better understanding of similarities and differences between the ESRD program and the ACO program will allow the nephrology community to have a more influential voice in shaping the future of health care delivery in the United States.

Healthcare costs associated with nephrology care in pre-dialysis chronic kidney disease patients.

PubMed

Vekeman, Francis; Yameogo, Nadege-Desiree; Lefebvre, Patrick; Bailey, Robert A; McKenzie, R Scott; Piech, Catherine Tak

2010-01-01

To compare the healthcare costs of pre-dialysis chronic kidney disease (CKD) patients cared for in a nephrology clinic setting versus other care settings. An analysis of health claims between 01/2002 and 09/2007 from the Ingenix Impact Database was conducted. Inclusion criteria were ≥ 18 years of age, ≥ 1 ICD-9 claim for CKD, and ≥ 1 estimated glomerular filtration rate (eGFR) value of < 60 mL/min/1.73 m(2). Patients were classified in the nephrology care cohort if they were treated in a nephrology clinic setting at least once during the study period. Univariate and multivariate analyses were conducted to compare average annualized healthcare costs of patients in nephrology care versus other care settings. Among the 20,135 patients identified for analysis, 1,547 patients were cared for in a nephrology clinic setting. Nephrology care was associated with lower healthcare costs with an unadjusted cost savings of $3,049 ($11,303 vs. $14,352, p = 0.0014) and a cost ratio of 0.8:1 relative to other care settings. After adjusting for covariates, nephrology care remained associated with lower costs (adjusted cost savings: $2,742, p = 0.006). Key limitations included potential inaccuracies of claims data, the lack of control for patients' ethnicity in the calculation of eGFR values, and the presence of potential biases due to the observational design of the study. The current study demonstrated that pre-dialysis CKD patients treated in nephrology clinics were associated with significantly lower healthcare costs compared with patients treated in other healthcare settings.

Nephrologists as Educators: Clarifying Roles, Seizing Opportunities

PubMed Central

Perazella, Mark A.

2016-01-01

Nephrologists play an important role in providing medical education in a variety of settings, including the medical school classroom, nephrology consult service, outpatient clinic, and dialysis unit. Therefore, nephrologists interact with a variety of learners. In this article the current state of published literature in medical education in nephrology is reviewed. Eight attending roles are identified of the nephrologist as a medical educator in the academic settings: inpatient internal medicine service, nephrology inpatient consult service, inpatient ESRD service, outpatient nephrology clinic, kidney transplantation, dialysis unit, classroom teacher, and research mentor. Defining each of these distinct settings could help to promote positive faculty development and encourage more rigorous education scholarship in nephrology. PMID:26276141

Navigating toward research success in times of uncertainty: funding opportunities for early career investigators in nephrology.

PubMed

Ikizler, T Alp; Lovett, David H; Chertow, Glenn M; Mitch, William E; Schiller, Brigitte

2015-03-01

There is considerable concern within the nephrology community about recent federal budget cuts and the decreasing availability of funds for research. This is especially difficult for junior investigators who are about to start a career as physician-scientists. Accordingly, it is imperative that resources other than federal funds be made available to these individuals during this most delicate yet crucial transition period. This commentary aims to provide an overview of nonfederal funding resources, focusing on the Norman S. Coplon Extramural Grant Program. This program emphasizes support of investigators at the most fragile period in their development of an academic career; it has provided >$11 million of research funds to more than 80 individuals since 2000. The outcome has been stellar, with more than 130 publications originating from these projects and >90% of awardees staying in academia. We hope these accomplishments will encourage similar activities by other entities and scientific programs in addition to ones that are ongoing. Ultimately, these collective efforts will inspire young researchers to use their knowledge, passion, and dedication to advance research into kidney diseases. Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Applying effective teaching and learning techniques to nephrology education.

PubMed

Rondon-Berrios, Helbert; Johnston, James R

2016-10-01

The interest in nephrology as a career has declined over the last several years. Some of the reasons cited for this decline include the complexity of the specialty, poor mentoring and inadequate teaching of nephrology from medical school through residency. The purpose of this article is to introduce the reader to advances in the science of adult learning, illustrate best teaching practices in medical education that can be extrapolated to nephrology and introduce the basic teaching methods that can be used on the wards, in clinics and in the classroom.

Iranian Nephrology and Urology Research Output in the Past Two Decades: A Bibliographic Analysis of Medline Database.

PubMed

Einollahi, Behzad; Motalebi, Mohsen; Taghipour, Mehrdad; Ebrahimi, Mehrdad

2015-09-01

We performed a bibliometric search to evaluate the number of papers published in the field of nephrology and urology by Iranian researchers in the past two decades. We did an online search in abstract/title part of articles with 129 keywords such as kidney, renal, hemodialysis, transplant, nephrology, glomerulonephritis, ureteral, nephrolithiasis, and etc. Endnote software version 7 was used to search articles published in PubMed database from November 1993 to November 2013. Those articles in which Iran was the affiliation of at least one of the authors were selected. These articles in the field of nephrology and urology were analyzed regarding the name of originated institution, field of study, total number of publications, type of study, collaboration rate of Iranian nephrologist and urologists for every year, annual sharing of Iranian articles in five journals with highest impact factor (IF) and journal IF. The total number of publications in the field of nephrology and urology was 3,771 (average of 189 papers per year). Most of the Iranian nephrology and urology papers were from the capital city, Tehran (50.03%). There was an increasing trend in the number of publications over the years. Most papers were about transplantation (44.6%), nephrology (20.9%) and hemodialysis (16.4%). Of all, 53.7% were retrospective articles, whereas the proportion of clinical trials was relatively small (10.8%). Although Iranian publications in the field of nephrology and urology have had a considerable and significant increase in the recent years amongst the Middle Eastern countries, there is a wide distance to be a science exporter country.

The future nephrology workforce: will there be one?

PubMed

Parker, Mark G; Ibrahim, Tod; Shaffer, Rachel; Rosner, Mitchell H; Molitoris, Bruce A

2011-06-01

Interest in nephrology as a career is declining and has been on the decline for nearly one decade. From 2002 to 2009, all internal medicine subspecialties except geriatric medicine increased the number of available fellowship positions. However, only two subspecialties attracted fewer United States medical graduates (USMGs) in 2009 than in 2002: geriatric medicine and nephrology. This drop occurred at a time when demand for nephrologists is increasing and when the specialty is having a harder time benefiting from the substantial contribution of international medical graduates (IMGs). Today's USMGs possess fundamentally different career and personal goals from their teachers and mentors. Medical students report receiving minimal exposure to nephrology in clinical rotations, and they perceive that the specialty is too complex, uninteresting, and lacks professional opportunity. Meanwhile, the demographics of kidney disease in the United States, as well as recent national health policy developments, indicate a growing need for nephrologists. Efforts to improve the educational continuum in nephrology and enhance mentorship are essential to restoring interest in nephrology for USMGs, maintaining its appeal among IMGs, and developing a workforce sufficient to meet future demand for renal care.

Are word-of-mouth communications contributing to a shortage of nephrology nurses?

PubMed

Wolfe, William A

2014-01-01

Nephrology nurse shortages have historically been viewed as a subset of the overall nursing supply in the United States. Not-here-to-fore considered as a contributing factor are the effects of word-of-mouth and Internet-based word-of-mouth communications from nurses who have had disappointing work experiences in hemodialysis clinics. This article discusses the potential effects of word-of-mouse communications and posits that negative word-of-mouse communications may discourage new and experienced nurses from considering the specialty of nephrology nursing, thus contributing to a nephrology nursing shortage.

Quality of survey reporting in nephrology journals: a methodologic review.

PubMed

Li, Alvin Ho-Ting; Thomas, Sonia M; Farag, Alexandra; Duffett, Mark; Garg, Amit X; Naylor, Kyla L

2014-12-05

Survey research is an important research method used to determine individuals' attitudes, knowledge, and behaviors; however, as with other research methods, inadequate reporting threatens the validity of results. This study aimed to describe the quality of reporting of surveys published between 2001 and 2011 in the field of nephrology. The top nephrology journals were systematically reviewed (2001-2011: American Journal of Kidney Diseases, Nephrology Dialysis Transplantation, and Kidney International; 2006-2011: Clinical Journal of the American Society of Nephrology) for studies whose primary objective was to collect and report survey results. Included were nephrology journals with a heavy focus on clinical research and high impact factors. All titles and abstracts were screened in duplicate. Surveys were excluded if they were part of a multimethod study, evaluated only psychometric characteristics, or used semi-structured interviews. Information was collected on survey and respondent characteristics, questionnaire development (e.g., pilot testing), psychometric characteristics (e.g., validity and reliability), survey methods used to optimize response rate (e.g., system of multiple contacts), and response rate. After a screening of 19,970 citations, 216 full-text articles were reviewed and 102 surveys were included. Approximately 85% of studies reported a response rate. Almost half of studies (46%) discussed how they developed their questionnaire and only a quarter of studies (28%) mentioned the validity or reliability of the questionnaire. The only characteristic that improved over the years was the proportion of articles reporting missing data (2001-2004: 46.4%; 2005-2008: 61.9%; and 2009-2011: 84.8%; respectively) (P<0.01). The quality of survey reporting in nephrology journals remains suboptimal. In particular, reporting of the validity and reliability of the questionnaire must be improved. Guidelines to improve survey reporting and increase transparency are clearly needed. Copyright © 2014 by the American Society of Nephrology.

Establishing a clinical trials network in nephrology: experience of the Australasian Kidney Trials Network

PubMed Central

Morrish, Alicia T; Hawley, Carmel M; Johnson, David W; Badve, Sunil V; Perkovic, Vlado; Reidlinger, Donna M; Cass, Alan

2014-01-01

Chronic kidney disease is a major public health problem globally. Despite this, there are fewer high-quality, high-impact clinical trials in nephrology than other internal medicine specialties, which has led to large gaps in evidence. To address this deficiency, the Australasian Kidney Trials Network, a Collaborative Research Group, was formed in 2005. Since then, the Network has provided infrastructure and expertise to conduct patient-focused high-quality, investigator-initiated clinical trials in nephrology. The Network has not only been successful in engaging the nephrology community in Australia and New Zealand but also in forming collaborations with leading researchers from other countries. This article describes the establishment, development, and functions of the Network. The article also discusses the current and future funding strategies to ensure uninterrupted conduct of much needed clinical trials in nephrology to improve the outcomes of patients affected by kidney diseases with cost-effective interventions. PMID:24088955

[Exercise in haemodyalisis patients: a literature systematic review].

PubMed

Segura-Ortí, Eva

2010-01-01

Exercise as a therapeutic tool used in End-stage renal disease patients (ESRD) in hemodialysis (HD) is not routinately applied, as it occurs with cardiac or respiratory patients. Lack of awareness of research in this field may contribute to the current situation. Thus, the aims of this review are: 1) to systematically review the literature of exercise training on adult HD patients or patients at a pre-HD stage; 2) to show the evidence on the benefits of exercise for counteracting physiological, functional and psychological impairments found even in older ESRD patients; 3) to recommend requirements of future research in order to include exercise prescription in the HD patients treatment. The Data bases reviewed from 2005 to 2009 were: MEDLINE (Ovid), CINAHL (EBSCOHost), SportDicus (EBSCOHost), Academic Search Complete (EBSCOHost), Fuente Académica (EBSCOHost), MedicLatina (EBSCOHost), PEDro y PubMed. Additionally, references from identified articles, several reviews on ESRD and abstracts to Nephrology Congresses were also reviewed. Randomized Controlled Trials on aerobic, strength and combined programs for HD patients were selected. Data from the studies was compiled and Van Tulder criteria were used for methodological quality assessment. Metanalysis included 6 studies on aerobic exercise, 2 on strength exercise and 5 on combined exercise programs. 640 patients were included in 16 included studies. Effects on physical function, health related quality of life and other secondary measurements were summarized by the Standardized Mean Difference (SMD) Moderate evidence exists on positive effects of aerobic training on peak oxygen consumption at the graded exercise test (SMD 6.55; CI 95%: 4.31-8.78). There is high evidence on positive effects of strength training on health related quality of life (SMD 11.03; CI 95%: 5.63-16.43). Finally, moderate evidence exists on positive effects of combined exercise on peak oxygen consumption at the graded exercise test (SMD 5.57; CI 95%: 2.52-8.61). Summarizing, moderate evidence exists on the improvement on exercise capacity of aerobic training, isolated or combined with strength training. Strength training improves health related quality of life, functional capacity and lower limbs strength. Future studies should clarify which out of the three modalities results in higher benefits for HD patients.

Onco-nephrology: a decalogue.

PubMed

Cosmai, Laura; Porta, Camillo; Gallieni, Maurizio; Perazella, Mark A

2016-04-01

Onco-nephrology is an evolving subspecialty that focuses on the complex relationships existing between kidney and cancer. In this opinion piece, we propose a 'decalogue of onco-nephrology', in order to highlight the areas where the nephrologist and oncologist should work closely over the ensuing years to provide cutting-edge care for patients afflicted with cancer and kidney disease. The 10 points we have highlighted include (1) acute kidney injury and chronic kidney disease in cancer patients; (2) nephrotoxic effects of anticancer therapy, either traditional chemotherapeutics or novel molecularly targeted agents; (3) paraneoplastic renal manifestations; (4) management of patients nephrectomized for a kidney cancer; (5) renal replacement therapy and active oncological treatments; (6) kidney transplantation in cancer survivors and cancer risk in ESRD patients; (7) oncological treatment in kidney transplant patients; (8) pain management in patients with cancer and kidney disease, (9) development of integrated guidelines for onco-nephrology patients and (10) clinical trials designed specifically for onco-nephrology. Following these points, a multidisciplinary onco-nephrology team will be key to providing outstanding, cutting-edge care in both the acute and chronic setting to these patients. © The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

E-nephrology.

PubMed

Manchanda, P K; Bid, H K

2011-01-01

Diagnosis of renal diseases is often delayed owing to the scarcity of trained physicians, lack of facilities, and shortage of funds limits effective management, particularly when it comes to the red zone of renal replacement therapy. The Internetis expected to open up a myriad resource of knowledge and applications for academicians, researchers and clinicians alike in all health care professions across the globe. Also, the Internet has grown rapidly over the years and will inevitably expand even more. Evolving technologies offer modern applications for information management, communications with multimedia and virtual reality. Now, these innovative technologies have opened up newer possibilities for nephrologists. As Internet is serving as a backbone for these modern technologies, it is an utmost necessity to use and refine Internet applications for future nephrologists. Increasingly easy access to Internet has dramatically reduced barriers in sharing of information among basic and clinical nephrologists. Considering the growing scope for nephrologists in the use of Internet, it is necessary to understand Internet as a source of information and backbone of modern application. This review illustrates expanding roles of the Internet for the nephrologists and provides ready to use compilation of useful academic, research, clinical resources and is expected to introduce, stimulate and guide nephrologists into the realm of the world wide web. It also investigates how Internet is supporting in growth and development of the field of nephrology and present and future scopes of Internet as a tool for professionals involved in this area as well as information about biological sciences, and it also gives information about societies in various continents working in field of nephrology and the links useful for clinicians and research scientists.

Home Palliative Care for Patients with Advanced Chronic Kidney Disease: Preliminary Results

PubMed Central

Teruel, José L.; Rexach, Lourdes; Burguera, Victor; Gomis, Antonio; Fernandez-Lucas, Milagros; Rivera, Maite; Diaz, Alicia; Collazo, Sergio; Liaño, Fernando

2015-01-01

Healthcare for patients with advanced chronic kidney disease (ACKD) on conservative treatment very often poses healthcare problems that are difficult to solve. At the end of 2011, we began a program based on the care and monitoring of these patients by Primary Care Teams. ACKD patients who opted for conservative treatment were offered the chance to be cared for mainly at home by the Primary Care doctor and nurse, under the coordination of the Palliative Care Unit and the Nephrology Department. During 2012, 2013, and 2014, 76 patients received treatment in this program (mean age: 81 years; mean Charlson age-comorbidity index: 10, and mean glomerular filtration rate: 12.4 mL/min/1.73 m2). The median patient follow-up time (until death or until 31 December 2014) was 165 days. During this period, 51% of patients did not have to visit the hospital’s emergency department and 58% did not require hospitalization. Forty-eight of the 76 patients died after a median time of 135 days in the program; 24 (50%) died at home. Our experience indicates that with the support of the Palliative Care Unit and the Nephrology Department, ACKD patients who are not dialysis candidates may be monitored at home by Primary Care Teams. PMID:27417813

The Kidney Research Predicament

PubMed Central

Bryan, Lisa; Ibrahim, Tod; Fischer, Michael J.

2014-01-01

Research funding from public and private sources has reached an all-time low. Economic conditions, sequestration, and a trend of low award success rates have created an imbalance between the supply of highly qualified research investigators and the availability of critically necessary research dollars. This grim environment continues to hinder the success of established investigators and deter potential investigators from joining the research workforce. Without action and support of innovative science, the future of the US health care system is in jeopardy, and its leadership role in medical research will decrease. This work discusses the effects of the decline in research funding, the plight of kidney research, and the impact of the American Society of Nephrology Grants Program on scientists. The ASN also calls on the entire nephrology community to rejuvenate the research environment, improve the lives of millions of people with kidney disease, and ultimately, find a cure. PMID:24652790

Exploring the uncharted territory of social media: the next frontier of medical education in nephrology

PubMed Central

Sridharan, Sivakumar; Parada, Xavier; Claure-Del Granado, Rolando; Orantes, Carlos; Madariaga, Hector; Penmatsa, Krishnam Raju; Basu, Gopal; Arce Amare, Fernanda

2018-01-01

Abstract Social media is gaining popularity amongst both medical educators and life-long learners. One of the most popular social media platforms used by the medical community is Twitter, which is popular amongst physicians, students and patients, and particularly in medical societies. Major international and regional societies commonly use Twitter to amplify their reach beyond what their live annual meetings can achieve. There has been a unique and notable effort by Nephrology societies to craft a structured social media strategy that results in the broadest reach to the community of nephrology providers. We report on the first three such experiments performed by three separate nephrology organizations. PMID:29644054

Exploring the uncharted territory of social media: the next frontier of medical education in nephrology.

PubMed

Desai, Tejas; Sridharan, Sivakumar; Parada, Xavier; Claure-Del Granado, Rolando; Orantes, Carlos; Madariaga, Hector; Penmatsa, Krishnam Raju; Basu, Gopal; Arce Amare, Fernanda

2018-04-01

Social media is gaining popularity amongst both medical educators and life-long learners. One of the most popular social media platforms used by the medical community is Twitter, which is popular amongst physicians, students and patients, and particularly in medical societies. Major international and regional societies commonly use Twitter to amplify their reach beyond what their live annual meetings can achieve. There has been a unique and notable effort by Nephrology societies to craft a structured social media strategy that results in the broadest reach to the community of nephrology providers. We report on the first three such experiments performed by three separate nephrology organizations.

Understanding the role of knowledge in the practice of expert nephrology nurses in Australia.

PubMed

Bonner, Ann

2007-09-01

This paper, which is abstracted from a larger study into the acquisition and exercise of nephrology nursing expertise, aims to explore the role of knowledge in expert practice. Using grounded theory methodology, the study involved 17 registered nurses who were practicing in a metropolitan renal unit in New South Wales, Australia. Concurrent data collection and analysis was undertaken, incorporating participants' observations and interviews. Having extensive nephrology nursing knowledge was a striking characteristic of a nursing expert. Expert nurses clearly relied on and utilized extensive nephrology nursing knowledge to practice. Of importance for nursing, the results of this study indicate that domain-specific knowledge is a crucial feature of expert practice.

Clinical Investigation Program. Annual Progress Report

DTIC Science & Technology

1990-10-01

1990 (C) Stevens EL, Venkataraman BW, Southgate M, Nakamura KT: Ontogeny of Sodium Nitroprusside and Atriopeptin III Relaxation in Guinea Pig Airway...of Nephrology Conference, Dec 89 Malinowski TR: Rhabdomyolysis Following Vaccination for Influenza. Hawaii Chapter Scientific Meeting, American College...Muscle Response to Acetylcholine and Histamine. Society for Pediatric Research Meeting, Anaheim, CA, May 90 (C) Stevens EL, Venkataraman BW, Southgate M

Health information technology: help or hindrance?

PubMed

Ketchersid, Terry

2014-07-01

The practice of medicine in general and nephrology in particular grows increasingly complex with each passing year. In parallel with this trend, the purchasers of health care are slowly shifting the reimbursement paradigm from one based on rewarding transactions, or work performed, to one that rewards value delivered. Within this context, the health-care value equation is broadly defined as quality divided by costs. Health information technology has been widely recognized as 1 of the foundations for delivering better care at lower costs. As the largest purchaser of health care in the world, the Centers for Medicare and Medicaid Services has deployed a series of interrelated programs designed to spur the adoption and utilization of health information technology. This review examines our known collective experience in the practice of nephrology to date with several of these programs and attempts to answer the following question: Is health information technology helping or hindering the delivery of value to the nation's health-care system? Through this review, it was concluded overall that the effect of health information technology appears positive; however, it cannot be objectively determined because of the infancy of its utilization in the practice of medicine. Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Evaluating sex and gender competencies in the medical curriculum: a case study.

PubMed

Miller, Virginia M; Flynn, Priscilla M; Lindor, Keith D

2012-06-01

Sex and gender differences exist in the manifestation and prevalence of many conditions and diseases. Yet many clinician training programs neglect to integrate this information across their curricula. This study aimed to measure the sex and gender medical knowledge of medical students enrolled in a program without an explicit directive to integrate sex and gender differences across a block system of core subjects. A forced-choice instrument consisting of 35 multiple-choice and true or false questions was adapted from an evaluation tool used in the European Curriculum in Gender Medicine held at Charité Hospital, Berlin, in September 2010. Fourth-year (response rate 93%) and second-year (response rate 70%) students enrolled in Mayo Medical School completed the instrument. More than 50% of students in both classes indicated that topics related to sex and gender were covered in gynecology, cardiology, and pediatrics, and <20% of students indicated inclusion of such topics in nephrology, neurology, and orthopedics. More than twice as many second-year students indicated that topics dealing with sex and gender were included in immunology course material compared with fourth-year students. A consensus of written comments indicated that concepts of sex and gender-based medicine need to be embedded into existing curriculum, with an emphasis on clinically relevant information. Although this study represents only one medical school in the United States, information regarding sex and gender aspects of medicine is not consistently included in this curriculum without an explicit directive. These results can provide guidance for curriculum improvement to train future physicians. Copyright © 2012 Elsevier HS Journals, Inc. All rights reserved.

E-Nephrology

PubMed Central

Manchanda, P. K.; Bid, H. K.

2011-01-01

Diagnosis of renal diseases is often delayed owing to the scarcity of trained physicians, lack of facilities, and shortage of funds limits effective management, particularly when it comes to the red zone of renal replacement therapy. The Internetis expected to open up a myriad resource of knowledge and applications for academicians, researchers and clinicians alike in all health care professions across the globe. Also, the Internet has grown rapidly over the years and will inevitably expand even more. Evolving technologies offer modern applications for information management, communications with multimedia and virtual reality. Now, these innovative technologies have opened up newer possibilities for nephrologists. As Internet is serving as a backbone for these modern technologies, it is an utmost necessity to use and refine Internet applications for future nephrologists. Increasingly easy access to Internet has dramatically reduced barriers in sharing of information among basic and clinical nephrologists. Considering the growing scope for nephrologists in the use of Internet, it is necessary to understand Internet as a source of information and backbone of modern application. This review illustrates expanding roles of the Internet for the nephrologists and provides ready to use compilation of useful academic, research, clinical resources and is expected to introduce, stimulate and guide nephrologists into the realm of the world wide web. It also investigates how Internet is supporting in growth and development of the field of nephrology and present and future scopes of Internet as a tool for professionals involved in this area as well as information about biological sciences, and it also gives information about societies in various continents working in field of nephrology and the links useful for clinicians and research scientists. PMID:21655161

Attitudes of Canadian nephrologists, family physicians and patients with kidney failure toward primary care delivery for chronic dialysis patients.

PubMed

Zimmerman, Deborah L; Selick, Avrum; Singh, Rajinder; Mendelssohn, David C

2003-02-01

Nephrologists have traditionally assumed responsibility for both nephrological and primary care health problems of their dialysis patients. However, given the increasing limitations of nephrology human resources, there is concern that traditional models may fall short of providing comprehensive care. We studied this issue by distributing three different self-administered surveys to 361 members of the Canadian Society of Nephrology, 325 family physicians, and 163 chronic dialysis patients. The overall response rate was 61.3% for nephrologists, 51% for family physicians, and 90% for patients. More than 50% of Canadian nephrologists are spending approximately one-third of their time in primary care delivery. The majority of these nephrologists and family physicians agree that nephrologists should not be solely responsible for the primary care of patients on dialysis. Yet, both groups of physicians have concerns that family physicians do not have the knowledge/training and time to care for this complicated group of patients. The patients themselves have more confidence in the primary care that is delivered by their family physicians than by their nephrologists. Unfortunately, there is little communication between the two physician groups either between themselves or with their patients about the services that should be provided by their nephrologist or their family physician. Nephrologists and family physicians agree that more primary care for dialysis patients should be provided by family physicians. However, the lack of communication between physicians and patients may result in either a duplication or omission of services that are required by this patient population. Dialysis delivery systems in Canada must evolve to ensure that comprehensive chronic dialysis and primary care is provided to these patients through cooperation and communication with primary care physicians.

[Using web 2.0 technologies and social media for the nephrologist].

PubMed

Santoro, Eugenio; Quintaliani, Giuseppe

2013-01-01

New media tools such as web 2.0 are increasingly being used in the medical field. RSS feeds, podcasts, blogs, wikis, online social networks and social media have all been proposed as innovative tools for the education and updating of clinicians, nurses, other health workers and medical students because of their ease of access and widespread use. Nephrology is one of the medical fields where these technologies have been successfully applied. Medical journals such as the American Journal Kidney Diseases and the Journal of the American Society of Nephrology, and medical societies such as the American Society of Nephrology, are all using these new and powerful communication tools. In addition, blogs and social networks have been developed to allow physicians to distribute, share and comment medical material concerning issues related to nephrology and kidney disease, including images, videos, slides, scientific abstracts and clinical trials updates. This review provides background information on the evolution of both web 2.0 and the social media and describes some of the most interesting applications of web 2.0 and its correlated tools in the field of nephrology.

EXPANDING CAPD IN LOW-RESOURCE SETTINGS: A DISTANCE LEARNING APPROACH.

PubMed

Rope, Robert; Nanayakkara, Nishantha; Wazil, Abdul; Dickowita, Sewmini; Abeyeskera, Rajitha; Gunerathne, Lishanthe; Adoosoriya, Dinuka; Karunasena, Nishamani; Ratnayake, Charaka; Anand, Shuchi; Saxena, Anjali

2018-05-23

Despite growing need, treatment for end-stage renal disease is limited in low- and middle-income countries due to resource restraints. We describe the development of an educational curriculum and quality improvement program to support continuous ambulatory peritoneal dialysis (CAPD) performed primarily by non-nephrology providers in Sri Lanka. We developed a program of education, outcome tracking, and expert consultation to support providers in Kandy, Sri Lanka. Education included videos and in-person didactics covering core topics in CAPD. Event-tracking sheets recorded root causes and management of infections and hospitalizations. Conferences reviewed clinical cases and overall clinic management. We evaluated the patient census, peritonitis rates, and root causes and management of infections over 1 year. The curriculum was published through the International Society of Nephrology online academy. High provider turnover limited curriculum assessments. The CAPD patient census rose from 63 to 116 during the year. The peritonitis rate declined significantly, from 0.8 episodes per patient-year in the first 6 months to 0.4 in the latter 6 months, though the most common root causes of peritonitis, related to contamination events and hygiene, persisted. The appropriate ascertainment of culture data and prescription of antibiotics also increased. Our project supported the expansion of a CAPD program in a resource-limited setting, while also improving peritonitis outcomes. Ongoing challenges include ensuring a durable educational system for rotating providers, tracking outcomes beyond peritonitis, and formalizing management protocols. Our program can serve as an example of how established dialysis programs can support the burgeoning work of providers in resource-limited setting.

Continuous Renal Replacement Therapy Improves Survival in Severely Burned Military Casualties with Acute Kidney Injury

DTIC Science & Technology

2008-02-01

of burn casualties with greater than 40% to- tal body surface area (TBSA) burns, acute kidney injury, or nephrology consultation in the 2 years before...TBSA burns with kidney injury with or without nephrology consultation (control group); 18 were treated with CRRT since (CRRT group). Groups were...with nephrology con- sultation in eight patients. Both 28-day mor- tality (22% vs. 75%, p 0.002) and in-hospital mortality (56% vs. 88%, p 0.04

Continuous Renal Replacement Therapy Improves Survival in Severely Burned Military Casualties With Acute Kidney Injury

DTIC Science & Technology

2007-10-01

of burn casualties with greater than 40% to- tal body surface area (TBSA) burns, acute kidney injury, or nephrology consultation in the 2 years before...TBSA burns with kidney injury with or without nephrology consultation (control group); 18 were treated with CRRT since (CRRT group). Groups were...with nephrology con- sultation in eight patients. Both 28-day mor- tality (22% vs. 75%, p 0.002) and in-hospital mortality (56% vs. 88%, p 0.04

Online CKD education for medical students, residents, and fellows: training in a new era.

PubMed

Bhasin, Bhavna; Estrella, Michelle M; Choi, Michael J

2013-07-01

CKD and its complications are associated with substantial morbidity and mortality. Studies have highlighted significant deficiencies in resident knowledge and awareness of CKD and its complications. There is a need to improve CKD education through medical school and residency. There is also a need to provide alternatives to traditional teaching methods to meet the challenges of learning in the context of work-hour restrictions and increasing workload among residents and fellows. Internet-based learning resources offer various educational tools, including websites, kidney blogs, online modules, and smartphone applications, which could potentially and efficiently advance CKD knowledge among medical trainees. In this review, we describe several online resources for CKD education that could be useful for medical students, residents, and fellows. Increased awareness of these tools and their utilization may significantly influence and hopefully improve the recognition and management of patients with CKD. Future studies may help evaluate the effectiveness of these online learning methods and their effect on CKD patient outcomes. In addition, in light of increased concern about nephrology workforce issues, the potential for these online tools to augment interest in nephrology careers should be investigated. Copyright © 2013 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Clinical Investigation Program, Reports Control Symbol MED-300(R1), Fiscal Year 1988

DTIC Science & Technology

1988-10-01

Dr. Venkataraman Balaraman, M.D. Department/Section: Clinical Investigation Key Words: arginine vasopressin (AVP); vascular smooth muscle responses...Kullama, Ph.D. Associate Investigators: Dr. Venkataraman Balaraman, M.D.; Dr. Kenneth T. Nakamura, M.D.; John R. Claybaugh, Ph.D. Department/Section...Harrison Hassell, MC Associate Investigators: John R. Claybaugh, Ph.D.; Arnold Siemsen, MD; Jon Streltzer, MD Department/Section: Medicine/ Nephrology

Attitudes and Opinions of Canadian Nephrologists Toward Continuous Quality Improvement Options.

PubMed

Iskander, Carina; McQuillan, Rory; Nesrallah, Gihad; Rabbat, Christian; Mendelssohn, David C

2017-01-01

A shift to holding individual physicians accountable for patient outcomes, rather than facilities, is intuitively attractive to policy makers and to the public. We were interested in nephrologists' attitudes to, and awareness of, quality metrics and how nephrologists would view a potential switch from the current model of facility-based quality measurement and reporting to publically available reports at the individual physician level. The study was conducted using a web-based survey instrument (Online Appendix 1). The survey was initially pilot tested on a group of 8 nephrologists from across Canada. The survey was then finalized and e-mailed to 330 nephrologists through the Canadian Society of Nephrology (CSN) e-mail distribution list. The 127 respondents were 80% university based, and 33% were medical/dialysis directors. The response rate was 43%. Results demonstrate that 89% of Canadian nephrologists are engaged in efforts to improve the quality of patient care. A minority of those surveyed (29%) had training in quality improvement. They feel accountable for this and would welcome the inclusion of patient-centered metrics of care quality. Support for public reporting as an effective strategy on an individual nephrologist level was 30%. Support for public reporting of individual nephrologist performance was low. The care of nephrology patients will be best served by the continued development of a critical mass of physicians trained in patient safety and quality improvement, by focusing on patient-centered metrics of care delivery, and by validating that all proposed new methods are shown to improve patient care and outcomes.

Medical student attitudes toward kidney physiology and nephrology: a qualitative study.

PubMed

Roberts, John K; Sparks, Matthew A; Lehrich, Ruediger W

2016-11-01

Interest in nephrology among trainees is waning in the USA. Early perceptions and attitudes to subject matter can be linked to the quality of pre-clinical curricula. We wanted to explore these attitudes in the setting of modern curriculum redesign. We utilized Q methodology to understand first-year medical student attitudes after an innovative kidney physiology curriculum redesign that focuses on blending multiple learning methods. First-year medical students were invited to take a Q sort survey at the conclusion of a kidney physiology course. Students prioritized statements related to their understanding of kidney physiology, learning preferences, preferred course characteristics, perceived clinical relevance of kidney physiology, and interest in nephrology as a career. Factor analysis was performed to identify different student viewpoints. At the conclusion of our modified course, all students (n = 108) were invited to take the survey and 44 (41%) Q sorts were returned. Two dominant viewpoints were defined according to interest in nephrology. The Potentials are students who understand kidney physiology, perceive kidney physiology as clinically relevant, attend class sessions, utilize videos, and are willing to shadow a nephrologist. The Uninterested are students who are less satisfied with their kidney physiology knowledge, prefer to study alone with a textbook, avoid lectures, and are not interested in learning about nephrology. In an updated renal physiology course, students that use multiple learning methods also have favorable attitudes toward learning kidney physiology. Thus, modern curriculum changes that accommodate a variety of learning styles may promote positive attitudes toward nephrology.

Do e-mail alerts of new research increase knowledge translation? A "Nephrology Now" randomized control trial.

PubMed

Tanna, Gemini V; Sood, Manish M; Schiff, Jeffrey; Schwartz, Daniel; Naimark, David M

2011-01-01

As the volume of medical literature increases exponentially, maintaining current clinical practice is becoming more difficult. Multiple, Internet-based journal clubs and alert services have recently emerged. The purpose of this study is to determine whether the use of the e-mail alert service, Nephrology Now, increases knowledge translation regarding current nephrology literature. Nephrology Now is a nonprofit, monthly e-mail alert service that highlights clinically relevant articles in nephrology. In 2007-2008, the authors randomized 1,683 subscribers into two different groups receiving select intervention articles, and then they used an online survey to assess both groups on their familiarity with the articles and their acquisition of knowledge. Of the randomized subscribers, 803 (47.7%) completed surveys, and the two groups had a similar number of responses (401 and 402, respectively). The authors noted no differences in baseline characteristics between the two groups. Familiarity increased as a result of the Nephrology Now alerts (0.23 ± 0.087 units on a familiarity scale; 95% confidence interval [CI]: 0.06-0.41; P = .007) especially in physicians (multivariate odds ratio 1.83; P = .0002). No detectable improvement in knowledge occurred (0.03 ± 0.083 units on a knowledge scale; 95% CI: -0.13 to 0.20; P = .687). An e-mail alert service of new literature improved a component of knowledge translation--familiarity--but not knowledge acquisition in a large, randomized, international population.

Peritoneal dialysis catheter implantation by nephrologists is associated with higher rates of peritoneal dialysis utilization: a population-based study.

PubMed

Perl, Jeffrey; Pierratos, Andreas; Kandasamy, Gokulan; McCormick, Brendan B; Quinn, Robert R; Jain, Arsh K; Huang, Anjie; Paterson, J Michael; Oliver, Matthew J

2015-02-01

The likelihood of peritoneal dialysis (PD) utilization following a PD catheter insertion attempt is poorly described. We explored the risk factors for PD nonuse, focusing on the method of PD catheter implantation. This population-based retrospective cohort study employed Ontario administrative health data to identify 3886 predialysis adults who had an incident PD catheter implantation between 2002 and 2010. The impact of the method of catheter implantation including open-surgical (open, n = 1884), surgical-laparoscopic (laparoscopic, n = 1154), nephrology-percutaneous (nephrology, n = 498) and radiology-percutaneous (radiology, n = 350) on rates of PD utilization (defined as four consecutive weeks of PD) was examined. Eighty-three percent of study patients received PD. After adjustment, relative to patients with openly inserted catheters, PD utilization was greater for those with nephrology-inserted catheters [adjusted hazard ratio (aHR) 1.59, 95% confidence interval (CI) 1.29-1.95] and similar for radiology-inserted catheters [aHR 1.16, 95% CI 0.94-1.43] or laparoscopic-inserted catheters [aHR 0.97 (95% CI 0.86-1.09)]. Among PD nonusers, death occurred in 10% of the open group, 6% of the laparoscopic group, 27% of the radiology group and in fewer than 3% of the nephrology group. Sixty-nine percent received hemodialysis in the open group, 63% in the laparoscopic group, 61% in the radiology group and 88% in the nephrology group. Those remaining predialysis comprised 12% of the open group, 22% of the laparoscopic group, 11% of the radiology group and <3% of the nephrology group. Nephrology insertion resulted in lower overall rates of PD nonuse, particularly due to death or remaining predialysis. Greater use may be related to insertion timing, technique or greater commitment on the part of nephrologists to the success of PD. © The Author 2014. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Emphasizing the Value of Nephrology Nursing Through Nursing-Sensitive Indicators: A Call for Action.

PubMed

Thomas-Hawkins, Charlotte; Latham, Carolyn E; Hain, Debra J

2017-01-01

Nursing is the largest healthcare profession in the United States (U.S.). As principal frontline caregivers in the U.S. healthcare system, nurses have tremendous influence over a patient's healthcare experience. A growing body of evidence states that the nursing workforce has a direct impact on healthcare quality. A standardized approach to measuring nursing's contribution to patient care and safety using nursing-sensitive quality indicators assists in examining the extent to which nurses and nursing affect the quality and safety of health care. This article focuses on nursing-sensitive quality indicators and discusses healthcare quality indicators and nursing-sensitive indicators used in the U.S. A summary of the work of the American Nephrology Nurses' Association Task Force on Nephrology Nursing-Sensitive Quality Indicators (NNSQI) and an NNSQI exemplar are provided. Copyright© by the American Nephrology Nurses Association.

Urinary stones in Malaysia--its incidence and management.

PubMed

Sreenevasan, G

1990-06-01

The life of Lord Moynihan is briefly reviewed. Incidence of stones in Peninsular Malaysia appears to show the same trend as in other industrialised countries. Management of urinary calculi both prior to and after the introduction of ESWL in a personal series is discussed. More than 90% of urinary stones are now treated by ESWL threatening the place of surgery in Urology. The pattern of incorporating renal transplantation into the urological training programme as practised in the Institute of Urology and Nephrology in Malaysia is suggested as a way to assure a place for surgery in Urology.

Lessons learned from the ASN Renal Educator Listserv and survey.

PubMed

Hoenig, Melanie P; Shapiro, Evelyn; Hladik, Gerald A

2013-06-01

Nephrology ranks next to last in career choices among US medical school graduates. The American Society of Nephrology established a Workforce Committee to help address this issue. Surveys of US medical students indicate that experiences during kidney pathophysiology courses in the preclerkship years may impact their decision to consider a career in nephrology. In October of 2011, preclinical kidney physiology and pathophysiology course directors at US medical schools were surveyed about teaching methods, curricular content, resources, and institutional support for teaching to identify what worked well and what impairs their teaching efforts. A Listserv of these educators, the American Society of Nephrology Renal Educators Listserv, was used to electronically administer the survey. Course leaders from 62 of 114 (54.4%) surveyed medical schools responded. Most of these educators are nephrologists, but physiologists and other clinicians also lead courses; 60% of course directors noted that lectures are videotaped, resulting in decreased attendance. A range of resources is used: 68% use audience response systems, 16% use the simulation center, and none of the educators indicated use of social media (such as Twitter or Facebook); 50% of respondents receive no remuneration, and 68% receive no full-time equivalent for their efforts. Audience response systems, virtual microscopy, and flash animations were identified as valuable teaching tools. Course directors, during subsequent dialogue on the American Society of Nephrology Renal Educators Listserv, have cited incorporation of case scenarios and integration of clinical exposure during preclinical years as methods that inspired interest. Hopefully, adoption of such approaches will ultimately serve to stimulate interest in nephrology.

An evaluation of Wikipedia as a resource for patient education in nephrology.

PubMed

Thomas, Garry R; Eng, Lawson; de Wolff, Jacob F; Grover, Samir C

2013-01-01

Wikipedia, a multilingual online encyclopedia, is a common starting point for patient medical searches. As its articles can be authored and edited by anyone worldwide, the credibility of the medical content of Wikipedia has been openly questioned. Wikipedia medical articles have also been criticized as too advanced for the general public. This study assesses the comprehensiveness, reliability, and readability of nephrology articles on Wikipedia. The International Statistical Classification of Diseases and Related problems, 10th Edition (ICD-10) diagnostic codes for nephrology (N00-N29.8) were used as a topic list to investigate the English Wikipedia database. Comprehensiveness was assessed by the proportion of ICD-10 codes that had corresponding articles. Reliability was measured by both the number of references per article and proportion of references from substantiated sources. Finally, readability was assessed using three validated indices (Flesch-Kincaid grade level, Automated readability index, and Flesch reading ease). Nephrology articles on Wikipedia were relatively comprehensive, with 70.5% of ICD-10 codes being represented. The articles were fairly reliable, with 7.1 ± 9.8 (mean ± SD) references per article, of which 59.7 ± 35.0% were substantiated references. Finally, all three readability indices determined that nephrology articles are written at a college level. Wikipedia is a comprehensive and fairly reliable medical resource for nephrology patients that is written at a college reading level. Accessibility of this information for the general public may be improved by hosting it at alternative Wikipedias targeted at a lower reading level, such as the Simple English Wikipedia. © 2013 Wiley Periodicals, Inc.

Assessment of the requisites of microbiology based infectious disease training under the pressure of consultation needs

PubMed Central

2011-01-01

Background Training of infectious disease (ID) specialists is structured on classical clinical microbiology training in Turkey and ID specialists work as clinical microbiologists at the same time. Hence, this study aimed to determine the clinical skills and knowledge required by clinical microbiologists. Methods A cross-sectional study was carried out between June 1, 2010 and September 15, 2010 in 32 ID departments in Turkey. Only patients hospitalized and followed up in the ID departments between January-June 2010 who required consultation with other disciplines were included. Results A total of 605 patients undergoing 1343 consultations were included, with pulmonology, neurology, cardiology, gastroenterology, nephrology, dermatology, haematology, and endocrinology being the most frequent consultation specialties. The consultation patterns were quite similar and were not affected by either the nature of infections or the critical clinical status of ID patients. Conclusions The results of our study show that certain internal medicine subdisciplines such as pulmonology, neurology and dermatology appear to be the principal clinical requisites in the training of ID specialists, rather than internal medicine as a whole. PMID:22177310

The Role of Clinical Pharmacists in Educating Nurses to Reduce Drug-Food Interactions (Absorption Phase) in Hospitalized Patients

PubMed Central

Abbasi Nazari, Mohammad; Salamzadeh, Jamshid; Hajebi, Giti; Gilbert, Benjamin

2011-01-01

Drug-food interactions can increase or decrease drug effects, resulting in therapeutic failure or toxicity. Activities that reduce these interactions play an important role for clinical pharmacists. This study was planned and performed in order to determine the role of clinical pharmacist in the prevention of absorption drug-food interactions through educating the nurses in a teaching hospital affiliated to Shahid Beheshti University of Medical Sciences, Tehran, Iran. The rate of interactions was determined using direct observation methods before and after the nurse training courses in four wards including gastrointestinal-liver, endocrine, vascular surgery and nephrology. Training courses consisted of the nurse attendance lecture delivered by a clinical pharmacist which included receiving information pamphlets. Total incorrect drug administration fell down from 44.6% to 31.5%. The analysis showed that the rate of absorption drug-food interactions significantly decreased after the nurse training courses (p < 0.001). Clinical pharmacist can play an important role in nurse training as an effective method to reduce drug-food interactions in hospitals. PMID:24363698

Biomarkers and surrogate endpoints in kidney disease.

PubMed

Hartung, Erum A

2016-03-01

Kidney disease and its related comorbidities impose a large public health burden. Despite this, the number of clinical trials in nephrology lags behind many other fields. An important factor contributing to the relatively slow pace of nephrology trials is that existing clinical endpoints have significant limitations. "Hard" endpoints for chronic kidney disease, such as progression to end-stage renal disease, may not be reached for decades. Traditional biomarkers, such as serum creatinine in acute kidney injury, may lack sensitivity and predictive value. Finding new biomarkers to serve as surrogate endpoints is therefore an important priority in kidney disease research and may help to accelerate nephrology clinical trials. In this paper, I first review key concepts related to the selection of clinical trial endpoints and discuss statistical and regulatory considerations related to the evaluation of biomarkers as surrogate endpoints. This is followed by a discussion of the challenges and opportunities in developing novel biomarkers and surrogate endpoints in three major areas of nephrology research: acute kidney injury, chronic kidney disease, and autosomal dominant polycystic kidney disease.

The Social Media Revolution in Nephrology Education.

PubMed

Colbert, Gates B; Topf, Joel; Jhaveri, Kenar D; Oates, Tom; Rheault, Michelle N; Shah, Silvi; Hiremath, Swapnil; Sparks, Matthew A

2018-05-01

The past decade has been marked by the increasing use of social media platforms, often on mobile devices. In the nephrology community, this has resulted in the organic and continued growth of individuals interested in using these platforms for education and professional development. Here, we review several social media educational resources used in nephrology education and tools including Twitter, videos, blogs, and visual abstracts. We will also review how these tools are used together in the form of games (NephMadness), online journal clubs (NephJC), interactive learning (GlomCon), and digital mentorship (Nephrology Social Media Collective [NSMC] Internship) to build unique educational experiences that are available globally 24 hours per day. Throughout this discussion, we focus on specific examples of free open-access medical education (FOAMed) tools that provide education and professional growth at minimal or no cost to the user. In addition, we discuss inclusion of FOAMed resource development in the promotion and tenure process, along with potential pitfalls and future directions.

Systems Thinking and Leadership: How Nephrologists Can Transform Dialysis Safety to Prevent Infections.

PubMed

Wong, Leslie P

2018-04-06

Infections are the second leading cause of death for patients with ESKD. Despite multiple efforts, nephrologists have been unable to prevent infections in dialysis facilities. The American Society of Nephrology and the Centers for Disease Control and Prevention have partnered to create Nephrologists Transforming Dialysis Safety to promote nephrologist leadership and engagement in efforts to "Target Zero" preventable dialysis infections. Because traditional approaches to infection control and prevention in dialysis facilities have had limited success, Nephrologists Transforming Dialysis Safety is reconceptualizing the problem in the context of the complexity of health care systems and organizational behavior. By identifying different parts of a problem and attempting to understand how these parts interact and produce a result, systems thinking has effectively tackled difficult problems in dynamic settings. The dialysis facility is composed of different physical and human elements that are interconnected and affect not only behavior but also, the existence of a culture of safety that promotes infection prevention. Because dialysis infections result from a complex system of interactions between caregivers, patients, dialysis organizations, and the environment, attempts to address infections by focusing on one element in isolation often fail. Creating a sense of urgency and commitment to eradicating dialysis infections requires leadership and motivational skills. These skills are not taught in the standard nephrology or medical director curriculum. Effective leadership by medical directors and engagement in infection prevention by nephrologists are required to create a culture of safety. It is imperative that nephrologists commit to leadership training and embrace their potential as change agents to prevent infections in dialysis facilities. This paper explores the systemic factors contributing to the ongoing dialysis infection crisis in the United States and the role of nephrologists in instilling a culture of safety in which infections can be anticipated and prevented. Copyright © 2018 by the American Society of Nephrology.

Professor Rastislav Dzúrik: the Man and the Scientist.

PubMed

Derzsiová, Katarina; Mydlík, Miroslav

2016-02-01

Rastislav Dzrik, finished his medical study at the Medical School of Comenius University in Bratislava in 1953. After graduation he began to work at the Institute of chemistry and biochemistry of the Medical School and in 1957 he continued working at the IIIrd Internal Clinic of this faculty, which became later the base of "Internal School of Professor T. R. Niederland" with biochemical focusing. In the year 1967 ProfessorDzrik in cooperation with ProfessorJan Brod founded the Nephrological Section of the Slovak Internal Society and then the postgraduate scientific-research activity in nephrology began. The main topics of his scientific activity, in which he received many priority results, were: Isolation and characteristic of inhibitor of glucose utilisation and of inhibitor of renal gluconeogenesis; Effect of "middle molecular substances, especially in the development of renal insufficiency; Isolation and identification of hippurate and pseudouridine. His publishing activity was manifested in more than 500 scientific papers, several monographs and many chapters in various textbooks and manuals of internal medicine and clinical biochemistry, and more than 1,000 citations. The most important success of Professor Dzrik was the textbook "Nephrology which was published in 2004 and he was its main editor. Rastislav Dzriks impact on the field of Nephrology in Slovakia was manifold. It included his complex work of clinical nephrology, his pedagogical activities, and last but not least his excellent organizing abilities.

Perceived barriers to guidelines in peritoneal dialysis.

PubMed

Allen, Nathan; Schwartz, Daniel; Sood, Amy R; Mendelssohn, David; Verrelli, Mauro; Tanna, Gemini; Schiff, Jeff; Komenda, Paul; Rigatto, Claudio; Sood, Manish M

2011-05-01

Little is known regarding barriers to guideline adherence in the nephrology community. We set out to identify perceived barriers to evidence-based medicine (EBM) and measurement of continuous quality indicators (CQI) in an international cohort of peritoneal dialysis (PD) practitioners. Subscribers to an online nephrology education site (Nephrology Now) were invited to participate in an online survey. Nephrology Now is a non-profit, monthly mailing list that highlights clinically relevant articles in nephrology. Four hundred and seventy-five physicians supplying PD care participated in an online survey assessing their use of EBM and CQI in their PD practice. Ordinal logistic regression was utilized to determine relationships between baseline characteristics and EBM and CQI practices. The majority of physicians were nephrologists (89.7%), and 50.4% worked in an academic centre. Respondents were from the following geographic regions: 13.5% Canadian, 24% American, 23.8% European, 4.4% Australian, 5.3% South American, 10.7% African and 12.2% Asian. Adherence to PD clinical practice guidelines were generally strong; however, lower adherence was associated with countries with lower healthcare expenditure, not using personal digital assistant (PDA), the longer the physician had been practising and smaller (< 20 patients per centre) PD practice. International variation in guideline adherence may be influenced by a country's healthcare expenditure, physician's PDA use and experience, and size of PD practice which may impact future guideline development and implementation.

[The Declaration of Istanbul on organ trafficking and transplant tourism].

PubMed

2009-01-01

A Summit Meeting that convened over 150 representatives of scientific and medical bodies from around the world was held in Istanbul from April 30 to May 2, 2008 to address the urgent and growing problem of organ sales, transplant tourism and trafficking in organ donors in the context of the global shortage of organs. Preparatory work for the meeting was undertaken by a Steering Committee convened by The Transplantation Society and the International Society of Nephrology in Dubai in December 2007. Participants at the Istanbul Summit were selected by the Steering Committee according to the following criteria: The country liaisons with The Transplantation Society representing virtually all countries with transplantation programs; representatives from international societies and the Vatican; key stakeholders in nephrology and transplantation; public policy experts in organ transplantation; and ethicists, anthropologists, sociologists, and legal academic well-recognized for their work on transplantation policy and practice. This Declaration represents the consensus of the Summit participants and is an authorized Spanish translation that will help disseminate this information among Mexican health professionals and interested readers.

[The Declaration of Istanbul on organ trafficking and transplant tourism].

PubMed

2008-01-01

To address the urgent and growing problems of organ sales, transplant tourism and trafficking in organ donors in context of global shortage of organs a Summit Meeting of more than 150 representatives of scientific and medical bodies from around the world was held in Istanbul from April 30 to May 2, 2008. Preparatory work for the meeting was undertaken by a Steering Committee convened by The Transplantation Society and the International Society of Nephrology in Dubai in 2007. Participants at the Istanbul Summit were selected by the Steering Committee according to the following considerations: The country liaisons with The Transplantation Society representing virtually all countries with transplantation programs; Representatives from international societies and the Vatican; Individuals holding leadership positions in nephrology and transplantation; Stakeholders in the public policy aspect of organ transplantation; and ethicists, anthropologists, sociologists, and legal academic well recognized for their writings regarding transplantation policy and practice. This Declaration represents the consensus of the Summit participants and it is an authorized Spanish translation version in order to divulging between Mexican healths professionals and to who concern this topic.

[Urinalysis in Italy in 2006].

PubMed

Gai, M; Lanfranco, G

2007-01-01

Urinalysis and proteinuria testing represent fundamental tests for the clinician, even though they too often lack standardization. Through the Italian Society of Nephrology Mailing List we sent a questionnaire to 282 centers, in order to assess the state of the art in Italy in the year 2006. 82% of the questionnaires were completed (nephrology laboratories: 64%, general laboratories: 36%). The questionnaire dealt with the main steps of preparation, analysis and report of urinalysis, and proteinuria / microalbuminuria measurement. 85% of the centers use first morning urine, and 7% second morning urine; only 57% of the centers supply with written instructions, 189 laboratories (82%) have only one bright field microscope, rate and time of centrifugation are very varied among centers, different units of measurement are used in reports. Few laboratories measure routinely the proteinuria / creatininuria ratio, there is no agreement on the urine sample type for microalbuminuria assay, total urinary proteins are measured through different methods. 92% of the centers is endowed with an internal quality control system, but only 47% participate in an external quality control program. These data confirm the lack of standardization for urine analysis methods and procedures.

Toward population management in an integrated care model.

PubMed

Maddux, Franklin W; McMurray, Stephen; Nissenson, Allen R

2013-04-01

Under the Patient Protection and Affordable Care Act of 2010, accountable care organizations (ACOs) will be the primary mechanism for achieving the dual goals of high-quality patient care at managed per capita costs. To achieve these goals in the newly emerging health care environment, the nephrology community must plan for and direct integrated delivery and coordination of renal care, focusing on population management. Even though the ESRD patient population is a complex group with comorbid conditions that may confound integration of care, the nephrology community has unique experience providing integrated care through ACO-like programs. Specifically, the recent ESRD Management Demonstration Project sponsored by the Centers for Medicare & Medicaid Services and the current ESRD Prospective Payment System with it Quality Incentive Program have demonstrated that integrated delivery of renal care can be accomplished in a manner that provides improved clinical outcomes with some financial margin of savings. Moving forward, integrated renal care will probably be linked to provider performance and quality outcomes measures, and clinical integration initiatives will share several common elements, namely performance-based payment models, coordination of communication via health care information technology, and development of best practices for care coordination and resource utilization. Integration initiatives must be designed to be measured and evaluated, and, consistent with principles of continuous quality improvement, each initiative will provide for iterative improvements of the initiative.

Toward population management in an integrated care model.

PubMed

Maddux, Franklin W; McMurray, Stephen; Nissenson, Allen R

2013-01-01

Under the Patient Protection and Affordable Care Act of 2010, accountable care organizations (ACOs) will be the primary mechanism for achieving the dual goals of high-quality patient care at managed per capita costs. To achieve these goals in the newly emerging health care environment, the nephrology community must plan for and direct integrated delivery and coordination of renal care, focusing on population management. Even though the ESRD patient population is a complex group with comorbid conditions that may confound integration of care, the nephrology community has unique experience providing integrated care through ACO-like programs. Specifically, the recent ESRD Management Demonstration Project sponsored by the Centers for Medicare & Medicaid Services and the current ESRD Prospective Payment System with it Quality Incentive Program have demonstrated that integrated delivery of renal care can be accomplished in a manner that provides improved clinical outcomes with some financial margin of savings. Moving forward, integrated renal care will probably be linked to provider performance and quality outcomes measures, and clinical integration initiatives will share several common elements, namely performance-based payment models, coordination of communication via health care information technology, and development of best practices for care coordination and resource utilization. Integration initiatives must be designed to be measured and evaluated, and, consistent with principles of continuous quality improvement, each initiative will provide for iterative improvements of the initiative. © 2013 S. Karger AG, Basel.

[The classics of Italian nephrology: the monograph ''Le nefropatie'' (Renal diseases) 1880-1946].

PubMed

Ferrata, Adolfo

2007-01-01

This paper, the first of the new feature ''The Classics of Italian Nephrology'', describes the monograph published in 1940 ''Le nefropatie. Manuale per i medici e studenti'' (Renal Diseases. Handbook for Doctors and Students). It was written by Adolfo Ferrata (1880-1946), who is remembered today for his important contributions to the advancement of hematology. The book, which has more than 400 pages and many illustrations, especially of pathologic anatomy, is the product of teamwork involving several pupils and coworkers of Ferrata. It describes all aspects of medical renal diseases known at the time, and from an historical viewpoint represents an interesting testimony of the nephrological practice in Italy in the 1940s.

Education on fluid management and encouraging critical thinking skills.

PubMed

Dale, Willette

2012-01-01

The unit is currently utilizing hematocrit-based blood volume monitoring on each patient, resulting in improved monitoring in patients achieving their target weight. The nurses expressed confidence in their understanding of the use of hematocrit-based blood volume monitoring. This learning experience provided a vivid look at the importance of fluid management in nephrology nursing. This area should always be included in nephrology nurse competencies and represented in a way that it ignites critical thinking within the nursing professional. It is the responsibility of a professional nurse to stay current in evidence-based practice and continuing education. Professional pride stimulates nephrology nurses to seek new learning experiences to enhance their practice.

Biomarkers and surrogate endpoints in kidney disease

PubMed Central

2015-01-01

Kidney disease and its related comorbidities impose a large public health burden. Despite this, the number of clinical trials in nephrology lags behind many other fields. An important factor contributing to the relatively slow pace of nephrology trials is that existing clinical endpoints have significant limitations. “Hard” endpoints for chronic kidney disease, such as progression to end-stage renal disease, may not be reached for decades. Traditional biomarkers, such as serum creatinine in acute kidney injury, may lack sensitivity and predictive value. Finding new biomarkers to serve as surrogate endpoints is therefore an important priority in kidney disease research and may help to accelerate nephrology clinical trials. In this paper, I first review key concepts related to the selection of clinical trial endpoints and discuss statistical and regulatory considerations related to the evaluation of biomarkers as surrogate endpoints. This is followed by a discussion of the challenges and opportunities in developing novel biomarkers and surrogate endpoints in three major areas of nephrology research: acute kidney injury, chronic kidney disease, and autosomal dominant polycystic kidney disease. PMID:25980469

Recent advances in nephrology: highlights from the 35th annual meeting of the American society of nephrology.

PubMed

Cases, Aleix

2002-12-01

The 35th Annual Meeting of the American Society of Nephrology, held in Philadelphia, Pennsylvania, United States (October 30 to November 4, 2002) presented the newest advances in basic and clinical nephrology science. Several presentations and symposia discussed the effects of various interventions and risk factors in clinical outcomes in dialysis patients. The recent evidences of pure red cell aplasia secondary to neutralizing antibodies against erythropoietin were also extensively discussed in a special symposium. Recent advances in the management of calcium phosphorus metabolism and secondary hyperparathyroidism, such as the clinical efficacy and safety of AMG-073, a new calcimimetic agent in the control of hyperparathyroidism in chronic kidney disease patients, or the use of sevelamer or lanthanum carbonate as phosphate binders, were presented. The results in animal models on improved sparing of renal function with rapamycin versus cyclosporin A represent a promising advance in renal transplantation. Finally, the recent discoveries with the newly identified disease gene PKHD1, which causes autosomal recessive polycystic kidney disease, were also presented at the meeting. (c) 2002 Prous Science. All rights reserved.

[Historical archives of Italian nephrology: The history of instrumentation in nephrology. Part I: Theoretical bases].

PubMed

Timio, M

2002-01-01

Microscopes and artificial kidneys have greatly influenced both diagnosis and therapy of renal diseases. Nonetheless, in tracing the influence of instrumentation on nephrology, as revealed by daily activity, we have to recognise the influence of science upon medical instruments. It is for this reason that, besides strictly clinical factors, the scientific factors that contributed to the development of modern nephrology have received considerable attention. Nobody can use an artificial kidney without bearing in mind the contribution of many segments of science. Each segment has a hypothesis in its historical growth, development and decline. The notion that the advancement of science was made possible by the increasing reliance measurements and other quantitative procedure is hardly a novel one. Moreover, it is rather obvious that the experimental process and the use of instrumentation played an important role in the history of nephrology. Measurements, experiments and the use of instruments were interrelated and represented many phases of the improvements made in diagnosis and therapeutics. Naturally, in the history and epistemology of nephrology instrumentation we find conceptual mistakes and erroneous approaches to the biological reality. However, according to Popper's teachings, mistakes are good for science as they give an extra kick to its growth and development. Medical instrumentation is an assembly of scientific theories; it also controls medical theories and promotes the development of new ones. In addition, it changed our approach to the patient. In the pre-physical era, medical practice was almost entirely an intellectual process based on medical theories that the patient was not expected to understand. In the period of physical examinations the physician included the sensual dimension (oral and visual process) and made direct contact with the patient. In the instrumentation period we experience the third type of examination, in which the physician went back to the position of having less contact with the patient. This separation is reminiscent of the pre-physical diagnosis.

Role of physician assistants in dialysis units and nephrology.

PubMed

Anderson, J E; Torres, J R; Bitter, D C; Anderson, S C; Briefel, G R

1999-04-01

We surveyed physician assistants who work in nephrology to report their experience level, primary employer, salary, job responsibilities, and job satisfaction. Additional data were obtained from the Nephrology Manpower Study. The 67 responding physician assistants of 97 surveyed have 10.8 +/- 6.5 years (mean +/- standard deviation) total experience (6.2 +/- 5.0 years in nephrology). Typically, nephrologists (56.1%) or hospitals (30.3%) employ them. The majority (74%) earn $49,999 to $75,000; 79.1% work in outpatient units, 52.4% in inpatient units, 52.4% in hospitals, 43.3% in outpatient offices, and 23.9% in transplant units. In outpatient units, they manage 111 +/- 111 patients, mostly in free-standing (71.1%), for-profit (69.7%), corporately owned (87.3%) units in urban (80%) or suburban (18%) areas. Most (>85%) manage all dialysis- and nondialysis-related problems, including health maintenance; 84.3% are contacted first by staff, and 78% see patients more often than physicians. Of nephrologists who responded to the Manpower Study, 8.9% work with physician assistants and 20.7% work with nurse practitioners. Nephrologists in academic practice or private nephrology groups are more likely to use physician assistants (P < 0.05) and nurse practitioners (P < 0.005) than those in solo practice or multispecialty groups. Nephrologists with physician assistants (33.8 +/- 19.5 v 41.7 +/- 16.8 h/wk) or nurse practitioners (35.8 +/- 18.1 v 42.7 +/- 16.9 h/wk) tended to spend less time in direct patient care than those without physician extenders (P < 0.001). Nephrologists with renal fellows, however, spent the least time of all in direct patient care (30.0 +/- 15.9 v 47.3 +/- 14.9 h/wk; P < 0.001). Physician assistants can perform nearly all the medical tasks in dialysis units. They may offer one approach to providing effective and complete care for patients if nephrology manpower becomes limited.

Nephrology and astrology--is there a link?

PubMed

Hughes, S

1990-07-01

Astrologers presume a link between the susceptibility of particular organs to disease and signs of the Zodiac. A simple test of the positive connection between renal disease and the sign of Libra was undertaken by studying the birth dates of consecutive nephrology in-patient admissions. No significant link was found on analysis, thus disproving the traditional astrologers' claims.

[Brazilian studies on nephrology produced in nursing thesis and dissertations].

PubMed

de Carvalho, Glória Maria Custódio; Lima, Francisca Elisângela Teixeira; Barbosa, Islene Victor; Melo, Elisabeth Mesquita

2010-01-01

The purpose was to evaluate the scientific production in Brazilian nursing about nephrology in theses and dissertations published from 2001 to 2007. A bibliometric study was carried out with the nursing thesis and dissertations according to the Center of Studies and Researches in Nursing catalog. It was found 50 works on nephrology, predominating: 45 (90%) dissertations; 30 (60%) in the state of São Paulo; 18 (36%) in clinics of dialysis; 39 (78%) samples were patients. Considering the types of study, it predominated: 26 (52%) exploratory, 28 (56%) survey and 27 (54%) quantitative. Concerning the theme, hemodialysis predominated with 21 (42%) publications. Scientific researches on this theme make possible a multi and interdisciplinary assistance to these clients, in an individualized, systematized and humanized way.

The Level of Anxiety and Depression in Dialysis Patients Undertaking Regular Physical Exercise Training--a Preliminary Study.

PubMed

Dziubek, Wioletta; Kowalska, Joanna; Kusztal, Mariusz; Rogowski, Łukasz; Gołębiowski, Tomasz; Nikifur, Małgorzata; Szczepańska-Gieracha, Joanna; Zembroń-Łacny, Agnieszka; Klinger, Marian; Woźniewski, Marek

2016-01-01

The aim of the study was to evaluate the effects of a six-month physical training undertaken by haemodialysis (HD) patients, on the depression and anxiety. Patients with end stage renal disease (ESRD) were recruited from the dialysis station at the Department of Nephrology and Transplantation Medicine in Wroclaw. Physical training took place at the beginning of the first 4-hours of dialysis, three times a week for six months. A personal questionnaire, Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) were used in the study. A total of 28 patients completed the study: 20 were randomised to endurance training and 8 were randomised to resistance training. Statistical analysis of depression and anxiety at the initial (t1) and final examination (t2) indicated a significant reduction in depression and anxiety, particularly anxiety as a trait (X2) in the whole study group. The change in anxiety as a state correlated with the disease duration, duration of dialysis and the initial level of anxiety as a state (t1X1). The change in anxiety as a trait significantly correlated with age and the initial level of anxiety (t1X2). Undertaking physical training during dialysis by patients with ESRD is beneficial in reducing their levels of anxiety and depression. Both resistance and endurance training improves mood, but only endurance training additionally results in anxiety reduction. © 2016 S. Karger AG, Basel.

Experienced physicians benefit from analyzing initial diagnostic hypotheses

PubMed Central

Bass, Adam; Geddes, Colin; Wright, Bruce; Coderre, Sylvain; Rikers, Remy; McLaughlin, Kevin

2013-01-01

Background Most incorrect diagnoses involve at least one cognitive error, of which premature closure is the most prevalent. While metacognitive strategies can mitigate premature closure in inexperienced learners, these are rarely studied in experienced physicians. Our objective here was to evaluate the effect of analytic information processing on diagnostic performance of nephrologists and nephrology residents. Methods We asked nine nephrologists and six nephrology residents at the University of Calgary and Glasgow University to diagnose ten nephrology cases. We provided presenting features along with contextual information, after which we asked for an initial diagnosis. We then primed participants to use either hypothetico-deductive reasoning or scheme-inductive reasoning to analyze the remaining case data and generate a final diagnosis. Results After analyzing initial hypotheses, both nephrologists and residents improved the accuracy of final diagnoses (31.1% vs. 65.6%, p < 0.001, and 40.0% vs. 70.0%, p < 0.001, respectively). We found a significant interaction between experience and analytic processing strategy (p = 0.02): nephrology residents had significantly increased odds of diagnostic success when using scheme-inductive reasoning (odds ratio [95% confidence interval] 5.69 [1.59, 20.33], p = 0.07), whereas the performance of experienced nephrologists did not differ between strategies (odds ratio 0.57 [0.23, 1.39], p = 0.20). Discussion Experienced nephrologists and nephrology residents can improve their performance by analyzing initial diagnostic hypotheses. The explanation of the interaction between experience and the effect of different reasoning strategies is unclear, but may relate to preferences in reasoning strategy, or the changes in knowledge structure with experience. PMID:26451203

[Nephrology as seen by nephrologists. An introspective investigation into the history and future of the professional community].

PubMed

Susi, Alessandra

2010-01-01

The professional community of nephrologists is going through a phase of ''rethinking'' the discipline that sees the role of nephrologists in an uncertain position between inpatient and outpatient care. A comparison of opinions within the community is necessary to understand what could be the future position of nephrology in the Italian healthcare system. In June 2009 a questionnaire was distributed among the members of the Italian Nephrology Society (SIN) to collect (i) their professional biographies and (ii) their opinion on the state of the art of nephrology, (iii) the working context in which they operate, (iv) the likely sources of change, and (v) the prospects for the development of the field. In October 2009 the respondents were 506, a sufficiently representative sample of the national population of nephrologists. One of the main findings was a lack of consensus about the clinical practice for the treatment of CKD. In particular, there was no general agreement about the stage of CKD at which the patient should enter the exclusive care of the nephrologist. Opinions were less divergent on (i) departmentalization phenomena, (ii) the outsourcing of dialysis services, and (iii) the future prospects of the specialty. In order to pursue common goals for the development of the discipline, the internal relations of the professional community should be strengthened both in terms of sharing clinical experience and defining the roles of clinicians within the community. The involvement of young nephrologists in the definition of strategies for the positioning of nephrology in the Italian healthcare system might also be considered a priority.

Evaluating the feasibility of the KDIGO CKD referral recommendations.

PubMed

Singh, Karandeep; Waikar, Sushrut S; Samal, Lipika

2017-07-07

In 2012, the international nephrology organization Kidney Disease Improving Global Outcomes (KDIGO) released recommendations for nephrology referral for chronic kidney disease (CKD) patients. The feasibility of adhering to these recommendations is unknown. We conducted a retrospective analysis of the primary care population at Brigham and Women's Hospital (BWH). We translated referral recommendations based upon serum creatinine, estimated glomerular filtration rate (eGFR), and albuminuria into a set of computable criteria in order to project referral volume if the KDIGO referral recommendations were to be implemented. Using electronic health record data, we evaluated each patient using the computable criteria at the times that the patient made clinic visits in 2013. We then compared the projected referral volume with baseline nephrology clinic volume. Out of 56,461 primary care patients at BWH, we identified 5593 (9.9%) who had CKD based on albuminuria or estimated GFR. Referring patients identified by the computable criteria would have resulted in 2240 additional referrals to nephrology. In 2013, this would represent a 38.0% (2240/5892) increase in total nephrology patient volume and 67.3% (2240/3326) increase in new referral volume. This is the first study to examine the projected impact of implementing the 2012 KDIGO referral recommendations. Given the large increase in the number of referrals, this study is suggestive that implementing the KDIGO referral guidelines may not be feasible under current practice models due to a supply-demand mismatch. We need to consider new strategies on how to deliver optimal care to CKD patients using the available workforce in the U.S. health care system.

A Peer-to-Peer Mentoring Program for In-Center Hemodialysis: A Patient-Centered Quality Improvement Program.

PubMed

St Clair Russell, Jennifer; Southerland, Shiree; Huff, Edwin D; Thomson, Maria; Meyer, Klemens B; Lynch, Janet R

2017-01-01

A patient-centered quality improvement program implemented in one Virginia hemodialysis facility sought to determine if peer-to-peer (P2P) programs can assist patients on in-center hemodialysis with self-management and improve outcomes. Using a single-arm, repeatedmeasurement, quasi-experimental design, 46 patients participated in a four-month P2P intervention. Outcomes include knowledge, self-management behaviors, and psychosocial health indicators: self-efficacy, perceived social support, hemodialysis social support, and healthrelated quality of life (HRQoL). Physiological health indicators included missed and shortened treatments, arteriovenous fistula placement, interdialytic weight gain, serum phosphorus, and hospitalizations. Mentees demonstrated increased knowledge, self-efficacy, perceived social support, hemodialysis social support, and HRQoL. Missed treatments decreased. Mentors experienced increases in knowledge, self-management, and social support. A P2P mentoring program for in-center hemodialysis can benefit both mentees and mentors. Copyright© by the American Nephrology Nurses Association.

Standardization of pediatric uroradiological terms: a multidisciplinary European glossary.

PubMed

Vivier, Pierre-Hugues; Augdal, Thomas A; Avni, Fred E; Bacchetta, Justine; Beetz, Rolf; Bjerre, Anna K; Blickman, Johan; Cochat, Pierre; Coppo, Rosana; Damasio, Beatrice; Darge, Kassa; El-Ghoneimi, Alaa; Hoebeke, Piet; Läckgren, Göran; Leclair, Marc-David; Lobo, Maria-Luisa; Manzoni, Gianantonio; Marks, Stephen D; Mattioli, Girolamo; Mentzel, Hans-Joachim; Mouriquand, Pierre; Nevéus, Tryggve; Ntoulia, Aikaterini; Ording-Muller, Lil-Sofie; Oswald, Josef; Papadopoulou, Frederica; Porcellini, Gabriella; Ring, Ekkehard; Rösch, Wolfgang; Teixeira, Ana F; Riccabona, Michael

2018-02-01

To promote the standardization of nephro-uroradiological terms used in children, the European Society of Paediatric Radiology uroradiology taskforce wrote a detailed glossary. This work has been subsequently submitted to European experts in pediatric urology and nephrology for discussion and acceptance to improve the quality of radiological reports and communication between different clinicians involved in pediatric urology and nephrology.

[Census of the renal and dialysis units by Italian Society of Nephrology: structure and organization for renal patient assistance in Italy (2014-2015)].

PubMed

Quintaliani, Giuseppe; Di Luca, Marina; Di Napoli, Anteo; Viglino, Giusto; Postorino, Maurizio; Amore, Alessandro; Andrulli, Simeone; Bellasi, Antonio; Brunori, Giuliano; Buongiorno, Erasmo; Castellino, Santina; D'Amelio, Alessandro; De Nicola, Luca; Gesualdo, Loreto; Di Landro, Domenico; Feriozzi, Sandro; Strippoli, Giovanni; Teatini, Ugo; Santoro, Antonio

2016-01-01

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. 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. 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.

[Cell engineering in nephrology: The current state and prospectives from the point of view of military medicine].

PubMed

Bel'skih, A N; Golota, A S; Krassii, A B; Nagibovich, O A

2015-09-01

This article is dedicated to the current state and prospectives of cell engineering in nephrology from the point of view of military medicine. The review is based on publications from January 1, 2014, to June 1, 2015, and consists of two parts. In the first part the main directions of the cell engineering development are mentioned. The only two clinical trials existed in the field are discussed in more detail. The second part deals with prospectives of cell engineering in nephrology. It is shown that currently this field is in the stage of preclinical experimentation. Of the two known clinical trials the first has failed to demonstrate any effectiveness of cell engineering, the second--will be completed only at the end of 2016. Also, the review notes an extraordinary cost of cell engineering experiments in nephrology. The analysis of publications allows to come to a conclusion that the future progress in prevention and treatment of acute kidney injury could go not in the direction of cell engineering but rather non-cell technologies. One of. the practical consequence of such a conclusion is a necessity to continue the improvement of already existing methods of machine renal replacement therapy.

Standardization of pediatric uroradiological terms: A multidisciplinary European glossary.

PubMed

Vivier, Pierre-Hugues; Augdal, Thomas A; Avni, Fred E; Bacchetta, Justine; Beetz, Rolf; Bjerre, Anna K; Blickman, Johan; Cochat, Pierre; Coppo, Rosana; Damasio, Beatrice; Darge, Kassa; El-Ghoneimi, Alaa; Hoebeke, Piet; Läckgren, Göran; Leclair, Marc-David; Lobo, Maria-Luisa; Manzoni, Gianantonio; Marks, Stephen D; Mattioli, Girolamo; Mentzel, Hans-Joachim; Mouriquand, Pierre; Nevéus, Tryggve; Ntoulia, Aikaterini; Ording-Muller, Lil-Sofie; Oswald, Josef; Papadopoulou, Frederica; Porcellini, Gabriella; Ring, Ekkehard; Rösch, Wolfgang; Teixeira, Ana F; Riccabona, Michael

2017-12-01

To promote the standardization of nephro-uroradiological terms used in children, the European Society of Pediatric Radiology uroradiology taskforce wrote a detailed glossary. This work has been subsequently submitted to European experts in pediatric urology and nephrology for discussion and acceptance to improve the quality of radiological reports and communication among different clinicians involved in pediatric urology and nephrology. Copyright © 2017. Published by Elsevier Ltd.

From Passive to Active Learners: The "Lived Experience" of Nurses in a Specialist Nephrology Nursing Education Programme

ERIC Educational Resources Information Center

Bridger, Jane

2007-01-01

Purpose: This study aims to explore the lived experience of learning for a group of staff nurses in the Middle East, who undertook a post-registration nursing education programme in the speciality of nephrology nursing (the NNP) between 2001 and 2002. The broad-based curriculum seeks to develop the staff nurses into active learners, able to…

The Full Spectrum of Clinical Ethical Issues in Kidney Failure. Findings of a Systematic Qualitative Review.

PubMed

Kahrass, Hannes; Strech, Daniel; Mertz, Marcel

2016-01-01

When treating patients with kidney failure, unavoidable ethical issues often arise. Current clinical practice guidelines some of them, but lack comprehensive information about the full range of relevant ethical issues in kidney failure. A systematic literature review of such ethical issues supports medical professionalism in nephrology, and offers a solid evidential base for efforts that aim to improve ethical conduct in health care. To identify the full spectrum of clinical ethical issues that can arise for patients with kidney failure in a systematic and transparent manner. A systematic review in Medline (publications in English or German between 2000 and 2014) and Google Books (with no restrictions) was conducted. Ethical issues were identified by qualitative text analysis and normative analysis. The literature review retrieved 106 references that together mentioned 27 ethical issues in clinical care of kidney failure. This set of ethical issues was structured into a matrix consisting of seven major categories and further first and second-order categories. The systematically-derived matrix helps raise awareness and understanding of the complexity of ethical issues in kidney failure. It can be used to identify ethical issues that should be addressed in specific training programs for clinicians, clinical practice guidelines, or other types of policies dealing with kidney failure.

The Full Spectrum of Clinical Ethical Issues in Kidney Failure. Findings of a Systematic Qualitative Review

PubMed Central

Kahrass, Hannes; Strech, Daniel; Mertz, Marcel

2016-01-01

Background When treating patients with kidney failure, unavoidable ethical issues often arise. Current clinical practice guidelines some of them, but lack comprehensive information about the full range of relevant ethical issues in kidney failure. A systematic literature review of such ethical issues supports medical professionalism in nephrology, and offers a solid evidential base for efforts that aim to improve ethical conduct in health care. Aim To identify the full spectrum of clinical ethical issues that can arise for patients with kidney failure in a systematic and transparent manner. Method A systematic review in Medline (publications in English or German between 2000 and 2014) and Google Books (with no restrictions) was conducted. Ethical issues were identified by qualitative text analysis and normative analysis. Results The literature review retrieved 106 references that together mentioned 27 ethical issues in clinical care of kidney failure. This set of ethical issues was structured into a matrix consisting of seven major categories and further first and second-order categories. Conclusions The systematically-derived matrix helps raise awareness and understanding of the complexity of ethical issues in kidney failure. It can be used to identify ethical issues that should be addressed in specific training programs for clinicians, clinical practice guidelines, or other types of policies dealing with kidney failure. PMID:26938863

[Integration of a psychologist into Nephrology-Dialysis-Hypertension Operative Unit: from needs evaluation to the definition of an intervention model].

PubMed

Monica, Ratti Maria; Delli Zotti, Giulia Bruna; Spotti, Donatella; Sarno, Lucio

2014-01-01

Chronic Kidney Disease (CKD) and the dialytic treatment cause a significant psychological impact on patients, their families and on the medical-nursing staff too. The psychological aspects linked to the chronic condition of Kidney Disease generate the need to integrated a psychologist into the healthcare team of the Nephrology, Dialysis and Hypertension Operative Unit, in order to offer a specific and professional support to the patient during the different stages of the disease, to their caregivers and to the medical team. The aim of this collaboration project between Nephrology and Psychology is to create a global and integrated healthcare model. It does not give attention simply to the physical dimension of patients affected by CKD, but also to the emotional-affective, cognitive and social dimensions and to the health environment.

Renal Replacement Therapy in Austere Environments

PubMed Central

Yuan, Christina M.; Perkins, Robert M.

2011-01-01

Myoglobinuric renal failure is the classically described acute renal event occurring in disaster environments—commonly after an earthquake—which most tests the ingenuity and flexibility of local and regional nephrology resources. In recent decades, several nephrology organizations have developed response teams and planning protocols to address disaster events, largely focusing on patients at risk for, or with, acute kidney injury (AKI). In this paper we briefly review the epidemiology and outcomes of patients with dialysis-requiring AKI after such events, while providing greater focus on the management of the end-stage renal disease population after a disaster which incapacitates a pre-existing nephrologic infrastructure (if it existed at all). “Austere” dialysis, as such, is defined as the provision of renal replacement therapy in any setting in which traditional, first-world therapies and resources are limited, incapacitated, or nonexistent. PMID:21603109

Characteristics of Pneumocystis pneumonia in Nancy from January 2007 to April 2011 and focus on an outbreak in nephrology.

PubMed

Debourgogne, A; Favreau, S; Ladrière, M; Bourry, S; Machouart, M

2014-03-01

Pneumocystis jirovecii is responsible for pneumonia in immunocompromised populations. Pneumocystis pneumonia has first been discovered as a common and life-threatening opportunistic infection in HIV-infected patients. The aim of this study is to characterize the epidemiological aspects of Pneumocystis pneumonia and then to highlight an outbreak of this infection in a nephrology unit with molecular tools. A multilocus sequence typing method has been used to study the epidemiology of strains isolated during this episode. From January 2007 to April 2011, 39 cases of P. jirovecii pneumonia have been observed. In two thirds of cases, underlying diseases as transplantations, hematologic or solid malignancies, or immunodepressed treatment were the main risk factors and in one third of cases, there were HIV positive patients. This distribution is due to an outbreak of 13 cases in a nephrology unit, where the MLST resulted in two strains profiles regrouping each one 6 and 4 cases among the 10 available isolates. New categories of risk patients of Pneumocystis infection have emerged with severe clinical manifestations and mostly with a fatal outcome. The origin of the transmission is still unknown but a local transmission has been showed in our nephrology unit. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Invited manuscript poster on renal-related education American Society of Nephrology, Nov. 16-21, 2010. Do medical trainees receive adequate training in the management of acute kidney injury?

PubMed

Ali, Mansoor N; Lewington, Andrew J P

2011-01-01

There has been increased interest in acute kidney injury (AKI) over the past decade following the recognition of the association of relatively small rises in serum creatinine with worse patient outcomes. This association has resulted in newly proposed definitions in AKI based on changes in serum creatinine. In 2009, the National Confidential Enquiry into Patient Outcomes and Death Adding Insult to Injury AKI study reported that only 50% of patients who died with a diagnosis of AKI received good care. The study identified multiple deficiencies and made a number of recommendations which included improving the training of undergraduate and postgraduate trainees in the management of AKI. The aim of the evaluation was to try and identify the perception of medical trainees in Leeds Teaching Hospitals of the training they had received on AKI. A simple questionnaire was used and captured the views of 73 trainees (including 13 final-year medical students). The evaluation indicated that the majority of trainees were unaware of newly proposed definitions of AKI, and many trainees felt that the training they had received in AKI was inadequate for their needs. Following this evaluation, we have made a number of changes to the training that is delivered to both undergraduate and postgraduate trainees in Leeds on the management of AKI.

Attitudes and practices of Chinese physicians regarding chronic kidney disease and acute kidney injury management: a questionnaire-based cross-sectional survey in secondary and tertiary hospitals.

PubMed

Wu, Yanhua; Chen, Yuanhan; Chen, Shixin; He, Yani; Liang, Huaban; Dong, Wei; Liang, Xinling

2018-05-10

This questionnaire-based cross-sectional survey reported the attitudes and practices of Chinese doctors regarding chronic kidney disease (CKD) and acute kidney injury (AKI) management. An online questionnaire consisting of general information, awareness of CKD and AKI, education status, renal laboratory items, and clinical practices between February 20, 2017 and August 15, 2017. Among the 1289 respondents from secondary and tertiary hospitals in 30 provinces, 718 (55.7%) were nephrologists, 94.3% had the ability to evaluate glomerular filtration rates, and 98.8% could evaluate urinary protein excretion, indicating that Chinese doctors met the minimum requirements to manage CKD. However, nearly half of all respondents reported that easy methods for spot urine creatinine-adjusted urinary protein assessments were unavailable. Awareness of the CKD risk stratification system and AKI definition was inadequate, and only 54.2% of respondents reported that they had received nutritional education for renal diseases. Although most of the respondents were nephrologists at university hospitals, 66.4% and 76.3% of respondents reported nephrology referrals and nephrology consultations, respectively, after AKI, suggesting an insufficient role for nephrologists. Finally, management models differed significantly, indicating that universal guidelines for CKD and AKI management are required across China. Several considerable challenges remain regarding CKD and AKI management in China, including inadequate knowledge and training systems, an absence of clinical protocols, and insufficient multidisciplinary cooperation.

Reporting Quality Assessment of Randomized Controlled Trials Published in Nephrology Urology Monthly Journal.

PubMed

Mehrazmay, Alireza; Karambakhsh, Alireza; Salesi, Mahmood

2015-07-01

Randomized controlled trials (RCTs) are important tools for evidence-based health care decisions. It is, therefore, important that they be conducted and reported with the highest possible standards. The aim of this study was to evaluate the reporting quality of the RCTs published in nephrology urology monthly journal and to examine whether there was a change over time in the reporting quality. The quality of each report was assessed using the Consolidated Standards of Reporting Trials (CONSORT) 2010 Statement checklist and a 5-point quality assessment instrument, i.e. the Jadad scale. Eighteen (14 Iranian and 4 non-Iranian) RCTs were published from 2012 to 2014 on topics including renal stone (16.6%), hemodialysis and transplantation (38.8%), and prostate conditions (11.1%). Interventions comprised surgery, drugs, and teaching method in 7 (38 %), 10 (55%), and 1 (5%) of them, respectively. According to the CONSORT checklist, the weakest reported items were registration number, identification as a randomized trial in the title, and settings and locations where the data were collected. The mean Jadad score of the reports was 2.72 ± 1.36 (54% of their maximum possible total score). According to the Jadad and CONSORT scales, there was an increase in the quality of reporting from 2012 to 2014. This assessment shows low reporting quality scores in reports. Training courses for researchers, using standard reporting tools (e.g. CONSORT 2010 Statement checklist), and consultation with methodologists can improve the quality of published RCTs.

Nuclear medicine in urology and nephrology

DOE Office of Scientific and Technical Information (OSTI.GOV)

O'Reilly, P.H.; Shields, R.A.; Testa, H.J.

This edition on radionuclide techniques in urology and nephrology reflects the many advances since 1979. Emphasis has been given to diuretic renography and studies of urinary reflux. A new chapter discusses the diagnosis of lower urinary tract problems. The editors have divided the book into three sections. The first part presents a description of the techniques and their interpretation. Renography, renal scanning, clearance studies, and bone scanning are covered. The second section gives an in-depth discussion of the application of these techniques to obstructive uropathy, urologic tumors, renal transplantation, trauma, and lower urinary tract, pediatric, and nephrologic problems. The lastmore » part of the book deals with basic principles. It expands on the relevant theoretical and technical aspects not covered in detail in part 1. In this last portion of the book the editors have grouped together the chapters on physics, instrumentation, radiopharmaceuticals, and radiation dosimetry.« less

Role of nuclear medicine in clinical urology and nephrology

DOE Office of Scientific and Technical Information (OSTI.GOV)

Blaufox, M.D.; Fine, E.; Lee, H.B.

The application of radionuclide studies to nephrologic and urologic practice has reached a measurable degree of maturity during the past several years. In spite of this, the utilization of these techniques in many institutions in the United States continues to be far less frequent than one would expect from the clinical advantages. The aim of this editorial is to try to place the role of nuclear medicine in urology and nephrology in perspective. At the present time, in spite of the large number of renal agents that have been developed, there is no practical ideal radiopharmaceutical that can serve asmore » a universal agent. Arbitrarily, one may reduce the chief armamentarium to only four radiopharmaceuticals; technetium-99m DTPA, I-131 OIH (orthoiodohippurate), technetium-99m glucoheptonate and technetium-99m DMSA. These agents are discussed with their relative advantages and disadvantages.« less

Socioeconomic, demographic and policy comparisons of living and deceased kidney transplantation rates across 53 countries.

PubMed

Bendorf, Aric; Pussell, Bruce A; Kelly, Patrick J; Kerridge, Ian H

2013-09-01

There are more than 1.7 million sufferers of end stage kidney disease (ESKD) worldwide and for many a donated kidney provides the only chance of regaining independence from dialysis. Unfortunately, the demand for kidneys for transplantation far exceeds the available supply. It is important, therefore, that we understand the factors that may influence kidney donation rates. While certain socio-demographic factors have been linked to kidney donation rates, few studies have examined the influence of multiple socio-demographic factors on rates of both living and deceased kidney transplantation (KT) and none have examined their comparative effect in large numbers of culturally and socio-politically diverse countries. In this study, we performed univariate and multivariate analyses of the influence of 15 socio-economic factors on both the living donor (LD) and the deceased donor (DD) kidney transplantation rates (KTR) in 53 countries. Our analyses demonstrated that factors such as UN HDI (United Nations Human Development Index), religion, GDP, education, age, healthcare expenditure, presumed consent legislation and existence of a nationally managed organ donation program were associated with higher deceased KTR. In contrast, the only factors associated with living KTR were a highly significant negative association with presumed consent and variable associations with different religions. We suggest that by identifying factors that affect kidney transplantation rates these can be used to develop programs for enhancing donor rates in individual countries where those rates are below the leading countries. © 2013 The Authors. Nephrology © 2013 Asian Pacific Society of Nephrology.

Automation, decision support, and expert systems in nephrology.

PubMed

Soman, Sandeep; Zasuwa, Gerard; Yee, Jerry

2008-01-01

Increasing data suggest that errors in medicine occur frequently and result in substantial harm to the patient. The Institute of Medicine report described the magnitude of the problem, and public interest in this issue, which was already large, has grown. The traditional approach in medicine has been to identify the persons making the errors and recommend corrective strategies. However, it has become increasingly clear that it is more productive to focus on the systems and processes through which care is provided. If these systems are set up in ways that would both make errors less likely and identify those that do occur and, at the same time, improve efficiency, then safety and productivity would be substantially improved. Clinical decision support systems (CDSSs) are active knowledge systems that use 2 or more items of patient data to generate case specific recommendations. CDSSs are typically designed to integrate a medical knowledge base, patient data, and an inference engine to generate case specific advice. This article describes how automation, templating, and CDSS improve efficiency, patient care, and safety by reducing the frequency and consequences of medical errors in nephrology. We discuss practical applications of these in 3 settings: a computerized anemia-management program (CAMP, Henry Ford Health System, Detroit, MI), vascular access surveillance systems, and monthly capitation notes in the hemodialysis unit.

Intra-operative hemodialysis during liver transplantation: an expanded role of the nephrology nurse.

PubMed

Henson, Angela; Carpenter, Sally

2010-01-01

Hemodialysis is widely acknowledged as a treatment option to stabilize acute medical conditions where biochemistry management is paramount. One of the most challenging situations is during liver transplantation, when patients with moderate renal dysfunction are likely to become acutely acidotic. For nephrology nurses, this extended role requires increased knowledge, advanced skills, and a high level of communication with unfamiliar team members. With appropriate procedures and a supportive environment, delivering such a service is feasible.

OBSERVATIONAL STUDIES VS. RANDOMIZED CONTROLLED TRIALS: AVENUES TO CAUSAL INFERENCE IN NEPHROLOGY

PubMed Central

Kovesdy, Csaba P; Kalantar-Zadeh, Kamyar

2011-01-01

A common frustration for practicing Nephrologists is the adage that the lack of randomized controlled trials (RCTs) does not allow us to establish causality, but merely associations. The field of Nephrology, like many other disciplines, has been suffering from a lack of RCTs. The view that short of RCTs there is no reliable evidence has hampered our ability to ascertain the best course of action for our patients. However, many clinically important questions in medicine and public health such as the association of smoking and lung cancer are not amenable to RCTs due to ethical or other considerations. Whereas RCTs unquestionably hold many advantages over observational studies, it should be recognized that they also have many flaws that render them fallible under certain circumstances. We provide a description of the various pros and cons of RCTs and of observational studies using examples from the Nephrology literature, and argue that it is simplistic to rank them solely based on pre-conceived notions about the superiority of one over the other. We also discuss methods whereby observational studies can become acceptable tools for causal inferences. Such approaches are especially important in a field like Nephrology where there are myriads of potential interventions based on complex pathophysiologic states, but where properly designed and conducted RCTs for all of these will probably never materialize. PMID:22364796

[Methodological approach to designing a telecare system for pre-dialysis and peritoneal dialysis patients].

PubMed

Calvillo-Arbizu, Jorge; Roa-Romero, Laura M; Milán-Martín, José A; Aresté-Fosalba, Nuria; Tornero-Molina, Fernando; Macía-Heras, Manuel; Vega-Díaz, Nicanor

2014-01-01

A major obstacle that hinders the implementation of technological solutions in healthcare is the rejection of developed systems by users (healthcare professionals and patients), who consider that they do not adapt to their real needs. (1) To design technological architecture for the telecare of nephrological patients by applying a methodology that prioritises the involvement of users (professionals and patients) throughout the design and development process; (2) to show how users' needs can be determined and addressed by means of technology, increasing the acceptance level of the final systems. In order to determine the main current needs in Nephrology, a group of Spanish Nephrology Services was involved. Needs were recorded through semi-structured interviews with the medical team and questionnaires for professionals and patients. A set of requirements were garnered from professionals and patients. In parallel, the group of biomedical engineers identified requirements for patient telecare from a technological perspective. All of these requirements drove the design of modular architecture for the telecare of peritoneal dialysis and pre-dialysis patients. This work shows how it is possible to involve users in the whole process of design and development of a system. The result of this work is the design of adaptable modular architecture for the telecare of nephrological patients and it addresses the preferences and needs of patient and professional users consulted.

Continuous ambulatory peritoneal dialysis: perspectives on patient selection in low- to middle-income countries

PubMed Central

Wearne, Nicola; Kilonzo, Kajiru; Effa, Emmanuel; Davidson, Bianca; Nourse, Peter; Ekrikpo, Udeme; Okpechi, Ikechi G

2017-01-01

Chronic kidney disease is a major public health problem that continues to show an unrelenting global increase in prevalence. The prevalence of chronic kidney disease has been predicted to grow the fastest in low- to middle-income countries (LMICs). There is evidence that people living in LMICs have the highest need for renal replacement therapy (RRT) despite the lowest access to various modalities of treatment. As continuous ambulatory peritoneal dialysis (CAPD) does not require advanced technologies, much infrastructure, or need for dialysis staff support, it should be an ideal form of RRT in LMICs, particularly for those living in remote areas. However, CAPD is scarcely available in many LMICs, and even where available, there are several hurdles to be confronted regarding patient selection for this modality. High cost of CAPD due to unavailability of fluids, low patient education and motivation, low remuneration for nephrologists, lack of expertise/experience for catheter insertion and management of complications, presence of associated comorbid diseases, and various socio-demographic factors contribute significantly toward reduced patient selection for CAPD. Cost of CAPD fluids seems to be a major constraint given that many countries do not have the capacity to manufacture fluids but instead rely heavily on fluids imported from developed countries. There is need to invest in fluid manufacturing (either nationally or regionally) in LMICs to improve uptake of patients treated with CAPD. Workforce training and retraining will be necessary to ensure that there is coordination of CAPD programs and increase the use of protocols designed to improve CAPD outcomes such as insertion of catheters, treatment of peritonitis, and treatment of complications associated with CAPD. Training of nephrology workforce in CAPD will increase workforce experience and make CAPD a more acceptable RRT modality with improved outcomes. PMID:28115864

AL-Amyloidosis Presenting with Negative Congo Red Staining in the Setting of High Clinical Suspicion: A Case Report

DTIC Science & Technology

2012-01-01

1Department of Internal Medicine, William Beaumont Army Medical Center, 5005 N Piedras Street, Building 7777, 9th floor East, El Paso, TX 79920, USA...2Department of Nephrology, William Beaumont Army Medical Center, 5005 N Piedras Street, Building 7777, 12th floor, El Paso, TX 79920, USA 3Propath...NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) William Beaumont Army Medical Center,Department of Nephrology,5005 N Piedras Street,Building

ESRD Databases, Public Policy, and Quality of Care: Translational Medicine and Nephrology.

PubMed

McClellan, William M; Plantinga, Laura C; Wilk, Adam S; Patzer, Rachel E

2017-01-06

Efforts to improve care of patients with ESRD and the policies that guide those activities depend on evidence-based best practices derived from clinical trials and carefully conducted observational studies. Our review describes this process in the context of the translational research model (bench to bedside to populations), with a particular emphasis on bedside care. We illustrate some of its accomplishments and describe the limitations of the data and evidence supporting policy and practice. Copyright © 2016 by the American Society of Nephrology.

Understanding the mobile internet to develop the next generation of online medical teaching tools

PubMed Central

Christiano, Cynthia; Ferris, Maria

2011-01-01

Healthcare providers (HCPs) use online medical information for self-directed learning and patient care. Recently, the mobile internet has emerged as a new platform for accessing medical information as it allows mobile devices to access online information in a manner compatible with their restricted storage. We investigated mobile internet usage parameters to direct the future development of mobile internet teaching websites. Nephrology On-Demand Mobile (NODM) (http://www.nephrologyondemand.org) was made accessible to all mobile devices. From February 1 to December 31, 2010, HCP use of NODM was tracked using code inserted into the root files. Nephrology On-Demand received 15 258 visits, of which approximately 10% were made to NODM, with the majority coming from the USA. Most access to NODM was through the Apple iOS family of devices and cellular connections were the most frequently used. These findings provide a basis for the future development of mobile nephrology and medical teaching tools. PMID:21659443

Understanding the mobile internet to develop the next generation of online medical teaching tools.

PubMed

Desai, Tejas; Christiano, Cynthia; Ferris, Maria

2011-01-01

Healthcare providers (HCPs) use online medical information for self-directed learning and patient care. Recently, the mobile internet has emerged as a new platform for accessing medical information as it allows mobile devices to access online information in a manner compatible with their restricted storage. We investigated mobile internet usage parameters to direct the future development of mobile internet teaching websites. Nephrology On-Demand Mobile (NOD(M)) (http://www.nephrologyondemand.org) was made accessible to all mobile devices. From February 1 to December 31, 2010, HCP use of NOD(M) was tracked using code inserted into the root files. Nephrology On-Demand received 15,258 visits, of which approximately 10% were made to NOD(M), with the majority coming from the USA. Most access to NOD(M) was through the Apple iOS family of devices and cellular connections were the most frequently used. These findings provide a basis for the future development of mobile nephrology and medical teaching tools.

Saint Marina: the protectress of nephrology.

PubMed

Eftychiadis, A C; Marketos, S G

1999-01-01

Saint virgin and martyr Marina (Margarita) of Antioch in Pisidia (255-270) is recognized as the patron saint of kidney sufferers and the protectress of nephrology. Beginning in the 13th century she heals in particular patients suffering from nephropathies, pregnant women having a difficult childbirth, barren women and sickly children. She protects the patients from every side effect and complication. Saint Marina is represented in hagiography as a victor, defeating the dragon satan, holding a hammer or a cross and wearing a belt around her back in the area of kidneys. According to writers, artists and sculptors the belt is the perceivable means of Saint Marina for the miraculous recovery from and healing of kidney diseases. Therefore, kidney sufferers and pregnant women put belts upon her relics for blessing and then wore them. From the Middle Ages and Renaissance and up to the contemporary period Saint Marina (Margarita) was considered the patron saint of kidney sufferers. Justifiably she is recognized by the modern medical world as the protectress of nephrology.

Early Nephrology Referral 6 Months Before Dialysis Initiation Can Reduce Early Death But Does Not Improve Long-Term Cardiovascular Outcome on Dialysis.

PubMed

Hayashi, Terumasa; Kimura, Tomonori; Yasuda, Keiko; Sasaki, Koichi; Obi, Yoshitsugu; Nagayama, Harumi; Ohno, Motoki; Uematsu, Kazusei; Tamai, Takehiro; Nishide, Takahiro; Rakugi, Hiromi; Isaka, Yoshitaka

2016-01-01

There is a paucity of studies on whether early referral (ER) to nephrologist could reduce cardiovascular mortality on dialysis, and the length of pre-dialysis nephrological care needed to reduce mortality on dialysis. A total of 604 consecutive patients who started dialysis between 2001 and 2009 in Senshu region, Osaka, Japan were analyzed. Non-linear associations between mortality and pre-dialysis duration of nephrological care were assessed using restricted cubic spline function, and predictors for death analyzed on Cox modeling. A total of 31.6%, 18.2%, 11.3% and 6.1% of patients had >12, 24, 36 and 48 months of pre-dialysis care, respectively. A total of 258 patients (42.7%) were categorized as ER (≥6 months pre-dialysis duration). During the follow-up period (median, 31.1 months), 218 patients died (cardiovascular, n=70; infection, n=69). Although patients with late referral (LR) had a proxy of inappropriate pre-dialysis care compared with the ER group, Cox multivariate analysis failed to show a favorable association between ER and cardiovascular outcome. In contrast, a deleterious effect of LR on overall survival was observed but was limited only to the first 12 months of dialysis (HR, 1.957; 95% CI: 1.104-3.469; P=0.021), but not observed thereafter. Current pre-dialysis nephrological care may reduce short-term mortality but may not improve cardiovascular mortality after dialysis initiation.

[Smart, Social, and Mobile: the future of Nephrology in the Era of Digital Health].

PubMed

Iannuzzella, Francesco; Murtas, Corrado; Bertolini, Riccardo; Corradini, Mattia; Pasquali, Sonia

2016-01-01

Healthcare is in the middle of a digital revolution. Physicians are adopting mobile apps that make them more effective and patients are taking to ones that give them more control over their healthcare. Mobile technology is changing Medicine. A new movement for free open access medical education (FOAMed) is growing through Social Media. E-learning is increasing access to new and exciting learning opportunities, deeply changing the traditional concept of continuous medical education. What will be the future of Nephrology in the era of Digital Health?

Australian consumer perspectives on dialysis: first national census.

PubMed

Ludlow, Marie J; Lauder, Lydia A; Mathew, Timothy H; Hawley, Carmel M; Fortnum, Debbie

2012-11-01

The percentage of people in Australia who undertake home dialysis has steadily decreased over the past 40 years and varies within Australia. Consumer factors related to this decline have not previously been determined. A 78-question survey was developed and piloted in 2008 and 2009. Survey forms were distributed to all adult routine dialysis patients in all Australian states and territories (except Northern Territory) between 2009 and 2010. Of 9223 distributed surveys, 3250 were completed and returned. 49% of respondents indicated they had no choice in the type of dialysis and 48% had no choice in dialysis location. Respondents were twice as likely to receive information about haemodialysis (85%) than APD (39%) or CAPD (41%). The provision of education regarding home modalities differed significantly between states, and decreased with increasing patient age. Additional nursing support and reimbursement of expenses increased the proportion of those willing to commence dialysis at home, from 13% to 34%. State differences in the willingness to consider home dialysis, the degree of choice in dialysis location, the desire to change current dialysis type and/or location, and the provision of information about dialysis were identified. The delivery of pre-dialysis education is variable, and does not support all options of dialysis for all individuals. State variances indicate that local policy and health professional teams significantly influence the operation of dialysis programs. © 2012 The Authors. Nephrology © 2012 Asian Pacific Society of Nephrology.

Who should get the last PICU bed?

PubMed

Wightman, Aaron; Largent, Emily; Del Beccaro, Mark; Lantos, John D

2014-05-01

Administrators sometimes face ethical dilemmas about the allocation of institutional resources. One such situation is when elective surgery cases require reserved ICU beds and the ICU is full. Such situations arise frequently in children's hospitals today. They are sometimes complicated by questions about whether every patient in the ICU belongs there. We present such a situation and responses from Mark Del Becarro, Vice President for Medical Affairs at Seattle Children's Hospital; Aaron Wightman, a nephrology fellow and bioethicist at Seattle Children's Hospital; and Emily Largent, a doctoral student in the joint JD/PhD Program in Health Policy at Harvard University. Copyright © 2014 by the American Academy of Pediatrics.

Latin American special project: kidney health cooperation project between Uruguay and Bolivia.

PubMed

Sola, Laura; Plata-Cornejo, Raúl; Fernández-Cean, Juan

2015-01-01

Uruguay and Bolivia are two countries that show heterogenicity of the Latin American region, including the national income, the expenditure on health and the services for renal care. In Bolivia, there is manpower shortage for renal care with only 5 nephrologists per million people (pmp) and the prevalence of patients on dialysis is only 200 pmp. This is much lower than the mean prevalence rate of renal replacement therapy for Latin America as a whole. Uruguay on the other hand has more dedicated renal resources with 50 nephrologists pmp, and renal replacement therapy is provided to ~ 1,000 dialysis patients pmp. In November 2012, a collaborative project financed by the Uruguayan International Cooperation Agency was signed by both the Uruguay and Bolivia Ministries of Health, and the goal was to develop a comprehensive program for the prevention and management of all stages of chronic kidney disease (CKD) in Bolivia. The specific objectives were to: a) promote renal healthcare in the primary healthcare setting, b) identify kidney disease in populations at risk, and c) optimize patient care at all stages of CKD, including dialysis and transplantation supported with a national ESRD registry in Bolivia. As a first step, delegates from the Bolivian Health Ministry, visited Uruguay in April 2014, primarily to strengthen the development of tools required for developing and maintaining a national registry. In addition, during this visit, a meeting with the president of the Latin American Society of Nephrology and Hypertension (SLANH) culminated in designing a training program for peritoneal dialysis. This highly cooperative relationship is advancing the prevention and care of CKD in Bolivia and may serve as a model for international approaches to advance system level CKD care in countries with limited healthcare resources.

Scientific publications in nephrology and urology journals from Chinese authors in East Asia: a 10-year survey of the literature.

PubMed

Xu, Jing; Mao, Zhi-Guo; Kong, Mei; Hu, Liang-Hao; Ye, Chao-Yang; Xu, Cheng-Gang; Rong, Shu; Sun, Li-Jun; Wu, Jun; Dai, Bing; Chen, Dong-Ping; Zhu, Yu-Xian; Zhang, Yi-Xiang; Zhang, Yu-Qiang; Zhao, Xue-Zhi; Mei, Chang-Lin

2011-04-08

Diseases of the kidneys and genitourinary tract are common health problems that affect people of all ages and demographic backgrounds. In this study, we compared the quantity and quality of nephrological and urological articles published in international journals from the three major regions of China: the mainland (ML), Hong Kong (HK), and Taiwan (TW). Nephrological and urological articles originating from ML, TW, and HK that were published in 61 journals from 1999-2008 were retrieved from the PubMed database. We recorded the numbers of total articles, clinical trials, randomized controlled trials, case reports, impact factors (IF), citations, and articles published in the leading general-medicine journals. We used these data to compare the quantity and quality of publication output from the three regions. The total number of articles increased significantly from 1999 to 2008 in the three regions. The number of articles from ML has exceeded that from HK since 2004, and surpassed that from TW in 2008. Publications from TW had the highest accumulated IF, total citations of articles, and the most articles published in leading general-medicine journals. However, HK publications had the highest average IF. Although ML produced the largest quantity of articles, it exhibited the lowest quality among the three regions. The number of nephrological and urological publications originating from the three major regions of China increased significantly from 1999 to 2008. The annual number of publications by ML researchers exceeded those from TW and HK. However, the quality of articles from TW and HK was higher than that from ML.

[Reasons for first-consultation in nephrology in the health area 5 of Britanny during the year 2014].

PubMed

Prévot, Jeanne; Bayat-Makoei, Sahar; Vigneau, Cécile

2017-04-01

In France, the coordinated healthcare circuit means that patients should be referred to specialists, for example nephrologists, by another physician. However, there are no recommendations concerning the reasons justifying the referral to a nephrologist. The main purpose of our study is to describe the motif of first consultations in nephrology in the health area 5 of Brittany. We retrospectively collected medical reports of first consultations by 17 nephrologists in the 4 centers of the study area, during the year 2014. In these letters, we noted the consultation motif, the specialty of the physician who refers the patient, and main characteristics of patients. We included 662 first consultations. The main reason for consultations was chronic kidney disease (68.7%), including chronic renal insufficiency (56.9%), proteinuria (7.3%), microscopic hematuria (3.3%) and searching for chronic kidney disease in the presence of risk factor (1.2%). Other frequent reasons were the follow-up consultation after a pregnancy complicated by preeclampsia (9.5%), urinary lithiasis (5.7%), hypertension (3.8%) and hydroelectrolytic disorder (3.5%). Non-nephrology reasons represent 3.2% of first consultations. Almost all patients have been referred by a physician (99.7%), mainly a general practitioner (71.9%). Nephrology first consultations are realized according to the coordinated healthcare circuit since almost all are requested by another physician. The reasons are adapted to the specialty. The main reason is chronic kidney disease, often already associated with renal insufficiency chronic. Copyright © 2016 Association Société de néphrologie. Published by Elsevier Masson SAS. All rights reserved.

PathoSpotter-K: A computational tool for the automatic identification of glomerular lesions in histological images of kidneys

NASA Astrophysics Data System (ADS)

Barros, George O.; Navarro, Brenda; Duarte, Angelo; Dos-Santos, Washington L. C.

2017-04-01

PathoSpotter is a computational system designed to assist pathologists in teaching about and researching kidney diseases. PathoSpotter-K is the version that was developed to detect nephrological lesions in digital images of kidneys. Here, we present the results obtained using the first version of PathoSpotter-K, which uses classical image processing and pattern recognition methods to detect proliferative glomerular lesions with an accuracy of 88.3 ± 3.6%. Such performance is only achieved by similar systems if they use images of cell in contexts that are much less complex than the glomerular structure. The results indicate that the approach can be applied to the development of systems designed to train pathology students and to assist pathologists in determining large-scale clinicopathological correlations in morphological research.

Perspectives on optimizing care of patients in multidisciplinary chronic kidney disease clinics.

PubMed

Collister, David; Russell, Randall; Verdon, Josee; Beaulieu, Monica; Levin, Adeera

2016-01-01

To summarize a jointly held symposium by the Canadian Society of Nephrology (CSN), the Canadian Association of Nephrology Administrators (CANA), and the Canadian Kidney Knowledge Translation and Generation Network (CANN-NET) entitled "Perspectives on Optimizing Care of Patients in Multidisciplinary Chronic Kidney Disease (CKD) Clinics" that was held on April 24, 2015, in Montreal, Quebec. The panel consisted of a variety of members from across Canada including a multidisciplinary CKD clinic patient (Randall Russell), nephrology fellow (Dr. David Collister), geriatrician (Dr. Josee Verdon), and nephrologists (Dr. Monica Beaulieu, Dr. Adeera Levin). The objectives of the symposium were (1) to gain an understanding of the goals of care for CKD patients, (2) to gain an appreciation of different perspectives regarding optimal care for patients with CKD, (3) to examine the components required for optimal care including education strategies, structures, and tools, and (4) to describe a framework and metrics for CKD care which respect patient and system needs. This article summarizes the key concepts discussed at the symposium from a patient and physician perspectives. Key messages include (1) understanding patient values and preferences is important as it provides a framework as to what to prioritize in multidisciplinary CKD clinic and provincial renal program models, (2) barriers to effective communication and education are common in the elderly, and adaptive strategies to limit their influence are critical to improve adherence and facilitate shared decision-making, (3) the use of standardized operating procedures (SOPs) improves efficiency and minimizes practice variability among health care practitioners, and (4) CKD scorecards with standardized system processes are useful in approaching variability as well as measuring and improving patient outcomes. The perspectives provided may not be applicable across centers given the differences in patient populations including age, ethnicity, culture, language, socioeconomic status, education, and multidisciplinary CKD clinic structure and function. Knowledge transmission by collaborative interprovincial and interprofessional networks may play a role in facilitating optimal CKD care. Validation of system and clinic models that improve outcomes is needed prior to disseminating these best practices.

Nanotechnological foundations of a «new» Nephrology.

PubMed

Sorian, M Laura; Rodríguez-Benot, Alberto; Valcárcel, Miguel

2018-05-16

After contextualising the generic frameworks of nanotechnology and nanomedicine, the 2disciplines are discussed in the field of Nephrology. The potential downside to nanonephrology is the renal clearance of nanoparticles, the use of which is ever-increasing both for nanomedicinal purposes and in nanofoods. The positive impact of nanotechnology in Nephrology is centred on the development of renal nanodiagnostics for basic renal function studies, the early diagnosis of acute kidney injury, reliable and simple follow-up of chronic kidney disease and the improvement of magnetic resonance imaging. Renal drug nanotherapies comprise an important and dual-faceted area: The protection of drugs and nephrotoxic agents (e.g. antibiotics, antiretrovirals, contrast media, etc.) on the one hand, and the development of new kidney disease medications on the other. Renal 'nanotheranostics' is a promising but little-studied area. The impact of nanostructured supports on renal tissue regeneration is also discussed. The article concludes with a brief analysis of the various nanonephrology perspectives. Copyright © 2018 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

[The Academy of Ideas - second edition 2014].

PubMed

2014-01-01

The Academy of Ideas is an initiative of the Italian Society of Nephrology, dedicated to young people who work in nephrology. The 2014 edition wants to foster innovative ideas at different levels of maturity along the research and innovation process, through two distinct sections meant for people who present basic or applied research ideas and for people who submit proofs of concepts transferable to products or services in a relatively short time period. The proposal aims to enhance grant application skills, giving to young researchers the opportunity of collaborating with multi-disciplinary groups of professionals; help young researchers to exploit ideas arising from clinical research and showing a Technology Readiness Level that allows immediate or close in time applicability; foster the understanding of the business perspective in the nephrology sector: giving to young scientists the opportunity to have in-hand experience on challenges related to bringing to the market research results; create a network of knowledge and collaboration among young researchers to facilitate the establishment of collaborative relationships and promote the creation of new projects and publications of high scientific impact.

Quality Assurance Audit of Technique Failure and 90-Day Mortality after Program Discharge in a Canadian Home Hemodialysis Program.

PubMed

Shah, Nikhil; Reintjes, Frances; Courtney, Mark; Klarenbach, Scott W; Ye, Feng; Schick-Makaroff, Kara; Jindal, Kailash; Pauly, Robert P

2017-07-24

Little is known about patients exiting home hemodialysis. We sought to characterize the reasons, clinical characteristics, and pre-exit health care team interactions of patients on home hemodialysis who died or underwent modality conversion (negative disposition) compared with prevalent patients and those who were transplanted (positive disposition). We conducted an audit of all consecutive patients incident to home hemodialysis from January of 2010 to December of 2014 as part of ongoing quality assurance. Records were reviewed for the 6 months before exit, and vital statistics were assessed up to 90 days postexit. Ninety-four patients completed training; 25 (27%) received a transplant, 11 (12%) died, and 23 (25%) were transferred to in-center hemodialysis. Compared with the positive disposition group, patients in the negative disposition group had a longer mean dialysis vintage (3.15 [SD=4.98] versus 1.06 [SD=1.16] years; P =0.003) and were performing conventional versus a more intensive hemodialysis prescription (23 of 34 versus 23 of 60; P <0.01). In the 6 months before exit, the negative disposition group had significantly more in-center respite dialysis sessions, had more and longer hospitalizations, and required more on-call care team support in terms of phone calls and drop-in visits (each P <0.05). The most common reason for modality conversion was medical instability in 15 of 23 (65%) followed by caregiver or care partner burnout in three of 23 (13%) each. The 90-day mortality among patients undergoing modality conversion was 26%. Over a 6-year period, approximately one third of patients exited the program due to death or modality conversion. Patients who die or transfer to another modality have significantly higher health care resource utilization ( e.g. , hospitalization, respite treatments, nursing time, etc. ). Copyright © 2017 by the American Society of Nephrology.

Renal services disaster planning: lessons learnt from the 2011 Queensland floods and North Queensland cyclone experiences.

PubMed

Johnson, David W; Hayes, Bronwyn; Gray, Nicholas A; Hawley, Carmel; Hole, Janet; Mantha, Murty

2013-01-01

In 2011, Queensland dialysis services experienced two unprecedented natural disasters within weeks of each other. Floods in south-east Queensland and Tropical Cyclone Yasi in North Queensland caused widespread flooding, property damage and affected the provision of dialysis services, leading to Australia's largest evacuation of dialysis patients. This paper details the responses to the disasters and examines what worked and what lessons were learnt. Recommendations are made for dialysis units in relation to disaster preparedness, response and recovery. © 2012 The Authors. Nephrology © 2012 Asian Pacific Society of Nephrology.

Developing risk prediction models for kidney injury and assessing incremental value for novel biomarkers.

PubMed

Kerr, Kathleen F; Meisner, Allison; Thiessen-Philbrook, Heather; Coca, Steven G; Parikh, Chirag R

2014-08-07

The field of nephrology is actively involved in developing biomarkers and improving models for predicting patients' risks of AKI and CKD and their outcomes. However, some important aspects of evaluating biomarkers and risk models are not widely appreciated, and statistical methods are still evolving. This review describes some of the most important statistical concepts for this area of research and identifies common pitfalls. Particular attention is paid to metrics proposed within the last 5 years for quantifying the incremental predictive value of a new biomarker. Copyright © 2014 by the American Society of Nephrology.

[Utilisation of salivary markers in nephrology].

PubMed

Podracká, Ľudmila; Celec, Peter; Šebeková, Katarína

2016-01-01

Saliva has a broad diagnostic potential which can be used for detection many pathological conditions including renal dysfunction. In saliva can be measured concentration of urea and creatinine as well as the other uremic markers. Saliva urea nitrogen and creatinine and blood urea and creatinine highly correlated therefore might be used for screening in patients with CKD. Saliva collection is truly non-invasive and is especially suitable for small children and elderly patients. Recently, semiquantitative saliva urea test strip is available. Saliva might become promising dia-gnostic biofluid in nephrological practice.Key words: chronic kidney disease - renal failure - salivary dipstick - salivary markers.

Conservative care as a treatment option for patients aged 75 years and older with CKD stage V: a National survey in the Netherlands.

PubMed

Susanto, Christopher; Kooman, J; Courtens, A M; Konings, C J A M

2018-01-01

Conservative care for patients aged 75 years and older with CKD stage 5 as a treatment option besides dialysis was proposed officially in the Netherlands in October 2016. This national survey showed the current implementation of this option in Netherlands nephrology departments. A web-based survey was sent to medical managers of 60 nephrology departments in the Netherlands in August 2016. Twenty-one medical managers (35%) completed the survey. The term "conservative care" is frequently used and well known. The estimated number of patients in whom the decision for maximal conservative care was made in 2015 was 310 of 2249 patients with CKD stage 5 age 75 years and older (range 5-50 patients per department). 164 patients became symptomatic and received no dialysis. There is no official registration for this treatment option and patient category. The practice patterns vary widely. Only one of 21 respondents reported a conservative care outpatient clinic. Formal training or education regarding conservative care is not available in most of departments. 95% of respondents discussed this treatment option with their patients. General practitioners are always being informed about their patient's decision. Their main role is providing or organizing palliative care support at the end of life and discussing advance care planning. Most respondents (86%) considered to include their patients in a prospective multicentre observational study, conservative care versus dialysis. Conservative care as a treatment option for patients with CKD stage 5 aged 75 years and older is well established. The practice patterns are varied in the Netherlands. Follow-up studies are needed to see whether the new multidisciplinary guideline facilitates harmonization of practice pattern. Funding is needed to optimize the implementation of conservative care.

Weight management strategies for those with chronic kidney disease - a consensus report from the Asia Pacific Society of Nephrology and Australia and New Zealand Society of Nephrology 2016 renal dietitians meeting.

PubMed

Lambert, Kelly; Beer, Jo; Dumont, Ruth; Hewitt, Katie; Manley, Karen; Meade, Anthony; Salamon, Karen; Campbell, Katrina

2017-07-25

Develop a consensus report to guide dietetic management of overweight or obese individuals with Chronic Kidney Disease (CKD). Six statements relating weight management in CKD guided a comprehensive review of the literature. A summary of the evidence was then presented at the renal nutrition meeting of the 2016 Asia Pacific Society of Nephrology and Australia and New Zealand Society of Nephrology. Majority agreement was defined as group agreement on a statement of between 50-74%, and consensus was considered ≥ 75% agreement. The recommendations were developed via a mini Delphi process. Two statements achieved group consensus: the current guidelines used by dietitians to estimate energy requirements for overweight and obese people with CKD are not relevant and weight loss medications may be unsafe or ineffective in isolation for those with CKD. One statement achieved group agreement: Meal replacement formulas are safe and efficacious in those with CKD. No agreement was achieved on the statements of whether there is strong evidence of benefit for weight loss prior to kidney transplantation; whether traditional weight loss strategies can be used in those with CKD and if bariatric surgery in those with end stage kidney disease is feasible and effective. There is a limited evidence base to guide the dietetic management of overweight and obese individuals with CKD. Medical or surgical strategies to facilitate weight loss are not recommended in isolation and require a multidisciplinary approach with the involvement of a skilled renal dietitian. This article is protected by copyright. All rights reserved.

Disaster nephrology: a new concept for an old problem

PubMed Central

Sever, Mehmet Sukru; Lameire, Norbert; Van Biesen, Wim; Vanholder, Raymond

2015-01-01

Natural and man-made mass disasters directly or indirectly affect huge populations, who need basic infrastructural help and support to survive. However, despite the potentially negative impact on survival chances, these health care issues are often neglected by the authorities. Treatment of both acute and chronic kidney diseases (CKDs) is especially problematic after disasters, because they almost always require complex technology and equipment, whereas specific drugs may be difficult to acquire for the treatment of the chronic kidney patients. Since many crush victims in spite of being rescued alive from under the rubble die afterward due to lack of dialysis possibilities, the terminology of ‘renal disaster’ was introduced after the Armenian earthquake. It should be remembered that apart from crush syndrome, multiple aetiologies of acute kidney injury (AKI) may be at play in disaster circumstances. The term ‘seismonephrology’ (or earthquake nephrology) was introduced to describe the need to treat not only a large number of AKI cases, but the management of patients with CKD not yet on renal replacement, as well as of patients on haemodialysis or peritoneal dialysis and transplanted patients. This wording was later replaced by ‘disaster nephrology’, because besides earthquakes, many other disasters such as hurricanes, tsunamis or wars may have a negative impact on the ultimate outcome of kidney patients. Disaster nephrology describes the handling of the many medical and logistic problems in treating kidney patients in difficult circumstances and also to avoid post-disaster chaos, which can be made possible by preparing medical and logistic scenarios. Learning and applying the basic principles of disaster nephrology is vital to minimize the risk of death both in AKI and CKD patients. PMID:26034592

Efficient strategies to find diagnostic test accuracy studies in kidney journals.

PubMed

Rogerson, Thomas E; Ladhani, Maleeka; Mitchell, Ruth; Craig, Jonathan C; Webster, Angela C

2015-08-01

Nephrologists looking for quick answers to diagnostic clinical questions in MEDLINE can use a range of published search strategies or Clinical Query limits to improve the precision of their searches. We aimed to evaluate existing search strategies for finding diagnostic test accuracy studies in nephrology journals. We assessed the accuracy of 14 search strategies for retrieving diagnostic test accuracy studies from three nephrology journals indexed in MEDLINE. Two investigators hand searched the same journals to create a reference set of diagnostic test accuracy studies to compare search strategy results against. We identified 103 diagnostic test accuracy studies, accounting for 2.1% of all studies published. The most specific search strategy was the Narrow Clinical Queries limit (sensitivity: 0.20, 95% CI 0.13-0.29; specificity: 0.99, 95% CI 0.99-0.99). Using the Narrow Clinical Queries limit, a searcher would need to screen three (95% CI 2-6) articles to find one diagnostic study. The most sensitive search strategy was van der Weijden 1999 Extended (sensitivity: 0.95; 95% CI 0.89-0.98; specificity 0.55, 95% CI 0.53-0.56) but required a searcher to screen 24 (95% CI 23-26) articles to find one diagnostic study. Bachmann 2002 was the best balanced search strategy, which was sensitive (0.88, 95% CI 0.81-0.94), but also specific (0.74, 95% CI 0.73-0.75), with a number needed to screen of 15 (95% CI 14-17). Diagnostic studies are infrequently published in nephrology journals. The addition of a strategy for diagnostic studies to a subject search strategy in MEDLINE may reduce the records needed to screen while preserving adequate search sensitivity for routine clinical use. © 2015 Asian Pacific Society of Nephrology.

Modifiable Risk Factors for Increased Arterial Stiffness in Outpatient Nephrology

PubMed Central

Elewa, Usama; Fernandez-Fernandez, Beatriz; Alegre, Raquel; Sanchez-Niño, Maria D.; Mahillo-Fernández, Ignacio; Perez-Gomez, Maria Vanessa; El-Fishawy, Hussein; Belal, Dawlat; Ortiz, Alberto

2015-01-01

Arterial stiffness, as measured by pulse wave velocity (PWV), is an independent predictor of cardiovascular events and mortality. Arterial stiffness increases with age. However, modifiable risk factors such as smoking, BP and salt intake also impact on PWV. The finding of modifiable risk factors may lead to the identification of treatable factors, and, thus, is of interest to practicing nephrologist. We have now studied the prevalence and correlates of arterial stiffness, assessed by PWV, in 191 patients from nephrology outpatient clinics in order to identify modifiable risk factors for arterial stiffness that may in the future guide therapeutic decision-making. PWV was above normal levels for age in 85/191 (44.5%) patients. Multivariate analysis showed that advanced age, systolic BP, diabetes mellitus, serum uric acid and calcium polystyrene sulfonate therapy or calcium-containing medication were independent predictors of PWV. A new parameter, Delta above upper limit of normal PWV (Delta PWV) was defined to decrease the weight of age on PWV values. Delta PWV was calculated as (measured PWV) - (upper limit of the age-adjusted PWV values for the general population). Mean±SD Delta PWV was 0.76±1.60 m/sec. In multivariate analysis, systolic blood pressure, active smoking and calcium polystyrene sulfonate therapy remained independent predictors of higher delta PWV, while age, urinary potassium and beta blocker therapy were independent predictors of lower delta PWV. In conclusion, arterial stiffness was frequent in nephrology outpatients. Systolic blood pressure, smoking, serum uric acid, calcium-containing medications, potassium metabolism and non-use of beta blockers are modifiable factors associated with increased arterial stiffness in Nephrology outpatients. PMID:25880081

Academy of Nutrition and Dietetics and National Kidney Foundation: revised 2014 Standards of Practice and Standards of Professional Performance for registered dietitian nutritionists (competent, proficient, and expert) in nephrology nutrition.

PubMed

Kent, Pamela S; McCarthy, Maureen P; Burrowes, Jerrilynn D; McCann, Linda; Pavlinac, Jessie; Goeddeke-Merickel, Catherine M; Wiesen, Karen; Kruger, Sarah; Byham-Gray, Laura; Pace, Rory C; Hannahs, Valarie; Benner, Debbie

2014-09-01

Compelling evidence indicates that the incidence of chronic kidney disease (CKD) is increasing because of an aging population and a higher prevalence of cardiovascular disease, diabetes, and hypertension. Nutrition management of patients with CKD requires early disease recognition, appropriate interpretation of the markers and stages of CKD, and collaboration with other health care practitioners. Better management of CKD can slow its progression, prevent metabolic complications, and reduce cardiovascular related outcomes. Caring for patients with CKD necessitates specialized knowledge and skills to meet the challenges associated with this growing epidemic. The Academy of Nutrition and Dietetics Renal Dietitians Practice Group and the National Kidney Foundation Council on Renal Nutrition, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, have updated the 2009 Standards of Practice in Nutrition Care and Standards of Professional Performance as a tool for registered dietitian nutritionists working in nephrology nutrition to assess their current skill levels and to identify areas for additional professional development in this practice area. The Standards of Practice apply to the care of patients/clients with kidney disease. The Standards of Professional Performance consist of six domains of professionalism, including: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Within each standard, specific indicators provide measurable action statements that illustrate how nephrology nutrition principles can be applied to practice. The indicators describe three skill levels (ie, competent, proficient, and expert) for registered dietitian nutritionists working in nephrology nutrition. Copyright © 2014 Academy of Nutrition and Dietetics and the National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Academy of Nutrition and Dietetics and National Kidney Foundation: revised 2014 standards of practice and standards of professional performance for registered dietitian nutritionists (competent, proficient, and expert) in nephrology nutrition.

PubMed

Kent, Pamela S; McCarthy, Maureen P; Burrowes, Jerrilynn D; McCann, Linda; Pavlinac, Jessie; Goeddeke-Merickel, Catherine M; Wiesen, Karen; Kruger, Sarah; Byham-Gray, Laura; Pace, Rory C; Hannahs, Valarie; Benner, Debbie

2014-09-01

Compelling evidence indicates that the incidence of chronic kidney disease (CKD) is increasing because of an aging population and a higher prevalence of cardiovascular disease, diabetes, and hypertension. Nutrition management of patients with CKD requires early disease recognition, appropriate interpretation of the markers and stages of CKD, and collaboration with other health care practitioners. Better management of CKD can slow its progression, prevent metabolic complications, and reduce cardiovascular related outcomes. Caring for patients with CKD necessitates specialized knowledge and skills to meet the challenges associated with this growing epidemic. The Academy of Nutrition and Dietetics Renal Dietitians Practice Group and the National Kidney Foundation Council on Renal Nutrition, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, have updated the 2009 Standards of Practice in Nutrition Care and Standards of Professional Performance as a tool for registered dietitian nutritionists working in nephrology nutrition to assess their current skill levels and to identify areas for additional professional development in this practice area. The Standards of Practice apply to the care of patients/clients with kidney disease. The Standards of Professional Performance consist of six domains of professionalism, including: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Within each standard, specific indicators provide measurable action statements that illustrate how nephrology nutrition principles can be applied to practice. The indicators describe three skill levels (ie, competent, proficient, and expert) for registered dietitian nutritionists working in nephrology nutrition. Copyright © 2014 Academy of Nutrition and Dietetics and the National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

The role of exercise training in the management of chronic kidney disease.

PubMed

Howden, Erin J; Coombes, Jeff S; Isbel, Nicole M

2015-11-01

In this review, we summarize recent studies of exercise interventions in chronic kidney disease (CKD), potential benefits, discuss barriers to implementation and make practical recommendations for incorporating exercise training into the care of patients with CKD. Interventions targeting increased fitness and physical activity are effective and may have multiple potential benefits. Recommendations regarding physical activity advice have been incorporated into the recent update of the KDIGO CKD guidelines, which suggest that patients perform 30 min of moderate intensity exercise on most days of the week. Exercise as simple, popular and inexpensive as walking appears to be associated with significant health benefits. More vigorous exercise requires increased supervision but can be safely prescribed to patients with a broad range of comorbidities and may be associated with greater gains in health. Physical activity, cardiorespiratory fitness and muscle function are low in patients with CKD. A sedentary lifestyle has been associated with increased mortality, morbidity and the risk factors that drive progression of both kidney and cardiac disease. There is much to learn about the benefits of different modalities of exercise but the time has come to routinely prescribe exercise interventions as part of standard nephrological care.

Changing Nephrology Nurses' Beliefs about the Value of Evidence-Based Practice and Their Ability to Implement in Clinical Practice.

PubMed

Hain, Debra; Haras, Mary S

2015-01-01

A rapidly evolving healthcare environment demands sound research evidence to inform clinical practice and improve patient outcomes. Over the past several decades, nurses have generated new knowledge by conducting research studies, but it takes time for this evidence to be implemented in practice. As nurses strive to be leaders and active participants in healthcare redesign, it is essential that they possess the requisite knowledge and skills to engage in evidence-based practice (EBP). Professional nursing organizations can make substantial contributions to the move healthcare quality forward by providing EBP workshops similar to those conducted by the American Nephrology Nurses'Association.

New magnetic resonance imaging methods in nephrology

PubMed Central

Zhang, Jeff L.; Morrell, Glen; Rusinek, Henry; Sigmund, Eric; Chandarana, Hersh; Lerman, Lilach O.; Prasad, Pottumarthi Vara; Niles, David; Artz, Nathan; Fain, Sean; Vivier, Pierre H.; Cheung, Alfred K.; Lee, Vivian S.

2013-01-01

Established as a method to study anatomic changes, such as renal tumors or atherosclerotic vascular disease, magnetic resonance imaging (MRI) to interrogate renal function has only recently begun to come of age. In this review, we briefly introduce some of the most important MRI techniques for renal functional imaging, and then review current findings on their use for diagnosis and monitoring of major kidney diseases. Specific applications include renovascular disease, diabetic nephropathy, renal transplants, renal masses, acute kidney injury and pediatric anomalies. With this review, we hope to encourage more collaboration between nephrologists and radiologists to accelerate the development and application of modern MRI tools in nephrology clinics. PMID:24067433

Nephrology key information for internists

PubMed Central

Salim, Sohail Abdul; Medaura, Juan A.; Malhotra, Bharat; Garla, Vishnu; Ahuja, Shradha; Lawson, Nicki; Pamarthy, Amaleswari; Sonani, Hardik; Kovvuru, Karthik; Palabindala, Venkataraman

2017-01-01

ABSTRACT Hospitalists and primary care physicians encounter renal disease daily. Although most cases of acute kidney injury (AKI) are secondary to dehydration and resolve by giving fluids, many cases of AKI are due to not uncommon but unfamiliar causes needing nephrology evaluation. Common indications to consult a nephrologist on an emergency basis include hyperkalemia or volume overload in end stage renal disease patients (ESRD). Other causes of immediate consultation are cresenteric glomerulonephritis / rapidly progressive glomerulonephritis in which renal prognosis of the patient depends on timely intervention. The following evidence-based key information could improve patient care and outcomes. Abbreviations: AKI: Acute kidney injury ESRD: End stage renal disease patients PMID:28638567

Microelectromechanical Systems and Nephrology: The Next Frontier in Renal Replacement Technology

PubMed Central

Kim, Steven; Roy, Shuvo

2013-01-01

Microelectromechanical systems (MEMS) is playing a prominent role in the development of many new and innovative biomedical devices, but remains a relatively underutilized technology in nephrology. The future landscape of clinical medicine and research will only see further expansion of MEMS based technologies in device designs and applications. The enthusiasm stems from the ability to create small-scale device features with high precision in a cost effective manner. MEMS also offers the possibility to integrate multiple components into a single device. The adoption of MEMS has the potential to revolutionize how nephrologists manage kidney disease by improving the delivery of renal replacement therapies and enhancing the monitoring of physiologic parameters. To introduce nephrologists to MEMS, this review will first define relevant terms and describe the basic processes used to fabricate MEMS devices. Next, a survey of MEMS devices being developed for various biomedical applications will be illustrated with current examples. Finally, MEMS technology specific to nephrology will be highlighted and future applications will be examined. The adoption of MEMS offers novel avenues to improve the care of kidney disease patients and assist nephrologists in clinical practice. This review will serve as an introduction for nephrologists to the exciting world of MEMS. PMID:24206604

[An evaluation of costs in nephrology by means of analytical accounting system].

PubMed

Hernández-Jaras, J; García Pérez, H; Pons, R; Calvo, C

2005-01-01

The analytical accounting is a countable technique directed to the evaluation, by means of pre-established criteria of distribution, of the internal economy of the hospital, in order to know the effectiveness and efficiency of Clinical Units. The aim of this study was to analyze the activity and costs of the Nephrology Department of General Hospital of Castellón. Activity of Hospitalization and Ambulatory Care, during 2003 was analysed. Hospitalization discharges were grouped in DGR and the costs per DGR were determinated. Total costs Hospitalisation and Ambulatory Care were 560.434,9 and 146.317,8 Euros, respectively. And the costs of one stay, one first outpatient visit and maintenance visit were 200, 63, and 31,6 Euros, respectively. Eighty per cent of the discharges were grouped in 9 DGR and DRG number 316 (Renal Failure) represented 30% of the total productivity. Costs of DGR 316 were 3.178,2 Euros and 16% represented laboratory cost and costs of diagnostic or therapeutic procedures. With introduction of analytical accounting and DGR system, the Nephrology Departments can acquire more full information on the results and costs of treatment. These techniques permits to improve the financial and economic performance.

Overcoming Barriers in Kidney Health-Forging a Platform for Innovation.

PubMed

Linde, Peter G; Archdeacon, Patrick; Breyer, Matthew D; Ibrahim, Tod; Inrig, Jula K; Kewalramani, Reshma; Lee, Celeste Castillo; Neuland, Carolyn Y; Roy-Chaudhury, Prabir; Sloand, James A; Meyer, Rachel; Smith, Kimberly A; Snook, Jennifer; West, Melissa; Falk, Ronald J

2016-07-01

Innovation in kidney diseases is not commensurate with the effect of these diseases on human health and mortality or innovation in other key therapeutic areas. A primary cause of the dearth in innovation is that kidney diseases disproportionately affect a demographic that is largely disenfranchised, lacking sufficient advocacy, public attention, and funding. A secondary and likely consequent cause is that the existing infrastructure supporting nephrology research pales in comparison with those for other internal medicine specialties, especially cardiology and oncology. Citing such inequities, however, is not enough. Changing the status quo will require a coordinated effort to identify and redress the existing deficits. Specifically, these deficits relate to the need to further develop and improve the following: understanding of the disease mechanisms and pathophysiology, patient engagement and activism, clinical trial infrastructure, and investigational clinical trial designs as well as coordinated efforts among critical stakeholders. This paper identifies potential solutions to these barriers, some of which are already underway through the Kidney Health Initiative. The Kidney Health Initiative is unique and will serve as a current and future platform from which to overcome these barriers to innovation in nephrology. Copyright © 2016 by the American Society of Nephrology.

Pragmatic Randomized, Controlled Trial of Patient Navigators and Enhanced Personal Health Records in CKD.

PubMed

Navaneethan, Sankar D; Jolly, Stacey E; Schold, Jesse D; Arrigain, Susana; Nakhoul, Georges; Konig, Victoria; Hyland, Jennifer; Burrucker, Yvette K; Dann, Priscilla Davis; Tucky, Barbara H; Sharp, John; Nally, Joseph V

2017-09-07

Patient navigators and enhanced personal health records improve the quality of health care delivered in other disease states. We aimed to develop a navigator program for patients with CKD and an electronic health record-based enhanced personal health record to disseminate CKD stage-specific goals of care and education. We also conducted a pragmatic randomized clinical trial to compare the effect of a navigator program for patients with CKD with enhanced personal health record and compare their combination compared with usual care among patients with CKD stage 3b/4. Two hundred and nine patients from six outpatient clinics (in both primary care and nephrology settings) were randomized in a 2×2 factorial design into four-study groups: ( 1 ) enhanced personal health record only, ( 2 ) patient navigator only, ( 3 ) both, and ( 4 ) usual care (control) group. Primary outcome measure was the change in eGFR over a 2-year follow-up period. Secondary outcome measures included acquisition of appropriate CKD-related laboratory measures, specialty referrals, and hospitalization rates. Median age of the study population was 68 years old, and 75% were white. At study entry, 54% of patients were followed by nephrologists, and 88% were on renin-angiotensin system blockers. After a 2-year follow-up, rate of decline in eGFR was similar across the four groups ( P =0.19). Measurements of CKD-related laboratory parameters were not significantly different among the groups. Furthermore, referral for dialysis education and vascular access placement, emergency room visits, and hospitalization rates were not statistically significant different between the groups. We successfully developed a patient navigator program and an enhanced personal health record for the CKD population. However, there were no differences in eGFR decline and other outcomes among the study groups. Larger and long-term studies along with cost-effectiveness analyses are needed to evaluate the role of patient navigators and patient education through an enhanced personal health record in those with CKD. Copyright © 2017 by the American Society of Nephrology.

System-Level Barriers and Facilitators for Foregoing or Withdrawing Dialysis: A Qualitative Study of Nephrologists in the United States and England.

PubMed

Grubbs, Vanessa; Tuot, Delphine S; Powe, Neil R; O'Donoghue, Donal; Chesla, Catherine A

2017-11-01

Despite a growing body of literature suggesting that dialysis does not confer morbidity or mortality benefits for all patients with chronic kidney failure, the initiation and continuation of dialysis therapy in patients with poor prognosis is commonplace. Our goal was to elicit nephrologists' perspectives on factors that affect decision making regarding end-stage renal disease. Semistructured, individual, qualitative interviews. Participants were purposively sampled based on age, race, sex, geographic location, and practice type. Each was asked about his or her perspectives and experiences related to foregoing and withdrawing dialysis therapy. Interviews were audiotaped, transcribed, and analyzed using narrative and thematic analysis. We conducted 59 semistructured interviews with nephrologists from the United States (n=41) and England (n=18). Most participants were 45 years or younger, men, and white. Average time since completing nephrology training was 14.2±11.6 (SD) years. Identified system-level facilitators and barriers for foregoing and withdrawing dialysis therapy stemmed from national and institutional policies and structural factors, how providers practice medicine (the culture of medicine), and beliefs and behaviors of the public (societal culture). In both countries, the predominant barriers described included lack of training in end-of-life conversations and expectations for aggressive care among non-nephrologists and the general public. Primary differences included financial incentives to dialyze in the United States and widespread outpatient conservative management programs in England. Participants' views may not fully capture those of all American or English nephrologists. Nephrologists in the United States and England identified several system-level factors that both facilitated and interfered with decision making around foregoing and withdrawing dialysis therapy. Efforts to expand facilitators while reducing barriers could lead to care practices more in keeping with patient prognosis. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Reduction of morbidity related to emergency access to dialysis with very low protein diet supplemented with ketoacids (VLPD+KA).

PubMed

Duenhas, Marta; Gonçalves, Elsa; Dias, Mônica; Leme, Graziela; Laranja, Sandra

2013-05-01

To delay the beginning of the renal replacement therapy (RRT) until the AV fistula is either made and mature or the training for peritoneal dialysis (PD) is given. Prospective study. Nephrology's Ambulatory, Hospital Servidor Público Estadual. 21 patients with chronic kidney disease (CKD) have been followed. For a period of 30 days, a VLPD+KA would be prescribed until the AV fistula was made or the PD training was given The patients were evaluated prior to the beginning of the VLPD+KA, on the 15th and the 30th day, and at the end of the study, with physical and nutritional evaluation, laboratory tests and 24-hour excretion of urinary urea and urinary protein, creatinine and urea residual clearance. 47.6% (10/21) of the patients have initiated HD with matured and suitable AV fistula made in 30 days; 33.3% (7/21) of the patients have been unfit to initiate RRT, even though with sufficient time for the creation of the AV fistula or the training for PD due to AV fistula thrombosis; 14.3% (3/21) of the patients have remained in the study with no need for dialysis, and 4.8% (1/21) have been excluded on the grounds of not having adhered to the VLPD+KA. The anthropometric parameters and the energy intake have not differed from one period to the other. The VLPD+KA is safe to maintain the nutritional status of patients of CKD until the AV fistula is made or the PD training is given.

In vitro generation of renal tubular epithelial cells from fibroblasts: implications for precision and regenerative medicine in nephrology.

PubMed

Wyatt, Christina M; Dubois, Nicole

2017-02-01

Prior efforts to generate renal epithelial cells in vitro have relied on pluripotent or bone marrow-derived mesenchymal stem cells. A recent publication in Nature Cell Biology describes the generation of induced tubular epithelial cells from fibroblasts, potentially offering a novel platform for personalized drug toxicity screening and in vitro disease modeling. This report serves as a promising proof of principle study and opens future research directions, including the optimization of the reprogramming process, efficient translation to adult human fibroblasts, and the generation of highly specific functional renal cell types. Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

Unique Study Designs in Nephrology: N-of-1 Trials and Other Designs.

PubMed

Samuel, Joyce P; Bell, Cynthia S

2016-11-01

Alternatives to the traditional parallel-group trial design may be required to answer clinical questions in special populations, rare conditions, or with limited resources. N-of-1 trials are a unique trial design which can inform personalized evidence-based decisions for the patient when data from traditional clinical trials are lacking or not generalizable. A concise overview of factorial design, cluster randomization, adaptive designs, crossover studies, and n-of-1 trials will be provided along with pertinent examples in nephrology. The indication for analysis strategies such as equivalence and noninferiority trials will be discussed, as well as analytic pitfalls. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

[Transplant Surgeon Meets Nephrologist: Important Nephrological Aspects Before and After Kidney or Liver Transplantation].

PubMed

Vondran, F W R; Wintterle, S; Bräsen, J H; Haller, H; Klempnauer, J; Richter, N; Lehner, F; Schiffer, M

2017-04-01

In cases of chronic renal insufficiency, successful kidney transplantation is the method of choice to restore patients' health, well-being and physical fitness. The interdisciplinary collaboration of nephrologists and transplant surgeons has always been a prerequisite for the successful pre-, peri- and post-transplant care of renal transplant patients. The same holds true for liver transplant patients. Here the nephrologist is often involved in cases requiring pre- or post-transplant dialysis as well as in decision making for combined liver-kidney transplantation. This review focuses on nephrological aspects in patient care before and after kidney and liver transplantation. Georg Thieme Verlag KG Stuttgart · New York.

Life and Work of Academician Momir Polenakovic.

PubMed

Kambovski, Vlado

2015-01-01

Talking about Acad. Momir Polenakovic, on the occasion of his 75th anniversary and 50 years of work, it is my pleasure to say that he is one of the rare medical workers, researchers, visionaries and educators, especially in the field of nephrology. With his work he became famous in Macedonia and in the world and raised the Macedonian nephrology to a European level. He is characterized with the highest virtues of the scientist: knowledge, diligence, searching for truth and empathy. Acad. Polenakovic is an example to all younger counterparts for his exceptionally correct and friendly relations with all his associates, and, he also supports his younger colleagues in their work and development.

Long-term prospective evaluation of an inpatient voiding reeducation program for lower urinary tract conditions in children.

PubMed

Golli, Tanja; Meglič, Anamarija; Kenda, Rajko B

2013-04-01

Our aim was to evaluate the efficacy of our treatment program for children with lower urinary tract conditions, developed at the Department of Pediatric Nephrology of the University Children's Hospital in Ljubljana. Sixty-four patients with lower urinary tract conditions were randomly allocated to two groups. Group A received treatment immediately, whereas patients of group B received no treatment for a period of 3 months-the amount of time it takes to complete our program. No child in group B experienced spontaneous regression of their symptoms in the 3-month delay period, while the patients of group A were already being treated and were achieving results. Thus, all the patients of group B then entered the program in exactly the same way as patients of group A. The final success rate in both groups did not differ significantly (p = 0.706-1.000) and ranged from 86.2 % for group A and 86.7 to 90 % for group B. Long-term follow-up showed statistically identical success rates (p = 1.000). This prospective controlled study with long-term follow-up (48 months) shows that our treatment program, applied as an inpatient voiding school program, is an effective method, with durable results.

Nephrologic Impact of Hurricanes Katrina and Rita in Areas Not Directly Affected.

PubMed

Dossabhoy, Neville R; Qadri, Mashood; Beal, Lauren M

2015-01-01

Hurricanes Katrina and Rita resulted in enormous loss of life and disrupted the delivery of health care in areas affected by them. In causing mass movements of patients, natural disasters can overwhelm the resources of nephrology communities in areas not suffering direct damage. The following largely personal account evaluates the impact these hurricanes had upon the nephrology community, patients and health care providers alike, in areas not directly affected by the storms. Mass evacuation of hundreds of dialysis patients to surrounding areas overwhelmed the capacity of local hemodialysis centers. Non-availability of medical records in patients arriving without a supply of their routine medications led to confusion and sub-optimal treatment of conditions such as hypertension and congestive heart failure. Availability of cadaveric organs for transplantation was reduced in the surrounding areas, as the usual lines of communication and transportation were severed for several weeks. All of these issues led to prolong waiting times for patients on the transplant list. The hurricanes severely disrupted usual supply lines of medications to hospitals; certain rare conditions may be seen in higher numbers as a result of the shortages induced. We present the interesting surge in cases of acute kidney injury secondary to use of intravenous immune globulin.

The Nephrologist’s Tumor: Basic Biology and Management of Renal Cell Carcinoma

PubMed Central

Hu, Susie L.; Chang, Anthony; Perazella, Mark A.; Okusa, Mark D.; Jaimes, Edgar A.

2016-01-01

Kidney cancer, or renal cell carcinoma (RCC), is a disease of increasing incidence that is commonly seen in the general practice of nephrology. However, RCC is under-recognized by the nephrology community, such that its presence in curricula and research by this group is lacking. In the most common form of RCC, clear cell renal cell carcinoma (ccRCC), inactivation of the von Hippel–Lindau tumor suppressor is nearly universal; thus, the biology of ccRCC is characterized by activation of hypoxia-relevant pathways that lead to the associated paraneoplastic syndromes. Therefore, RCC is labeled the internist’s tumor. In light of this characterization and multiple other metabolic abnormalities recently associated with ccRCC, it can now be viewed as a metabolic disease. In this review, we discuss the basic biology, pathology, and approaches for treatment of RCC. It is important to distinguish between kidney confinement and distant spread of RCC, because this difference affects diagnostic and therapeutic approaches and patient survival, and it is important to recognize the key interplay between RCC, RCC therapy, and CKD. Better understanding of all aspects of this disease will lead to optimal patient care and more recognition of an increasingly prevalent nephrologic disease, which we now appropriately label the nephrologist’s tumor. PMID:26961346

Managing Disruptive Behavior by Patients and Physicians: A Responsibility of the Dialysis Facility Medical Director.

PubMed

Jones, Edward R; Goldman, Richard S

2015-08-07

The Centers for Medicare & Medicaid Services' Conditions for Coverage make the medical director of an ESRD facility responsible for all aspects of care, including high-quality health care delivery (e.g., safe, effective, timely, efficient, and patient centered). Because of the high-pressure environment of the dialysis facility, conflicts are common. Conflict frequently occurs when aberrant behaviors disrupt the dialysis facility. Patients, family members, friends, and, less commonly appreciated, nephrology clinicians (i.e., nephrologists and advanced care practitioners) may manifest disruptive behavior. Disruptive behavior in the dialysis facility impairs the ability to deliver high-quality care. Furthermore, disruptive behavior is the leading cause for involuntary discharge (IVD) or involuntary transfer (IVT) of a patient from a facility. IVD usually results in loss of continuity of care, increased emergency department visits, and increased unscheduled, acute dialysis treatments. A sufficient number of IVDs and IVTs also trigger an extensive review of the facility by the regional ESRD Networks, exposing the facility to possible Medicare-imposed sanctions. Medical directors must be equipped to recognize and correct disruptive behavior. Nephrology-based literature and tools exist to help dialysis facility medical directors successfully address and resolve disruptive behavior before medical directors must involuntarily discharge a patient or terminate an attending clinician. Copyright © 2015 by the American Society of Nephrology.

Improving care coordination between nephrology and primary care: a quality improvement initiative using the renal physicians association toolkit.

PubMed

Haley, William E; Beckrich, Amy L; Sayre, Judith; McNeil, Rebecca; Fumo, Peter; Rao, Vijaykumar M; Lerma, Edgar V

2015-01-01

Individuals at risk for chronic kidney disease (CKD), including those with diabetes mellitus and hypertension, are prevalent in primary care physician (PCP) practices. A major systemic barrier to mitigating risk of progression to kidney failure and to optimal care is failure of communication and coordination among PCPs and nephrologists. Quality improvement. Longitudinal practice-level study of tool-based intervention in nephrology practices and their referring PCP practices. 9 PCP and 5 nephrology practices in Philadelphia and Chicago. Tools from Renal Physicians Association toolkit were modified and provided for use by PCPs and nephrologists to improve identification of CKD, communication, and comanagement. CKD identification, referral to nephrologists, communication among PCPs and nephrologists, comanagement processes. Pre- and postimplementation interviews, questionnaires, site visits, and monthly teleconferences were used to ascertain practice patterns, perceptions, and tool use. Interview transcripts were reviewed for themes using qualitative analysis based on grounded theory. Chart audits assessed CKD identification and referral (PCPs). PCPs improved processes for CKD identification, referral to nephrologists, communication, and execution of comanagement plans. Documentation of glomerular filtration rate was increased significantly (P=0.01). Nephrologists improved referral and comanagement processes. PCP postintervention interviews documented increased awareness of risk factors, the need to track high-risk patients, and the importance of early referral. Final nephrologist interviews revealed heightened attention to communication and comanagement with PCPs and increased levels of satisfaction among all parties. Nephrology practices volunteered to participate and recruit their referring PCP practices. Audit tools were developed for quality improvement assessment, but were not designed to provide statistically significant estimates. The use of specifically tailored tools led to enhanced awareness and identification of CKD among PCPs, increased communication between practices, and improvement in comanagement and cooperation between PCPs and nephrologists. Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Severe hyperkalaemia: demographics and outcome

PubMed Central

Phillips, B.M.; Milner, S.; Zouwail, S.; Roberts, G.; Cowan, M.; Riley, S.G.; Phillips, A.O.

2014-01-01

Background Few studies have evaluated the prevalence of severe hyperkalaemia in unselected patient populations. We identified all episodes of severe hyperkalaemia occurring in 1 year, and described patient demographics, clinical response and outcome. We also assessed junior doctor knowledge of its causes and significance. Materials and methods A retrospective interrogation of the database of the regional biochemical laboratory identified all episodes of severe hyperkalaemia (K≥ 6.5 mmol/L) occurring in 2011. The understanding of trainee doctors of the importance, causes and treatment of severe hyperkalaemia was assessed by structured questionnaire. Results Severe hyperkalaemia was recorded in 433 samples (365 patients) giving a prevalence of 0.11%. Thirty-six per cent of episodes occurred in patients under the care of a nephrologist, who were significantly younger than those not under the care of a nephrologist. In the nephrology cohort, 86% occurred in patients with chronic kidney disease (CKD), the majority of which had CKD Stage 5. In the non-nephrology cohort, only 65% occurred in the context of CKD, which was equally distributed between Stages 3 and 5 CKD. In both patient groups, roughly 50% of episodes occurred in association with acute kidney injury (AKI). Acute mortality (death within 48 h of documented severe hyperkalaemia) was higher in the non-nephrology compared with the nephrology cohort. Time to repeat serum potassium was influenced by the clinical setting with shorter time to repeat for acute care compared with ward settings. Assessment of trainee doctor's knowledge suggested significant deficiencies in relation to severe hyperkalaemia. Conclusions The prevalence of severe hyperkalaemia was low and occurred predominantly in the context of CKD and/or AKI. The majority of episodes occurred in patients not under the care of a nephrologist. Variability in time to repeat serum potassium levels suggested deficiencies in care, and assessment of trainee doctor’s knowledge suggests the need for further educational initiatives to highlight its importance. PMID:25852860

The Evolution of Academic Performance in Nine Subspecialties of Internal Medicine: An Analysis of Journal Citation Reports from 1998 to 2010

PubMed Central

Zhang, Xue-Guang; Zhang, Li; Liu, Shu-Wen; Cao, Xue-Ying; Wang, Yuan-Da; Wei, Ri-Bao; Cai, Guang-Yan; Chen, Xiang-Mei

2012-01-01

Background Internal medicine includes several subspecialties. This study aimed to describe change trend of impact factors in different subspecialties of internal medicine during the past 12 years, as well as the developmental differences among each subspecialty, and the possible influencing factors behind these changes and differences. Methods Nine subspecialties of internal medicine were chosen for comparison. All data were collected from the Science Citation Index Expanded and Journal Citation Reports database. Results (1) Journal numbers in nine subspecialties increased significantly from 1998 to 2010, with an average increment of 80.23%, in which cardiac and cardiovascular system diseases increased 131.2% rank the first; hematology increased 45% rank the least. (2) Impact Factor in subspecialties of infectious disease, cardiac and cardiovascular system diseases, gastroenterology and hepatology, hematology, endocrinology and metabolism increased significantly (p<0.05), in which gastroenterology and hepatology had the largest increase of 65.4%. (3) Journal impact factor of 0–2 had the largest proportion in all subspecialties. Among the journals with high impact factor (IF>6), hematology had the maximum proportion of 10%, nephrology and respiratory system disease had the minimum of 4%. Among the journal with low impact factor (IF<2), journal in nephrology and allergy had the most (60%), while endocrinology and metabolism had the least (40%). There were differences in median number of IF among the different subspecialties (p<0.05), in which endocrinology and metabolism had the highest, nephrology had the lowest. (4) The highest IF had a correlation with journal numbers and total paper numbers in each field. Conclusion The IF of internal medicine journals showed an increasingly positive trend, in which gastroenterology and hepatology increase the most. Hematology had more high IF journals. Endocrinology and metabolism had higher average IF. Nephrology remained the lowest position. Numbers of journals and total papers were associated with the highest IF. PMID:23118973

The British Columbia Nephrologists' Access Study (BCNAS) - a prospective, health services interventional study to develop waiting time benchmarks and reduce wait times for out-patient nephrology consultations.

PubMed

Schachter, Michael E; Romann, Alexandra; Djurdev, Ognjenka; Levin, Adeera; Beaulieu, Monica

2013-08-29

Early referral and management of high-risk chronic kidney disease may prevent or delay the need for dialysis. Automatic eGFR reporting has increased demand for out-patient nephrology consultations and in some cases, prolonged queues. In Canada, a national task force suggested the development of waiting time targets, which has not been done for nephrology. We sought to describe waiting time for outpatient nephrology consultations in British Columbia (BC). Data collection occurred in 2 phases: 1) Baseline Description (Jan 18-28, 2010) and 2) Post Waiting Time Benchmark-Introduction (Jan 16-27, 2012). Waiting time was defined as the interval from receipt of referral letters to assessment. Using a modified Delphi process, Nephrologists and Family Physicians (FP) developed waiting time targets for commonly referred conditions through meetings and surveys. Rules were developed to weigh-in nephrologists', FPs', and patients' perspectives in order to generate waiting time benchmarks. Targets consider comorbidities, eGFR, BP and albuminuria. Referred conditions were assigned a priority score between 1-4. BC nephrologists were encouraged to centrally triage referrals to see the first available nephrologist. Waiting time benchmarks were simultaneously introduced to guide patient scheduling. A post-intervention waiting time evaluation was then repeated. In 2010 and 2012, 43/52 (83%) and 46/57 (81%) of BC nephrologists participated. Waiting time decreased from 98(IQR44,157) to 64(IQR21,120) days from 2010 to 2012 (p = <.001), despite no change in referral eGFR, demographics, nor number of office hrs/wk. Waiting time improved most for high priority patients. An integrated, Provincial initiative to measure wait times, develop waiting benchmarks, and engage physicians in active waiting time management associated with improved access to nephrologists in BC. Improvements in waiting time was most marked for the highest priority patients, which suggests that benchmarks had an influence on triaging behavior. Further research is needed to determine whether this effect is sustainable.

Transition of adolescent and young adult patients with childhood-onset chronic kidney disease from pediatric to adult renal services: a nationwide survey in Japan.

PubMed

Hattori, Motoshi; Iwano, Masayuki; Sako, Mayumi; Honda, Masataka; Okada, Hirokazu; Akioka, Yuko; Ashida, Akira; Kawasaki, Yukihiko; Kiyomoto, Hideyasu; Terada, Yoshio; Hirano, Daishi; Fujieda, Mikiya; Fujimoto, Shouichi; Masaki, Takao; Maruyama, Shoichi; Mastuo, Seiich

2016-12-01

Transition of adolescent and young adult (AYA) patients with childhood-onset chronic kidney diseases (C-CKD) from pediatric to adult renal services has received increasing attention. However, information on transition of Japanese patients with C-CKD is limited. The Transition Medicine Working Group, in collaboration with the Japanese Society for Nephrology, the Japanese Society for Pediatric Nephrology and the Japanese Society of Pediatric Urology, conducted a retrospective cross-sectional study in 2014 on issues concerning the transition of Japanese patients with C-CKD. Few institutions in Japan had transition programs and/or transition coordinators for patients with C-CKD. Refusal to transfer by patients or their families, lack of concern about transition and inability to decide on transfer were common reasons for non-transfer of patients still followed by pediatric renal services. Around 25 % of patients who had ended or interrupted follow-up by pediatric renal services presented to adult renal services because of symptoms associated with C-CKD. Patients with various types of childhood-onset nephrourological diseases were transferred from pediatric to adult renal services. IgA nephropathy, minimal change nephrotic syndrome and congenital anomalies of the kidney and urinary tract were the most frequent primary kidney diseases in adult patients with C-CKD. These survey results indicate the need for introduction of transitional care for Japanese AYA patients with C-CKD. Consensus guidelines for the optimal clinical management of AYA patients with C-CKD are required to ensure the continuity of care from child to adult renal services.

Chronic kidney disease hotspots in developing countries in South Asia.

PubMed

Abraham, Georgi; Varughese, Santosh; Thandavan, Thiagarajan; Iyengar, Arpana; Fernando, Edwin; Naqvi, S A Jaffar; Sheriff, Rezvi; Ur-Rashid, Harun; Gopalakrishnan, Natarajan; Kafle, Rishi Kumar

2016-02-01

In many developing countries in the South Asian region, screening for chronic diseases in the community has shown a widely varying prevalence. However, certain geographical regions have shown a high prevalence of chronic kidney disease (CKD) of unknown etiology. This predominantly affects the young and middle-aged population with a lower socioeconomic status. Here, we describe the hotspots of CKD of undiagnosed etiology in South Asian countries including the North, Central and Eastern provinces of Sri Lanka and the coastal region of the state of Andhra Pradesh in India. Screening of these populations has revealed cases of CKD in various stages. Race has also been shown to be a factor, with a much lower prevalence of CKD in whites compared to Asians, which could be related to the known influence of ethnicity on CKD development as well as environmental factors. The difference between developed and developing nations is most stark in the realm of healthcare, which translates into CKD hotspots in many regions of South Asian countries. Additionally, the burden of CKD stage G5 remains unknown due to the lack of registry reports, poor access to healthcare and lack of an organized chronic disease management program. The population receiving various forms of renal replacement therapy has dramatically increased in the last decade due to better access to point of care, despite the disproportionate increase in nephrology manpower. In this article we will discuss the nephrology care provided in various countries in South Asia, including India, Bangladesh, Pakistan, Nepal, Bhutan, Sri Lanka and Afghanistan.

Jewish medicine and the University of Padua: contribution of the Padua graduate Toviah Cohen to nephrology.

PubMed

Massry, S G; Smogorzewski, M; Hazani, E; Shasha, S M

1999-01-01

During the period of the 11th to 17th century, the access of Jews to European universities was restricted and even those who were fortunate enough to be admitted to a university were not awarded a degree at the end of their studies. An exception to this situation was the University of Padua that allowed Jewish students to study and awarded them degrees; indeed 229 physicians graduated from this university between 1409 and 1721. Among these physicians there were many luminaries such as Joseph Del Medigo, Salmon Congeliano and Toviah Cohen. The latter made many contributions to the field of nephrology. In this treatise Maaseh Toviah he discussed uroscopy, kidney function, body fluid homeostasis and obstructive uropathy.

Balancing the Duty to Treat Patients with Ebola Virus Disease with the Risks to Dialysis Personnel.

PubMed

Evans, Nicholas G

2015-12-07

In 2014, the author was invited to present at the American Society for Nephrology's annual conference in Philadelphia on the ethics of treating patients with Ebola virus disease. The argument was made that the status of health care workers, including nephrologists, was the dominant ethical standard that generated both the duty to treat and the conflicts between this commitment and other ethical commitments that arise in public health emergencies. Conflicts between duty to treat and personal safety, duty to community, and duty to colleagues were illustrated, and suggestions for designing ethics into medical practice were given. This article is a summary of that presentation. Copyright © 2015 by the American Society of Nephrology.

Depression in dialysis patients.

PubMed

King-Wing Ma, Terry; Kam-Tao Li, Philip

2016-08-01

Depression is the most common psychiatric illness in patients with end-stage renal disease (ESRD). The reported prevalence of depression in dialysis population varied from 22.8% (interview-based diagnosis) to 39.3% (self- or clinician-administered rating scales). Such differences were attributed to the overlapping symptoms of uraemia and depression. Systemic review and meta-analysis of observational studies showed that depression was a significant predictor of mortality in dialysis population. The optimal screening tool for depression in dialysis patients remains uncertain. The Beck Depression Inventory (BDI), Patient Health Questionnaire (PHQ) and Center for Epidemiologic Studies Depression Scale (CESD) have been validated for screening purposes. Patients who scored ≥14 using BDI should be referred to a psychiatrist for early evaluation. Structured Clinical Interview for DSM disorders (SCID) remains the gold standard for diagnosis. Non-pharmacological treatment options include cognitive behavioural therapy and exercise training programs. Although frequent haemodialysis may have beneficial effects on patients' physical and mental well-being, it cannot and should not be viewed as a treatment of depression. Selective serotonin reuptake inhibitors (SSRIs) are generally effective and safe in ESRD patients, but most studies were small, non-randomized and uncontrolled. The European Renal Best Practice (ERBP) guideline suggests a trial of SSRI for 8 to 12 weeks in dialysis patients who have moderate-major depression. The treatment effect should be re-evaluated after 12 weeks to avoid prolonging ineffective medication. This review will discuss the current understanding in the diagnosis and management of depression in dialysis patients. © 2016 Asian Pacific Society of Nephrology.

Awareness and Knowledge Among Internal Medicine Resident Trainees for Dose Adjustment of Analgesics and Neuropsychotropic Medications in CKD.

PubMed

Saad, Chadi Y; Fogel, Joshua; Rubinstein, Sofia

2018-03-01

Errors in drug dosing lead to poor patient outcomes and are common in patients with chronic kidney disease (CKD). Because the majority of patients with CKD are being treated by physicians specializing in internal medicine, we studied the awareness and knowledge that internal medicine resident trainees (IMRTs) have regarding the correct dosage of commonly used analgesic and neuropsychotropic medications for patients with CKD. We surveyed 353 IMRTs about their awareness of whether a medication needs dose adjustment in patients with CKD and knowledge for medication adjustment by level of glomerular filtration rate. There were high percentages for lack of awareness and knowledge. For analgesics, this lack of awareness/knowledge was highest for acetaminophen (awareness 83.0%, knowledge 90.9%). For neuropsychotropics, this was highest for paroxetine (awareness 74.5%, knowledge 91.5%). Analyses for postgraduate year (PGY) -1 trainees and PGY-2 trainees for analgesics showed higher odds for lack of awareness for tramadol (PGY-1 odds ratio [OR] 2.37, 95% confidence interval [CI] 1.2-4.62, P < 0.05; PGY-2 OR 2.34, 95% CI 1.16-4.72, P < 0.05) and for lack of knowledge for meperedine (PGY-1 OR 4.01, 95% CI 1.81-8.89, P < 0.05; PGY-2 OR 3.30, 95% CI 1.44-7.59, P < 0.05). Nephrology residency rotation for the neuropsychotropic medication of gabapentin showed lower odds for both lack of awareness (OR 0.56, 95% CI 0.32-0.97, P < 0.05) and knowledge (OR 0.52, 95% CI 0.27-0.997, P < 0.05). Awareness and knowledge are poor among IMRTs for dose adjustments of analgesics and neuropsychotropic medication classes in patients with CKD. There should be a renewed focus during IMRTs' residency on additional nephrology exposure and formal didactic educational training to help them better manage complex treatment regimens to prevent medication dosing errors.

“Advice to the medical students in my service”: the rediscovery of a golden book by Jean Hamburger, father of nephrology and of medical humanities

PubMed Central

2013-01-01

Jean Hamburger (1909–1992) is considered the founder of the concept of medical intensive care (réanimation médicale) and the first to propose the name Nephrology for the branch of medicine dealing with kidney diseases. One of the first kidney grafts in the world (with short-term success), in 1953, and the first dialysis session in France, in 1955, were performed under his guidance. His achievements as a writer were at least comparable: Hamburger was awarded several important literary prizes, including prix Femina, prix Balzac and the Cino del Duca prize (1979), awarded, among others, to Jorge Luis Borges and Konrad Lorenz. Here we would like to offer a selected reading of a “golden” book, “Conseils aux étudiants en medicine de mon service” (“Advice to the Medical Students in my Service”), the first book dedicated to patient-physician relationship in Nephrology, written when dialysis and transplantation were becoming clinical options (1963). The themes include: the central role of the patient, who should be known by name, profession, life style, and not by disease; the importance of the setting of the care; the need for truth-telling and for leaving hope; the role of research not only in the progression of science, but also in the daily clinical practice. PMID:23497662

The National Institute of Diabetes and Digestive and Kidney Diseases Central Repositories: a valuable resource for nephrology research.

PubMed

Rasooly, Rebekah S; Akolkar, Beena; Spain, Lisa M; Guill, Michael H; Del Vecchio, Corey T; Carroll, Leslie E

2015-04-07

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Central Repositories, part of the National Institutes of Health (NIH), are an important resource available to researchers and the general public. The Central Repositories house samples, genetic data, phenotypic data, and study documentation from >100 NIDDK-funded clinical studies, in areas such as diabetes, digestive disease, and liver disease research. The Central Repositories also have an exceptionally rich collection of studies related to kidney disease, including the Modification of Diet in Renal Disease landmark study and recent data from the Chronic Renal Insufficiency Cohort and CKD in Children Cohort studies. The data are carefully curated and linked to the samples from the study. The NIDDK is working to make the materials and data accessible to researchers. The Data Repositories continue to improve flexible online searching tools that help researchers identify the samples or data of interest, and NIDDK has created several different paths to access the data and samples, including some funding initiatives. Over the past several years, the Central Repositories have seen steadily increasing interest and use of the stored materials. NIDDK plans to make more collections available and do more outreach and education about use of the datasets to the nephrology research community in the future to enhance the value of this resource. Copyright © 2015 by the American Society of Nephrology.

"Advice to the medical students in my service": the rediscovery of a golden book by Jean Hamburger, father of nephrology and of medical humanities.

PubMed

Barbara, Piccoli Giorgina

2013-03-15

Jean Hamburger (1909-1992) is considered the founder of the concept of medical intensive care (réanimation médicale) and the first to propose the name Nephrology for the branch of medicine dealing with kidney diseases. One of the first kidney grafts in the world (with short-term success), in 1953, and the first dialysis session in France, in 1955, were performed under his guidance. His achievements as a writer were at least comparable: Hamburger was awarded several important literary prizes, including prix Femina, prix Balzac and the Cino del Duca prize (1979), awarded, among others, to Jorge Luis Borges and Konrad Lorenz.Here we would like to offer a selected reading of a "golden" book, "Conseils aux étudiants en medicine de mon service" ("Advice to the Medical Students in my Service"), the first book dedicated to patient-physician relationship in Nephrology, written when dialysis and transplantation were becoming clinical options (1963). The themes include: the central role of the patient, who should be known by name, profession, life style, and not by disease; the importance of the setting of the care; the need for truth-telling and for leaving hope; the role of research not only in the progression of science, but also in the daily clinical practice.

Introduction of Biosimilar Therapeutics Into Nephrology Practice in the United States: Report of a Scientific Workshop Sponsored by the National Kidney Foundation.

PubMed

Wish, Jay B; Charytan, Chaim; Chertow, Glenn M; Kalantar-Zadeh, Kamyar; Kliger, Alan S; Rubin, Robert J; Yee, Jerry; Fishbane, Steven

2016-12-01

Biosimilars are biologic medicines highly similar to the reference product with no meaningful clinical differences in terms of safety, purity, and potency. All biologic medicines are produced by living cells, resulting in an inherent heterogeneity in their higher order structures and post-translational modifications. In 2010, the US Congress enacted legislation to streamline the approval process for biosimilars of products losing patent protection, with the goal of decreasing costs and improving patient access to therapeutically important but expensive biologic agents. In 2015, the US Food and Drug Administration approved the first biosimilar agent through this pathway. Approval of additional biosimilar agents in the United States, including those used by nephrologists, is anticipated. Given the relative lack of knowledge regarding biosimilars and their approval process and a lack of trust by the nephrology community regarding their safety and efficacy, the National Kidney Foundation conducted a symposium, Introduction of Biosimilar Therapeutics Into Nephrology Practice in the U.S., September 17 to 18, 2015. Issues related to manufacturing, the regulatory approval process, interchangeability, substitution/switching, nomenclature, and clinician and patient awareness and acceptance were examined. This report summarizes the main discussions at the symposium, highlights several controversies, and makes recommendations related to public policy, professional and patient education, and research needs. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Munchausen syndrome by proxy and pediatric nephrology.

PubMed

Bertulli, Cristina; Cochat, Pierre

2017-11-01

Munchausen syndrome by proxy is a persistent fabrication of illness done by a person to another. Renal and urologic forms of this syndrome are not as uncommon as can be thought; a review of all the cases of Munchausen-by-proxy syndrome reveals that 25% of the children had renal or urologic issues. This syndrome can result in a serious diagnostic dilemma for the physicians; knowing this entity can allow early recognition of falsification and limit the physical and psychological damages caused in the victim. In this study, we reviewed the pediatric nephrology cases of Munchausen syndrome by proxy, grouping them through the principal signs of presentation. Copyright © 2017 Société francophone de néphrologie, dialyse et transplantation. Published by Elsevier Masson SAS. All rights reserved.

Influence of Judaism and Jewish physicians on Greek and Byzantine medicine and their contribution to nephrology.

PubMed

Massry, S G; Smogorzewski, M; Hazani, E; Shasha, S M

1997-01-01

Both the Old Testament and the Talmud contain a great deal of information on medicine, nephrology, health and disease. The basic premise of early Jewish medicine is based on the notion that disease is due to structural changes in internal organs. This is in contrast to the mythical dogma of humoralism as the basis of health and disease espoused by Hippocrates and Galen. The Old Testament and the Mosaic Codes provided the basis for modern public health and for the hygienic rules practised in our times. The Talmudists laid the foundations for the science of pathology as we know it today. These issues are discussed in detail and the contributions of three prominent medieval physicians (Asaph Judaeus, Isaac Judaeus and Maimonides) are presented.

Wars, disasters and kidneys.

PubMed

Lameire, N

2014-12-01

This paper summarizes the impact that wars had on the history of nephrology, both worldwide and in the Ghent Medical Faculty notably on the definition, research and clinical aspects of acute kidney injury. The paper briefly describes the role of 'trench nephritis' as observed both during World War I and II, supporting the hypothesis that many of the clinical cases could have been due to Hantavirus nephropathy. The lessons learned from the experience with crush syndrome first observed in World War II and subsequently investigated over many decades form the basis for the creation of the Renal Disaster Relief Task Force of the International Society of Nephrology. Over the last 15 years, this Task Force has successfully intervened both in the prevention and management of crush syndrome in numerous disaster situations like major earthquakes.

Save life and improve quality: report from the 5th Congress of International Society for Hemodialysis.

PubMed

Chen, Hung-Chun; Lim, Lee-Moay; Chang, Jer-Ming; Misra, Madhukar

2014-01-01

The 5th congress of International Society for Hemodialysis took place last August 3-5, 2012 at the Grand Hotel in Taipei and focused on "Save Life and Improve Quality." It attracted a total of 927 participants from 18 countries. The full spectrum of hemodialysis was covered with plenary lectures and symposiums delivered by experts from different subspecialties in nephrology starting from the history of hemodialysis, mineral bone disease, microinflammation and advanced techniques in hemodialysis. It was followed by critical care in nephrology, anemia, and nutrition in dialysis. Last but not the least, natural disasters and medical economics in hemodialysis were also discussed extensively. This special article will highlight the authentic contributions and innovative clinical presentations from the meeting. © 2013 International Society for Hemodialysis.

[From the Mailing List SIN: expected and unexpected professional risks for the nephrologists--reflections from an outbreak of Burkholderia cepacia bacteremia in a hemodialysis unit].

PubMed

Bellazzi, R; Ciniselli, F

2005-01-01

An outbreak of bacteremia in 20 hemodialysed patients who developed central venous catheter (CVC) infection related to Burkholderia cepacia is reported, introducing medical and professional responsibilities in nephrology units. The cepacia was documented in the blood stream, in the CVC biofilm, in the water supply and in the distribution. This and other confounding factors delayed the identification of the contamination source. Finally, it was isolated, clonally identical to that found in the blood stream, from ammonium chloride solution used to disinfect the skin and distributed in a sterile disposable kit. Burkholderia cepacia was clonally different in blood with respect to water. The possible differing responsibilities in the organizational steps of nephrology activity are discussed.

34 CFR 642.1 - Training Program for Federal TRIO Programs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... these regulations as the Training Program—provides Federal financial assistance to train the staff and... 34 Education 3 2010-07-01 2010-07-01 false Training Program for Federal TRIO Programs. 642.1... POSTSECONDARY EDUCATION, DEPARTMENT OF EDUCATION TRAINING PROGRAM FOR FEDERAL TRIO PROGRAMS General § 642.1...

American Nephrology Nurses' Association

MedlinePlus

... Contact National Office ANNA Election Center Member Spotlight Leadership Board of Directors ANNA Chapter Support Team Chapter ... Opportunities Members Only ANNA Connected ANNA Open Forum Leadership Library Membership Card Member Directory Social Media Post ...

Tractor Trailer Driver's Training Programs. Performance Report.

ERIC Educational Resources Information Center

New Hampshire Vocational Technical Coll., Nashua.

This document describes a project to develop a 320-hour tractor trailer driver training program and a 20-hour commercial driver licensing upgrade training program. Of 34 graduates from the training program, 28 secured employment in the trucking industry. From August 1989 to June 1990, 725 students were trained in the upgrade training program with…

Improving Global Kidney Health: International Society of Nephrology Initiatives and the Global Kidney Health Atlas.

PubMed

Levin, Adeera

2018-01-01

Chronic Kidney Disease (CKD) is a major public health problem and is increasingly being recognized as an important driver of costs in all health care systems. The diversity of outcomes for people living with CKD is in part due to variability in biology, access to care, environmental factors, and health care system differences. The International Society of Nephrology (ISN), working in collaboration with its partners, has evolved into a philanthropic organization, from a traditional medical society, committed to a vision that sees "a future where all people have access to sustainable kidney health". A set of activities, including a Global Kidney Health Summit, the Global Kidney Health Atlas, and a Global Kidney Health Policy Forum, which has formed the basis of a multi-stakeholder engagement process, building on a solid base of ISN programs and educational activities, is described. Through building awareness and increasing capacity to conduct research, the international community will build a more solid foundation on which to advocate for sustainable, ethical solutions to the problem of kidney disease throughout the world. The ISN aims to improve kidney health worldwide through a variety of diverse activities addressing education, advocacy, and research. Collaboration with partners within and outside the medical community is key in achieving this goal. Key Messages: Kidney disease is an important public health problem and is driven by genetic, environmental, and socioeconomic factors. Through active collaboration with diverse partners, the international community is striving for sustainable kidney health and aims to achieve this through coordinated work in a variety of spheres. © 2018 The Author(s) Published by S. Karger AG, Basel.

Public preferences for establishing nephrology facilities in Greenland: estimating willingness-to-pay using a discrete choice experiment.

PubMed

Kjær, Trine; Bech, Mickael; Kronborg, Christian; Mørkbak, Morten Raun

2013-10-01

At present there are no nephrology facilities in Greenland. Greenlandic patients with renal failure needing dialysis thus have to travel to Denmark to obtain treatment. For patients in haemodialysis this necessitates a permanent residence in Denmark. Our study was aimed at examining Greenlanders' preferences for establishing nephrology facilities in Greenland at Queen Ingrid's Hospital in Nuuk, and to estimate the associated change in welfare. Preferences were elicited using a discrete choice experiment (DCE). A random sample of 500 individuals of the general population was sent a postal questionnaire in which they were asked to consider the trade-offs of establishing nephrology facilities in Greenland as opposed to the current situation. This involved trading off the benefits of having such facilities in their home country against the costs of the intervention. Besides including a payment attribute described in terms of incremental tax payment, the DCE included two interventions attributes related to (1) the organisation of labour, and (2) the physical settings of the patients. Respondents succeeded in answering the DCE despite cultural and linguistic disparity. We found that all the included attributes had a significant effect on respondents' choices, and that respondents' answers to the DCE were in keeping with their values as stated in the questionnaire. DCE data was analyzed using a random parameter logit model reparametrized in willingness-to-pay space. The results showed that establishing facilities in Greenland were preferred to the current treatment in Denmark. The welfare estimate from the DCE, at DKK 18.74 million, exceeds the estimated annual costs of establishing treatment facilities for patients with chronic renal failure. Given the estimated confidence interval this result seems robust. Establishing facilities in Greenland therefore would appear to be welfare-improving, deriving positive net benefits. Despite the relatively narrow policy focus, we believe that our findings provide some insight into individuals' preferences for decentralization of public services and on citizens' views of 'self-governance' that go beyond the case of Greenland. More generally, this paper illustrates how DCE can be applied successfully to developing countries with culturally, demographically, and geographically distinct features.

Influence of Nephrologist Care on Management and Outcomes in Adults with Chronic Kidney Disease.

PubMed

Ricardo, Ana C; Roy, Jason A; Tao, Kaixiang; Alper, Arnold; Chen, Jing; Drawz, Paul E; Fink, Jeffrey C; Hsu, Chi-Yuan; Kusek, John W; Ojo, Akinlolu; Schreiber, Martin; Fischer, Michael J

2016-01-01

Predialysis nephrology care for adults with late stage chronic kidney disease (CKD) is associated with improved outcomes. Less is known about the effects of nephrology care in earlier stages of CKD. We aimed to evaluate the effect of nephrology care on management of CKD risk factors and complications, CKD progression, incident cardiovascular disease (CVD), and death. This was a prospective cohort study. Participants included 3855 men and women aged 21 to 74 years enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study with a mean (SD) estimated glomerular filtration rate (eGFR) at entry of 45 (17) ml/min/1.73 m(2), followed for a median of 6.6 years. The main predictor was self-reported prior contact with a nephrologist at study enrollment. Outcomes evaluated included CKD progression (≥ 50 % eGFR loss or end-stage renal disease), incident CVD, and death. Two-thirds (67 %) of the participants reported prior contact with a nephrologist at study enrollment. They were younger, more likely to be male, non-Hispanic white, and had lower eGFR and higher urine protein (p < 0.05). A subgroup with eGFR 30- < 60 ml/min/1.73 m(2) and prior contact with a nephrologist were more likely to receive pharmacologic treatment for CKD-related complications and to report angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEi/ARB) use. After propensity score matching (for reporting prior contact with a nephrologist vs. not) and adjusting for demographic and clinical variables, prior contact with a nephrologist was not significantly associated with CKD progression, incident CVD or death (p > 0.05). One-third of CRIC participants had not seen a nephrologist before enrollment, and this prior contact was subject to age, sex, and ethnic-related disparities. While prior nephrology care was associated with more frequent treatment of CKD complications and use of ACEi/ARB medications, there was neither an association between this care and achievement of guideline-recommended intermediate measures, nor long-term adverse outcomes.

The British Columbia Nephrologists’ Access Study (BCNAS) – a prospective, health services interventional study to develop waiting time benchmarks and reduce wait times for out-patient nephrology consultations

PubMed Central

2013-01-01

Background Early referral and management of high-risk chronic kidney disease may prevent or delay the need for dialysis. Automatic eGFR reporting has increased demand for out-patient nephrology consultations and in some cases, prolonged queues. In Canada, a national task force suggested the development of waiting time targets, which has not been done for nephrology. Methods We sought to describe waiting time for outpatient nephrology consultations in British Columbia (BC). Data collection occurred in 2 phases: 1) Baseline Description (Jan 18-28, 2010) and 2) Post Waiting Time Benchmark-Introduction (Jan 16-27, 2012). Waiting time was defined as the interval from receipt of referral letters to assessment. Using a modified Delphi process, Nephrologists and Family Physicians (FP) developed waiting time targets for commonly referred conditions through meetings and surveys. Rules were developed to weigh-in nephrologists’, FPs’, and patients’ perspectives in order to generate waiting time benchmarks. Targets consider comorbidities, eGFR, BP and albuminuria. Referred conditions were assigned a priority score between 1-4. BC nephrologists were encouraged to centrally triage referrals to see the first available nephrologist. Waiting time benchmarks were simultaneously introduced to guide patient scheduling. A post-intervention waiting time evaluation was then repeated. Results In 2010 and 2012, 43/52 (83%) and 46/57 (81%) of BC nephrologists participated. Waiting time decreased from 98(IQR44,157) to 64(IQR21,120) days from 2010 to 2012 (p = <.001), despite no change in referral eGFR, demographics, nor number of office hrs/wk. Waiting time improved most for high priority patients. Conclusions An integrated, Provincial initiative to measure wait times, develop waiting benchmarks, and engage physicians in active waiting time management associated with improved access to nephrologists in BC. Improvements in waiting time was most marked for the highest priority patients, which suggests that benchmarks had an influence on triaging behavior. Further research is needed to determine whether this effect is sustainable. PMID:23988113

Spiritual care and kidney disease in NZ: a qualitative study with New Zealand renal specialists.

PubMed

Egan, Richard; Macleod, Rod; Tiatia, Ramona; Wood, Sarah; Mountier, Jane; Walker, Rob

2014-11-01

People with chronic kidney disease have a shortened life expectancy and carry a high symptom burden. Research suggests that attending to renal patients' spiritual needs may contribute to an improvement in their quality of life. The aim of this qualitative study was to investigate the provision of spiritual care in New Zealand renal units from the perspective of specialists. The study followed a generic qualitative approach and included semi-structured interviews with specialists recruited from New Zealand's ten renal centres. Five specialist doctors and nine specialist nurses were recruited for interviews. Understandings of spirituality were broad, with most participants having an inclusive understanding. Patients' spiritual needs were generally acknowledged and respected though formal spiritual assessments were not done. Consideration of death was discussed as an often-unexamined need. The dominant position was that the specialists did not provide explicit spiritual care of patients but there was some ad hoc provision offered through pre-dialysis educators, family meetings, Māori liaison staff members and the efforts of individuals. Chaplains were well used in some services. Participants had received no pre and little in-service training or education in spiritual care. Suggestions for improvements included in-service training, better utilization of chaplaincy services and training in advance care planning. Most participants indicated they would attempt to provide some form of spiritual care, either directly or by referring the patient to appropriate services. However, participants generally demonstrated a lack of confidence in addressing a patient's spiritual needs. © 2014 Asian Pacific Society of Nephrology.

Application to graduate psychology programs by undergraduate students of color: the impact of a research training program.

PubMed

Hall, Gordon C Nagayama; Allard, Carolyn B

2009-07-01

The top 86 students were selected from a pool of approximately 400 applicants to a summer clinical psychology research training program for undergraduate students of color. Forty-three of the students were randomly assigned to 1 of 2 clinical psychology research training programs, and 43 were randomly assigned to a control condition without training. The multicultural version of the training program emphasized the cultural context of psychology in all areas of training, whereas cultural context was de-emphasized in the monocultural version of the program. Although the cultural content of the 2 training programs was effectively manipulated as indicated by a fidelity check by an outside expert, there were no significant differences between the effects of the 2 programs on the outcomes measured in this study. The primary differences in this study were between students who did versus those who did not participate in a training program. Sixty-five percent of the students who completed the multicultural training program applied to graduate schools in psychology, compared with 47% of those who completed the monocultural training program, and 31% of those in the control group. Participation in summer research training programs also increased self-perceptions of multicultural competence.

Emergency management training program: Guide to good practice

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1991-07-01

The Emergency Management Training Program Guide to Good Practice is a project of the Training Resources and Data Exchange (TRADE) Emergency Management Issues Special Interest Group (EMI SIG). EMI SIG members expressed interest in a resource to assist in development of a comprehensive emergency management training program. This publication provides guidelines, methods, and materials for EMI SIG members to use, assisting in complete and effective emergency management programs. The purposes of the Emergency Management Training Program Guide to Good Practice are: Provide guidance in the development and management of Emergency Management (EM) training programs; Assist EM trainers to incorporate componentsmore » of the DOE Emergency Management System philosophy of planning, preparedness, readiness assurance, and response into EM training programs; Help EM training managers meet EM training requirements and conditions established by current regulations and policies; Supplement other TRADE EMI SIG documents and complement individual facility training documents. This program is designed for emergency management personnel who are responsible for providing or overseeing EM training but who do not necessarily possess expertise in developing training. It provides good practices from the manager's point of view on how to produce, administer, and document facility EM training programs in the spirit of the DOE EM system philosophy. Basic guidance is also included for personnel who design, develop, deliver, and/or evaluate EM training programs or parts. This guidance includes key points of EM training programs and identifies other documents that contain useful and/or more detailed training information.« less

Emergency management training program: Guide to good practice

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1991-07-01

The Emergency Management Training Program Guide to Good Practice is a project of the Training Resources and Data Exchange (TRADE) Emergency Management Issues Special Interest Group (EMI SIG). EMI SIG members expressed interest in a resource to assist in development of a comprehensive emergency management training program. This publication provides guidelines, methods, and materials for EMI SIG members to use, assisting in complete and effective emergency management programs. The purposes of the Emergency Management Training Program Guide to Good Practice are: Provide guidance in the development and management of Emergency Management (EM) training programs; Assist EM trainers to incorporate componentsmore » of the DOE Emergency Management System philosophy of planning, preparedness, readiness assurance, and response into EM training programs; Help EM training managers meet EM training requirements and conditions established by current regulations and policies; Supplement other TRADE EMI SIG documents and complement individual facility training documents. This program is designed for emergency management personnel who are responsible for providing or overseeing EM training but who do not necessarily possess expertise in developing training. It provides good practices from the manager`s point of view on how to produce, administer, and document facility EM training programs in the spirit of the DOE EM system philosophy. Basic guidance is also included for personnel who design, develop, deliver, and/or evaluate EM training programs or parts. This guidance includes key points of EM training programs and identifies other documents that contain useful and/or more detailed training information.« less

A statewide nurse training program for a hospital based infant abusive head trauma prevention program.

PubMed

Nocera, Maryalice; Shanahan, Meghan; Murphy, Robert A; Sullivan, Kelly M; Barr, Marilyn; Price, Julie; Zolotor, Adam

2016-01-01

Successful implementation of universal patient education programs requires training large numbers of nursing staff in new content and procedures and maintaining fidelity to program standards. In preparation for statewide adoption of a hospital based universal education program, nursing staff at 85 hospitals and 1 birthing center in North Carolina received standardized training. This article describes the training program and reports findings from the process, outcome and impact evaluations of this training. Evaluation strategies were designed to query nurse satisfaction with training and course content; determine if training conveyed new information, and assess if nurses applied lessons from the training sessions to deliver the program as designed. Trainings were conducted during April 2008-February 2010. Evaluations were received from 4358 attendees. Information was obtained about training type, participants' perceptions of newness and usefulness of information and how the program compared to other education materials. Program fidelity data were collected using telephone surveys about compliance to delivery of teaching points and teaching behaviors. Results demonstrate high levels of satisfaction and perceptions of program utility as well as adherence to program model. These findings support the feasibility of implementing a universal patient education programs with strong uptake utilizing large scale systematic training programs. Copyright © 2015 Elsevier Ltd. All rights reserved.

Participation in Training for Depression Care Quality Improvement: A Randomized Trial of Community Engagement or Technical Support.

PubMed

Chung, Bowen; Ngo, Victoria K; Ong, Michael K; Pulido, Esmeralda; Jones, Felica; Gilmore, James; Stoker-Mtume, Norma; Johnson, Megan; Tang, Lingqi; Wells, Kenneth Brooks; Sherbourne, Cathy; Miranda, Jeanne

2015-08-01

Community engagement and planning (CEP) could improve dissemination of depression care quality improvement in underresourced communities, but whether its effects on provider training participation differ from those of standard technical assistance, or resources for services (RS), is unknown. This study compared program- and staff-level participation in depression care quality improvement training among programs enrolled in CEP, which trained networks of health care and social-community agencies jointly, and RS, which provided technical support to individual programs. Matched programs from health care and social-community service sectors in two communities were randomly assigned to RS or CEP. Data were from 1,622 eligible staff members from 95 enrolled programs. Primary outcomes were any staff trained (for programs) and total hours of training (for staff). Secondary staff-level outcomes were hours of training in specific depression collaborative care components. CEP programs were more likely than RS programs to participate in any training (p=.006). Within health care sectors, CEP programs were more likely than RS programs to participate in training (p=.016), but within social-community sectors, there was no difference in training by intervention. Among staff who participated in training, mean training hours were greater among CEP programs versus RS programs for any type of training (p<.001) and for training related to each component of depression care (p<.001) except medication management. CEP may be an effective strategy to promote staff participation in depression care improvement efforts in underresourced communities.

Symptom Management of the Patient with CKD: The Role of Dialysis.

PubMed

Cabrera, Valerie Jorge; Hansson, Joni; Kliger, Alan S; Finkelstein, Fredric O

2017-04-03

As kidney disease progresses, patients often experience a variety of symptoms. A challenge for the nephrologist is to help determine if these symptoms are related to advancing CKD or the effect of various comorbidities and/or medications prescribed. The clinician also must decide the timing of dialysis initiation. The initiation of dialysis can have a variable effect on quality of life measures and the alleviation of uremic signs and symptoms, such as anorexia, fatigue, cognitive impairment, depressive symptoms, pruritus, and sleep disturbances. Thus, the initiation of dialysis should be a shared decision-making process among the patient, the family and the nephrology team; information should be provided, in an ongoing dialogue, to patients and their families concerning the benefits, risks, and effect of dialysis therapies on their lives. Copyright © 2017 by the American Society of Nephrology.

Multicystic dysplastic kidney: a retrospective study.

PubMed

Sharada, Sathish; Vijayakumar, Mahalingam; Nageswaran, Prahlad; Ekambaram, Sudha; Udani, Amish

2014-08-01

To report the renal structural and functional anomalies in children with multicystic dysplastic kidneys. Retrospective descriptive analysis of 47 children with multicystic dysplastic kidney seen in a pediatric nephrology unit over a period of 6 years. Antenatal diagnosis of multicystic dysplastic kidney was made in 34 (72.3%) patients. On follow up of 31 children for more than 12 months, 21 (68%) had involution, 4 [13%] had non-regression, and 4 (13%) were nephrectomized. Vesico-ureteric reflux (n=13; 28%) was the commonest renal abnormality. The serum creatinine values were higher (P=0.006) in children with contralateral reflux. Sub-nephrotic proteinuria was noted in 9 (29%) and was significantly associated with complete involution (P=<0.023). None of the patients developed hypertension and 2 (6.4%) had renal failure. Close nephrological follow-up is needed in children with multicystic dysplasia of kidneys.

Year in review 2005: Critical Care – nephrology

PubMed Central

Ricci, Zaccaria; Ronco, Claudio

2006-01-01

We summarize original research in the field of critical care nephrology accepted or published in 2005 in Critical Care and, when considered relevant or directly linked to this research, in other journals. The articles have been grouped into four categories to facilitate a rapid overview. First, physiopathology, epidemiology and prognosis of acute renal failure (ARF): an extensive review and some observational studies have been performed with the aim of describing aspects of ARF physiopathology, precise epidemiology and long-term outcomes. Second, several authors have performed clinical trials utilizing a potential nephro-protective drug, fenoldopam, with different results. Third, the issue of continuous renal replacement therapies dose has been addressed in a small prospective study and a large observational trial. And fourth, alternative indications to extracorporeal treatment of ARF and systemic inflammatory response syndrome have been explored by three original clinical studies. PMID:16919174

Military nephrology—what a civilian doctor should know

PubMed Central

2011-01-01

This article provides some background on military nephrology in the UK. The primary objective of the Defence Medical Services is the maintenance of operational capability of military personnel. This includes exclusion of nephrological diseases that might reduce renal reserve to a critical level under field conditions, increasing susceptibility to trauma, burns, infection and adverse environmental conditions and increasing the need for renal support. Renal failure potentially compromises not only the patient but also his comrades through reduced staffing and inability to execute the military mission. Safety of weapon systems for which the patient is responsible may be reduced. At forward locations, need for evacuation may put aircraft or vehicles and their crew with medical attendants at unnecessary risk. Regular follow-up and continuity of care are difficult owing to the demands of military life that include frequent postings and deployments. PMID:25984145

Cranberry use among pediatric nephrology patients.

PubMed

Super, Elizabeth A; Kemper, Kathi J; Woods, Charles; Nagaraj, Shashi

2005-01-01

Recurrent urinary tract infections are common in children, and the use of complementary therapies is common in other children with recurrent illnesses. However, little is known about the use of cranberry products by children with renal disease. We hypothesized that, because cranberry is often used to prevent urinary tract infections (UTI) in adult women, many parents would give it to their children, particularly to children prone to recurrent UTI (rUTI). Anonymous, cross-sectional, self-administered survey of parents of children seen in the pediatric nephrology clinic at Brenner Children's Hospital between June 1, 2004, and August 13, 2004. Of the 117 parents surveyed, the patients' average age was 10.3 years, and 15% reported rUTI as a problem. Overall, 29% of surveyed parents gave cranberry products therapeutically; as expected, use was higher among those with rUTI (65%) than among those with other renal conditions (23%); odds ratio = 6.1 (2.0, 18.4, P < .001); many parents gave cranberry to treat as well as prevent diverse renal problems. Most felt it was beneficial and only 1 parent reported a side effect (nausea). Only 23% of those who used it had discussed cranberry use with their physician. Cranberry is commonly used therapeutically among patients seen in a pediatric nephrology clinic and is perceived as useful by parents, though uncommonly discussed with physicians. Randomized controlled trials are needed to determine the effectiveness of cranberry juice therapy for rUTI in children.

Factors influencing practice variation in the management of nephrotic syndrome: a qualitative study of pediatric nephrology care providers

PubMed Central

Samuel, Susan M.; Flynn, Rachel; Zappitelli, Michael; Dart, Allison; Parekh, Rulan; Pinsk, Maury; Mammen, Cherry; Wade, Andrew; Scott, Shannon D.

2017-01-01

Background: Treatment protocols for childhood nephrotic syndrome are highly variable between providers and care centres. We conducted a qualitative study to understand the complex multilevel processes that lead to practice variation and influence provider management of nephrotic syndrome. Methods: Focus groups with multidisciplinary pediatric nephrology care providers (n = 67) from 10 Canadian pediatric nephrology centres that had more than 1 pediatric nephrologist were conducted between September 2013 and April 2015. Focus group discussions were guided by the Ottawa Model for Research Use. We used a semistructured interview guide to elicit participants' perspectives regarding 1) the work setting and context of the clinical environment, 2) reasons for variation at the provider level and 3) clinical practice guidelines for nephrotic syndrome. Focus group discussions were transcribed and analyzed concurrently with the use of qualitative content analysis. Results: Emerging themes were grouped into 2 categories: centre-level factors and provider-level factors. At the centre level, the type of care model used, clinic structures and resources, and lack of communication and collaboration within and between Canadian centres influenced care variation. At the provider level, use of experiential knowledge versus empirical knowledge and interpretation of patient characteristics influenced provider management of nephrotic syndrome. Interpretation: Centre- and provider-level factors play an important role in shaping practice differences in the management of childhood nephrotic syndrome. Further research is needed to determine whether variation in care is associated with disparities in outcomes. PMID:28592406

Establishing Core Outcome Domains in Hemodialysis: Report of the Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) Consensus Workshop.

PubMed

Tong, Allison; Manns, Braden; Hemmelgarn, Brenda; Wheeler, David C; Evangelidis, Nicole; Tugwell, Peter; Crowe, Sally; Van Biesen, Wim; Winkelmayer, Wolfgang C; O'Donoghue, Donal; Tam-Tham, Helen; Shen, Jenny I; Pinter, Jule; Larkins, Nicholas; Youssouf, Sajeda; Mandayam, Sreedhar; Ju, Angela; Craig, Jonathan C

2017-01-01

Evidence-informed decision making in clinical care and policy in nephrology is undermined by trials that selectively report a large number of heterogeneous outcomes, many of which are not patient centered. The Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) Initiative convened an international consensus workshop on November 7, 2015, to discuss the identification and implementation of a potential core outcome set for all trials in hemodialysis. The purpose of this article is to report qualitative analyses of the workshop discussions, describing the key aspects to consider when establishing core outcomes in trials involving patients on hemodialysis therapy. Key stakeholders including 8 patients/caregivers and 47 health professionals (nephrologists, policymakers, industry, and researchers) attended the workshop. Attendees suggested that identifying core outcomes required equitable stakeholder engagement to ensure relevance across patient populations, flexibility to consider evolving priorities over time, deconstruction of language and meaning for conceptual consistency and clarity, understanding of potential overlap and associations between outcomes, and an assessment of applicability to the range of interventions in hemodialysis. For implementation, they proposed that core outcomes must have simple, inexpensive, and validated outcome measures that could be used in clinical care (quality indicators) and trials (including pragmatic trials) and endorsement by regulatory agencies. Integrating these recommendations may foster acceptance and optimize the uptake and translation of core outcomes in hemodialysis, leading to more informative research, for better treatment and improved patient outcomes. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

14 CFR 121.407 - Training program: Approval of airplane simulators and other training devices.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Training program: Approval of airplane... Program § 121.407 Training program: Approval of airplane simulators and other training devices. (a) Each airplane simulator and other training device that is used in a training course permitted under § 121.409...

14 CFR 121.407 - Training program: Approval of airplane simulators and other training devices.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Training program: Approval of airplane... Program § 121.407 Training program: Approval of airplane simulators and other training devices. (a) Each airplane simulator and other training device that is used in a training course permitted under § 121.409...

14 CFR 121.407 - Training program: Approval of airplane simulators and other training devices.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Training program: Approval of airplane... Program § 121.407 Training program: Approval of airplane simulators and other training devices. (a) Each airplane simulator and other training device that is used in a training course permitted under § 121.409...

14 CFR 121.407 - Training program: Approval of airplane simulators and other training devices.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Training program: Approval of airplane... Program § 121.407 Training program: Approval of airplane simulators and other training devices. (a) Each airplane simulator and other training device that is used in a training course permitted under § 121.409...

78 FR 47419 - Requirements for the OSHA Training Institute Education Centers Program and the OSHA Outreach...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-05

...] Requirements for the OSHA Training Institute Education Centers Program and the OSHA Outreach Training Program... approval of the information collection requirements contained in the OSHA Training Institute Education... Educational Programs, or Kimberly Mason, OSHA Training Institute Education Centers Program at the address...

34 CFR 642.10 - Activities the Secretary assists under the Training Program.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Secretary assists under the Training Program. (a) A Training Program project trains the staff and leadership... 34 Education 3 2010-07-01 2010-07-01 false Activities the Secretary assists under the Training... (Continued) OFFICE OF POSTSECONDARY EDUCATION, DEPARTMENT OF EDUCATION TRAINING PROGRAM FOR FEDERAL TRIO...

25 CFR 26.32 - What constitutes a complete Job Training Program application?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false What constitutes a complete Job Training Program... JOB PLACEMENT AND TRAINING PROGRAM Training Services § 26.32 What constitutes a complete Job Training Program application? A request for training includes: (a) Intake and application data; (b) Feasible...

42 CFR 432.30 - Training programs: General requirements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... inservice training for newly appointed staff, and continuing training opportunities to improve the operation... 42 Public Health 4 2013-10-01 2013-10-01 false Training programs: General requirements. 432.30... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STATE PERSONNEL ADMINISTRATION Training Programs...

42 CFR 432.30 - Training programs: General requirements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... inservice training for newly appointed staff, and continuing training opportunities to improve the operation... 42 Public Health 4 2014-10-01 2014-10-01 false Training programs: General requirements. 432.30... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STATE PERSONNEL ADMINISTRATION Training Programs...

42 CFR 432.30 - Training programs: General requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... inservice training for newly appointed staff, and continuing training opportunities to improve the operation... 42 Public Health 4 2011-10-01 2011-10-01 false Training programs: General requirements. 432.30... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STATE PERSONNEL ADMINISTRATION Training Programs...

42 CFR 432.30 - Training programs: General requirements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... inservice training for newly appointed staff, and continuing training opportunities to improve the operation... 42 Public Health 4 2012-10-01 2012-10-01 false Training programs: General requirements. 432.30... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STATE PERSONNEL ADMINISTRATION Training Programs...

42 CFR 432.30 - Training programs: General requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... inservice training for newly appointed staff, and continuing training opportunities to improve the operation... 42 Public Health 4 2010-10-01 2010-10-01 false Training programs: General requirements. 432.30... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STATE PERSONNEL ADMINISTRATION Training Programs...

14 CFR 142.39 - Training program curriculum requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Training program curriculum requirements... TRANSPORTATION (CONTINUED) SCHOOLS AND OTHER CERTIFICATED AGENCIES TRAINING CENTERS Aircrew Curriculum and Syllabus Requirements § 142.39 Training program curriculum requirements. Each training program curriculum...

14 CFR 142.39 - Training program curriculum requirements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Training program curriculum requirements... TRANSPORTATION (CONTINUED) SCHOOLS AND OTHER CERTIFICATED AGENCIES TRAINING CENTERS Aircrew Curriculum and Syllabus Requirements § 142.39 Training program curriculum requirements. Each training program curriculum...

Family behavior, adaptation, and treatment adherence of pediatric nephrology patients.

PubMed

Davis, M C; Tucker, C M; Fennell, R S

1996-04-01

In this exploratory study we investigated the relationships among family behavior variables (e.g., family expressiveness), adaptive functioning skills, maladaptive behavior, and adherence to treatment in pediatric renal failure patients. The study included 22 pediatric outpatients with renal failure who had not yet received dialysis or transplantation (RF) and their parents, and 12 pediatric outpatients with kidney transplants (TX) and their parents. For the RF patients, significant correlations were found between some of their adaptive functioning skills and measures of their medication adherence, diet adherence, and clinic appointment adherence; however, for the TX patients significant correlations were found only between some of their adaptive functioning skills and measures of their medication adherence. For the RF patients only, some measures of their family behavior were significantly correlated with measures of their medication adherence and diet adherence. Additionally, some measures of the RF patients' family behavior were significantly related to their communication skills, socialization skills, overall adaptive functioning skills, and maladaptive behavior. For the TX patients, only their socialization skill level was significantly correlated with one measure of their family behavior. It is concluded that facilitation of adaptive and physical functioning among renal pediatric patients likely requires multidimensional training and/or counselling interventions with the children and their families, and that some of the content and/or emphasis of this training likely needs to differ for RF patients versus TX patients.

25 CFR 26.4 - Who administers the Job Placement and Training Program?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Who administers the Job Placement and Training Program... PLACEMENT AND TRAINING PROGRAM General Applicability § 26.4 Who administers the Job Placement and Training Program? The Job Placement and Training Program is administered by the Bureau of Indian Affairs or a...

Cockpit Resource Management (CRM) training in the 1550th combat crew training wing

NASA Technical Reports Server (NTRS)

Fiedler, Michael T.

1987-01-01

The training program the 1550th Combat Crew Training Wing at Kirtland Air Force Base, New Mexico, implemented in September 1985 is discussed. The program is called Aircrew Coordination Training (ACT), and it is designed specifically to help aircrew members work more effectively as a team in their respective aircraft and hopefully to reduce human factors-related accidents. The scope of the 1550th CCTW's training responsibilities is described, the structure of the program, along with a brief look at the content of the academic part of the course. Then the Mission-Oriented Simulator Training (MOST) program is discussed; a program similar to the Line Oriented Flight Training (LOFT) programs. Finally, the future plans for the Aircrew Coordination Training Program at the 1550th is discussed.

Play Therapy Training among School Psychology, Social Work, and School Counseling Graduate Training Programs

ERIC Educational Resources Information Center

Pascarella, Christina Bechle

2012-01-01

This study examined play therapy training across the nation among school psychology, social work, and school counseling graduate training programs. It also compared current training to previous training among school psychology and school counseling programs. A random sample of trainers was selected from lists of graduate programs provided by…

Alternative approaches to ambulatory training: internal medicine residents' and program directors' perspectives.

PubMed

Thomas, Kris G; West, Colin P; Popkave, Carol; Bellini, Lisa M; Weinberger, Steven E; Kolars, Joseph C; Kogan, Jennifer R

2009-08-01

Internal medicine ambulatory training redesign, including recommendations to increase ambulatory training, is a focus of national discussion. Residents' and program directors' perceptions about ambulatory training models are unknown. To describe internal medicine residents' and program directors' perceptions regarding ambulatory training duration, alternative ambulatory training models, and factors important for ambulatory education. National cohort study. Internal medicine residents (N = 14,941) and program directors (N = 222) who completed the 2007 Internal Medicine In-Training Examination (IM-ITE) Residents Questionnaire or Program Directors Survey, representing 389 US residency programs. A total of 58.4% of program directors and 43.7% of residents preferred one-third or more training time in outpatient settings. Resident preferences for one-third or more outpatient training increased with higher levels of training (48.3% PGY3), female sex (52.7%), primary care program enrollment (64.8%), and anticipated outpatient-focused career, such as geriatrics. Most program directors (77.3%) and residents (58.4%) preferred training models containing weekly clinic. Although residents and program directors reported problems with competing inpatient-outpatient responsibilities (74.9% and 88.1%, respectively) and felt that absence of conflict with inpatient responsibilities is important for good outpatient training (69.4% and 74.2%, respectively), only 41.6% of residents and 22.7% of program directors supported models eliminating ambulatory sessions during inpatient rotations. Residents' and program directors' preferences for outpatient training differ from recommendations for increased ambulatory training. Discordance was observed between reported problems with conflicting inpatient-outpatient responsibilities and preferences for models maintaining longitudinal clinic during inpatient rotations. Further study regarding benefits and barriers of ambulatory redesign is needed.

5 CFR 410.304 - Funding training programs.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Funding training programs. 410.304 Section 410.304 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS TRAINING Establishing and Implementing Training Programs § 410.304 Funding training programs. Section 4112 of title 5...

Challenges in Measuring Benefit of Clinical Research Training Programs--the ASH Clinical Research Training Institute Example.

PubMed

Sung, Lillian; Crowther, Mark; Byrd, John; Gitlin, Scott D; Basso, Joe; Burns, Linda

2015-12-01

The American Society of Hematology developed the Clinical Research Training Institute (CRTI) to address the lack of training in patient-oriented research among hematologists. As the program continues, we need to consider metrics for measuring the benefits of such a training program. This article addresses the benefits of clinical research training programs. The fundamental and key components are education and mentorship. However, there are several other benefits including promotion of collaboration, job and advancement opportunities, and promotion of work-life balance. The benefits of clinical research training programs need to be measured so that funders and society can judge if they are worth the investment in time and resources. Identification of elements that are important to program benefit is essential to measuring the benefit of the program as well as program planning. Future work should focus on the constructs which contribute to benefits of clinical research training programs such as CRTI.

14 CFR 121.407 - Training program: Approval of airplane simulators and other training devices.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Training program: Approval of airplane... Program § 121.407 Training program: Approval of airplane simulators and other training devices. Link to an amendment published at 78 FR 67836, Nov. 12, 2013. (a) Each airplane simulator and other training device...

Abortion training in Canadian obstetrics and gynecology residency programs.

PubMed

Liauw, J; Dineley, B; Gerster, K; Hill, N; Costescu, D

2016-11-01

To evaluate the current state of abortion training in Canadian Obstetrics and Gynecology residency programs. Surveys were distributed to all Canadian Obstetrics and Gynecology residents and program directors. Data were collected on inclusion of abortion training in the curriculum, structure of the training and expected competency of residents in various abortion procedures. We distributed and collected surveys between November 2014 and May 2015. In total, 301 residents and 15 program directors responded, giving response rates of 55% and 94%, respectively. Based on responses by program directors, half of the programs had "opt-in" abortion training, and half of the programs had "opt-out" abortion training. Upon completion of residency, 66% of residents expected to be competent in providing first-trimester surgical abortion in an ambulatory setting, and 35% expected to be competent in second-trimester surgical abortion. Overall, 15% of residents reported that they were not aware of or did not have access to abortion training within their program, and 69% desired more abortion training during residency. Abortion training in Canadian Obstetrics and Gynecology residency programs is inconsistent, and residents desire more training in abortion. This suggests an ongoing unmet need for training in this area. Policies mandating standardized abortion training in obstetrics and gynecology residency programs are necessary to improve delivery of family planning services to Canadian women. Abortion training in Canadian Obstetrics and Gynecology residency programs is inconsistent, does not meet resident demand and is unlikely to fulfill the Royal College of Physicians and Surgeons of Canada objectives of training in the specialty. Copyright © 2016 Elsevier Inc. All rights reserved.

25 CFR 26.30 - Does the Job Training Program provide part-time training or short-term training?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Does the Job Training Program provide part-time training or short-term training? 26.30 Section 26.30 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR HUMAN SERVICES JOB PLACEMENT AND TRAINING PROGRAM Training Services § 26.30 Does the Job Training...

76 FR 35474 - UAW-Chrysler Technical Training Center, Technology Training Joint Programs Staff, Including On...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-17

...-Chrysler Technical Training Center, Technology Training Joint Programs Staff, Including On-Site Leased Workers From Cranks, O/E Learning, DBSI, IDEA, and Tonic/MVP, Detroit, MI; UAW-Chrysler Technical Training... workers and former workers of UAW-Chrysler Technical Training Center, Technology Training Joint Programs...

Training College Outdoor Program Leaders.

ERIC Educational Resources Information Center

Curtis, Rick

This paper describes a training program for college outdoor program leaders developed by the Outdoor Action Program at Princeton University (New Jersey). The training program includes a leader training course, a safety management seminar, a wilderness first aid course, cardiopulmonary resuscitation, and group skills workshop. This paper describes…

75 FR 13521 - Centers for Independent Living Program-Training and Technical Assistance

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-22

... DEPARTMENT OF EDUCATION Centers for Independent Living Program--Training and Technical Assistance... for Independent Living Program--Training and Technical Assistance (CIL-TA program). The Assistant... appropriated for the CIL program to provide training and technical assistance to CILs, agencies eligible to...

Program Activity/Training Plans. STIP II (Skill Training Improvement Programs Round II).

ERIC Educational Resources Information Center

Los Angeles Community Coll. District, CA.

Detailed operational guidelines, training objectives, and learning activities are provided for the Los Angeles Community College District's Skill Training Improvement Programs (STIP II), which are designed to train students for immediate employment. The first of four reports covers Los Angeles Southwest College's computer programming trainee…

34 CFR 385.1 - What is the Rehabilitation Training program?

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 2 2011-07-01 2010-07-01 true What is the Rehabilitation Training program? 385.1... § 385.1 What is the Rehabilitation Training program? (a) The Rehabilitation Training program is designed... CFR part 386). (2) Experimental and Innovative Training (34 CFR part 387). (3) State Vocational...

34 CFR 385.1 - What is the Rehabilitation Training program?

Code of Federal Regulations, 2014 CFR

2014-07-01

... 34 Education 2 2014-07-01 2013-07-01 true What is the Rehabilitation Training program? 385.1... § 385.1 What is the Rehabilitation Training program? (a) The Rehabilitation Training program is designed... CFR part 386). (2) Experimental and Innovative Training (34 CFR part 387). (3) State Vocational...

34 CFR 428.1 - What is the Bilingual Vocational Instructor Training Program?

Code of Federal Regulations, 2011 CFR

2011-07-01

... TRAINING PROGRAM General § 428.1 What is the Bilingual Vocational Instructor Training Program? The Bilingual Vocational Instructor Training Program provides financial assistance for preservice and inservice... 34 Education 3 2011-07-01 2011-07-01 false What is the Bilingual Vocational Instructor Training...

34 CFR 428.1 - What is the Bilingual Vocational Instructor Training Program?

Code of Federal Regulations, 2012 CFR

2012-07-01

... TRAINING PROGRAM General § 428.1 What is the Bilingual Vocational Instructor Training Program? The Bilingual Vocational Instructor Training Program provides financial assistance for preservice and inservice... 34 Education 3 2012-07-01 2012-07-01 false What is the Bilingual Vocational Instructor Training...

34 CFR 428.1 - What is the Bilingual Vocational Instructor Training Program?

Code of Federal Regulations, 2010 CFR

2010-07-01

... TRAINING PROGRAM General § 428.1 What is the Bilingual Vocational Instructor Training Program? The Bilingual Vocational Instructor Training Program provides financial assistance for preservice and inservice... 34 Education 3 2010-07-01 2010-07-01 false What is the Bilingual Vocational Instructor Training...

34 CFR 428.1 - What is the Bilingual Vocational Instructor Training Program?

Code of Federal Regulations, 2013 CFR

2013-07-01

... TRAINING PROGRAM General § 428.1 What is the Bilingual Vocational Instructor Training Program? The Bilingual Vocational Instructor Training Program provides financial assistance for preservice and inservice... 34 Education 3 2013-07-01 2013-07-01 false What is the Bilingual Vocational Instructor Training...

34 CFR 428.1 - What is the Bilingual Vocational Instructor Training Program?

Code of Federal Regulations, 2014 CFR

2014-07-01

... TRAINING PROGRAM General § 428.1 What is the Bilingual Vocational Instructor Training Program? The Bilingual Vocational Instructor Training Program provides financial assistance for preservice and inservice... 34 Education 3 2014-07-01 2014-07-01 false What is the Bilingual Vocational Instructor Training...

Exceptional Children Conference Papers: Training and Personnel in Early Childhood Education Programs.

ERIC Educational Resources Information Center

Council for Exceptional Children, Arlington, VA.

Four papers discuss training and personnel in early childhood education. The concepts developed by the Division of Training Programs in seeking to award a grant for planning inservice training programs are described by J. Gerald Minskoff as is the role of a training coordinator. An evaluation of a pilot program to train teacher aides is presented…

ADVANCE: Study to Evaluate Cinacalcet Plus Low Dose Vitamin D on Vascular Calcification in Subjects With Chronic Kidney Disease Receiving Hemodialysis

ClinicalTrials.gov

2014-07-14

Chronic Kidney Disease; End Stage Renal Disease; Coronary Artery Calcification; Vascular Calcification; Calcification; Cardiovascular Disease; Chronic Renal Failure; Hyperparathyroidism; Kidney Disease; Nephrology; Secondary Hyperparathyroidism

49 CFR 227.119 - Training program.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 4 2011-10-01 2011-10-01 false Training program. 227.119 Section 227.119... Employees. § 227.119 Training program. (a) The railroad shall institute an occupational noise and hearing conservation training program for all employees included in the hearing conservation program. (1) The railroad...

49 CFR 655.14 - Education and training programs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 7 2011-10-01 2011-10-01 false Education and training programs. 655.14 Section... OPERATIONS Program Requirements § 655.14 Education and training programs. Each employer shall establish an employee education and training program for all covered employees, including: (a) Education. The education...

49 CFR 655.14 - Education and training programs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 7 2010-10-01 2010-10-01 false Education and training programs. 655.14 Section... OPERATIONS Program Requirements § 655.14 Education and training programs. Each employer shall establish an employee education and training program for all covered employees, including: (a) Education. The education...

49 CFR 655.14 - Education and training programs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 7 2012-10-01 2012-10-01 false Education and training programs. 655.14 Section... OPERATIONS Program Requirements § 655.14 Education and training programs. Each employer shall establish an employee education and training program for all covered employees, including: (a) Education. The education...

49 CFR 655.14 - Education and training programs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 7 2014-10-01 2014-10-01 false Education and training programs. 655.14 Section... OPERATIONS Program Requirements § 655.14 Education and training programs. Each employer shall establish an employee education and training program for all covered employees, including: (a) Education. The education...

49 CFR 655.14 - Education and training programs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 7 2013-10-01 2013-10-01 false Education and training programs. 655.14 Section... OPERATIONS Program Requirements § 655.14 Education and training programs. Each employer shall establish an employee education and training program for all covered employees, including: (a) Education. The education...

Oxidative Stress in Kidney Diseases: The Cause or the Consequence?

PubMed

Krata, Natalia; Zagożdżon, Radosław; Foroncewicz, Bartosz; Mucha, Krzysztof

2018-06-01

Exaggerated oxidative stress (OS) is usually considered as a disturbance in regular function of an organism. The excessive levels of OS mediators may lead to major damage within the organism's cells and tissues. Therefore, the OS-associated biomarkers may be considered as new diagnostic tools of various diseases. In nephrology, researchers are looking for alternative methods replacing the renal biopsy in patients with suspicion of chronic kidney disease (CKD). Currently, CKD is a frequent health problem in world population, which can lead to progressive loss of kidney function and eventually to end-stage renal disease. The course of CKD depends on the primary disease. It is assumed that one of the factors influencing the course of CKD might be OS. In the current work, we review whether monitoring the OS-associated biomarkers in nephrology patients can support the decision-making process regarding diagnosis, prognostication and treatment initiation.

Diagnosing kidney disease in the genetic era.

PubMed

Prakash, Sindhuri; Gharavi, Ali G

2015-07-01

Recent technological improvements have increased the use of genetic testing in the clinic. This review serves to summarize the many practical benefits of genetic testing, discusses various methodologies that can be used clinically, and exemplifies ways in which genetics is propelling the field forward in nephrology. The advent of next-generation sequencing and microarray technologies has heralded an unprecedented number of discoveries in the field of nephrology, providing many opportunities for incorporating genomic diagnostics into clinical care. The use of genetic testing, particularly in pediatrics, can provide accurate diagnoses in puzzling cases, resolve misclassification of disease, and identify subsets of individuals with treatable conditions. Genetic testing may have broad benefits for patients and their families. Knowing the precise molecular etiology of disease can help clinicians determine the exact therapeutic course, and counsel patients and their families about prognosis. Genetic discoveries can also improve the classification of kidney disease and identify new targets for therapy.

The future management of nephrology and dialysis.

PubMed

Graziani, Giorgio; Vanni, Elena

2003-01-01

This is a report of a combined experience of a nephrologist, who had been previously working for many years in a public hospital, and a business planning manager coming from a financial administration department of a multinational company. The Istituto Clinico Humanitas is a multi-specialist hospital accreditated with the National Health System, containing 473 beds available: 398 inpatient, 28 intensive care and 47 day hospital beds. Human resources include approximately 250 medical doctors, 500 nurses and ancillary workers. In 2002 the hospital treated about 17,500 inpatients, 18,450 day hospital patients, nearly 18,600 surgical interventions and 470,000 outpatients examinations and tests were performed. The detailed clinical activity of the general medicine and the nephrology units in 2002, the role of the scientific direction and that of the Humanitas Foundation have been presented. The work experience, in particular the advantages and disavantages of public versus private environment, represents another important topic of this paper.

Chronic hyperkalemia in non-dialysis CKD: controversial issues in nephrology practice.

PubMed

De Nicola, Luca; Di Lullo, Luca; Paoletti, Ernesto; Cupisti, Adamasco; Bianchi, Stefano

2018-06-07

Chronic hyperkalemia is a major complication of chronic kidney disease (CKD) that occurs frequently, heralds poor prognosis, and necessitates careful management by the nephrologist. Current strategies aimed at prevention and treatment of hyperkalemia are still suboptimal, as evidenced by the relatively high prevalence of hyperkalemia in patients under stable nephrology care, and even in the ideal setting of randomized trials where best treatment and monitoring are mandatory. The aim of this review was to identify and discuss a range of unresolved issues related to the management of chronic hyperkalemia in non-dialysis CKD. The following topics of clinical interest were addressed: diagnosis, relationship with main comorbidities of CKD, therapy with inhibitors of the renin-angiotensin-aldosterone system, efficacy of current dietary and pharmacological treatment, and the potential role of the new generation of potassium binders. Opinion-based answers are provided for each of these controversial issues.

Mapping training needs for dissemination and implementation research: lessons from a synthesis of existing D&I research training programs.

PubMed

Chambers, David A; Proctor, Enola K; Brownson, Ross C; Straus, Sharon E

2017-09-01

With recent growth in the field of dissemination and implementation (D&I) research, multiple training programs have been developed to build capacity, including summer training institutes, graduate courses, degree programs, workshops, and conferences. While opportunities for D&I research training have expanded, course organizers acknowledge that available slots are insufficient to meet demand within the scientific and practitioner community. In addition, individual programs have struggled to best fit various needs of trainees, sometimes splitting coursework between specific D&I content and more introductory grant writing material. This article, stemming from a 2013 NIH workshop, reviews experiences across multiple training programs to align training needs, career stage and role, and availability of programs. We briefly review D&I needs and opportunities by career stage and role, discuss variations among existing training programs in format, mentoring relationships, and other characteristics, identify challenges of mapping needs of trainees to programs, and present recommendations for future D&I research training.

Multiple Teacher Training Programs: Information on Budgets, Services, and Target Groups. Fact Sheet for the Chairman, Budget Committee, House of Representatives.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC. Health, Education, and Human Services Div.

This study examined the total number of federally funded teacher training programs (excluding student loans and grants that could be used for teacher training), the budget obligations for teacher training programs, the number of teachers trained by these programs, and differences in services across the programs. The study found that in fiscal year…

Management Training, Yes! Excellence?

ERIC Educational Resources Information Center

Davis, Gary E.

1990-01-01

Management training programs are a necessity for transportation supervisors. Basic and advanced training programs are available through associations for business officials and university fleet management training programs. (MLF)

34 CFR 263.4 - What training costs may a Professional Development program include?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false What training costs may a Professional Development... GRANT PROGRAMS Professional Development Program § 263.4 What training costs may a Professional Development program include? (a) A Professional Development program may include, as training costs, assistance...

34 CFR 263.4 - What training costs may a Professional Development program include?

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 1 2011-07-01 2011-07-01 false What training costs may a Professional Development... GRANT PROGRAMS Professional Development Program § 263.4 What training costs may a Professional Development program include? (a) A Professional Development program may include, as training costs, assistance...

Payload training methodology study

NASA Technical Reports Server (NTRS)

1990-01-01

The results of the Payload Training Methodology Study (PTMS) are documented. Methods and procedures are defined for the development of payload training programs to be conducted at the Marshall Space Flight Center Payload Training Complex (PCT) for the Space Station Freedom program. The study outlines the overall training program concept as well as the six methodologies associated with the program implementation. The program concept outlines the entire payload training program from initial identification of training requirements to the development of detailed design specifications for simulators and instructional material. The following six methodologies are defined: (1) The Training and Simulation Needs Assessment Methodology; (2) The Simulation Approach Methodology; (3) The Simulation Definition Analysis Methodology; (4) The Simulator Requirements Standardization Methodology; (5) The Simulator Development Verification Methodology; and (6) The Simulator Validation Methodology.

Using Adult Learning Theory for New-Hire Training

ERIC Educational Resources Information Center

Woodard, Chris A.

2007-01-01

To test if adult learning theory can inform a training program for newly-hired employees in industry, a training program was set up using Knowles' concepts of andragogy. Evaluation results from before and after the new training program indicate that the perceptions of those in the new training program changed in a positive direction. This…

Subspeciality training in hematology and oncology, 2003: results of a survey of training program directors conducted by the American Society of Hematology.

PubMed

Todd, Robert F; Gitlin, Scott D; Burns, Linda J

2004-06-15

A survey of directors of adult and pediatric hematology/oncology subspecialty training programs in the United States and Canada was conducted to assess the environment in which recruitment and training is conducted in these medical disciplines. A total of 107 program directors responded to the survey, representing 66% of internal medicine and 47% of pediatric subspecialty programs in hematology or hematology/oncology. Specific areas covered in the web-based questionnaire included the type and demographics of the training program, profile of the training program director, characteristics of the applicant pool and existing trainee recruits, characteristics of the training program environment and curricula, research productivity of trainees, and the career pathways taken by recent training program graduates (including dominant areas of clinical interest). The results of this survey show considerable heterogeneity in the recruiting practices and the environment in which subspecialty training occurs, leading the authors to recommend improvements in or a heightened attention to issues, including recruitment of minority trainees, flexibility to recruit international medical school graduates, timing of trainee acceptance, maintaining the financial support of Medicare graduation medical education (GME), training of physician scientists, organization of the continuity clinic experience, visibility of nonmalignant hematology as a career path, and level of training program director support.

Nephrology comanagement and the quality of antibiotic prescribing in primary care for patients with chronic kidney disease: a retrospective cross-sectional study.

PubMed

Zhu, Justin X G; Nash, Danielle M; McArthur, Eric; Farag, Alexandra; Garg, Amit X; Jain, Arsh K

2018-04-12

In primary care, patients with chronic kidney disease (CKD) are frequently prescribed excessive doses of antibiotics relative to their kidney function. We examined whether nephrology comanagement is associated with improved prescribing in primary care. In a retrospective propensity score-matched cross-sectional study, we studied the appropriateness of antibiotic prescriptions by primary care physicians to Ontarians ≥66 years of age with CKD Stages 4 and 5 (estimated glomerular filtration rate <30 mL/min/1.73 m2 not receiving dialysis) from 1 April 2003 to 31 March 2014. Comanagement was defined as having at least one outpatient visit with a nephrologist within the year prior to antibiotic prescription date. We compared the rate of appropriately dosed antibiotics in primary care between 3937 patients who were comanaged by a nephrologist and 3937 patients who were not. Only 1184 (30%) of 3937 noncomanaged patients had appropriately dosed antibiotic prescriptions prescribed by a primary care physician. Nephrology comanagement was associated with an increased likelihood that an appropriately dosed prescription was prescribed by a primary care physician; however, the magnitude of the effect was modest [1342/3937 (34%); odds ratio 1.20 (95% confidence interval 1.09-1.32); P < 0.001]. The majority of antibiotics prescribed by primary care physicians are inappropriately dosed in CKD patients, whether or not a nephrologist is comanaging the patient. Nephrologists have an opportunity to increase awareness of appropriate dosing of medications in primary care through the patients they comanage.

Moderator's view: Predictive models: a prelude to precision nephrology.

PubMed

Zoccali, Carmine

2017-05-01

Appropriate diagnosis is fundamental in medicine because it sets the basis for the prediction of disease outcome at the single patient level (prognosis) and decisions regarding the most appropriate therapy. However, given the large series of social, clinical and biological factors that determine the likelihood of an individual's future outcome, prognosis only partly depends on diagnosis and aetiology and treatment is not decided solely on the basis of the underlying diagnosis. This issue is crucial in multifactorial diseases like atherosclerosis, where the use of statins has now shifted from 'treating hypercholesterolaemia' to 'treating the risk of adverse cardiovascular events'. Approaches that take due account of prognosis limit the lingering risk of over-diagnosis and maximize the value of prognostic information in the clinical decision process. In the nephrology realm, the application of a well-validated risk equation for kidney failure in Canada led to a 35% reduction in new referrals. Prognostic models based on simple clinical data extractable from clinical files have recently been developed to predict all-cause and cardiovascular mortality in end-stage kidney disease patients. However, research on predictive models in renal diseases remains suboptimal and non-accounting for competing events and measurement errors, and a lack of calibration analyses and external validation are common fallacies in currently available studies. More focus on this blossoming research area is desirable. The nephrology community may now start to apply the best validated risk scores and further test their potential usefulness in chronic kidney disease patients in diverse clinical situations and geographical areas. © The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

A Concept-Wide Association Study of Clinical Notes to Discover New Predictors of Kidney Failure.

PubMed

Singh, Karandeep; Betensky, Rebecca A; Wright, Adam; Curhan, Gary C; Bates, David W; Waikar, Sushrut S

2016-12-07

Identifying predictors of kidney disease progression is critical toward the development of strategies to prevent kidney failure. Clinical notes provide a unique opportunity for big data approaches to identify novel risk factors for disease. We used natural language processing tools to extract concepts from the preceding year's clinical notes among patients newly referred to a tertiary care center's outpatient nephrology clinics and retrospectively evaluated these concepts as predictors for the subsequent development of ESRD using proportional subdistribution hazards (competing risk) regression. The primary outcome was time to ESRD, accounting for a competing risk of death. We identified predictors from univariate and multivariate (adjusting for Tangri linear predictor) models using a 5% threshold for false discovery rate (q value <0.05). We included all patients seen by an adult outpatient nephrologist between January 1, 2004 and June 18, 2014 and excluded patients seen only by transplant nephrology, with preexisting ESRD, with fewer than five clinical notes, with no follow-up, or with no baseline creatinine values. Among the 4013 patients selected in the final study cohort, we identified 960 concepts in the unadjusted analysis and 885 concepts in the adjusted analysis. Novel predictors identified included high-dose ascorbic acid (adjusted hazard ratio, 5.48; 95% confidence interval, 2.80 to 10.70; q<0.001) and fast food (adjusted hazard ratio, 4.34; 95% confidence interval, 2.55 to 7.40; q<0.001). Novel predictors of human disease may be identified using an unbiased approach to analyze text from the electronic health record. Copyright © 2016 by the American Society of Nephrology.

Information Technology Training in India toward Globalization

NASA Astrophysics Data System (ADS)

Yamashita, Katsuhiko

This paper describes Toshiba‧s training program in Information Technology in India. It is not a simple technology training, but a training for globalization of Japanese engineers so that they can cope with people from different culture and business practices. We first describe why such training program became necessary. We then describe how the training courses and contents are developed. The operation of the training program and our effort in continual improvement are explained. The effectiveness of the program is also evaluated. The training program presented is a first in its kind and we believe that it can contribute to changing Toshiba from inside toward more globalized corporation. We also believe that this kind of overseas training is effective in training young students so that they can cope with globalizing society after graduation.

Preparing the Communication Specialist: Some Implications of an Ongoing "Train the Trainer" Program in One Industry.

ERIC Educational Resources Information Center

Shaw, Mark R.; Caplette, Michele

Interviews with six managers trained to teach the Interpersonal Managing Skills (IMS) program at the Lockheed Missiles and Space Company provided insights into three aspects of communication training programs: training skills, the trainer role, and methods of training the trainer. A highly structured, packaged program, IMS teaches five…

Rehabilitation Training Program and Special Capacity Building Program, 1997-1998: Catalog of Projects under the Rehabilitation Services Administration.

ERIC Educational Resources Information Center

Office of Special Education and Rehabilitative Services (ED), Washington, DC.

This directory lists programs funded by rehabilitation training grants funded under the Rehabilitation Act of 1973 (Section 304a). These programs are grouped under the following categories: (1) rehabilitation long-term training; (2) experimental and innovative training; (3) state vocational rehabilitation unit in-service training; (4)…

Variability of ethics education in laboratory medicine training programs: results of an international survey.

PubMed

Bruns, David E; Burtis, Carl A; Gronowski, Ann M; McQueen, Matthew J; Newman, Anthony; Jonsson, Jon J

2015-03-10

Ethical considerations are increasingly important in medicine. We aimed to determine the mode and extent of teaching of ethics in training programs in clinical chemistry and laboratory medicine. We developed an on-line survey of teaching in areas of ethics relevant to laboratory medicine. Reponses were invited from directors of training programs who were recruited via email to leaders of national organizations. The survey was completed by 80 directors from 24 countries who directed 113 programs. The largest numbers of respondents directed postdoctoral training of scientists (42%) or physicians (33%), post-masters degree programs (33%), and PhD programs (29%). Most programs (82%) were 2years or longer in duration. Formal training was offered in research ethics by 39%, medical ethics by 31%, professional ethics by 24% and business ethics by 9%. The number of reported hours of formal training varied widely, e.g., from 0 to >15h/year for research ethics and from 0 to >15h for medical ethics. Ethics training was required and/or tested in 75% of programs that offered training. A majority (54%) of respondents reported plans to add or enhance training in ethics; many indicated a desire for online resources related to ethics, especially resources with self-assessment tools. Formal teaching of ethics is absent from many training programs in clinical chemistry and laboratory medicine, with heterogeneity in the extent and methods of ethics training among the programs that provide the training. A perceived need exists for online training tools, especially tools with self-assessment components. Copyright © 2014 Elsevier B.V. All rights reserved.

Home Dialysis in the Prospective Payment System Era.

PubMed

Lin, Eugene; Cheng, Xingxing S; Chin, Kuo-Kai; Zubair, Talhah; Chertow, Glenn M; Bendavid, Eran; Bhattacharya, Jayanta

2017-10-01

The ESRD Prospective Payment System introduced two incentives to increase home dialysis use: bundling injectable medications into a single payment for treatment and paying for home dialysis training. We evaluated the effects of the ESRD Prospective Payment System on home dialysis use by patients starting dialysis in the United States from January 1, 2006 to August 31, 2013. We analyzed data on dialysis modality, insurance type, and comorbidities from the United States Renal Data System. We estimated the effect of the policy on home dialysis use with multivariable logistic regression and compared the effect on Medicare Parts A/B beneficiaries with the effect on patients with other types of insurance. The ESRD Prospective Payment System associated with a 5.0% (95% confidence interval [95% CI], 4.0% to 6.0%) increase in home dialysis use by the end of the study period. Home dialysis use increased by 5.8% (95% CI, 4.3% to 6.9%) among Medicare beneficiaries and 4.1% (95% CI, 2.3% to 5.4%) among patients covered by other forms of health insurance. The difference between these groups was not statistically significant (1.8%; 95% CI, -0.2% to 3.8%). Conversely, in both populations, the training add-on did not associate with increases in home dialysis use beyond the effect of the policy. The ESRD Prospective Payment System bundling, but not the training add-on, associated with substantial increases in home dialysis, which were identical for both Medicare and non-Medicare patients. These spill-over effects suggest that major payment changes in Medicare can affect all patients with ESRD. Copyright © 2017 by the American Society of Nephrology.

Diagnosis, Treatment, and Prevention of Hemodialysis Emergencies.

PubMed

Saha, Manish; Allon, Michael

2017-02-07

Given the high comorbidity in patients on hemodialysis and the complexity of the dialysis treatment, it is remarkable how rarely a life-threatening complication occurs during dialysis. The low rate of dialysis emergencies can be attributed to numerous safety features in modern dialysis machines; meticulous treatment and testing of the dialysate solution to prevent exposure to trace elements, toxins, and pathogens; adherence to detailed treatment protocols; and extensive training of dialysis staff to handle medical emergencies. Most hemodialysis emergencies can be attributed to human error. A smaller number are due to rare idiosyncratic reactions. In this review, we highlight major emergencies that may occur during hemodialysis treatments, describe their pathogenesis, offer measures to minimize them, and provide specific interventions to prevent catastrophic consequences on the rare occasions when such emergencies arise. These emergencies include dialysis disequilibrium syndrome, venous air embolism, hemolysis, venous needle dislodgement, vascular access hemorrhage, major allergic reactions to the dialyzer or treatment medications, and disruption or contamination of the dialysis water system. Finally, we describe root cause analysis after a dialysis emergency has occurred to prevent a future recurrence. Copyright © 2017 by the American Society of Nephrology.

Strategic National HRD Initiatives: Lessons from the Management Training Program of Japan. [and] Invited Reaction: The Little-Known Impact of U.S. Training Programs on the Japanese Quality Movement. [and] Invited Reaction: Comments on Strategic National Initiatives: Lessons from the Management Training Program of Japan.

ERIC Educational Resources Information Center

Robinson, Alan G.; And Others

1995-01-01

Robinson and Stern describe the Management Training Program introduced by the U.S. Air Force in postwar Japan and its effect on Japanese industry. Roberts compares it with U.S. Training within Industries. Umetani comments that the discussion would have been more convincing had its relationship with other Japanese training programs been addressed.…

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

Training programs at DOE facilities should prepare personnel to safely and efficiently operate and maintain the facilities in accordance with DOE requirements. This guide presents good practices for a systematic approach to on-the-job training (OJT) and OJT programs and should be used in conjunction with DOE Training Program Handbook: A Systematic Approach to Training, and with the DOE Handbook entitled Alternative Systematic Approaches to Training to develop performance-based OJT programs. DOE contractors may also use this guide to modify existing OJT programs that do not meet the systematic approach to training (SAT) objectives.

Air Transport and Travel Industry Training Board

ERIC Educational Resources Information Center

Industrial Training Journal, 1974

1974-01-01

Seeing its role as one of stimulating, guiding, and coordinating training activities rather than providing central training facilities, three programs have been developed by the Air Transport and Travel Industry Training Board: (1) an occupational program, (2) a company program, and (3) an industry program. (MW)

42 CFR 51.27 - Training.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Training. 51.27 Section 51.27 Public Health PUBLIC... Training. A P&A system shall provide training for program staff, and may also provide training for...)(1) Training of program staff to work with family members of clients served by the program where the...

Evaluating Job Training Programs in the United States: Evidence and Explanations. Technical Assistance Report.

ERIC Educational Resources Information Center

Grubb, W. Norton

Recent studies of the effectiveness of the following types of job training programs were reviewed: mainstream job training (Comprehensive Employment and Training Act and Job Training Partnership Act programs); welfare-to-work; experimental; job training for specific population groups; and specific services. Special attention was paid to the…

25 CFR 26.29 - What is the scope of the Job Training Program?

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 1 2013-04-01 2013-04-01 false What is the scope of the Job Training Program? 26.29 Section 26.29 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR HUMAN SERVICES JOB PLACEMENT AND TRAINING PROGRAM Training Services § 26.29 What is the scope of the Job Training Program? A...

25 CFR 26.29 - What is the scope of the Job Training Program?

Code of Federal Regulations, 2012 CFR

2012-04-01

... 25 Indians 1 2012-04-01 2011-04-01 true What is the scope of the Job Training Program? 26.29 Section 26.29 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR HUMAN SERVICES JOB PLACEMENT AND TRAINING PROGRAM Training Services § 26.29 What is the scope of the Job Training Program? A...

25 CFR 26.29 - What is the scope of the Job Training Program?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 1 2014-04-01 2014-04-01 false What is the scope of the Job Training Program? 26.29 Section 26.29 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR HUMAN SERVICES JOB PLACEMENT AND TRAINING PROGRAM Training Services § 26.29 What is the scope of the Job Training Program? A...

25 CFR 26.29 - What is the scope of the Job Training Program?

Code of Federal Regulations, 2011 CFR

2011-04-01

... 25 Indians 1 2011-04-01 2011-04-01 false What is the scope of the Job Training Program? 26.29 Section 26.29 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR HUMAN SERVICES JOB PLACEMENT AND TRAINING PROGRAM Training Services § 26.29 What is the scope of the Job Training Program? A...

25 CFR 26.29 - What is the scope of the Job Training Program?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false What is the scope of the Job Training Program? 26.29 Section 26.29 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR HUMAN SERVICES JOB PLACEMENT AND TRAINING PROGRAM Training Services § 26.29 What is the scope of the Job Training Program? A...

25 CFR 26.3 - What is the purpose of the Job Placement and Training Program?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false What is the purpose of the Job Placement and Training... PLACEMENT AND TRAINING PROGRAM General Applicability § 26.3 What is the purpose of the Job Placement and Training Program? The purpose of the Job Placement and Training Program is to assist eligible applicants to...

Evolutionary trade-offs in kidney injury and repair.

PubMed

Lei, Yutian; Anders, Hans-Joachim

2017-11-01

Evolutionary medicine has proven helpful to understand the origin of human disease, e.g. in identifying causal roles of recent environmental changes impacting on human physiology (environment-phenotype mismatch). In contrast, diseases affecting only a limited number of members of a species often originate from evolutionary trade-offs for usually physiologic adaptations assuring reproductive success in the context of extrinsic threats. For example, the G1 and G2 variants of the APOL1 gene supporting control of Trypanosoma infection come with the trade-off that they promote the progression of kidney disease. In this review we extend the concept of evolutionary nephrology by discussing how the physiologic adaptations (danger responses) to tissue injury create evolutionary trade-offs that drive histopathological changes underlying acute and chronic kidney diseases. The evolution of multicellular organisms positively selected a number of danger response programs for their overwhelming benefits in assuring survival such as clotting, inflammation, epithelial healing and mesenchymal healing, i.e. fibrosis and sclerosis. Upon kidney injury these danger programs often present as pathomechanisms driving persistent nephron loss and renal failure. We explore how classic kidney disease entities involve insufficient or overshooting activation of these danger response programs for which the underlying genetic basis remains largely to be defined. Dissecting the causative and hierarchical relationships between danger programs should help to identify molecular targets to control kidney injury and to improve disease outcomes.

Guidelines for postdoctoral training in rehabilitation psychology.

PubMed

Stiers, William; Hanson, Stephanie; Turner, Aaron P; Stucky, Kirk; Barisa, Mark; Brownsberger, Mary; Van Tubbergen, Marie; Ashman, Teresa; Kuemmel, Angela

2012-11-01

This article describes the methods and results of a national conference that was held to (1) develop consensus guidelines about the structure and process of rehabilitation psychology postdoctoral training programs and (2) create a Council of Rehabilitation Psychology Postdoctoral Training Programs to promote training programs' abilities to implement the guidelines and to formally recognize programs in compliance with the guidelines. Forty-six conference participants were chosen to include important stakeholders in rehabilitation psychology, representatives of rehabilitation psychology training and practice communities, representatives of psychology accreditation and certification bodies, and persons involved in medical education practice and research. Consensus guidelines were developed for rehabilitation psychology postdoctoral training program structure and process and for establishing the Council of Rehabilitation Psychology Postdoctoral Training Programs. The Conference developed aspirational guidelines for postdoctoral education and training programs in applied rehabilitation psychology and established a Council of Rehabilitation Psychology Postdoctoral Training Programs as a means of promoting their adoption by training programs. These efforts are designed to promote quality, consistency, and excellence in the education and training of rehabilitation psychology practitioners and to promote competence in their practice. It is hoped that these efforts will stimulate discussion, assist in the development of improved teaching and evaluation methods, lead to interesting research questions, and generally facilitate the continued systematic development of the profession of rehabilitation psychology. PsycINFO Database Record (c) 2012 APA, all rights reserved

Training of Personnel to Work with Young Children in India.

ERIC Educational Resources Information Center

Kahalakdina, M.

1984-01-01

Describes recruitment procedures for child care workers in India. Includes a description of training programs, training needs and approaches, and curriculum and training procedures. Monitoring and evaluation of child welfare programs are discussed. Appendices include descriptions of and norms for training programs. (AS)

Helping to Meet Today's Energy Demands: Natural Gas Technician Training in Algeria

ERIC Educational Resources Information Center

Dutton, Bernard

1976-01-01

The training program, located in Arzew, Algeria, is designed to train technicians in all phases of gas technology. The program provides classroom instruction, on-the-job training, and language instruction. The different phases involved in the training program are described. (EC)

49 CFR 236.1041 - Training and qualification program, general.

Code of Federal Regulations, 2010 CFR

2010-10-01

... INSTALLATION, INSPECTION, MAINTENANCE, AND REPAIR OF SIGNAL AND TRAIN CONTROL SYSTEMS, DEVICES, AND APPLIANCES Positive Train Control Systems § 236.1041 Training and qualification program, general. (a) Training program...-critical elements of the railroad's PTC systems, including central office, wayside, or onboard subsystems...

34 CFR 385.1 - What is the Rehabilitation Training program?

Code of Federal Regulations, 2012 CFR

2012-07-01

... § 385.1 What is the Rehabilitation Training program? (a) The Rehabilitation Training program is designed... CFR part 386). (2) Experimental and Innovative Training (34 CFR part 387). (3) State Vocational...

34 CFR 385.1 - What is the Rehabilitation Training program?

Code of Federal Regulations, 2013 CFR

2013-07-01

... § 385.1 What is the Rehabilitation Training program? (a) The Rehabilitation Training program is designed... CFR part 386). (2) Experimental and Innovative Training (34 CFR part 387). (3) State Vocational...

Clinician scientist training program: a proposal for training medical students in clinical research.

PubMed

Mark, A L; Kelch, R P

2001-11-01

There is national alarm about a decline in the number of clinician scientists. Most of the proposed solutions have focused on housestaff and junior faculty. We propose a new national program for training medical students in clinical research. This program, coined "Clinician Scientist Training Program" (CSTP), would consist of a combined degree program in medicine (MD) and clinical research (eg, masters in translational research or masters in clinical epidemiology). Students could enroll in the program at any stage during medical school. After 3 years of medical school, students would spend at least 2 years in a combined didactic and mentored clinical research training program and then complete medical school. Students could elect to pursue more prolonged clinical research training toward a combined PhD and MD. The CSTP is designed to meet six critical challenges: 1) engage students early in clinical research training; 2) provide a didactic clinical research curriculum; 3) expose students to several years of mentored clinical research training; 4) promote debt prevention by providing tuition payments during medical education and a stipend during clinical research training; 5) facilitate prolonged exposure to a community of peers and mentors in a program with national and institutional identity and respect; and 6) permit enrollment in the program as students enter medical school or at any stage during medical school. If the success of the Medical Scientist Training Program in training medical students in basic research is a guide, the CSTP could become a linchpin for training future generations of clinician scientists.

Training teachers in generalized writing of behavior modification programs for multihandicapped deaf children.

PubMed

Hundert, J

1982-01-01

In contrast to previous studies where teachers were instructed how to implement behavior modification programs designed by an experimenter, teachers in the present experiment were taught how to write as well as implement behavior modification programs. The generalized effects of two training conditions on teacher and pupil behaviors were assessed by a multiple baseline design where, following baseline, two teachers of multi-handicapped deaf children were taught to set objectives and measure pupil performance (measurement training), Later, through a training manual, they learned a general problem-solving approach to writing behavior modification programs (programming training). After both training conditions, experimenter feedback was given for teachers' application of training to a target behavior for one pupil and generalization was measured across target behaviors for the same pupil and across pupils. It was found that measurement training had little general effect on either teacher behavior or pupil behavior. However, after programming training, teachers increased their program writing and correct use of behavior modification procedures and generalized this training across pupils and target behaviors. Along with these effects, there was improvement in pupil behaviors. Possible explanation for generalized effects of teacher training were considered.

Fostering Reciprocity in Global Health Partnerships Through a Structured, Hands-On Experience for Visiting Postgraduate Medical Trainees

PubMed Central

Umoren, Rachel A.; Einterz, Robert M.; Litzelman, Debra K.; Pettigrew, Ronald K.; Ayaya, Samuel O.; Liechty, Edward A.

2014-01-01

Background Global health programs that allow international experiences for US learners should also enable reciprocal learning experiences for international learners, particularly if that is a need identified by the partner institution. Methods A partnership between Indiana University and Moi University, Kenya, has successfully hosted 41 visiting Kenyan internal medicine and pediatrics registrars at Indiana University since 2006. The program's logistics, curriculum, and evaluation are described. Results The registrars rotated through nephrology, cardiology, hematology and oncology, infectious diseases, and intensive care, as well as related ambulatory experiences, functioning on a level comparable to fourth-year medical students. They showed significant improvement in pretest and posttest scores on a standardized National Board of Medical Examiners examination (P  =  .048). International learners experienced culture shock, yet they felt the Indiana University elective was helpful and would recommend it to future participants. Conclusions Global health programs can reciprocate the benefits derived for US students and residents by offering learning experiences to international learners if that is an expressed need from the international partner. Barriers to those experiences can be overcome, and the hands-on, elective experience has the potential to positively affect the knowledge and attitudes of participants as well as the home nation. PMID:24949140

The ESRD Quality Incentive Program—Can We Bridge the Chasm?

PubMed Central

Weiner, Daniel

2017-01-01

The ESRD Quality Incentive Program (QIP) is the first mandatory federal pay for performance program launched on January 1, 2012. The QIP is tied to the ESRD prospective payment system and mandated by the Medicare Improvements for Patients and Providers Act of 2008, which directed the Centers for Medicare and Medicaid Services to expand the payment bundle for renal dialysis services and legislated that payment be tied to quality measures. The QIP links 2% of the payment that a dialysis facility receives for Medicare patients on dialysis to the facility’s performance on quality of care measures. Quality measures are evaluated annually for inclusion on the basis of importance, validity, and performance gap. Other quality assessment programs overlap with the QIP; all have substantial effects on provision of care as clinicians, patients, regulators, and dialysis organizations scramble to keep up with the frequent release of wide-ranging regulations. In this review, we provide an overview of quality assessment and quality measures, focusing on the ESRD QIP, its effect on care, and its potential future directions. We conclude that a patient-centered, individualized, and parsimonious approach to quality assessment needs to be maintained to allow the nephrology community to further bridge the quality chasm in dialysis care. PMID:28298324

The Efficacy of Stuttering Measurement Training: Evaluating Two Training Programs

PubMed Central

Bainbridge, Lauren A.; Stavros, Candace; Ebrahimian, Mineh; Wang, Yuedong

2015-01-01

Purpose Two stuttering measurement training programs currently used for training clinicians were evaluated for their efficacy in improving the accuracy of total stuttering event counting. Method Four groups, each with 12 randomly allocated participants, completed a pretest–posttest design training study. They were evaluated by their counts of stuttering events on eight 3-min audiovisual speech samples from adults and children who stutter. Stuttering judgment training involved use of either the Stuttering Measurement System (SMS), Stuttering Measurement Assessment and Training (SMAAT) programs, or no training. To test for the reliability of any training effect, SMS training was repeated with the 4th group. Results Both SMS-trained groups produced approximately 34% improvement, significantly better than no training or the SMAAT program. The SMAAT program produced a mixed result. Conclusions The SMS program was shown to produce a “medium” effect size improvement in the accuracy of stuttering event counts, and this improvement was almost perfectly replicated in a 2nd group. Half of the SMAAT judges produced a 36% improvement in accuracy, but the other half showed no improvement. Additional studies are needed to demonstrate the durability of the reported improvements, but these positive effects justify the importance of stuttering measurement training. PMID:25629956

The efficacy of stuttering measurement training: evaluating two training programs.

PubMed

Bainbridge, Lauren A; Stavros, Candace; Ebrahimian, Mineh; Wang, Yuedong; Ingham, Roger J

2015-04-01

Two stuttering measurement training programs currently used for training clinicians were evaluated for their efficacy in improving the accuracy of total stuttering event counting. Four groups, each with 12 randomly allocated participants, completed a pretest-posttest design training study. They were evaluated by their counts of stuttering events on eight 3-min audiovisual speech samples from adults and children who stutter. Stuttering judgment training involved use of either the Stuttering Measurement System (SMS), Stuttering Measurement Assessment and Training (SMAAT) programs, or no training. To test for the reliability of any training effect, SMS training was repeated with the 4th group. Both SMS-trained groups produced approximately 34% improvement, significantly better than no training or the SMAAT program. The SMAAT program produced a mixed result. The SMS program was shown to produce a "medium" effect size improvement in the accuracy of stuttering event counts, and this improvement was almost perfectly replicated in a 2nd group. Half of the SMAAT judges produced a 36% improvement in accuracy, but the other half showed no improvement. Additional studies are needed to demonstrate the durability of the reported improvements, but these positive effects justify the importance of stuttering measurement training.

Effects of a 12-week Tai Chi Chuan program versus a balance training program on postural control and walking ability in older people.

PubMed

Lelard, Thierry; Doutrellot, Pierre-Louis; David, Pascal; Ahmaidi, Said

2010-01-01

Lelard T, Doutrellot P-L, David P, Ahmaidi S. Effects of a 12-week Tai Chi Chuan program versus a balance training program on postural control and walking ability in older people. To compare the respective effects of 2 balance training programs: a Tai Chi (TC) program and a balance training program on static postural control and walking ability. Randomized controlled trial. General community. Older subjects (N=28) participated in the study. The TC group (n=14; mean age +/- SD, 76.8+/-5.1y) and the balance training group (n=14; 77.0+/-4.5y) were both trained for 12 weeks. Static postural control was assessed via measurement of center of pressure sway under eyes open (EO) and eyes closed (EC) conditions. Walking speed over a 10-meter course was also assessed. After the 12-week training period, there were no significant differences in walking speed or postural parameters in either the EO or EC conditions for the TC and balance training groups. Performance in the EC condition was lower than in the EO condition in pretest and posttest for the balance training and TC groups. The Romberg quotient (EO/EC ratio) was significantly higher after the balance training program than the TC program (P<.05). We cannot conclude that the balance training program has better effects than the TC program on postural control or walking ability. None of the outcome measures showed significant change posttraining in either the TC or the balance training groups. However, the differences described in the Romberg quotient after the training period between the TC and the balance training groups suggest that TC should be helpful to limit the deleterious effects of eye closure on postural balance. Copyright (c) 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

30 CFR 77.107 - Training programs.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Training programs. 77.107 Section 77.107... and Certified Persons § 77.107 Training programs. Every operator of a coal mine shall provide a program, approved by the Secretary, of training and retraining both qualified and certified persons needed...

30 CFR 77.107 - Training programs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Training programs. 77.107 Section 77.107... and Certified Persons § 77.107 Training programs. Every operator of a coal mine shall provide a program, approved by the Secretary, of training and retraining both qualified and certified persons needed...

34 CFR 387.1 - What is the Experimental and Innovative Training Program?

Code of Federal Regulations, 2014 CFR

2014-07-01

... 34 Education 2 2014-07-01 2013-07-01 true What is the Experimental and Innovative Training Program...) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EXPERIMENTAL AND INNOVATIVE TRAINING General § 387.1 What is the Experimental and Innovative Training Program? This program is...

34 CFR 387.1 - What is the Experimental and Innovative Training Program?

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 2 2011-07-01 2010-07-01 true What is the Experimental and Innovative Training Program...) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EXPERIMENTAL AND INNOVATIVE TRAINING General § 387.1 What is the Experimental and Innovative Training Program? This program is...

Organized Hypocrisy in EFL Teacher Training Programs

ERIC Educational Resources Information Center

Karim, Abdul; Mohamed, Abdul Rashid; Ismail, Shaik Abdul Malik Mohamed; Rahman, Mohammad Mosiur

2018-01-01

Embracing the reasons for the failure of donor-sponsored English-teacher training programs is very critical since it precedes the revisions, improvements and quality assurance for the futuristic training programs. Ideating such philosophy, the current study concerns the blatant penetration with regard to the donor-aided training programs in…

30 CFR 77.1706 - First aid training program; minimum requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false First aid training program; minimum... OF UNDERGROUND COAL MINES Miscellaneous § 77.1706 First aid training program; minimum requirements. (a) All first aid training programs required under the provisions of §§ 77.1703 and 77.1704 shall...

Re-Employment Training: Evaluation of the Oakland University RECAP/JETS Program.

ERIC Educational Resources Information Center

Ramey, Luellen

This document provides a description and evaluation of the RECAP (Re-employment Career Planning)/JETS (Job, Education/Training, Selection) program, a cooperative re-employment training program for displaced automobile industry workers in Michigan. Following the brief introduction, program development and pre-training preparation are discussed,…

Electrician Cluster, STEP Training Plan. Skills Training and Education Program.

ERIC Educational Resources Information Center

Alabama State Dept. of Postsecondary Education, Montgomery.

This guide is a training plan for the electrical skills cluster of the Skills Training and Education Program (STEP), an open-entry, open-exit program funded by the Job Training Partnership Act (JTPA). In the STEP training plan, each task has its own lesson plan guide. This manual contains the following information: definitions, instructions for…

Clerical Cluster, STEP Training Plan. Skills Training and Education Program.

ERIC Educational Resources Information Center

Alabama State Dept. of Postsecondary Education, Montgomery.

This guide is a training plan for the clerical skills cluster of the Skills Training and Education Program (STEP), an open-entry, open-exit program funded by the Job Training Partnership Act (JTPA). In the STEP training plan, each task has its own lesson plan guide. This manual contains the following information: definitions, instructions for…

45 CFR 1306.23 - Training.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 4 2011-10-01 2011-10-01 false Training. 1306.23 Section 1306.23 Public Welfare... STAFFING REQUIREMENTS AND PROGRAM OPTIONS Head Start Program Staffing Requirements § 1306.23 Training. (a) Head Start grantees must provide pre-service training and in-service training opportunities to program...

An Innovative Instrument Flight Training Program.

ERIC Educational Resources Information Center

Caro, Paul W.

An innovative flight training program, its development, and initial administration are described. The program involves use of a commercially available training device in a twin-engine transition and instrument training course. Principal features of the training include redefinition of the flight instructor's role, and incentive award system,…

Training the Sales Neophyte

ERIC Educational Resources Information Center

Harris, Clyde E., Jr.

1975-01-01

The article reappraises initial sales training and presents a program emphasizing objectives, responsibility for training, program content, and teaching techniques. Formal Initial Responsive Sales Training System (FIRSTS) is the name of the program explored and evaluated. (Author/MW)

Building capacity for water, sanitation, and hygiene programming: Training evaluation theory applied to CLTS management training in Kenya.

PubMed

Crocker, Jonny; Shields, Katherine F; Venkataramanan, Vidya; Saywell, Darren; Bartram, Jamie

2016-10-01

Training and capacity building are long established critical components of global water, sanitation, and hygiene (WaSH) policies, strategies, and programs. Expanding capacity building support for WaSH in developing countries is one of the targets of the Sustainable Development Goals. There are many training evaluation methods and tools available. However, training evaluations in WaSH have been infrequent, have often not utilized these methods and tools, and have lacked rigor. We developed a conceptual framework for evaluating training in WaSH by reviewing and adapting concepts from literature. Our framework includes three target outcomes: learning, individual performance, and improved programming; and two sets of influences: trainee and context factors. We applied the framework to evaluate a seven-month community-led total sanitation (CLTS) management training program delivered to 42 government officials in Kenya from September 2013 to May 2014. Trainees were given a pre-training questionnaire and were interviewed at two weeks and seven months after initial training. We qualitatively analyzed the data using our conceptual framework. The training program resulted in trainees learning the CLTS process and new skills, and improving their individual performance through application of advocacy, partnership, and supervision soft skills. The link from trainees' performance to improved programming was constrained by resource limitations and pre-existing rigidity of trainees' organizations. Training-over-time enhanced outcomes and enabled trainees to overcome constraints in their work. Training in soft skills is relevant to managing public health programs beyond WaSH. We make recommendations on how training programs can be targeted and adapted to improve outcomes. Our conceptual framework can be used as a tool both for planning and evaluating training programs in WaSH. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Quality assurance in postgraduate pathology training the Dutch way: regular assessment, monitoring of training programs but no end of training examination.

PubMed

van der Valk, Paul

2016-01-01

It might seem self-evident that in the transition from a supervised trainee to an independent professional who is no longer supervised, formal assessment of whether the trainee knows his/her trade well enough to function independently is necessary. This would then constitute an end of training examination. Such examinations are practiced in several countries but a rather heterogeneous situation exists in the EU countries. In the Netherlands, the training program is not concluded by a summative examination and reasons behind this situation are discussed. Quality assurance of postgraduate medical training in the Netherlands has been developed along two tracks: (1) not a single testing moment but continuous evaluation of the performance of the trainee in 'real time' situations and (2) monitoring of the quality of the offered training program through regular site-visits. Regular (monthly and/or yearly) evaluations should be part of every self-respecting training program. In the Netherlands, these evaluations are formative only: their intention is to provide the trainee a tool by which he or she can see whether they are on track with their training schedule. In the system in the Netherlands, regular site-visits to training programs constitute a crucial element of quality assurance of postgraduate training. During the site-visit, the position and perceptions of the trainee are key elements. The perception by the trainee of the training program, the institution (or department) offering the training program, and the professionals involved in the training program is explicitly solicited and systematically assessed. With this two-tiered approach high-quality postgraduate training is assured without the need for an end of training examination.

The need for improved dermoscopy training in residency: a survey of US dermatology residents and program directors

PubMed Central

Patel, Parth; Khanna, Sarika; McLellan, Beth; Krishnamurthy, Karthik

2017-01-01

Background Inadequate dermoscopy training represents a major barrier to proper dermoscopy use. Objective To better understand the status of dermoscopy training in US residency programs. Methods A survey was sent to 417 dermatology residents and 118 program directors of dermatology residency programs. Results Comparing different training times for the same training type, residents with 1–10 hours of dedicated training had similar confidence using dermoscopy in general (p = 1.000) and satisfaction with training (p = .3224) than residents with >10 hours of dedicated training. Comparing similar training times for different training types, residents with 1–10 hours of dedicated training had significantly increased confidence using dermoscopy in general (p = .0105) and satisfaction with training (p = .0066) than residents with 1–10 hours of only bedside training. Lastly, residents with 1–10 hours of dedicated training and >10 hours of dedicated training had significantly increased confidence using dermoscopy in general (p = .0002, p = .2471) and satisfaction with training (p <.0001, p < .0001) than residents with no dermoscopy training at all. Conclusions Dermoscopy training in residency should include formal dermoscopy training that is overseen by the program director and is possibly supplemented by outside dermoscopy training. PMID:28515987

Monetary incentives to reinforce engagement and achievement in a job-skills training program for homeless, unemployed adults.

PubMed

Koffarnus, Mikhail N; Wong, Conrad J; Fingerhood, Michael; Svikis, Dace S; Bigelow, George E; Silverman, Kenneth

2013-01-01

The current study examined whether monetary incentives could increase engagement and achievement in a job-skills training program for unemployed, homeless, alcohol-dependent adults. Participants (n=124) were randomized to a no-reinforcement group (n=39), during which access to the training program was provided but no incentives were given; a training reinforcement group (n=42), during which incentives were contingent on attendance and performance; or an abstinence and training reinforcement group (n=43), during which incentives were contingent on attendance and performance, but access was granted only if participants demonstrated abstinence from alcohol. abstinence and training reinforcement and training reinforcement participants advanced further in training and attended more hours than no-reinforcement participants. Monetary incentives were effective in promoting engagement and achievement in a job-skills training program for individuals who often do not take advantage of training programs. © Society for the Experimental Analysis of Behavior.

Guidelines for development of NASA (National Aeronautics and Space Administration) computer security training programs

NASA Technical Reports Server (NTRS)

Tompkins, F. G.

1983-01-01

The report presents guidance for the NASA Computer Security Program Manager and the NASA Center Computer Security Officials as they develop training requirements and implement computer security training programs. NASA audiences are categorized based on the computer security knowledge required to accomplish identified job functions. Training requirements, in terms of training subject areas, are presented for both computer security program management personnel and computer resource providers and users. Sources of computer security training are identified.

14 CFR 91.1073 - Training program: General.

Code of Federal Regulations, 2010 CFR

2010-01-01

... ensure that each pilot annually completes at least one flight training session in an approved simulator for at least one program aircraft. The training session may be the flight training portion of any of... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Training program: General. 91.1073 Section...

Alterations in Strength and Maximal Oxygen Uptake Consequent to Nautilus Circuit Weight Training.

ERIC Educational Resources Information Center

Messier, Stephen P.; Dill, Mary Elizabeth

1985-01-01

The study compared the effects on muscular strength and maximal oxygen uptake of a Nautilus circuit weight training program, a free weight strength training program, and a running program. Nautilus circuit weight training appears to be equally effective for a training period of short duration. (MT)

5 CFR 410.301 - Scope and general conduct of training programs.

Code of Federal Regulations, 2010 CFR

2010-01-01

... other human resource functions. Training programs established by agencies under chapter 41 of title 5... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Scope and general conduct of training... REGULATIONS TRAINING Establishing and Implementing Training Programs § 410.301 Scope and general conduct of...

A National Policy for Workplace Training. Lessons from State and Local Experiments.

ERIC Educational Resources Information Center

Batt, Rosemary; Osterman, Paul

Selected state and local experiments in developing/supporting workplace-centered training programs were analyzed to identify issues relevant to developing a national policy for workplace training. Intensive case studies of state economic development/training programs in California and Illinois and the employment and training programs provided by…

Training for Development 1970. The United States Participant Training Program.

ERIC Educational Resources Information Center

Agency for International Development (Dept. of State), Washington, DC. Office of International Training.

The report describes the program of training for foreign students conducted by the Office of International Training of the Agency for International Development (AID). The report's first chapter describes the history, nature, and importance of participant training and diagrams the administrative structure of the program. Chapter 2 describes the…

SNAP Employment and Training: Washington's Basic Food Employment & Training Program (BFET)

ERIC Educational Resources Information Center

Mohan, Lavanya

2014-01-01

SNAP Employment & Training (E&T) is an important component of SNAP (Supplemental Nutrition Assistance Program, formerly known as the Food Stamp Program) that supports a variety of education, training, employment, and related services for SNAP recipients. It gives recipients opportunities to gain skills, training, or experience that will…

Design of training programs for a positive youth development program: Project P.A.T.H.S. in Hong Kong.

PubMed

Shek, Daniel T L; Chak, Yammy L Y

2010-01-01

To facilitate the implementation of the Secondary 1 to Secondary 3 program of the Project P.A.T.H.S. in Hong Kong, systematic training programs are designed for the potential program implementers. The rationales, objectives and design of the Secondary 1 to Secondary 3 training programs are outlined in this paper. The training programs cover theories of adolescent development, positive youth development, background and curricula of the Project P.A.T.H.S., factors affecting program implementation quality and evaluation of the project. Besides introducing the curriculum units, the training programs also focus on nature of learning and related theories (particularly experiential learning), teaching methods and instructional techniques, motivating students, and classroom management.

Simulation For Task Practice in Technical Training.

ERIC Educational Resources Information Center

Mallory, W. J.

1981-01-01

Describes two programs used by the Ford Motor Company to train manufacturing skilled trades personnel. Programmable Controller Maintenance Training Program for Industrial Technicians and Troubleshooting Strategy Program use simulation and provide improved task performance after training. (JOW)

North American veterinary pathology residency training programs: an overview of where they are today and where they were five years ago, with an analysis of trends.

PubMed

Fitzgerald, Scott D; Reed, Willie M; Kaneene, John B

2007-01-01

An e-mail/telephone survey of all active North American residency training programs in veterinary pathology was conducted in September 2005. The purpose of this survey was to determine current numbers of trainees, their program length and type, and salaries; to compare current numbers to five years earlier; and, finally, to gauge interest in expanding current programs. All 41 training institutions contacted responded to the survey. Briefly, the survey found that there are currently 235 veterinary pathology residents, for a mean of 5.7 residents per training program. The number of residents currently in training programs and the number of applicants for these programs has increased compared to five years earlier. There is widespread interest in further expanding capacity in these programs, and the coalition of the American College of Veterinary Pathologists and the Society of Toxicologic Pathology is a well-known source of possible funding for additional residents. This survey report further documents the numbers of combined residency/PhD programs, average starting salaries for new residents, outside sponsorship effects on pathology training programs, and some of the common concerns regarding veterinary pathology training programs voiced by the respondents. While residency training capacity has expanded in the last five years, and there is widespread desire to further expand these training programs, a shortage of veterinary pathologists for future market needs will need to be addressed by increased funding from as yet unspecified sources.

Psychological Effects of Automated External Defibrillator Training A randomized trial

PubMed Central

Meischke, Hendrika; Diehr, Paula; Phelps, Randi; Damon, Susan; Rea, Tom

2011-01-01

Objectives The objective of this study was to test if an Automated External Defibrillator (AED) training program would positively affect the mental health of family members of high risk patients. Methods 305 ischemic heart disease patients and their family members were randomized to one of four AED training programs: two video-based training programs and two face-to-face training programs that emphasized self-efficacy and perceived control. Patients and family members were surveyed at baseline, 3 and 9 months post ischemic event on demographic characteristics, measures of quality of life (SF=36) , self-efficacy and perceived control. For this study, family members were the focus rather than the patients. Results Regression analyses showed that family members in the face-to-face training programs did not score better on any of the mental health status variables than family members who participated in the other training programs but for an increase in self-efficacy beliefs at 3 months post training. Conclusion The findings suggest that a specifically designed AED training program emphasizing self-efficacy and perceived control beliefs is not likely to enhance family member mental health. PMID:21411144

Chemical Dependency and Violence: Working with Dually Affected Families. A Cross-Training Program Manual for Counselors and Advocates.

ERIC Educational Resources Information Center

Wright, Janet M.

This manual is designed as a cross-training program guide for counselors working in the fields of woman abuse and chemical dependency. (A cross-training program is a system for one (or more) agency personnel to train each other in their respective areas of expertise.) Chapter 1 discusses the rationale and goals of a cross-training program; issues…

Urologic Oncology Branch - Training - NCI/AFUD | Center for Cancer Research

Cancer.gov

Postdoctoral Research Training Program This program is designed to train Ph.D. postdoctoral scientists in the growing field of urologic oncology. This program offers fellows the opportunity to participate in a diverse training experience that includes clinical and laboratory research on several urologic malignancies. The program provides an opportunity for selected individuals

Psychosocial Training in U.S. Internal Medicine and Family Practice Residency Programs.

ERIC Educational Resources Information Center

Gaufberg, Elizabeth H.; Joseph, Robert C.; Pels, Richard J.; Wyshak, Grace; Wieman, Dow; Nadelson, Carol C.

2001-01-01

Surveyed directors of internal medicine (IM) and family practice (FP) residency programs regarding the format, content, and quantity of psychosocial training in their programs, their opinions on topics related to such training, and program demographics. Found considerable variation in content and time devoted to psychosocial training within and…

Demographic Changes in School Psychology Training Programs between 1997 and 2005

ERIC Educational Resources Information Center

Cannon, Sharon

2009-01-01

The purpose of this study seeks to add to the body of knowledge regarding school psychology training programs by analyzing the data of the 2005 National Association of School Psychologists (NASP) Graduate Training in School Psychology Database, a national survey of psychology training programs. Program directors of all known existing school…

34 CFR 390.1 - What is the Rehabilitation Short-Term Training program?

Code of Federal Regulations, 2012 CFR

2012-07-01

... 34 Education 2 2012-07-01 2012-07-01 false What is the Rehabilitation Short-Term Training program...-TERM TRAINING General § 390.1 What is the Rehabilitation Short-Term Training program? This program is designed for the support of special seminars, institutes, workshops, and other short-term courses in...

34 CFR 390.1 - What is the Rehabilitation Short-Term Training program?

Code of Federal Regulations, 2014 CFR

2014-07-01

... 34 Education 2 2014-07-01 2013-07-01 true What is the Rehabilitation Short-Term Training program...-TERM TRAINING General § 390.1 What is the Rehabilitation Short-Term Training program? This program is designed for the support of special seminars, institutes, workshops, and other short-term courses in...

34 CFR 390.1 - What is the Rehabilitation Short-Term Training program?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 2 2010-07-01 2010-07-01 false What is the Rehabilitation Short-Term Training program...-TERM TRAINING General § 390.1 What is the Rehabilitation Short-Term Training program? This program is designed for the support of special seminars, institutes, workshops, and other short-term courses in...

34 CFR 390.1 - What is the Rehabilitation Short-Term Training program?

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 2 2011-07-01 2010-07-01 true What is the Rehabilitation Short-Term Training program...-TERM TRAINING General § 390.1 What is the Rehabilitation Short-Term Training program? This program is designed for the support of special seminars, institutes, workshops, and other short-term courses in...

34 CFR 390.1 - What is the Rehabilitation Short-Term Training program?

Code of Federal Regulations, 2013 CFR

2013-07-01

... 34 Education 2 2013-07-01 2013-07-01 false What is the Rehabilitation Short-Term Training program...-TERM TRAINING General § 390.1 What is the Rehabilitation Short-Term Training program? This program is designed for the support of special seminars, institutes, workshops, and other short-term courses in...

Improving Psychosexual Knowledge in Adolescents with Autism Spectrum Disorder: Pilot of the Tackling Teenage Training Program

ERIC Educational Resources Information Center

Dekker, Linda P.; van der Vegt, Esther J.; Visser, Kirsten; Tick, Nouchka; Boudesteijn, Frieda; Verhulst, Frank C.; Maras, Athanasios; Greaves-Lord, Kirstin

2015-01-01

Previous studies have shown that psychosexual functioning in adolescents with autism spectrum disorder (ASD) is hampered and emphasize the need for a specialized training program tailored to their needs. Therefore, an individual training program was developed; the Tackling Teenage Training (TTT) program. The current pilot study systematically…

OSHA Training Programs. Module SH-48. Safety and Health.

ERIC Educational Resources Information Center

Center for Occupational Research and Development, Inc., Waco, TX.

This student module on OSHA (Occupational Safety and Health Act) training programs is one of 50 modules concerned with job safety and health. This module provides a list of OSHA training requirements and describes OSHA training programs and other safety organizations' programs. Following the introduction, 11 objectives (each keyed to a page in the…

30 CFR 75.1713-6 - First-aid training program; minimum requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false First-aid training program; minimum... § 75.1713-6 First-aid training program; minimum requirements. (a) All first-aid training programs... course of instruction similar to that outlined in “First Aid, A Bureau of Mines Instruction Manual.” (b...

Strategies for Involving the Private Sector in Job Training Programs.

ERIC Educational Resources Information Center

Greenwood, Katy; And Others

This two-part report describes various strategies for involving the private sector in job training programs and summarizes a study conducted with prime sponsors of Comprehensive Employment and Training Act (CETA) programs in Texas. Included in a discussion of involving the private sector in job training programs are the following topics: the new…

Evaluation of a Behavior Management Training Program for Nursing Home Caregivers.

ERIC Educational Resources Information Center

Marsiske, Michael; And Others

This study examined the effectiveness of a new skills training program designed to increase nurse aides' knowledge of behavior management. The training program, designed as five 90-minute group learning modules, was implemented in two Western Pennsylvania nursing homes over a 5-month period. Topics covered within the training program included…

A national survey of terrorism preparedness training among pediatric, family practice, and emergency medicine programs.

PubMed

Martin, Shelly D; Bush, Anneke C; Lynch, Julia A

2006-09-01

Domestic terrorism is a real threat focusing on a need to engage in effective emergency preparedness planning and training. Front-line physicians are an important component of any emergency preparedness plan. Potential victims of an attack include children who have unique physiologic and psychological vulnerabilities in disasters. Front-line providers need to have adequate training to effectively participate in local planning initiatives and to recognize and treat casualties including children. The goal of the survey was to assess the current state of terrorism preparedness training, including child victims, by emergency medicine, family practice, and pediatric residency programs in the United States and to assess methods of training and barriers to establishing effective training. A survey was e-mailed to a comprehensive list of all US pediatric, family practice, and emergency medicine residency programs 3 times between September 2003 and January 2004. The survey measured the perceived risk of terrorist attack, level of training by type of attack, level of training regarding children, method of training, and barriers to training. Overall, 21% of programs responded (46 of 182 pediatric, 75 of 400 family practice, and 29 of 125 emergency medicine programs). Across all of the event types, emergency medicine programs were more likely to report adequate/comprehensive training. However, < 50% of emergency medicine programs report adequate training for children. Didactic classroom-based lectures were the most commonly used method of training. Emergency medicine programs were more likely to use scenario-based exercises. Among programs that use scenario exercises, 93% report that they never (40%) or only sometimes (53%) incorporate child victims into the scenarios. Time, funding, access to subject matter experts, and availability of training material are the most important barriers to effective training. Children are a precious national resource and a vulnerable population in disasters. Despite the availability of terrorism preparedness funding, these data suggest that we are failing to provide adequate training to front-line providers who may care for children in a catastrophic domestic terrorist event.

Effectiveness of a training program to increase the capacity of health care providers to provide HIV/AIDS care and treatment in Swaziland.

PubMed

Kamiru, H N; Ross, M W; Bartholomew, L K; McCurdy, S A; Kline, M W

2009-11-01

Implementation of HIV care and treatment programs in sub-Saharan Africa is a complex undertaking that requires training of health care providers (HCPs). Many sub-Saharan African countries have introduced training programs to build human resources for health. Evaluation of the ongoing trainings is warranted so that programs can be improved. The purpose of this study was to evaluate Baylor International Pediatric AIDS Initiative's (BIPAI) HCP training program in Swaziland. The specific aims were: (1) to assess coverage and delivery of the training program; and (2) to determine the impact of the training program on HCPs' knowledge about HIV and pediatric practices, attitudes toward HIV/AIDS patients, and self-efficacy to provide antiretroviral therapy (ART). The evaluation was a multimethod design with two types of data collection and analysis: (1) one-group pretest-posttest survey with 101 HCPs; and (2) semi-structured in-depth interviews with seven trainers from Baylor College of Medicine and 16 local HCPs in Swaziland. Quantitative data were analyzed using Stata Statistical Software version 8.2 for descriptive and multivariate analysis while factor analysis was done using Statistical Program for Social Sciences version 14. The transcribed interviews were analyzed using a didactic approach. Process evaluation showed that the training had good coverage, was delivered as intended, and improved as the work progressed. The training program led to a significant increase (p=0.0000) in HCPs' knowledge about HIV/AIDS, ART, and relevant clinical pediatrics practices between pretest (mean 68.7% SD 13.7) and post training (mean 84.0% SD 12.0). The training program also increased trainees' self-efficacy to provide ART and their attitudes toward AIDS patients (p=0.0000 and 0.02, respectively). In conclusion, BIPAI training program in Swaziland had good coverage of all health care facilities and HCPs in Swaziland. The training was effective in imparting knowledge and skills to HCPs and in their attitudes toward HIV/AIDS patients.

Developing and fostering a dynamic program for training in veterinary pathology and clinical pathology: veterinary students to post-graduate education.

PubMed

Lairmore, Michael D; Oglesbee, Michael; Weisbrode, Steve E; Wellman, Maxey; Rosol, Thomas; Stromberg, Paul

2007-01-01

Recent reports project a deficiency of veterinary pathologists, indicating a need to train highly qualified veterinary pathologists, particularly in academic veterinary medicine. The need to provide high-quality research training for veterinary pathologists has been recognized by the veterinary pathology training program of the Ohio State University (OSU) since its inception. The OSU program incorporates elements of both residency training and graduate education into a unified program. This review illustrates the components and structure of the training program and reflects on future challenges in training veterinary pathologists. Key elements of the OSU program include an experienced faculty, dedicated staff, and high-quality students who have a sense of common mission. The program is supported through cultural and infrastructure support. Financial compensation, limited research funding, and attractive work environments, including work-life balance, will undoubtedly continue to be forces in the marketplace for veterinary pathologists. To remain competitive and to expand the ability to train veterinary pathologists with research skills, programs must support strong faculty members, provide appropriate infrastructure support, and seek active partnerships with private industry to expand program opportunities. Shortages of trained faculty may be partially resolved by regional cooperation to share faculty expertise or through the use of communications technology to bridge distances between programs. To foster continued interest in academic careers, training programs will need to continue to evolve and respond to trainees' needs while maintaining strong allegiances to high-quality pathology training. Work-life balance, collegial environments that foster a culture of respect for veterinary pathology, and continued efforts to reach out to veterinary students to provide opportunities to learn about the diverse careers offered in veterinary pathology will pay long-term dividends for the future of the profession.

Developing and Fostering a Dynamic Program for Training in Veterinary Pathology and Clinical Pathology: Veterinary Students to Post-graduate Education

PubMed Central

Lairmore, Michael D.; Oglesbee, Michael; Weisbrode, Steve E.; Wellman, Maxey; Rosol, Thomas; Stromberg, Paul

2011-01-01

Recent reports project a deficiency of veterinary pathologists, indicating a need to train highly qualified veterinary pathologists, particularly in academic veterinary medicine. The need to provide high-quality research training for veterinary pathologists has been recognized by the veterinary pathology training program of the Ohio State University (OSU) since its inception. The OSU program incorporates elements of both residency training and graduate education into a unified program. This review illustrates the components and structure of the training program and reflects on future challenges in training veterinary pathologists. Key elements of the OSU program include an experienced faculty, dedicated staff, and high-quality students who have a sense of common mission. The program is supported through cultural and infrastructure support. Financial compensation, limited research funding, and attractive work environments, including work–life balance, will undoubtedly continue to be forces in the marketplace for veterinary pathologists. To remain competitive and to expand the ability to train veterinary pathologists with research skills, programs must support strong faculty members, provide appropriate infrastructure support, and seek active partnerships with private industry to expand program opportunities. Shortages of trained faculty may be partially resolved by regional cooperation to share faculty expertise or through the use of communications technology to bridge distances between programs. To foster continued interest in academic careers, training programs will need to continue to evolve and respond to trainees' needs while maintaining strong allegiances to high-quality pathology training. Work–life balance, collegial environments that foster a culture of respect for veterinary pathology, and continued efforts to reach out to veterinary students to provide opportunities to learn about the diverse careers offered in veterinary pathology will pay long-term dividends for the future of the profession. PMID:18287474

AED (Automated External Defibrillator) Programs: Questions and Answers

MedlinePlus

... Training CPR In Schools Training Kits RQI AHA Blended Learning & eLearning Guide AHA Instructors ECC Educational Conferences Programs ... Training CPR In Schools Training Kits RQI AHA Blended Learning & eLearning Guide AHA Instructors ECC Educational Conferences Programs ...

Injuries in women associated with a periodized strength training and running program.

PubMed

Reynolds, K L; Harman, E A; Worsham, R E; Sykes, M B; Frykman, P N; Backus, V L

2001-02-01

Forty-five women participated in a 24-week physical training program designed to improve lifting, load carriage, and running performance. Activities included weightlifting, running, backpacking, lift and carry drills, and sprint running. Physicians documented by passive surveillance all training-related injuries. Thirty-two women successfully completed training program. Twenty-two women (48.9%) suffered least 1 injury during training, but only 2 women had to drop out of the study because of injuries. The rate of injury associated with lost training time was 2.8 injuries per 1,000 training hours of exposure. Total clinic visits and days lost from training were 89 and 69, respectively. Most injuries were the overuse type involving the lower back, knees, and feet. Weightlifting accounted for a majority of the lost training days. A combined strength training and running program resulted in significant performance gains in women. Only 2 out of 45 participants left the training program cause of injuries.

Workload Impact of Medical Subspecialties in the Teaching Hospital

ERIC Educational Resources Information Center

Van Peenen, Hubert J.

1973-01-01

This paper documents, using a single test as a model, the significant increase in clinical laboratory workload which occurred in a university hospital when strong sections of nephrology, hematology-oncology, and immunology-rheumatology were added to the department of medicine. (Author)

American Society of Nephrology

MedlinePlus

... heart failure https://t.co/PkE9xXgnUF – @ASNKidney on Twitter #Amish mutation protects against #diabetes and may extend life | @NYTimes https://t.co/7wnc2AhBdO – @ASNKidney on Twitter .@US_FDA issues safety alert for #gout medication | @ ...

Improving Medical Care With Electronic Interventions Based on Automated Text and Phone Messages

ClinicalTrials.gov

2017-09-21

General Medicine; Maternal Health; Pediatric Health; Neurology; Psychiatry; Emergency Medicine; Internal Medicine; Nephrology; Wellness; Mobile Health; Surgery; Mental Health; Chronic Obstructive Pulmonary Disease; Diabetes Mellitus; CHF; Depression; Breast Feeding; PostPartum Depression; Perinatal Mood and Anxiety Disorder

DOE handbook: Guide to good practices for training and qualification of maintenance personnel

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1996-03-01

The purpose of this Handbook is to provide contractor training organizations with information that can be used to verify the adequacy of and/or modify existing maintenance training programs, or to develop new training programs. This guide, used in conjunction with facility-specific job analyses, provides a framework for training and qualification programs for maintenance personnel at DOE reactor and nonreactor nuclear facilities. Recommendations for qualification are made in four areas: education, experience, physical attributes, and training. The functional positions of maintenance mechanic, electrician, and instrumentation and control technician are covered by this guide. Sufficient common knowledge and skills were found tomore » include the three disciplines in one guide to good practices. Contents include: qualifications; on-the-job training; trainee evaluation; continuing training; training effectiveness evaluation; and program records. Appendices are included which relate to: administrative training; industrial safety training; fundamentals training; tools and equipment training; facility systems and component knowledge training; facility systems and component skills training; and specialized skills training.« less

Effects of standard training in the use of closed-circuit televisions in visually impaired adults: design of a training protocol and a randomized controlled trial.

PubMed

Burggraaff, Marloes C; van Nispen, Ruth M A; Melis-Dankers, Bart J M; van Rens, Ger H M B

2010-03-10

Reading problems are frequently reported by visually impaired persons. A closed-circuit television (CCTV) can be helpful to maintain reading ability, however, it is difficult to learn how to use this device. In the Netherlands, an evidence-based rehabilitation program in the use of CCTVs was lacking. Therefore, a standard training protocol needed to be developed and tested in a randomized controlled trial (RCT) to provide an evidence-based training program in the use of this device. To develop a standard training program, information was collected by studying literature, observing training in the use of CCTVs, discussing the content of the training program with professionals and organizing focus and discussion groups. The effectiveness of the program was evaluated in an RCT, to obtain an evidence-based training program. Dutch patients (n = 122) were randomized into a treatment group: normal instructions from the supplier combined with training in the use of CCTVs, or into a control group: instructions from the supplier only. The effect of the training program was evaluated in terms of: change in reading ability (reading speed and reading comprehension), patients' skills to operate the CCTV, perceived (vision-related) quality of life and tasks performed in daily living. The development of the CCTV training protocol and the design of the RCT in the present study may serve as an example to obtain an evidence-based training program. The training program was adjusted to the needs and learning abilities of individual patients, however, for scientific reasons it might have been preferable to standardize the protocol further, in order to gain more comparable results. http://www.trialregister.nl, identifier: NTR1031.

Effects of standard training in the use of closed-circuit televisions in visually impaired adults: design of a training protocol and a randomized controlled trial

PubMed Central

2010-01-01

Background Reading problems are frequently reported by visually impaired persons. A closed-circuit television (CCTV) can be helpful to maintain reading ability, however, it is difficult to learn how to use this device. In the Netherlands, an evidence-based rehabilitation program in the use of CCTVs was lacking. Therefore, a standard training protocol needed to be developed and tested in a randomized controlled trial (RCT) to provide an evidence-based training program in the use of this device. Methods/Design To develop a standard training program, information was collected by studying literature, observing training in the use of CCTVs, discussing the content of the training program with professionals and organizing focus and discussion groups. The effectiveness of the program was evaluated in an RCT, to obtain an evidence-based training program. Dutch patients (n = 122) were randomized into a treatment group: normal instructions from the supplier combined with training in the use of CCTVs, or into a control group: instructions from the supplier only. The effect of the training program was evaluated in terms of: change in reading ability (reading speed and reading comprehension), patients' skills to operate the CCTV, perceived (vision-related) quality of life and tasks performed in daily living. Discussion The development of the CCTV training protocol and the design of the RCT in the present study may serve as an example to obtain an evidence-based training program. The training program was adjusted to the needs and learning abilities of individual patients, however, for scientific reasons it might have been preferable to standardize the protocol further, in order to gain more comparable results. Trial registration http://www.trialregister.nl, identifier: NTR1031 PMID:20219120

Development and evaluation of a leadership training program for public health emergency response: results from a Chinese study.

PubMed

Wang, Chongjian; Wei, Sheng; Xiang, Hao; Wu, Jing; Xu, Yihua; Liu, Li; Nie, Shaofa

2008-10-30

Since the 9/11 attack and severe acute respiratory syndrome (SARS), the development of qualified and able public health leaders has become a new urgency in building the infrastructure needed to address public health emergencies. Although previous studies have reported that the training of individual leaders is an important approach, the systemic and scientific training model need further improvement and development. The purpose of this study was to develop, deliver, and evaluate a participatory leadership training program for emergency response. Forty-one public health leaders (N = 41) from five provinces completed the entire emergency preparedness training program in China. The program was evaluated by anonymous questionnaires and semi-structured interviews held prior to training, immediately post-training and 12-month after training (Follow-up). The emergency preparedness training resulted in positive shifts in knowledge, self-assessment of skills for public health leaders. More than ninety-five percent of participants reported that the training model was scientific and feasible. Moreover, the response of participants in the program to the avian influenza outbreak, as well as the planned evaluations for this leadership training program, further demonstrated both the successful approaches and methods and the positive impact of this integrated leadership training initiative. The emergency preparedness training program met its aims and objectives satisfactorily, and improved the emergency capability of public health leaders. This suggests that the leadership training model was effective and feasible in improving the emergency preparedness capability.

A preliminary report on resident emergency psychiatry training from a survey of psychiatry chief residents.

PubMed

Bennett, Jeffrey I; Dzara, Kristina; Mazhar, Mir Nadeem; Behere, Aniruddh

2011-03-01

The Accreditation Council for Graduate Medical Education (ACGME) requirements stipulate that psychiatry residents need to be educated in the area of emergency psychiatry. Existing research investigating the current state of this training is limited, and no research to date has assessed whether the ACGME Residency Review Committee requirements for psychiatry residency training are followed by psychiatry residency training programs. We administered, to chief resident attendees of a national leadership conference, a 24-item paper survey on the types and amount of emergency psychiatry training provided by their psychiatric residency training programs. Descriptive statistics were used in the analysis. Of 154 surveys distributed, 111 were returned (72% response rate). Nearly one-third of chief resident respondents indicated that more than 50% of their program's emergency psychiatry training was provided during on-call periods. A minority indicated that they were aware of the ACGME program requirements for emergency psychiatry training. While training in emergency psychiatry occurred in many programs through rotations-different from the on-call period-direct supervision was available during on-call training only about one-third of the time. The findings suggest that about one-third of psychiatry residency training programs do not adhere to the ACGME standards for emergency psychiatry training. Enhanced knowledge of the ACGME requirements may enhance psychiatry residents' understanding on how their programs are fulfilling the need for more emergency psychiatry training. Alternative settings to the on-call period for emergency psychiatry training are more likely to provide for direct supervision.

The development of a TED-Ed online resident research training program.

PubMed

Moreau, Katherine A; Pound, Catherine M; Peddle, Beth; Tokarewicz, Jaclyn; Eady, Kaylee

2014-01-01

Pediatric health research is important for improving the health and well-being of children and their families. To foster the development of physicians' research competencies, it is vital to integrate practical and context-specific research training into residency programs. To describe the development of a resident research training program at one tertiary care pediatric academic health sciences center in Ontario, Canada. We surveyed residents and pediatricians/research staff to establish the need and content for a resident research training program. Residents and resident research supervisors agreed or strongly agreed that research training is important for residents. However, few residents and supervisors believed that their academic health sciences center provided adequate training and resources to support resident research. As such, an online resident research training program was established. Residents and supervisors agreed that the program should focus on the following topics: 1) critically evaluating research literature, 2) writing a research proposal, 3) submitting an application for research funding, and 4) writing a manuscript. This highly accessible, context-specific, and inexpensive online program model may be of interest and benefit to other residency programs as a means to enhance residents' scholarly roles. A formal evaluation of the research training program is now underway.

[Optimization of registry of deaths from chronic kidney disease in agricultural communities in Central America].

PubMed

Escamilla-Cejudo, José Antonio; Báez, Jorge Lara; Peña, Rodolfo; Luna, Patricia Lorena Ruiz; Ordunez, Pedro

2016-11-01

Several Central American countries are seeing continued growth in the number of deaths from chronic kidney disease of nontraditional causes (CKDnT) among farm workers and there is underreporting. This report presents the results of a consensus process coordinated by the Pan American Health Organization/World Health Organization (PAHO/WHO), the United States Centers for Disease Control and Prevention (CDC), and the Latin American Society of Nephrology and Hypertension (SLANH). This consensus seeks to increase the probability of detecting and recording deaths from these causes. There has been recognition of the negative impact of the lack of a standardized instrument and the lack of training in the medical profession for adequate registration of the cause or causes of death. As a result of the consensus, the following has been proposed: temporarily use a code from the Codes for Special Purposes in the International Classification of Diseases (ICD-10); continue to promote use of the WHO international standardized instrument for recording causes and preceding events related to death; increase training of physicians responsible for filling out death certificates; take action to increase the coverage and quality of information on mortality; and create a decision tree to facilitate selection of CKDnT as a specific cause of death, while presenting the role that different regional and subregional mechanisms in the Region of the Americas should play in order to improve CKD and CKDnT mortality records.

Awareness and knowledge among internal medicine house-staff for dose adjustment of commonly used medications in patients with CKD.

PubMed

Surana, Sikander; Kumar, Neeru; Vasudeva, Amita; Shaikh, Gulvahid; Jhaveri, Kenar D; Shah, Hitesh; Malieckal, Deepa; Fogel, Joshua; Sidhu, Gurwinder; Rubinstein, Sofia

2017-01-17

Drug dosing errors result in adverse patient outcomes and are more common in patients with chronic kidney disease (CKD). As internists treat the majority of patients with CKD, we study if Internal Medicine house-staff have awareness and knowledge about the correct dosage of commonly used medications for those with CKD. A cross-sectional survey was performed and included 341 participants. The outcomes were the awareness of whether a medication needs dose adjustment in patients with CKD and whether there was knowledge for the level of glomerular filtration rate (GFR) a medication needs to be adjusted. The overall pattern for all post-graduate year (PGY) groups in all medication classes was a lack of awareness and knowledge. For awareness, there were statistically significant increased mean differences for PGY2 and PGY3 as compared to PGY1 for allergy, endocrine, gastrointestinal, and rheumatologic medication classes but not for analgesic, cardiovascular, and neuropsychotropic medication classes. For knowledge, there were statistically significant increased mean differences for PGY2 and PGY3 as compared to PGY1 for allergy, cardiovascular, endocrine, and gastrointestinal, medication classes but not for analgesic, neuropsychotropic, and rheumatologic medication classes. Internal Medicine house-staff across all levels of training demonstrated poor awareness and knowledge for many medication classes in CKD patients. Internal Medicine house-staff should receive more nephrology exposure and formal didactic educational training during residency to better manage complex treatment regimens and prevent medication dosing errors.

[Acute Kidney Injury: the nephrology plus value and competence and a good organization can ameliorate the prognosis].

PubMed

Fagugli, Riccardo Maria; Guastoni, Carlo Maria; Battistoni, Sara; Patera, Francesco; Quintaliani, Giuseppe

2016-01-01

Epidemiology of Acute Kidney Injury (AKI) has changed radically in the past 15 years: we have observed an exponential increase of cases with high mortality and residual disability, particularly in those patients who need dialysis treatment. Those who survive AKI have an increased risk of requiring dialysis after hospital discharge over the short term as well as long term. They have an increased risk of deteriorating residual kidney function and cardiovascular events as well as a shorter life expectancy. Given the severe prognosis, difficulties of treatment, high level of resources needed, increased workload and consequently costs, several aspects of AKI have not been sufficiently investigated. Any national register of AKI has not been developed and its absence has an impact on provisional strategies. Specific training should be planned beginning with University, which should include practical training in Intensive Care Units. A definition of the organizational characteristics and requirements for the care of AKI is needed. Treatment of AKI is not based exclusively on dialysis efficiency or technology, but also on professional skills, volume of activity, clinical experience, model of healthcare organizations, continuity of processes and medical activities to guarantee such as a closed-staff system. Progress in knowledge and technology has only partially modified the outcome and prognosis of AKI patients; consequently, new strategies based on increased awareness, on the implementation of professional skills, and on revision, definition and updating of resources for the organization of AKI management are needed and expected over the short term.

Impact of a provider training program on the treatment of children with autism spectrum disorder at psychosocial care units in Brazil.

PubMed

Silva, Luciana C; Teixeira, Maria C T V; Ribeiro, Edith L; Paula, Cristiane S

2017-12-18

To develop, implement, and verify the impact of a training program for health care providers working with children with autism spectrum disorder (ASD) in psychosocial care centers for children and adolescents (Centro de Atenção Psicossocial à Infância e à Adolescência - CAPSi) in São Paulo, Brazil. This quasi-experimental study was conducted with 14 professionals from four CAPSi units. The training program consisted of six phases: 1) pre-intervention observation; 2) meeting with staff to assess the main needs of the training program; 3) developing materials for training and evaluation; 4) meetings to discuss program implementation; 5) a final meeting for case discussion and evaluation; and 6) distance supervision. Three measures were used to evaluate the training program: i) the Knowledge, Attitudes, and Practices (KAP) questionnaire; ii) videos containing questions designed to assess program comprehension; and iii) a satisfaction survey. Thirteen videos were produced to as visual aids for use during the training program, and a further 26 videos were developed to evaluate it. The program was well evaluated by the participants. The video responses and KAP questionnaire scores suggest that staff knowledge and attitudes improved after training. The positive findings of this study suggest that the tested training program is feasible for use with multidisciplinary teams working in the CAPSi environment.

Guidelines for competency development and measurement in rehabilitation psychology postdoctoral training.

PubMed

Stiers, William; Barisa, Mark; Stucky, Kirk; Pawlowski, Carey; Van Tubbergen, Marie; Turner, Aaron P; Hibbard, Mary; Caplan, Bruce

2015-05-01

This study describes the results of a multidisciplinary conference (the Baltimore Conference) that met to develop consensus guidelines for competency specification and measurement in postdoctoral training in rehabilitation psychology. Forty-six conference participants were chosen to include representatives of rehabilitation psychology training and practice communities, representatives of psychology accreditation and certification bodies, persons involved in medical education practice and research, and consumers of training programs (students). Consensus education and training guidelines were developed that specify the key competencies in rehabilitation psychology postdoctoral training, and structured observation checklists were developed for their measurement. This study continues the development of more than 50 years of thinking about education and training in rehabilitation psychology and builds on the existing work to further advance the development of guidelines in this area. The conference developed aspirational guidelines for competency specification and measurement in rehabilitation psychology postdoctoral training (i.e., for studying the outcomes of these training programs). Structured observation of trainee competencies allows examination of actual training outcomes in relation to intended outcomes and provides a methodology for studying how program outcomes are related to program structures and processes so that program improvement can occur. Best practices in applying program evaluation research methods to the study of professional training programs are discussed. (c) 2015 APA, all rights reserved).

Multicultural Training in Doctoral School Psychology Programs: In Search of the Model Program?

ERIC Educational Resources Information Center

Kearns, Tori; Ford, Laurie; Brown, Kimberly

The multicultural training (MCT) of APA-accredited School Psychology programs was studied. The sample included faculty and students from five programs nominated for strong MCT and five comparison programs randomly selected from the list of remaining APA-accredited programs. Program training was evaluated using a survey based on APA guidelines for…

Reaching for the stars: The story of astronaut training and the lunar landing

NASA Technical Reports Server (NTRS)

Goldstein, Stanley H.

1987-01-01

The training for the Mercury, Gemini, and Apollo programs is described. The form and function of training and the historical background which shaped the nature of that training are reviewed. For the three programs, the astronaut selection, the meeting of training requirements, and program management are addressed.

25 CFR 26.32 - What constitutes a complete Job Training Program application?

Code of Federal Regulations, 2011 CFR

2011-04-01

... 25 Indians 1 2011-04-01 2011-04-01 false What constitutes a complete Job Training Program application? 26.32 Section 26.32 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR HUMAN SERVICES JOB PLACEMENT AND TRAINING PROGRAM Training Services § 26.32 What constitutes a complete Job Training...

25 CFR 26.32 - What constitutes a complete Job Training Program application?

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 1 2013-04-01 2013-04-01 false What constitutes a complete Job Training Program application? 26.32 Section 26.32 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR HUMAN SERVICES JOB PLACEMENT AND TRAINING PROGRAM Training Services § 26.32 What constitutes a complete Job Training...

25 CFR 26.32 - What constitutes a complete Job Training Program application?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 1 2014-04-01 2014-04-01 false What constitutes a complete Job Training Program application? 26.32 Section 26.32 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR HUMAN SERVICES JOB PLACEMENT AND TRAINING PROGRAM Training Services § 26.32 What constitutes a complete Job Training...

25 CFR 26.32 - What constitutes a complete Job Training Program application?

Code of Federal Regulations, 2012 CFR

2012-04-01

... 25 Indians 1 2012-04-01 2011-04-01 true What constitutes a complete Job Training Program application? 26.32 Section 26.32 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR HUMAN SERVICES JOB PLACEMENT AND TRAINING PROGRAM Training Services § 26.32 What constitutes a complete Job Training...

Administrators' Roles in Training Programs and Training Transfer

ERIC Educational Resources Information Center

Ismail, Azman; Hua, Ng Kueh; Ismail, Yusof; Samah, Ainon Jauhariah Abu; Bakar, Rixal Abu; Ibrahim, Nurshahira

2015-01-01

An administrator plays a vital role in the growth and development of his/her subordinates. Despite this notion, the role of an administrator in the context of training programs and transfer of training is not well studied. Therefore, this study is set to examine the relationship between administrator's role in training programs and training…

Enablers of and barriers to abortion training.

PubMed

Guiahi, Maryam; Lim, Sahnah; Westover, Corey; Gold, Marji; Westhoff, Carolyn L

2013-06-01

Since the legalization of abortion services in the United States, provision of abortions has remained a controversial issue of high political interest. Routine abortion training is not offered at all obstetrics and gynecology (Ob-Gyn) training programs, despite a specific training requirement by the Accreditation Council for Graduate Medical Education. Previous studies that described Ob-Gyn programs with routine abortion training either examined associations by using national surveys of program directors or described the experience of a single program. We set out to identify enablers of and barriers to Ob-Gyn abortion training in the context of a New York City political initiative, in order to better understand how to improve abortion training at other sites. We conducted in-depth qualitative interviews with 22 stakeholders from 7 New York City public hospitals and focus group interviews with 62 current residents at 6 sites. Enablers of abortion training included program location, high-capacity services, faculty commitment to abortion training, external programmatic support, and resident interest. Barriers to abortion training included lack of leadership continuity, leadership conflict, lack of second-trimester abortion services, difficulty obtaining mifepristone, optional rather than routine training, and antiabortion values of hospital personnel. Supportive leadership, faculty commitment, and external programmatic support appear to be key elements for establishing routine abortion training at Ob-Gyn residency training programs.

20 CFR 632.254 - Program startup.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Program startup. 632.254 Section 632.254 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR INDIAN AND NATIVE AMERICAN EMPLOYMENT AND TRAINING PROGRAMS Summer Youth Employment and Training Programs § 632.254 Program startup...

20 CFR 632.254 - Program startup.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false Program startup. 632.254 Section 632.254 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR INDIAN AND NATIVE AMERICAN EMPLOYMENT AND TRAINING PROGRAMS Summer Youth Employment and Training Programs § 632.254 Program startup...

20 CFR 632.254 - Program startup.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 3 2012-04-01 2012-04-01 false Program startup. 632.254 Section 632.254 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR INDIAN AND NATIVE AMERICAN EMPLOYMENT AND TRAINING PROGRAMS Summer Youth Employment and Training Programs § 632.254 Program startup...

Tobacco Dependence Treatment Training Programs: An International Survey

PubMed Central

Rigotti, Nancy A.; Raw, Martin; McNeill, Ann; Murray, Rachael; Piné-Abata, Hembadoon; Bitton, Asaf; McEwen, Andy

2016-01-01

Abstract Introduction: In line with Article 14 guidelines for the WHO Framework Convention on Tobacco Control, we aimed to assess the progress in training individuals to deliver tobacco cessation treatment. Methods: Cross-sectional web-based survey in May–September 2013 among 122 experts in tobacco control and training from 84 countries (73% response rate among 115 countries surveyed). We measured training program prevalence, participants, and challenges faced. Results: Overall, 21% ( n = 18/84) of countries, mostly low and middle-income countries (LMICs; P = .002), reported no training program. Among 66 countries reporting at least one training program, most (84%) trained healthcare professionals but 54% also trained other individuals including community health workers, teachers, and religious leaders. Most programs (54%) cited funding challenges, although stability of funding varied by income level. Government funding was more commonly reported in higher income countries (high 56%, upper middle 50%, lower middle 27%, low 25%; P = .03) while programs in LMICs relied more on nongovernmental organizations (high 11%, upper middle 37%, lower middle 27%, low 38%; P = .02). Conclusions: One in five countries reported having no tobacco treatment training program representing little progress in terms of training individuals to deliver tobacco treatment in LMICs. Without more trained tobacco treatment providers, one of the tenets of Article 14 is not yet being met and health inequalities are likely to widen. More effort and resources are needed to ensure that healthcare worker educational programs include training to assess tobacco use and deliver brief advice and that training is available for individuals outside the healthcare system in areas with limited healthcare access. PMID:26117835

Postdoctoral training in posttraumatic stress disorder research.

PubMed

Sloan, Denise M; Vogt, Dawne; Wisco, Blair E; Keane, Terence M

2015-03-01

Postdoctoral training is increasingly common in the field of psychology. Although many individuals pursue postdoctoral training in psychology, guidelines for research training programs at this level do not exist. The rapid advances in the field, particularly with respect to genetics, neuroimaging, and data analytic approaches, require clinical scientists to possess knowledge and expertise across a broad array of areas. Postdoctoral training is often needed to acquire such a skill set. This paper describes a postdoctoral training program designed for individuals pursuing academic careers in traumatic stress disorders research. In this paper, we describe the structure of our training program, challenges we have faced during the 15 years of its existence, and how we have addressed these challenges. We conclude with a presentation of outcome data for the training program and a discussion of how training programs in other settings might be structured. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Scapular-Muscle Performance: Two Training Programs in Adolescent Swimmers

PubMed Central

Van de Velde, Annemie; De Mey, Kristof; Maenhout, Annelies; Calders, Patrick; Cools, Ann M.

2011-01-01

Abstract Context: Swimming requires well-balanced scapular-muscle performance. An additional strength-training program for the shoulders is pursued by swimmers, but whether these muscle-training programs need to be generic or specific for endurance or strength is unknown. Objective: To evaluate isokinetic scapular-muscle performance in a population of adolescent swimmers and to compare the results of training programs designed for strength or muscle endurance. Design: Controlled laboratory study. Setting: University human research laboratory. Patients or Other Participants: Eighteen adolescent swimmers. Intervention(s): Each participant pursued a 12-week scapular-training program designed to improve either muscle strength or muscle endurance. Main Outcome Measure(s): Bilateral peak force, fatigue index, and protraction/retraction strength ratios before and after the scapular-training program. Results: Scapular protraction/retraction ratios were slightly higher than 1 (dominant side  =  1.08, nondominant side  =  1.25, P  =  .006). Side-to-side differences in retraction strength were apparent both before and after the training program (P  =  .03 and P  = .05, respectively). After the training program, maximal protraction (P < .05) and retraction (P < .01) strength improved on the nondominant side. Peak force and fatigue index were not different between the training groups. The fatigue indexes for protraction on both sides (P < .05) and retraction on the nondominant side (P  =  .009) were higher after the training program. Conclusions: We describe the scapular-muscle characteristics of a group of adolescent swimmers. Both muscle-strength and muscle-endurance programs improved absolute muscle strength. Neither of the strength programs had a positive effect on scapular-muscle endurance. Our results may be valuable for coaches and physiotherapists when they are designing exercise programs for swimmers. PMID:21391801

Apprenticeship Training: Gasfitter Program.

ERIC Educational Resources Information Center

Alberta Learning, Edmonton. Apprenticeship and Industry Training.

This document presents information about the apprenticeship training program of Alberta, Canada, in general and the gasfitter program in particular. The first part of the document discusses the following items: Alberta's apprenticeship and industry training system; the apprenticeship and industry training committee structure; local apprenticeship…

Improved Training Program for Fall Prevention of Warfighters with Lower Extremity Trauma

DTIC Science & Technology

2016-10-01

productive, active civilian life. The training program utilizes a microprocessor -controlled treadmill designed to deliver task- specific training...National Military Medical Center (WRNMMC), and Mayo. The fall prevention training program utilizes a microprocessor -controlled treadmill to deliver

Hairstylist Program. Apprenticeship Training.

ERIC Educational Resources Information Center

Alberta Learning, Edmonton. Apprenticeship and Industry Training.

This document presents information about the apprenticeship training program of Alberta, Canada, in general and the hairstylist program in particular. The first part of the document discusses the following items: Alberta's apprenticeship and industry training system; the apprenticeship and industry training committee structure; local…

Cabinetmaker Program. Apprenticeship Training.

ERIC Educational Resources Information Center

Alberta Learning, Edmonton. Apprenticeship and Industry Training.

This document presents information about the apprenticeship training program of Alberta, Canada, in general and the cabinetmaking program in particular. The first part of the document discusses the following items: Alberta's apprenticeship and industry training system; the apprenticeship and industry training committee structure; local…

Supported Employment Staff Training Manual.

ERIC Educational Resources Information Center

Inge, Katherine; And Others

This training manual provides practical guidelines for staff development in supported employment programs for individuals with severe disabilities. It provides information on designing and developing training programs using adult learning principles, for program managers or trainers responsible for implementing inservice training and technical…

Differences between physicians in the likelihood of referral and acceptance of elderly patients for dialysis-influence of age and comorbidity.

PubMed

Visser, Annemieke; Dijkstra, Geke J; Huisman, Roel M; Gansevoort, Ron T; de Jong, Paul E; Reijneveld, Sijmen A

2007-11-01

Incidence of dialysis in elderly patients in the Netherlands is low compared to other countries. This study aims to assess the impact of patients' age and comorbidity on the likelihood of referral and acceptance of patients for dialysis and whether this is affected by physician characteristics. A vignette study was performed among 209 primary care physicians, 162 non-nephrology specialists and 20 nephrologists working in the north of the Netherlands. Physicians were offered six vignettes concerning case-reports of patients with end-stage renal disease (ESRD) and varying comorbidities or circumstances and asked about the likelihood of referral/acceptance of the patient in the given circumstances. The likelihood of referral within groups of physicians varied widely, especially within the group of primary care physicians and non-nephrology specialists, but was not affected by characteristics of physicians. The likelihood of referral or acceptance of patients for dialysis depended on the patient's age, and type and severity of comorbidity. In general, primary care physicians and non-nephrology specialists were less likely to refer than nephrologists were to accept. Differences within and between groups of physicians were larger for 80- than for 65-year-old patients, and for patients with less severe shortness of breath and cognitive impairments and more severe diabetes and social impairments. Hardly any differences were found for patients with cancer. Patients' age and comorbidities affect the likelihood of referral. Differences between groups of physicians suggest that there is insufficient agreement on the extent to which these factors should affect the referral/acceptance of patients for dialysis. These findings underline the need for more research into circumstances under which patients might benefit from dialysis. Guidelines should be developed to improve the referral of elderly and less healthy patients.

Different rates of progression and mortality in patients with chronic kidney disease at outpatient nephrology clinics across Europe.

PubMed

Brück, Katharina; Jager, Kitty J; Zoccali, Carmine; Bello, Aminu K; Minutolo, Roberto; Ioannou, Kyriakos; Verbeke, Francis; Völzke, Henry; Arnlöv, Johan; Leonardis, Daniela; Ferraro, Pietro Manuel; Brenner, Hermann; Caplin, Ben; Kalra, Philip A; Wanner, Christoph; Castelao, Alberto Martinez; Gorriz, Jose Luis; Hallan, Stein; Rothenbacher, Dietrich; Gibertoni, Dino; De Nicola, Luca; Heinze, Georg; Van Biesen, Wim; Stel, Vianda S

2018-06-01

The incidence of renal replacement therapy varies across countries. However, little is known about the epidemiology of chronic kidney disease (CKD) outcomes. Here we describe progression and mortality risk of patients with CKD but not on renal replacement therapy at outpatient nephrology clinics across Europe using individual data from nine CKD cohorts participating in the European CKD Burden Consortium. A joint model assessed the mean change in estimated glomerular filtration rate (eGFR) and mortality risk simultaneously, thereby accounting for mortality risk when estimating eGFR decline and vice versa, while also correcting for the measurement error in eGFR. Results were adjusted for important risk factors (baseline eGFR, age, sex, albuminuria, primary renal disease, diabetes, hypertension, obesity and smoking) in 27,771 patients from five countries. The adjusted mean annual eGFR decline varied from 0.77 (95% confidence interval 0.45, 1.08) ml/min/1.73m 2 in the Belgium cohort to 2.43 (2.11, 2.75) ml/min/1.73m 2 in the Spanish cohort. As compared to the Italian PIRP cohort, the adjusted mortality hazard ratio varied from 0.22 (0.11, 0.43) in the London LACKABO cohort to 1.30 (1.13, 1.49) in the English CRISIS cohort. These results suggest that the eGFR decline showed minor variation but mortality showed the most variation. Thus, different health care organization systems are potentially associated with differences in outcome of patients with CKD within Europe. These results can be used by policy makers to plan resources on a regional, national and European level. Copyright © 2018 International Society of Nephrology. All rights reserved.

The biobank for the molecular classification of kidney disease: research translation and precision medicine in nephrology.

PubMed

Muruve, Daniel A; Mann, Michelle C; Chapman, Kevin; Wong, Josee F; Ravani, Pietro; Page, Stacey A; Benediktsson, Hallgrimur

2017-07-26

Advances in technology and the ability to interrogate disease pathogenesis using systems biology approaches are exploding. As exemplified by the substantial progress in the personalized diagnosis and treatment of cancer, the application of systems biology to enable precision medicine in other disciplines such as Nephrology is well underway. Infrastructure that permits the integration of clinical data, patient biospecimens and advanced technologies is required for institutions to contribute to, and benefit from research in molecular disease classification and to devise specific and patient-oriented treatments. We describe the establishment of the Biobank for the Molecular Classification of Kidney Disease (BMCKD) at the University of Calgary, Alberta, Canada. The BMCKD consists of a fully equipped wet laboratory, an information technology infrastructure, and a formal operational, ethical and legal framework for banking human biospecimens and storing clinical data. The BMCKD first consolidated a large retrospective cohort of kidney biopsy specimens to create a population-based renal pathology database and tissue inventory of glomerular and other kidney diseases. The BMCKD will continue to prospectively bank all kidney biopsies performed in Southern Alberta. The BMCKD is equipped to perform molecular, clinical and epidemiologic studies in renal pathology. The BMCKD also developed formal biobanking procedures for human specimens such as blood, urine and nucleic acids collected for basic and clinical research studies or for advanced diagnostic technologies in clinical care. The BMCKD is guided by standard operating procedures, an ethics framework and legal agreements with stakeholders that include researchers, data custodians and patients. The design and structure of the BMCKD permits its inclusion in a wide variety of research and clinical activities. The BMCKD is a core multidisciplinary facility that will bridge basic and clinical research and integrate precision medicine into renal pathology and nephrology.

The cost-saving effect and prevention of medication errors by clinical pharmacist intervention in a nephrology unit.

PubMed

Chen, Chia-Chi; Hsiao, Fei-Yuan; Shen, Li-Jiuan; Wu, Chien-Chih

2017-08-01

Medication errors may lead to adverse drug events (ADEs), which endangers patient safety and increases healthcare-related costs. The on-ward deployment of clinical pharmacists has been shown to reduce preventable ADEs, and save costs. The purpose of this study was to evaluate the ADEs prevention and cost-saving effects by clinical pharmacist deployment in a nephrology ward.This was a retrospective study, which compared the number of pharmacist interventions 1 year before and after a clinical pharmacist was deployed in a nephrology ward. The clinical pharmacist attended ward rounds, reviewed and revised all medication orders, and gave active recommendations of medication use. For intervention analysis, the numbers and types of the pharmacist's interventions in medication orders and the active recommendations were compared. For cost analysis, both estimated cost saving and avoidance were calculated and compared.The total numbers of pharmacist interventions in medication orders were 824 in 2012 (preintervention), and 1977 in 2013 (postintervention). The numbers of active recommendation were 40 in 2012, and 253 in 2013. The estimated cost savings in 2012 and 2013 were NT$52,072 and NT$144,138, respectively. The estimated cost avoidances of preventable ADEs in 2012 and 2013 were NT$3,383,700 and NT$7,342,200, respectively. The benefit/cost ratio increased from 4.29 to 9.36, and average admission days decreased by 2 days after the on-ward deployment of a clinical pharmacist.The number of pharmacist's interventions increased dramatically after her on-ward deployment. This service could reduce medication errors, preventable ADEs, and costs of both medications and potential ADEs.

Pre-End-Stage Renal Disease Care and Early Survival among Incident Dialysis Patients in the US Military Health System.

PubMed

Nee, Robert; Fisher, Evan; Yuan, Christina M; Agodoa, Lawrence Y; Abbott, Kevin C

2017-01-01

Previous reports showed an increased early mortality after chronic dialysis initiation among the end-stage renal disease (ESRD) population. We hypothesized that ESRD patients in the Military Health System (MHS) would have greater access to pre-ESRD care and hence better survival rates during this early high-risk period. In this retrospective cohort study, using the US Renal Data System database, we identified 1,256,640 patients initiated on chronic dialysis from January 2, 2004 through December 31, 2014, from which a bootstrap sample of 3,984 non-MHS incident dialysis patients were compared with 996 MHS patients. We assessed care by a nephrologist and dietitian, erythropoietin administration, and vascular access use at dialysis initiation as well as all-cause mortality as outcome variables. MHS patients were significantly more likely to have had pre-ESRD nephrology care (adjusted OR [aOR] 2.9; 95% CI 2.3-3.7) and arteriovenous fistula used at dialysis initiation (aOR 2.2; 95% CI 1.7-2.7). Crude mortality rates peaked between the 4th and the 8th week for both cohorts but were reduced among MHS patients. The baseline adjusted Cox model showed significantly lower death rates among MHS vs. non-MHS patients at 6, 9, and 12 months. This survival advantage among MHS patients was attenuated after further adjustment for pre-ESRD nephrology care and dialysis vascular access. MHS patients had improved survival within the first 12 months compared to the general ESRD population, which may be explained in part by differences in pre-ESRD nephrology care and vascular access types. © 2017 S. Karger AG, Basel.

A Local Industry Solves Its Training Needs: A Cooperative Training Venture that Works.

ERIC Educational Resources Information Center

Cantor, Jeffrey A.

The Maritime Trades Program is a cooperative training program that was established through the joint efforts of 14 shipyards in the Tidewater area of Virginia. Established in 1980, the program originally operated under the guidelines imposed by the Comprehensive Employment and Training Act (CETA). Now, however, the program operates in accordance…

Training That Works: Lessons from California's Employment Training Panel Program.

ERIC Educational Resources Information Center

Moore, Richard W.; Blake, Daniel R.; Phillips, G. Michael; McConaughy, Daniel

California's Employment Training Panel Program (ETP), the largest state-funded customized training program for incumbent workers in the nation, has had a positive impact on the economy of California, and its success has policy implications for other state programs. The impact of ETP on trainees includes the following: they are more attached to the…

Workplace Violence Training Programs for Health Care Workers: An Analysis of Program Elements.

PubMed

Arbury, Sheila; Hodgson, Michael; Zankowski, Donna; Lipscomb, Jane

2017-06-01

Commercial workplace violence (WPV) prevention training programs differ in their approach to violence prevention and the content they present. This study reviews 12 such programs using criteria developed from training topics in the Occupational Safety and Health Administration's (OSHA) Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers and a review of the WPV literature. None of the training programs addressed all the review criteria. The most significant gap in content was the lack of attention to facility-specific risk assessment and policies. To fill this gap, health care facilities should supplement purchased training programs with specific training in organizational policies and procedures, emergency action plans, communication, facility risk assessment, and employee post-incident debriefing and monitoring. Critical to success is a dedicated program manager who understands risk assessment, facility clinical operations, and program management and evaluation.

Effects of Cogmed working memory training on cognitive performance.

PubMed

Etherton, Joseph L; Oberle, Crystal D; Rhoton, Jayson; Ney, Ashley

2018-04-16

Research on the cognitive benefits of working memory training programs has produced inconsistent results. Such research has frequently used laboratory-specific training tasks, or dual-task n-back training. The current study used the commercial Cogmed Working Memory (WM) Training program, involving several different training tasks involving visual and auditory input. Healthy college undergraduates were assigned to either the full Cogmed training program of 25, 40-min training sessions; an abbreviated Cogmed program of 25, 20-min training sessions; or a no-contact control group. Pretest and posttest measures included multiple measures of attention, working memory, fluid intelligence, and executive functions. Although improvement was observed for the full training group for a digit span task, no training-related improvement was observed for any of the other measures. Results of the study suggest that WM training does not improve performance on unrelated tasks or enhance other cognitive abilities.

Communication training for aircrews: A review of theoretical and pragmatic aspects of training program design

NASA Technical Reports Server (NTRS)

Linde, Charlotte; Goguen, Joseph; Devenish, Linda

1987-01-01

This study is the final report of a project studying methods of communications training applicable to both civilian and military aviation personnel, including multiperson teams or single pilot fixed wing or rotary wing aircraft. A review is provided of a number of theories proposed as relevant for producing training materials for improved communications. Criteria are given for evaluating the applicability of training programs to the aviation environment, and these criteria are applied to United Airlines' Resources Management Training, as well as to a number of commercially available general purpose training programs. The report considers in detail assertiveness training and grid management training, examining their theoretical background and attempts made to validate their effectiveness. It was found that there are substantive difficulties in assessing the effectiveness of both training programs, as well as problems with the theories underlying them. However, because the aviation environment offers unique advantages for studying the effectiveness of communications training, recommendations are made on the design of appropriate training programs and on procedures that might be used to validate them.

"Ballistic Six" Upper-Extremity Plyometric Training for the Pediatric Volleyball Players.

PubMed

Turgut, Elif; Cinar-Medeni, Ozge; Colakoglu, Filiz F; Baltaci, Gul

2017-09-19

The Ballistic Six exercise program includes commonly used upper-body exercises, and the program is recommended for overhead throwing athletes. The purpose of the current study was to investigate the effects of a 12-week the Ballistic Six upper-extremity plyometric training program on upper-body explosive power, endurance, and reaction time in pediatric overhead athletes. Twenty-eight female pediatric volleyball players participated in the study. The participants were randomly divided into 2 study groups: an intervention group (upper-extremity plyometric training in addition to the volleyball training; n = 14) and a control group (the volleyball training only; n = 14). All the participants were assessed before and after a 12-week training program for upper-body power, strength and endurance, and reaction time. Statistical comparison was performed using an analysis of variance test. Comparisons showed that after a 12-week training program, the Ballistic Six upper-body plyometric training program resulted in more improvements in an overhead medicine ball throwing distance and a push-up performance, as well as greater improvements in the reaction time in the nonthrowing arm when compared with control training. In addition, a 12-week training program was found to be effective in achieving improvements in the reaction time in the throwing arm for both groups similarly. Compared with regular training, upper-body plyometric training resulted in additional improvements in upper-body power and strength and endurance among pediatric volleyball players. The findings of the study provide a basis for developing training protocols for pediatric volleyball players.

Content and Methods used to Train Tobacco Cessation Treatment Providers: An International Survey.

PubMed

Kruse, Gina R; Rigotti, Nancy A; Raw, Martin; McNeill, Ann; Murray, Rachael; Piné-Abata, Hembadoon; Bitton, Asaf; McEwen, Andy

2017-12-01

There are limited existing data describing the training methods used to educate tobacco cessation treatment providers around the world. To measure the prevalence of tobacco cessation treatment content, skills training and teaching methods reported by tobacco treatment training programs across the world. Web-based survey in May-September 2013 among tobacco cessation training experts across six geographic regions and four World Bank income levels. Response rate was 73% (84 of 115 countries contacted). Of 104 individual programs from 84 countries, most reported teaching brief advice (78%) and one-to-one counseling (74%); telephone counseling was uncommon (33%). Overall, teaching of knowledge topics was more commonly reported than skills training. Programs in lower income countries less often reported teaching about medications, behavioral treatments and biomarkers and less often reported skills-based training about interviewing clients, medication management, biomarker measurement, assessing client outcomes, and assisting clients with co-morbidities. Programs reported a median 15 hours of training. Face-to-face training was common (85%); online programs were rare (19%). Almost half (47%) included no learner assessment. Only 35% offered continuing education. Nearly all programs reported teaching evidence-based treatment modalities in a face-to-face format. Few programs delivered training online or offered continuing education. Skills-based training was less common among low- and middle-income countries (LMICs). There is a large unmet need for tobacco treatment training protocols which emphasize practical skills, and which are more rapidly scalable than face-to-face training in LMICs.

Apprenticeship Training: Communication Technician Program.

ERIC Educational Resources Information Center

Alberta Learning, Edmonton. Apprenticeship and Industry Training.

This document presents information about the apprenticeship training program of Alberta, Canada, in general and the communication technician program in particular. The first part of the document discusses the following items: Alberta's apprenticeship and industry training system; the apprenticeship and industry training committee structure; local…

Concrete Finisher Program. Apprenticeship Training.

ERIC Educational Resources Information Center

Alberta Learning, Edmonton. Apprenticeship and Industry Training.

This document presents information about the apprenticeship training program of Alberta, Canada, in general and the concrete finishing program in particular. The first part of the document discusses the following items: Alberta's apprenticeship and industry training system; the apprenticeship and industry training committee structure; local…

Dual and parallel postdoctoral training programs: implications for the osteopathic medical profession.

PubMed

Burkhart, Diane N; Lischka, Terri A

2011-04-01

Students in colleges of osteopathic medicine have several options when considering postdoctoral training programs. In addition to training programs approved solely by the American Osteopathic Association or accredited solely by the Accreditation Council for Graduate Medical Education (ACGME), students can pursue programs accredited by both organizations (ie, dually accredited programs) or osteopathic programs that occur side-by-side with ACGME programs (ie, parallel programs). In the present article, we report on the availability and growth of these 2 training options and describe their benefits and drawbacks for trainees and the osteopathic medical profession as a whole.

The effects of cross-training on fitness and injury in women.

PubMed

Grier, Tyson; Canham-Chervak, Michelle; Anderson, Morgan K; Bushman, Timothy T; Jones, Bruce H

2015-01-01

As combat arms occupations become available to women, adequate muscular strength and aerobic endurance will be essential for the completion of physically demanding job-related tasks. Therefore, in addition to US Army Physical Readiness Training, Soldiers will often engage in their own personal physical fitness training programs. To evaluate fitness and injury outcomes for women participating in personal cross-training programs compared to women performing one mode of training or having no personal fitness program. Demographics, physical training activities, physical fitness, and injuries were obtained from surveys administered to female Soldiers in an infantry division. Women were categorized into the following 4 groups based on their personal physical fitness program: cross-training (CT), running only (R), weight training only (WT), and no personal fitness program (NPF). An ANOVA was used to compare physical training, health behaviors, and physical fitness across groups. A χ² test was used to compare injury rates between fitness programs. Risk (%), risk ratios (RR) and 95% confidence intervals (95% CI) were used to determine injury risk. A total of 620 women completed the survey and indicated whether or not they had a personal fitness program (cross-training, n=260; running only, n=93; weight training only, n=86; no personal fitness program, n=181). Average age and body mass index was 26.2±5.8 years and 24.5±3.3 kg/m² respectively with no differences between the 4 fitness groups. The cross-training group had higher physical performance on the muscular endurance (push-ups and sit-ups) portion of the Army physical fitness test (APFT) when compared to the 3 other groups (CT 42 push-ups vs (R 38, WT 35, NPF 36)); (CT 68 sit-ups vs (R 63, WT 62, NPF 62)). For the aerobic endurance (2-mile run) portion of the APFT, the cross-training group had higher performance when compared to those with no personal fitness program (CT 17.4 minutes vs NPF 18.5 minutes). Overall, 53% of female Soldiers sustained an injury over a 12-month period. All injury rates and lower extremity injury rates among women with a cross-training personal fitness program were not different from the other personal fitness programs. Those performing cross-training were 2.6 and 2.1 times more likely to experience a running related injury when compared to those in the weight training and no personal fitness group, respectively. On the other hand, women performing cross-training were 65% less likely to experience a lifting/moving heavy objects related injury when compared to the weight training only group. Women who participated in a cross-training program for personal physical fitness training had higher muscular endurance compared to the other fitness groups and higher aerobic endurance when compared to the no personal fitness group. There were no differences for all injuries and lower body injuries between cross-training and other fitness programs. Cross-training may be the best option for improving physical fitness when compared to just one mode of fitness training.

Psychological Assessment Training in Clinical Psychology Doctoral Programs.

PubMed

Mihura, Joni L; Roy, Manali; Graceffo, Robert A

2017-01-01

We surveyed American Psychological Association-accredited clinical psychology doctoral programs' (n = 83) training in psychological assessment-specifically, their coverage of various assessment topics and tests in courses and practica, and whether the training was optional or required. We report results overall and separately per training model (clinical science, scientist-practitioner, and practitioner-focused). Overall, our results suggest that psychological assessment training is as active, or even more active, than in previous years. Areas of increased emphasis include clinical interviewing and psychometrics; multimethod, outcomes, health, and collaborative or therapeutic assessment; and different types of cognitive and self-report personality tests. All or almost all practice-focused programs offered training with the Thematic Apperception Test and Rorschach compared to about half of the scientist-practitioner programs and a third of the clinical science programs. Although almost all programs reported teaching multimethod assessment, what constitutes different methods of assessing psychopathology should be clarified in future studies because many programs appear to rely on one method-self-report (especially clinical science programs). Although doctoral programs covered many assessment topics and tests in didactic courses, there appears to be a shortage of program-run opportunities for students to obtain applied assessment training. Finally, we encourage doctoral programs to be familiar with (a) internships' assessment expectations and opportunities, (b) the professional guidelines for assessment training, and (c) the American Psychological Association's requirements for preinternship assessment competencies.

Customized Job Training and Credit Programs.

ERIC Educational Resources Information Center

Clarke, Robert G.

1984-01-01

Outlines the similarities and differences between traditional degree programs and industrial training programs and offers suggestions for colleges initiating industrial training efforts, covering areas such as administrative responses, the target group, internal communication, faculty, instructional implications, program delivery, finances,…

Availability and Diversity of Training Programs for Responders to International Disasters and Complex Humanitarian Emergencies

PubMed Central

Jacquet, Gabrielle A.; Obi, Chioma C.; Chang, Mary P.; Bayram, Jamil D.

2014-01-01

Introduction: Volunteers and members of relief organizations increasingly seek formal training prior to international field deployment. This paper identifies training programs for personnel responding to international disasters and complex humanitarian emergencies, and provides concise information – if available- regarding the founding organization, year established, location, cost, duration of training, participants targeted, and the content of each program. Methods: An environmental scan was conducted through a combination of a peer-reviewed literature search and an open Internet search for the training programs. Literature search engines included EMBASE, Cochrane, Scopus, PubMed, Web of Science databases using the search terms “international,” “disaster,” “complex humanitarian emergencies,” “training,” and “humanitarian response”. Both searches were conducted between January 2, 2013 and September 12, 2013. Results: 14 peer-reviewed articles mentioned or described eight training programs, while open Internet search revealed 13 additional programs. In total, twenty-one training programs were identified as currently available for responders to international disasters and CHE. Each of the programs identified has different goals and objectives, duration, expenses, targeted trainees and modules. Each of the programs identified has different goals and objectives, duration, expenses, targeted trainees and modules. Seven programs (33%) are free of charge and four programs (19%) focus on the mental aspects of disasters. The mean duration for each training program is 5 to 7 days. Fourteen of the trainings are conducted in multiple locations (66%), two in Cuba (9%) and two in Australia (9%). The cost-reported in US dollars- ranges from $100 to $2,400 with a mean cost of $480 and a median cost of $135. Most of the programs are open to the public, but some are only available by invitation only, such as the International Mobilization Preparation for Action (IMPACT) and the United Nations Humanitarian Civil-Military Coordination (UN-CMCoord) Field Course. Conclusions: A variety of training programs are available for responders to disasters and complex humanitarian emergencies. These programs vary in their objectives, audiences, modules, geographical locations, eligibility and financial cost. This paper presents an overview of available programs and serves as a resource for potential responders interested in capacity-building training prior to deployment. PMID:24987573

34 CFR 415.1 - What is the Demonstration Centers for the Training of Dislocated Workers Program?

Code of Federal Regulations, 2011 CFR

2011-07-01

... CENTERS FOR THE TRAINING OF DISLOCATED WORKERS PROGRAM General § 415.1 What is the Demonstration Centers for the Training of Dislocated Workers Program? The Demonstration Centers for the Training of... 34 Education 3 2011-07-01 2011-07-01 false What is the Demonstration Centers for the Training of...

34 CFR 415.1 - What is the Demonstration Centers for the Training of Dislocated Workers Program?

Code of Federal Regulations, 2010 CFR

2010-07-01

... CENTERS FOR THE TRAINING OF DISLOCATED WORKERS PROGRAM General § 415.1 What is the Demonstration Centers for the Training of Dislocated Workers Program? The Demonstration Centers for the Training of... 34 Education 3 2010-07-01 2010-07-01 false What is the Demonstration Centers for the Training of...

Development of a training program to support health care professionals to deliver the SPACE for COPD self-management program

PubMed Central

Blackmore, Claire; Johnson-Warrington, Vicki L; Williams, Johanna EA; Apps, Lindsay D; Young, Hannah ML; Bourne, Claire LA; Singh, Sally J

2017-01-01

Background With the growing burden of COPD and associated morbidity and mortality, a need for self-management has been identified. The Self-management Programme of Activity, Coping and Education for Chronic Obstructive Pulmonary Disease (SPACE for COPD) manual was developed to support self-management in COPD patients. Currently, there is no literature available regarding health care professionals’ training needs when supporting patients with COPD on self-management. Aim This study sought to identify these needs to inform, design and develop a training program for health care professionals being trained to deliver a self-management program in COPD. Methods Fourteen health care professionals from both primary and secondary care COPD services participated in face-to-face semistructured interviews. Thematic analysis was used to produce a framework and identify training needs and views on delivery of the SPACE for COPD self-management program. Components of training were web-based knowledge training, with pre-and posttraining knowledge questionnaires, and a 1-day program to introduce the self-management manual. Feedback was given after training to guide the development of the training program. Results Health care professionals were able to identify areas where they required increased knowledge to support patients. This was overwhelming in aspects of COPD seen to be outside of their current clinical role. Skills in goal setting and behavioral change were not elicited as a training need, suggesting a lack of understanding of components of supporting self-management. An increase in knowledge of COPD was demonstrated following the training program. Conclusion Both knowledge and skill gaps existed in those who would deliver self-management. Analysis of this has enabled a training program to be designed to address these gaps and enable health care professionals to support patients in self-management. PMID:28652720

Development of a training program to support health care professionals to deliver the SPACE for COPD self-management program.

PubMed

Blackmore, Claire; Johnson-Warrington, Vicki L; Williams, Johanna Ea; Apps, Lindsay D; Young, Hannah Ml; Bourne, Claire LA; Singh, Sally J

2017-01-01

With the growing burden of COPD and associated morbidity and mortality, a need for self-management has been identified. The Self-management Programme of Activity, Coping and Education for Chronic Obstructive Pulmonary Disease (SPACE for COPD) manual was developed to support self-management in COPD patients. Currently, there is no literature available regarding health care professionals' training needs when supporting patients with COPD on self-management. This study sought to identify these needs to inform, design and develop a training program for health care professionals being trained to deliver a self-management program in COPD. Fourteen health care professionals from both primary and secondary care COPD services participated in face-to-face semistructured interviews. Thematic analysis was used to produce a framework and identify training needs and views on delivery of the SPACE for COPD self-management program. Components of training were web-based knowledge training, with pre-and posttraining knowledge questionnaires, and a 1-day program to introduce the self-management manual. Feedback was given after training to guide the development of the training program. Health care professionals were able to identify areas where they required increased knowledge to support patients. This was overwhelming in aspects of COPD seen to be outside of their current clinical role. Skills in goal setting and behavioral change were not elicited as a training need, suggesting a lack of understanding of components of supporting self-management. An increase in knowledge of COPD was demonstrated following the training program. Both knowledge and skill gaps existed in those who would deliver self-management. Analysis of this has enabled a training program to be designed to address these gaps and enable health care professionals to support patients in self-management.

Advanced ultrasound training for fourth-year medical students: a novel training program at The Ohio State University College of Medicine.

PubMed

Bahner, David P; Royall, Nelson A

2013-02-01

Ultrasound training and education in medical schools is rare, and the foci of current ultrasound curricula are limited. There is a significant need for advanced ultrasound training models in medical school curricula to reduce educational burdens for physician residency programs and improve overall physician competency.The authors describe and evaluate the advanced ultrasound training program developed at The Ohio State University College of Medicine (OSU COM). The OSU COM program is a longitudinal advanced ultrasound curriculum for fourth-year medical students pursuing specialties that require frequent use of focused ultrasound. One hundred fifty student participants have completed the yearlong program to date. Participants engage in didactic lectures, journal club sessions, hands-on training, teaching and patient-modeling activities, and complete a final project. Experienced Ohio State University Medical Center faculty are recruited from specialties that frequently use ultrasound (e.g., emergency medicine, internal medicine, obstetrics-gynecology). A multimodal instructional assessment approach ensures that ultrasound training yields experience with cognitive, behavioral, and constructive learning components. The authors discuss the benefits of the program as well as its challenges and future directions.The advanced ultrasound training program at OSU COM demonstrates a novel approach to providing ultrasound training for medical students, offering a feasible model for meeting training guidelines without increasing the educational requirements for residency programs.

Research Ethics Education in Post-Graduate Medical Curricula in I.R. Iran.

PubMed

Nikravanfard, Nazila; Khorasanizadeh, Faezeh; Zendehdel, Kazem

2017-08-01

Research ethics training during post-graduate education is necessary to improve ethical standards in the design and conduct of biomedical research. We studied quality and quantity of research ethics training in the curricula of post-graduate programs in the medical science in I.R. Iran. We evaluated curricula of 125 post-graduate programs in medical sciences in I.R. Iran. We qualitatively studied the curricula by education level, including the Master and PhD degrees and analyzed the contents and the amount of teaching allocated for ethics training in each curriculum. We found no research ethics training in 72 (58%) of the programs. Among the 53 (42%) programs that considered research ethics training, only 17 programs had specific courses for research ethics and eight of them had detailed topics on their courses. The research ethics training was optional in 25% and mandatory in 76% of the programs. Post-graduate studies that were approved in the more recent years had more attention to the research ethics training. Research ethics training was neglected in most of the medical post-graduate programs. We suggest including sufficient amount of mandatory research ethics training in Master and PhD programs in I.R. Iran. Further research about quality of research ethics training and implementation of curricula in the biomedical institutions is warranted. © 2016 John Wiley & Sons Ltd.

The effectiveness of multimedia visual perceptual training groups for the preschool children with developmental delay.

PubMed

Chen, Yi-Nan; Lin, Chin-Kai; Wei, Ta-Sen; Liu, Chi-Hsin; Wuang, Yee-Pay

2013-12-01

This study compared the effectiveness of three approaches to improving visual perception among preschool children 4-6 years old with developmental delays: multimedia visual perceptual group training, multimedia visual perceptual individual training, and paper visual perceptual group training. A control group received no special training. This study employed a pretest-posttest control group of true experimental design. A total of 64 children 4-6 years old with developmental delays were randomized into four groups: (1) multimedia visual perceptual group training (15 subjects); (2) multimedia visual perceptual individual training group (15 subjects); paper visual perceptual group training (19 subjects); and (4) a control group (15 subjects) with no visual perceptual training. Forty minute training sessions were conducted once a week for 14 weeks. The Test of Visual Perception Skills, third edition, was used to evaluate the effectiveness of the intervention. Paired-samples t-test showed significant differences pre- and post-test among the three groups, but no significant difference was found between the pre-test and post-test scores among the control group. ANOVA results showed significant differences in improvement levels among the four study groups. Scheffe post hoc test results showed significant differences between: group 1 and group 2; group 1 and group 3; group 1 and the control group; and group 2 and the control group. No significant differences were reported between group 2 and group 3, and group 3 and the control group. The results showed all three therapeutic programs produced significant differences between pretest and posttest scores. The training effect on the multimedia visual perceptual group program and the individual program was greater than the developmental effect Both the multimedia visual perceptual group training program and the multimedia visual perceptual individual training program produced significant effects on visual perception. The multimedia visual perceptual group training program was more effective for improving visual perception than was multimedia visual perceptual individual training program. The multimedia visual perceptual group training program was more effective than was the paper visual perceptual group training program. Copyright © 2013 Elsevier Ltd. All rights reserved.

45 CFR 235.62 - State plan requirements for training programs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (ASSISTANCE PROGRAMS), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATION OF FINANCIAL ASSISTANCE PROGRAMS § 235.62 State plan requirements for training programs. A State... 45 Public Welfare 2 2010-10-01 2010-10-01 false State plan requirements for training programs. 235...

14 CFR 91.1097 - Pilot and flight attendant crewmember training programs.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 2 2011-01-01 2011-01-01 false Pilot and flight attendant crewmember... RULES Fractional Ownership Operations Program Management § 91.1097 Pilot and flight attendant crewmember training programs. (a) Each program manager must establish and maintain an approved pilot training program...

14 CFR 91.1097 - Pilot and flight attendant crewmember training programs.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Pilot and flight attendant crewmember... RULES Fractional Ownership Operations Program Management § 91.1097 Pilot and flight attendant crewmember training programs. (a) Each program manager must establish and maintain an approved pilot training program...

Annual progress report : for the period of January 2001 through December 2001 : Florida Transit Training Program (2001) : Florida Technical Assistance Program (2001)

DOT National Transportation Integrated Search

2001-01-01

The following progress report is intended to highlight the significant activities of the Florida Transit Training Program and Florida Technical Assistant Program for the 2001 year. Activities of the Florida Statewide Transit Training Program are pres...

20 CFR 628.540 - Volunteer program.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR PROGRAMS UNDER TITLE II OF THE JOB TRAINING PARTNERSHIP ACT Program Design Requirements for Programs Under Title II of the Job Training Partnership Act § 628.540 Volunteer program. Pursuant to sections 204(c)(6) and 264(d)(7) of the...

20 CFR 628.530 - Referrals of participants to non-title II programs.

Code of Federal Regulations, 2010 CFR

2010-04-01

... programs. 628.530 Section 628.530 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR PROGRAMS UNDER TITLE II OF THE JOB TRAINING PARTNERSHIP ACT Program Design Requirements for Programs Under Title II of the Job Training Partnership Act § 628.530 Referrals of participants to non...

Urologic Oncology Branch - Training - NCI/AFUD | Center for Cancer Research

Cancer.gov

Postdoctoral Research Training Program This program is designed to train Ph.D. postdoctoral scientists in the growing field of urologic oncology. This program offers fellows the opportunity to participate in a diverse training experience that includes clinical and laboratory research on several urologic malignancies. The program provides an opportunity for selected individuals to complete a research project under the direction of a Senior Investigator in the Intramural Program of the National Cancer Institute.

[The two-year post graduate training program for nurses: implementation status and personal perspectives].

PubMed

Yin, Yu-Chun

2013-06-01

The Taiwan Joint Commission on Hospital Accreditation (TJCHA) authorized the Teaching Quality Improvement Program for Teaching Hospitals as a way for the Department of Health to plan and implement improvements. The program assists medical and paramedical professionals to establish a postgraduate clinical training system. The two-year postgraduate training program for nurses is one of the program's regular activities, divided into three phases that include location-based curriculum training (3 months), core curriculum training (9 months), and professional courses training (12 months). This paper describes the origin, current implementation status, and efficacy / key problems of this two-year post graduate training program, Information regarding the opinions of new nurses, preceptors, and nursing managers on the three aspects is drawn from the author's relevant professional experience, interactions with nurses, and a review of the literature. Findings include: (1) nursing departments should operate in accordance with TJCHA guidelines; (2) department training should be adequate to promote the ability and willingness of nurses to train a new generation of clinical preceptors; and (3) participant opinions on project execution progress and difficulties. Findings may be referenced to better achieve Teaching Quality Improvement Program for Teaching Hospital objectives.

Identifying barriers to medication discharge counselling by pharmacists.

PubMed

Walker, Sandra A N; Lo, Jennifer K; Compani, Sara; Ko, Emily; Le, Minh-Hien; Marchesano, Romina; Natanson, Rimona; Pradhan, Rahim; Rzyczniak, Grace; Teo, Vincent; Vyas, Anju

2014-05-01

Medication errors may occur more frequently at discharge, making discharge counselling a vital facet of medication reconciliation. Discharge counselling is a recognized patient safety initiative for which pharmacists have appropriate expertise, but data are lacking about the barriers to provision of this service to adult inpatients by pharmacists. To determine the proportion of eligible patients who received discharge counselling, to quantify perceived barriers preventing pharmacists from performing discharge counselling, and to determine the relative frequency of barriers and associated time expenditures. In this prospective study, 8 pharmacists working in general medicine, medical oncology, or nephrology wards of an acute care hospital completed a survey for each of the first 50 patients eligible for discharge counselling on their respective wards from June 2010 to February 2011. Patients discharged to another facility (rehabilitation, palliative care, or long-term care), those with hospital stay less than 48 h before discharge, and those whose medications were unchanged from hospital admission were ineligible. Discharge counselling was performed for 116 (29%) of the 403 eligible patients and involved a median preparation time of 25 min and median counselling time of 15 min per patient. At least one documented barrier to discharge counselling existed for 295 (73%) of the patients. Several barriers to discharge counselling occurred significantly more frequently on the general medicine and oncology wards than on the nephrology ward (p < 0.05). The most common barrier was failure to notify the pharmacist about impending patient discharge (130/313 [41%]). Time constraints existed for 130 (32%) of the patients, the most common related to clarification of prescriptions (96 [24%]), creation of a medication list (69 [17%]), and faxing of prescriptions (64 [16%]). This study generated objective data about the barriers to and time constraints associated with medication discharge counselling by pharmacists. These findings should raise awareness of the challenges faced by pharmacists in busy hospital positions and may support avenues of change for their hospital discharge counselling programs.

Design and implementation of the first nationwide, web-based Chinese Renal Data System (CNRDS)

PubMed Central

2012-01-01

Background In April 2010, with an endorsement from the Ministry of Health of the People's Republic of China, the Chinese Society of Nephrology launched the first nationwide, web-based prospective renal data registration platform, the Chinese Renal Data System (CNRDS), to collect structured demographic, clinical, and laboratory data for dialysis cases, as well as to establish a kidney disease database for researchers and policy makers. Methods The CNRDS program uses information technology to facilitate healthcare professionals to create a blood purification registry and to deliver an evidence-based care and education protocol tailored to chronic kidney disease, as well as online forum for communication between nephrologists. The online portal https://www.cnrds.net is implemented as a Java web application using an Apache Tomcat web server and a MySQL database. All data are stored in a central databank to establish a Chinese renal database for research and publication purposes. Results Currently, over 270,000 clinical cases, including general patient information, diagnostics, therapies, medications, and laboratory tests, have been registered in CNRDS by 3,669 healthcare institutions qualified for hemodialysis therapy. At the 2011 annual blood purification forum of the Chinese Society of Nephrology, the CNRDS 2010 annual report was reviewed and accepted by the society members and government representatives. Conclusions CNRDS is the first national, web-based application for collecting and managing electronic medical records of patients with dialysis in China. It provides both an easily accessible platform for nephrologists to store and organize their patient data and acts as a communication platform among participating doctors. Moreover, it is the largest database for treatment and patient care of end-stage renal disease (ESRD) patients in China, which will be beneficial for scientific research and epidemiological investigations aimed at improving the quality of life of such patients. Furthermore, it is a model nationwide disease registry, which could potentially be used for other diseases. PMID:22369692

Design and implementation of the first nationwide, web-based Chinese Renal Data System (CNRDS).

PubMed

Xie, Fengbo; Zhang, Dong; Wu, Jinzhao; Zhang, Yunfeng; Yang, Qing; Sun, Xuefeng; Cheng, Jing; Chen, Xiangmei

2012-02-28

In April 2010, with an endorsement from the Ministry of Health of the People's Republic of China, the Chinese Society of Nephrology launched the first nationwide, web-based prospective renal data registration platform, the Chinese Renal Data System (CNRDS), to collect structured demographic, clinical, and laboratory data for dialysis cases, as well as to establish a kidney disease database for researchers and policy makers. The CNRDS program uses information technology to facilitate healthcare professionals to create a blood purification registry and to deliver an evidence-based care and education protocol tailored to chronic kidney disease, as well as online forum for communication between nephrologists. The online portal https://www.cnrds.net is implemented as a Java web application using an Apache Tomcat web server and a MySQL database. All data are stored in a central databank to establish a Chinese renal database for research and publication purposes. Currently, over 270,000 clinical cases, including general patient information, diagnostics, therapies, medications, and laboratory tests, have been registered in CNRDS by 3,669 healthcare institutions qualified for hemodialysis therapy. At the 2011 annual blood purification forum of the Chinese Society of Nephrology, the CNRDS 2010 annual report was reviewed and accepted by the society members and government representatives. CNRDS is the first national, web-based application for collecting and managing electronic medical records of patients with dialysis in China. It provides both an easily accessible platform for nephrologists to store and organize their patient data and acts as a communication platform among participating doctors. Moreover, it is the largest database for treatment and patient care of end-stage renal disease (ESRD) patients in China, which will be beneficial for scientific research and epidemiological investigations aimed at improving the quality of life of such patients. Furthermore, it is a model nationwide disease registry, which could potentially be used for other diseases.

Training in interprofessional collaboration: pedagogic innovation in family medicine units.

PubMed

Paré, Line; Maziade, Jean; Pelletier, Francine; Houle, Nathalie; Iloko-Fundi, Maximilien

2012-04-01

A number of agencies that accredit university health sciences programs recently added standards for the acquisition of knowledge and skills with respect to interprofessional collaboration. Within primary care settings there are no practical training programs that allow students from different disciplines to develop competencies in this area. The training program was developed within family medicine units affiliated with Université Laval in Quebec for family medicine residents and trainees from various disciplines to develop competencies in patient-centred, interprofessional collaborative practice in primary care. Based on adult learning theories, the program was divided into 3 phases--preparing family medicine unit professionals, training preceptors, and training the residents and trainees. The program's pedagogic strategies allowed participants to learn with, from, and about one another while preparing them to engage in contemporary primary care practices. A combination of quantitative and qualitative methods was used to evaluate the implementation process and the immediate results of the training program. The training program had a positive effect on both the clinical settings and the students. Preparation of clinical settings is an important issue that must be considered when planning practical interprofessional training.

Women and the sciences.

PubMed

Marcantoni, Carmelita; Castellino, Santina; Cicchetti, Teresa; Rastelli, Stefania; Mallamaci, Francesca

2011-01-01

The education level of women has increased significantly in recent decades. However, although there is a continued positive trend overall, women remain underrepresented (or misrepresented?) in the main fields of science. In Europe the proportion of women in scientific research is growing faster than that of men, but women are more likely than men to choose education, arts and humanities, health and welfare. Moreover, of the total number of women graduating in all faculties (55%), the percentage of women graduating in medicine is 65%-68%, in Europe as in the United States. As far as nephrology is concerned, unpublished data from the Italian Society of Nephrology indicate that female nephrologists make up almost 30% of the total number in the age group between 40 and 55, and this proportion is even higher in the age group younger than 40 years. In comparison with the past, there are some hints that things are going to change, but the path is still a difficult one, much effort is needed and there is a long way ahead.

Quality Measures for Dialysis: Time for a Balanced Scorecard.

PubMed

Kliger, Alan S

2016-02-05

Recent federal legislation establishes a merit-based incentive payment system for physicians, with a scorecard for each professional. The Centers for Medicare and Medicaid Services evaluate quality of care with clinical performance measures and have used these metrics for public reporting and payment to dialysis facilities. Similar metrics may be used for the future merit-based incentive payment system. In nephrology, most clinical performance measures measure processes and intermediate outcomes of care. These metrics were developed from population studies of best practice and do not identify opportunities for individualizing care on the basis of patient characteristics and individual goals of treatment. The In-Center Hemodialysis (ICH) Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey examines patients' perception of care and has entered the arena to evaluate quality of care. A balanced scorecard of quality performance should include three elements: population-based best clinical practice, patient perceptions, and individually crafted patient goals of care. Copyright © 2016 by the American Society of Nephrology.

Pain Management in CKD: A Guide for Nephrology Providers.

PubMed

Koncicki, Holly M; Unruh, Mark; Schell, Jane O

2017-03-01

Although pain is one of the most commonly experienced symptoms by patients with chronic kidney disease, it is under-recognized, the severity is underestimated, and the treatment is inadequate. Pain management is one of the general primary palliative care competencies for medical providers. This review provides nephrology providers with basic skills for pain management. These skills include recognition of types of pain (nociceptive and neuropathic) syndromes and appropriate history-taking skills. Through this history, providers can identify clinical circumstances in which specialist referral is beneficial, including those who are at high risk for addiction, at risk for adverse effects to medications, and those with complicated care needs such as patients with a limited prognosis. Management of pain begins with the development of a shared treatment plan, identification of appropriate medications, and continual follow-up and assessment of efficacy and adverse effects. Through adequate pain management, providers can positively affect the health of individual patients and the performance of health care systems. Copyright © 2016 National Kidney Foundation, Inc. All rights reserved.

[Italian health centers and Web Marketing strategy: necessary improvements, even in nephrology].

PubMed

Rinaldi Miliani, Maria; Barracca, Antonio; Quintaliani, Giuseppe

2017-09-28

The complete digitalization of the health system is an objective that Italy, from 2014, is pursuing with great difficulty, spurred by the many European initiatives dedicated to it. Despite the social and cultural background seems to be clearly ready for an application of the renewal strategies, e-Health and m-Health are struggling to get off the ground throughout the territory. The main difficulties are find at local level and don't spare any medical discipline, nephrology included. The characteristics of the official websites belonging to the local health centers demonstrate it. Today, these institutions are still sparsely present on Social Media or in the Italian Smart Mobile Technology landscape. The article illustrates the main features of the phenomenon and calls for reflection on the necessity to accelerate the digital innovation of the communication with patients. This is a possible strategy for reducing chronicity through prevention, and, potentially, for decreasing health costs. Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.

Cost Evaluation of Dried Blood Spot Home Sampling as Compared to Conventional Sampling for Therapeutic Drug Monitoring in Children

PubMed Central

Martial, Lisa C.; Aarnoutse, Rob E.; Schreuder, Michiel F.; Henriet, Stefanie S.; Brüggemann, Roger J. M.; Joore, Manuela A.

2016-01-01

Dried blood spot (DBS) sampling for the purpose of therapeutic drug monitoring can be an attractive alternative for conventional blood sampling, especially in children. This study aimed to compare all costs involved in conventional sampling versus DBS home sampling in two pediatric populations: renal transplant patients and hemato-oncology patients. Total costs were computed from a societal perspective by adding up healthcare cost, patient related costs and costs related to loss of productivity of the caregiver. Switching to DBS home sampling was associated with a cost reduction of 43% for hemato-oncology patients (€277 to €158) and 61% for nephrology patients (€259 to €102) from a societal perspective (total costs) per blood draw. From a healthcare perspective, costs reduced with 7% for hemato-oncology patients and with 21% for nephrology patients. Total savings depend on the number of hospital visits that can be avoided by using home sampling instead of conventional sampling. PMID:27941974

Cost Evaluation of Dried Blood Spot Home Sampling as Compared to Conventional Sampling for Therapeutic Drug Monitoring in Children.

PubMed

Martial, Lisa C; Aarnoutse, Rob E; Schreuder, Michiel F; Henriet, Stefanie S; Brüggemann, Roger J M; Joore, Manuela A

2016-01-01

Dried blood spot (DBS) sampling for the purpose of therapeutic drug monitoring can be an attractive alternative for conventional blood sampling, especially in children. This study aimed to compare all costs involved in conventional sampling versus DBS home sampling in two pediatric populations: renal transplant patients and hemato-oncology patients. Total costs were computed from a societal perspective by adding up healthcare cost, patient related costs and costs related to loss of productivity of the caregiver. Switching to DBS home sampling was associated with a cost reduction of 43% for hemato-oncology patients (€277 to €158) and 61% for nephrology patients (€259 to €102) from a societal perspective (total costs) per blood draw. From a healthcare perspective, costs reduced with 7% for hemato-oncology patients and with 21% for nephrology patients. Total savings depend on the number of hospital visits that can be avoided by using home sampling instead of conventional sampling.

Clinical audit, a valuable tool to improve quality of care: General methodology and applications in nephrology.

PubMed

Esposito, Pasquale; Dal Canton, Antonio

2014-11-06

Evaluation and improvement of quality of care provided to the patients are of crucial importance in the daily clinical practice and in the health policy planning and financing. Different tools have been developed, including incident analysis, health technology assessment and clinical audit. The clinical audit consist of measuring a clinical outcome or a process, against well-defined standards set on the principles of evidence-based medicine in order to identify the changes needed to improve the quality of care. In particular, patients suffering from chronic renal diseases, present many problems that have been set as topics for clinical audit projects, such as hypertension, anaemia and mineral metabolism management. Although the results of these studies have been encouraging, demonstrating the effectiveness of audit, overall the present evidence is not clearly in favour of clinical audit. These findings call attention to the need to further studies to validate this methodology in different operating scenarios. This review examines the principle of clinical audit, focusing on experiences performed in nephrology settings.

Leading team learning: what makes interprofessional teams learn to work well?

PubMed

Chatalalsingh, Carole; Reeves, Scott

2014-11-01

This article describes an ethnographic study focused on exploring leaders of team learning in well-established nephrology teams in an academic healthcare organization in Canada. Employing situational theory of leadership, the article provides details on how well established team members advance as "learning leaders". Data were gathered by ethnographic methods over a 9-month period with the members of two nephrology teams. These learning to care for the sick teams involved over 30 regulated health professionals, such as physicians, nurses, social workers, pharmacists, dietitians and other healthcare practitioners, staff, students and trainees, all of whom were collectively managing obstacles and coordinating efforts. Analysis involved an inductive thematic analysis of observations, reflections, and interview transcripts. The study indicated how well established members progress as team-learning leaders, and how they adapt to an interprofessional culture through the activities they employ to enable day-to-day learning. The article uses situational theory of leadership to generate a detailed illumination of the nature of leaders' interactions within an interprofessional context.

OCCUPATIONAL EDUCATION AND TRAINING FOR TOMORROW'S WORLD OF WORK. NUMBER 6, BUSINESS, LABOR, AND OTHER PRIVATE PROGRAMS.

ERIC Educational Resources Information Center

SCHWEITZER, HARVEY

BUSINESS AND INDUSTRY HAVE A LONG HISTORY OF DEVELOPING AND CONDUCTING TRAINING PROGRAMS. A 1962 U.S. DEPARTMENT OF LABOR SURVEY COVERING 710,662 ESTABLISHMENTS WHICH EMPLOYED FROM FOUR TO OVER 500 EMPLOYEES FOUND THAT ABOUT ONE-FIFTH HAD TRAINING PROGRAMS IN OPERATION. ADVANTAGES OF TRAINING PROGRAMS IN BUSINESS AND INDUSTRY ARE -- (1) THE…

Training in interprofessional collaboration

PubMed Central

Paré, Line; Maziade, Jean; Pelletier, Francine; Houle, Nathalie; Iloko-Fundi, Maximilien

2012-01-01

Abstract Problem addressed A number of agencies that accredit university health sciences programs recently added standards for the acquisition of knowledge and skills with respect to interprofessional collaboration. Within primary care settings there are no practical training programs that allow students from different disciplines to develop competencies in this area. Objective of the program The training program was developed within family medicine units affiliated with Université Laval in Quebec for family medicine residents and trainees from various disciplines to develop competencies in patient-centred, interprofessional collaborative practice in primary care. Program description Based on adult learning theories, the program was divided into 3 phases—preparing family medicine unit professionals, training preceptors, and training the residents and trainees. The program’s pedagogic strategies allowed participants to learn with, from, and about one another while preparing them to engage in contemporary primary care practices. A combination of quantitative and qualitative methods was used to evaluate the implementation process and the immediate results of the training program. Conclusion The training program had a positive effect on both the clinical settings and the students. Preparation of clinical settings is an important issue that must be considered when planning practical interprofessional training. PMID:22611607

Measuring trainer fidelity in the transfer of suicide prevention training

PubMed Central

Cross, Wendi F.; Pisani, Anthony R.; Schmeelk-Cone, Karen; Xia, Yinglin; Tu, Xin; McMahon, Marcie; Munfakh, Jimmie Lou; Gould, Madelyn S.

2014-01-01

Background Finding effective and efficient models to train large numbers of suicide prevention interventionists, including ‘hotline’ crisis counselors, is a high priority. Train-the-trainer (TTT) models are widely used but understudied. Aims To assess the extent to which trainers following TTT delivered the Applied Suicide Intervention Skills Training (ASIST) program with fidelity, and to examine fidelity across two trainings and seven training segments. Methods We recorded and reliably rated trainer fidelity, defined as adherence to program content and competence of program delivery, for 34 newly trained ASIST trainers delivering the program to crisis center staff on two separate occasions. A total of 324 observations were coded. Trainer demographics were also collected. Results On average, trainers delivered two-thirds of the program. Previous training was associated with lower levels of trainer adherence to the program. 18% of trainers' observations were rated as solidly competent. Trainers did not improve fidelity from their first to second training. Significantly higher fidelity was found for lectures and lower fidelity was found for interactive training activities including asking about suicide and creating a safe plan. Conclusions We found wide variability in trainer fidelity to the ASIST program following TTT and few trainers had high levels of both adherence and competence. More research is needed to examine the cost-effectiveness of TTT models. PMID:24901061

Status of training programs and perceived labor problems in four types of noncommercial foodservice operations.

PubMed

Cluskey, M; Messersmith, A M

1991-10-01

Training is essential for the effective delivery of quality foodservice products. A well-developed training program is ongoing, comprehensive, planned in advance, and performance based. Such programs facilitate performance and may be beneficial to develop employees and reduce employee turnover rates. The purpose of this study was to investigate the kinds of training programs that are being developed and delivered to employees in noncommercial foodservice operations. A survey instrument was mailed nationally to foodservice directors and administrators in health care and educational foodservice operations requesting information about training programs used for their nonsupervisory foodservice employees. Information regarding perceived existence of potential labor problems was also collected. Relationships between training programs and perception of labor problems were investigated. Training appears to be conducted in some form within the four types of noncommercial foodservice operations investigated. The most severely perceived labor problems among nonsupervisory employees include low motivation, lack of skills, and poor promotability.

Transfer of Training After an Organizational Intervention in Swedish Sports Clubs: A Self-Determination Theory Perspective.

PubMed

Stenling, Andreas; Tafvelin, Susanne

2016-10-01

Leadership development programs are common in sports, but seldom evaluated; hence, we have limited knowledge about what the participants actually learn and the impact these programs have on sports clubs' daily operations. The purpose of the current study was to integrate a transfer of training model with self-determination theory to understand predictors of learning and training transfer, following a leadership development program among organizational leaders in Swedish sports clubs. Bayesian multilevel path analysis showed that autonomous motivation and an autonomy-supportive implementation of the program positively predicted near transfer (i.e., immediately after the training program) and that perceiving an autonomy-supportive climate in the sports club positively predicted far transfer (i.e., 1 year after the training program). This study extends previous research by integrating a transfer of training model with self-determination theory and identified important motivational factors that predict near and far training transfer.

Survey of robotic surgery training in obstetrics and gynecology residency.

PubMed

Gobern, Joseph M; Novak, Christopher M; Lockrow, Ernest G

2011-01-01

To examine the status of resident training in robotic surgery in obstetrics and gynecology programs in the United States, an online survey was emailed to residency program directors of 247 accredited programs identified through the Accreditation Council for Graduate Medical Education website. Eighty-three of 247 program directors responded, representing a 34% response rate. Robotic surgical systems for gynecologic procedures were used at 65 (78%) institutions. Robotic surgery training was part of residency curriculum at 48 (58%) residency programs. Half of respondents were undecided on training effectiveness. Most program directors believed the role of robotic surgery would increase and play a more integral role in gynecologic surgery. Robotic surgery was widely reported in residency training hospitals with limited availability of effective resident training. Robotic surgery training in obstetrics and gynecology residency needs further assessment and may benefit from a structured curriculum. Published by Elsevier Inc.

Improving psychosexual knowledge in adolescents with autism spectrum disorder: pilot of the tackling teenage training program.

PubMed

Dekker, Linda P; van der Vegt, Esther J M; Visser, Kirsten; Tick, Nouchka; Boudesteijn, Frieda; Verhulst, Frank C; Maras, Athanasios; Greaves-Lord, Kirstin

2015-06-01

Previous studies have shown that psychosexual functioning in adolescents with autism spectrum disorder (ASD) is hampered and emphasize the need for a specialized training program tailored to their needs. Therefore, an individual training program was developed; the Tackling Teenage Training (TTT) program. The current pilot study systematically evaluated whether psychosexual knowledge increased after taking part in the TTT program, using a pre- and post-training design in 30 adolescents with ASD (77 % male, mean age = 14.80 years, mean intelligence = 96.96). Psychosexual knowledge increased significantly (pre-training total score: M = 25.74, SD = 6.20; post-training total score: M = 33.52 (SD = 2.78); F(1,29) = 65.20, p < .001). The TTT program may be useful to improve psychosexual knowledge and functioning in adolescents with ASD, yet these findings are preliminary, and a more elaborate controlled trial is needed.

76 FR 35918 - Susan Harwood Training Grant Program, FY 2011

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-20

... DEPARTMENT OF LABOR Occupational Safety and Health Administration Susan Harwood Training Grant... Funding Opportunity for Susan Harwood Training Grant Program, FY 2011. Funding Opportunity No.: SHTG-FY-11... of approximately $4.7 million for Susan Harwood Training Program grants under the following...

75 FR 29783 - Susan Harwood Training Grant Program, FY 2010

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-27

... DEPARTMENT OF LABOR Occupational Safety and Health Administration Susan Harwood Training Grant... Funding Opportunity for Susan Harwood Training Grant Program, FY 2010. Funding Opportunity No.: SHTG-FY-10... availability of approximately $8 million for the Susan Harwood Training Grant Program for Capacity Building...

Lather-Interior Systems Mechanic Program. Apprenticeship Training.

ERIC Educational Resources Information Center

Alberta Learning, Edmonton. Apprenticeship and Industry Training.

This document presents information about the apprenticeship training program of Alberta, Canada, in general and the lather-interior systems mechanic program in particular. The first part of the document discusses the following items: Alberta's apprenticeship and industry training system; the apprenticeship and industry training committee…

Apprenticeship Training: Auto Body Technician Program.

ERIC Educational Resources Information Center

Alberta Learning, Edmonton. Apprenticeship and Industry Training.

This document presents information about the apprenticeship training program of Alberta, Canada, in general and the auto body technician program in particular. The first part of the document discusses the following items: Alberta's apprenticeship and industry training system; the apprenticeship and industry training committee structure; local…

78 FR 66344 - Applications for New Awards; Rehabilitation Training: Rehabilitation Long-Term Training Program...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-05

...-Term Training Program--Vocational Rehabilitation Counseling AGENCY: Office of Special Education and...: Rehabilitation Long- Term Training Program--Vocational Rehabilitation Counseling Notice inviting applications for... in the priority area of rehabilitation counseling. Absolute Priority 2: This priority is from the...

20 CFR 628.700 - Scope and purpose.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR PROGRAMS UNDER TITLE II OF THE JOB TRAINING PARTNERSHIP ACT The Summer Youth Employment and Training Program § 628.700 Scope and purpose. This subpart contains the regulations for the Summer Youth Employment and Training Program (SYETP...

Outdoor Power Equipment Technician Program. Apprenticeship Training.

ERIC Educational Resources Information Center

Alberta Learning, Edmonton. Apprenticeship and Industry Training.

This document presents information about the apprenticeship training program of Alberta, Canada, in general and the outdoor power equipment technician program in particular. The first part of the document discusses the following items: Alberta's apprenticeship and industry training system; the apprenticeship and industry training committee…

Wanted: interdisciplinary, multidisciplinary, and knowledge translation and exchange training for students of public health.

PubMed

Mishra, Lipi; Banerjee, Ananya T; MacLennan, Mary E; Gorczynski, Paul F; Zinszer, Kate A

2011-01-01

Students vocalized their concern with public health training programs in Canada at the 2010 CPHA Centennial Conference. Given these concerns, we reviewed the objectives and curricula of public health graduate (master's) programs in Canada. Our objective was to understand to what extent public and population health graduate programs in Canada support interdisciplinary, multidisciplinary and knowledge translation and exchange (KTE) training. This was achieved through a review of all public and population health master's programs in Canada identified from the public health graduate programs listed on the Public Health Agency of Canada website (n = 33) plus an additional four programs that were not originally captured on the list. Of the 37 programs reviewed, 28 (76%) stated that interdisciplinary, multidisciplinary or cross-disciplinary training opportunities are of value to their program, with 12 programs (32%) providing multidisciplinary or interdisciplinary training opportunities in their curriculum. Only 14 (38%) of the 37 programs provided value statements of KTE activities in their program goals or course objectives, with 10 (27%) programs offering KTE training in their curriculum. This review provides a glimpse into how public health programs in Canada value and support interdisciplinary and multidisciplinary collaboration as well as KTE activities.

DEVELOPMENT OF AN EMERGENCY NURSING TRAINING CURRICULUM IN GHANA

PubMed Central

Bell, Sue Anne; Oteng, Rockefeller; Redman, Richard; Lapham, Jeremy; Bam, Victoria; Dzomecku, Veronica; Yakubu, Jamila; Tagoe, Nadia; Donkor, Peter

2014-01-01

The formal provision of emergency health care is a developing specialty in many sub-Saharan African countries, including Ghana. While emergency medicine training programs for physicians are on the rise, there are few established training programs for emergency nurses. The results of a unique collaboration are described between a university in the United States, a Ghanaian university and a Ghanaian teaching hospital that has developed an emergency nursing diploma program. The expected outcomes of this training program include: a) an innovative, interdisciplinary, team-based clinical training model b) a unique and low-resource emergency nursing curriculum and c) a comprehensive and sustainable training program to increase in-country retention of nurses. PMID:24631161

Current status of endoscopic simulation in gastroenterology fellowship training programs.

PubMed

Jirapinyo, Pichamol; Thompson, Christopher C

2015-07-01

Recent guidelines have encouraged gastroenterology and surgical training programs to integrate simulation into their core endoscopic curricula. However, the role that simulation currently has within training programs is unknown. This study aims to assess the current status of simulation among gastroenterology fellowship programs. This questionnaire study consisted of 38 fields divided into two sections. The first section queried program directors' experience on simulation and assessed the current status of simulation at their institution. The second portion surveyed their opinion on the potential role of simulation on the training curriculum. The study was conducted at the 2013 American Gastroenterological Association Training Directors' Workshop in Phoenix, Arizona. The participants were program directors from Accreditation Council for Graduate Medical Education accredited gastroenterology training programs, who attended the workshop. The questionnaire was returned by 69 of 97 program directors (response rate of 71%). 42% of programs had an endoscopic simulator. Computerized simulators (61.5%) were the most common, followed by mechanical (30.8%) and animal tissue (7.7%) simulators, respectively. Eleven programs (15%) required fellows to use simulation prior to clinical cases. Only one program has a minimum number of hours fellows have to participate in simulation training. Current simulators are deemed as easy to use (76%) and good educational tools (65%). Problems are cost (72%) and accessibility (69%). The majority of program directors believe that there is a need for endoscopic simulator training, with only 8% disagreeing. Additionally, a majority believe there is a role for simulation prior to initiation of clinical cases with 15% disagreeing. Gastroenterology fellowship program directors widely recognize the importance of simulation. Nevertheless, simulation is used by only 42% of programs and only 15% of programs require that trainees use simulation prior to clinical cases. No programs currently use simulation as part of the evaluation process.

Evaluating an australian emergency nurse practitioner candidate training program.

PubMed

Plath, Sharyn J; Wright, Mary; Hocking, Julia

2017-11-01

Nurse Practitioners (NPs) receive core clinical training at master's level, with their employer providing the opportunity to upskill in clinical and procedural competencies. It is increasingly recognised that this generic education requires supplementary training for operating effectively within a specific clinical environment. In this paper we describe a pilot program designed to train Australian NP Candidates to work effectively within the Emergency Department Fast Track model of care. The training program consisted of a 12-month period: four hours in-house training per week over two semesters, running concurrently with the NP candidate's University semesters, and 3 months' clinical practice to consolidate. The training team defined milestones for Semesters one and two, and developed a case review form to assess application of the candidate's knowledge in new clinical situations, as well as check for gaps in understanding. A clinical skills guide was developed for the candidate to work toward, and a comprehensive assessment was carried out at two time points in the training program. Feedback was obtained from the mentors and the candidate at the end point of the training program, and has been used to refine the program for 2017. This in-house training program provided specialised, evidence-based training for the emergency department environment, resulting in development of the nurse practitioner candidate as a high functioning team member. Copyright © 2017 College of Emergency Nursing Australasia. All rights reserved.

A practical guide to exercise training for heart failure patients.

PubMed

Smart, Neil; Fang, Zhi You; Marwick, Thomas H

2003-02-01

Exercise training has been shown to improve exercise capacity in patients with heart failure. We sought to examine the optimal strategy of exercise training for patients with heart failure. Review of the published data on the characteristics of the training program, with comparison of physiologic markers of exercise capacity in heart failure patients and healthy individuals and comparison of the change in these characteristics after an exercise training program. Many factors, including the duration, supervision, and venue of exercise training; the volume of working muscle; the delivery mode (eg, continuous vs. intermittent exercise), training intensity; and the concurrent effects of medical treatments may influence the results of exercise training in heart failure. Starting in an individually prescribed and safely monitored hospital-based program, followed by progression to an ongoing and progressive home program of exercise appears to be the best solution to the barriers of anxiety, adherence, and "ease of access" encountered by the heart failure patient. Various exercise training programs have been shown to improve exercise capacity and symptom status in heart failure, but these improvements may only be preserved with an ongoing maintenance program.

The development of a TED-Ed online resident research training program

PubMed Central

Moreau, Katherine A.; Pound, Catherine M.; Peddle, Beth; Tokarewicz, Jaclyn; Eady, Kaylee

2014-01-01

Background Pediatric health research is important for improving the health and well-being of children and their families. To foster the development of physicians’ research competencies, it is vital to integrate practical and context-specific research training into residency programs. Purpose To describe the development of a resident research training program at one tertiary care pediatric academic health sciences center in Ontario, Canada. Methods We surveyed residents and pediatricians/research staff to establish the need and content for a resident research training program. Results Residents and resident research supervisors agreed or strongly agreed that research training is important for residents. However, few residents and supervisors believed that their academic health sciences center provided adequate training and resources to support resident research. As such, an online resident research training program was established. Residents and supervisors agreed that the program should focus on the following topics: 1) critically evaluating research literature, 2) writing a research proposal, 3) submitting an application for research funding, and 4) writing a manuscript. Discussion This highly accessible, context-specific, and inexpensive online program model may be of interest and benefit to other residency programs as a means to enhance residents’ scholarly roles. A formal evaluation of the research training program is now underway. PMID:25526717

The development of a TED-Ed online resident research training program.

PubMed

Moreau, Katherine A; Pound, Catherine M; Peddle, Beth; Tokarewicz, Jaclyn; Eady, Kaylee

2014-01-01

Background Pediatric health research is important for improving the health and well-being of children and their families. To foster the development of physicians' research competencies, it is vital to integrate practical and context-specific research training into residency programs. Purpose To describe the development of a resident research training program at one tertiary care pediatric academic health sciences center in Ontario, Canada. Methods We surveyed residents and pediatricians/research staff to establish the need and content for a resident research training program. Results Residents and resident research supervisors agreed or strongly agreed that research training is important for residents. However, few residents and supervisors believed that their academic health sciences center provided adequate training and resources to support resident research. As such, an online resident research training program was established. Residents and supervisors agreed that the program should focus on the following topics: 1) critically evaluating research literature, 2) writing a research proposal, 3) submitting an application for research funding, and 4) writing a manuscript. Discussion This highly accessible, context-specific, and inexpensive online program model may be of interest and benefit to other residency programs as a means to enhance residents' scholarly roles. A formal evaluation of the research training program is now underway.

The effect of a complex training program on skating abilities in ice hockey players.

PubMed

Lee, Changyoung; Lee, Sookyung; Yoo, Jaehyun

2014-04-01

[Purpose] Little data exist on systemic training programs to improve skating abilities in ice hockey players. The purpose of this study was to evaluate the effectiveness of a complex training program on skating abilities in ice hockey players. [Methods] Ten male ice hockey players (training group) that engaged in 12 weeks of complex training and skating training and ten male players (control group) that only participated in 12 weeks of skating training completed on-ice skating tests including a 5 time 18 meters shuttle, t-test, Rink dash 5 times, and line drill before, during, and the training. [Results] Significant group-by-time interactions were found in all skating ability tests. [Conclusion] The complex training program intervention for 12 weeks improved their skating abilities of the ice hockey players.

A preliminary report of music-based training for adult cochlear implant users: Rationales and development.

PubMed

Gfeller, Kate; Guthe, Emily; Driscoll, Virginia; Brown, Carolyn J

2015-09-01

This paper provides a preliminary report of a music-based training program for adult cochlear implant (CI) recipients. Included in this report are descriptions of the rationale for music-based training, factors influencing program development, and the resulting program components. Prior studies describing experience-based plasticity in response to music training, auditory training for persons with hearing impairment, and music training for CI recipients were reviewed. These sources revealed rationales for using music to enhance speech, factors associated with successful auditory training, relevant aspects of electric hearing and music perception, and extant evidence regarding limitations and advantages associated with parameters for music training with CI users. This informed the development of a computer-based music training program designed specifically for adult CI users. Principles and parameters for perceptual training of music, such as stimulus choice, rehabilitation approach, and motivational concerns were developed in relation to the unique auditory characteristics of adults with electric hearing. An outline of the resulting program components and the outcome measures for evaluating program effectiveness are presented. Music training can enhance the perceptual accuracy of music, but is also hypothesized to enhance several features of speech with similar processing requirements as music (e.g., pitch and timbre). However, additional evaluation of specific training parameters and the impact of music-based training on speech perception of CI users is required.

A preliminary report of music-based training for adult cochlear implant users: rationales and development

PubMed Central

Gfeller, Kate; Guthe, Emily; Driscoll, Virginia; Brown, Carolyn J.

2015-01-01

Objective This paper provides a preliminary report of a music-based training program for adult cochlear implant (CI) recipients. Included in this report are descriptions of the rationale for music-based training, factors influencing program development, and the resulting program components. Methods Prior studies describing experience-based plasticity in response to music training, auditory training for persons with hearing impairment, and music training for cochlear implant recipients were reviewed. These sources revealed rationales for using music to enhance speech, factors associated with successful auditory training, relevant aspects of electric hearing and music perception, and extant evidence regarding limitations and advantages associated with parameters for music training with CI users. This information formed the development of a computer-based music training program designed specifically for adult CI users. Results Principles and parameters for perceptual training of music, such as stimulus choice, rehabilitation approach, and motivational concerns were developed in relation to the unique auditory characteristics of adults with electric hearing. An outline of the resulting program components and the outcome measures for evaluating program effectiveness are presented. Conclusions Music training can enhance the perceptual accuracy of music, but is also hypothesized to enhance several features of speech with similar processing requirements as music (e.g., pitch and timbre). However, additional evaluation of specific training parameters and the impact of music-based training on speech perception of CI users are required. PMID:26561884

30 CFR 75.160 - Training programs.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Training programs. 75.160 Section 75.160... MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Qualified and Certified Persons § 75.160 Training programs... training and retraining of both qualified and certified persons needed to carry out functions prescribed in...

75 FR 38837 - Susan Harwood Training Grant Program, FY 2010

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-06

... DEPARTMENT OF LABOR Occupational Safety and Health Administration Susan Harwood Training Grant... Funding Opportunity for Susan Harwood Training Grant Program, FY 2010. Funding Opportunity No.: SHTG-FY-10... availability of approximately $2.75 million for the Susan Harwood Training Grant Program for Targeted Topic...

The Computer in Performance and Instruction: Or, How to Tell the True Color of a Chameleon.

ERIC Educational Resources Information Center

Davis, Richard

1979-01-01

Discusses such potential uses for the computer in employee training programs as management support for training and performance, training project control, improved design and development methods, training program implementation and delivery, and program evaluation, revision, and maintenance. (JEG)

Nontraditional Training and Employment Progams Serving Women Directory.

ERIC Educational Resources Information Center

Women's Bureau (DOL), Washington, DC.

This document provides short descriptions of 125 programs providing job training and preemployment skills training for women in nontraditional occupations (primarily skilled trades and crafts). Eighteen exemplary programs in all regions of the country are described. These descriptions are followed by descriptions of other training programs,…

14 CFR 142.37 - Approval of flight aircrew training program.

Code of Federal Regulations, 2011 CFR

2011-01-01

... TRANSPORTATION (CONTINUED) SCHOOLS AND OTHER CERTIFICATED AGENCIES TRAINING CENTERS Aircrew Curriculum and... the Administrator for training program approval. (b) A curriculum approved under SFAR 58 of part 121... application for training program approval must indicate— (1) Which courses are part of the core curriculum and...

7 CFR 1945.35 - Special EM loan training.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) PROGRAM REGULATIONS (CONTINUED) EMERGENCY Disaster Assistance-General § 1945.35 Special EM loan training... workshop and a test. (c) Objective. The basic objective of this training program is to keep State and... employees in administering the EM loan program. (d) Comprehensive EM loan training package. A comprehensive...

10 CFR 60.161 - Training and certification program.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 2 2010-01-01 2010-01-01 false Training and certification program. 60.161 Section 60.161 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) DISPOSAL OF HIGH-LEVEL RADIOACTIVE WASTES IN GEOLOGIC REPOSITORIES Training and Certification of Personnel § 60.161 Training and certification program. DOE shall...

34 CFR 642.12 - What activities may a project conduct?

Code of Federal Regulations, 2011 CFR

2011-07-01

... POSTSECONDARY EDUCATION, DEPARTMENT OF EDUCATION TRAINING PROGRAM FOR FEDERAL TRIO PROGRAMS What Types of... project conduct? A Training program project may include on-site training, on-line training, conferences, internships, seminars, workshops, and the publication of manuals designed to improve the operations of Federal...

34 CFR 642.12 - What activities may a project conduct?

Code of Federal Regulations, 2012 CFR

2012-07-01

... POSTSECONDARY EDUCATION, DEPARTMENT OF EDUCATION TRAINING PROGRAM FOR FEDERAL TRIO PROGRAMS What Types of... project conduct? A Training program project may include on-site training, on-line training, conferences, internships, seminars, workshops, and the publication of manuals designed to improve the operations of Federal...

34 CFR 642.12 - What activities may a project conduct?

Code of Federal Regulations, 2014 CFR

2014-07-01

... POSTSECONDARY EDUCATION, DEPARTMENT OF EDUCATION TRAINING PROGRAM FOR FEDERAL TRIO PROGRAMS What Types of... project conduct? A Training program project may include on-site training, on-line training, conferences, internships, seminars, workshops, and the publication of manuals designed to improve the operations of Federal...

34 CFR 642.12 - What activities may a project conduct?

Code of Federal Regulations, 2013 CFR

2013-07-01

... POSTSECONDARY EDUCATION, DEPARTMENT OF EDUCATION TRAINING PROGRAM FOR FEDERAL TRIO PROGRAMS What Types of... project conduct? A Training program project may include on-site training, on-line training, conferences, internships, seminars, workshops, and the publication of manuals designed to improve the operations of Federal...

A Clinical Psychology Training Program Interfaces with the Schools.

ERIC Educational Resources Information Center

Winder, Alvin E.

This paper describes how clinical child psychologists are trained in a pediatric psychology program and emphasizes their interface with the school. The need for clinical child psychology training is stressed, and training programs for pediatric psychologists and clinical child psychologists are compared. The collaborative pediatric psychology…

Peace Corps Stateside Teacher Training for Volunteers in Liberia. Volume IV: Training Program for Secondary School Teachers (Group C). Final Report.

ERIC Educational Resources Information Center

PSI Associates, Inc., Washington, DC.

The Peace Corps stateside training program for secondary school teachers in Liberia trained 37 volunteers in several subject area groups--language arts, mathematics and science, and health. Because many of the teachers had never taught before, their 4-week training program concentrated on teaching and learning theories and specific teaching…

Experience of Social Media, Training and Development on Work Proficiency: A Qualitative Study with Security Personnel

ERIC Educational Resources Information Center

Okyireh, Rexford Owusu; Okyireh, Marijke Akua Adobea

2016-01-01

How useful is social media and training programs to the development of professionals in the security sector? In this study the researchers examined three key issues pertaining to training programs. These were marketing of training programs, participant experiences of training content and work proficiency. A sample of ten participants of a forensic…

Training Public Health Advisors.

PubMed

Meyer, Pamela A; Brusuelas, Kristin M; Baden, Daniel J; Duncan, Heather L

2015-01-01

Federal public health advisors provide guidance and assistance to health departments to improve public health program work. The Centers for Disease Control and Prevention (CDC) prepares them with specialized training in administering public health programs. This article describes the evolving training and is based on internal CDC documents and interviews. The first federal public health advisors worked in health departments to assist with controlling syphilis after World War II. Over time, more CDC prevention programs hired them. To meet emerging needs, 3 major changes occurred: the Public Health Prevention Service, a fellowship program, in 1999; the Public Health Associate Program in 2007; and integration of those programs. Key components of the updated training are competency-based training, field experience, supervision, recruitment and retention, and stakeholder support. The enduring strength of the training has been the experience in a public health agency developing practical skills for program implementation and management.

Corps of Engineers National Automation Team (CENAT) Technology Transfer Test Bed (T(3)B) Demonstration of the Design 4D Program

DTIC Science & Technology

1989-11-01

other design tools. RESULTS OF TEST/DEMONSTRATION: Training for the Design 4D Program was conducted at USACERL. Although nearly half of the test...subjects had difficulty with the prompts, their understanding of the program improved after experimenting with the commands. After training , most felt...Equipment Testing Process 3 TEST DISTRICT TRAINING ........................................... 10 Training Process Post Training Survey Post Training

Teaching-skills training programs for family medicine residents: systematic review of formats, content, and effects of existing programs.

PubMed

Lacasse, Miriam; Ratnapalan, Savithiri

2009-09-01

To review the literature on teaching-skills training programs for family medicine residents and to identify formats and content of these programs and their effects. Ovid MEDLINE (1950 to mid-July 2008) and the Education Resources Information Center database (pre-1966 to mid-July 2008) were searched using and combining the MeSH terms teaching, internship and residency, and family practice; and teaching, graduate medical education, and family practice. The initial MEDLINE and Education Resources Information Center database searches identified 362 and 33 references, respectively. Titles and abstracts were reviewed and studies were included if they described the format or content of a teaching-skills program or if they were primary studies of the effects of a teaching-skills program for family medicine residents or family medicine and other specialty trainees. The bibliographies of those articles were reviewed for unidentified studies. A total of 8 articles were identified for systematic review. Selection was limited to articles published in English. Teaching-skills training programs for family medicine residents vary from half-day curricula to a few months of training. Their content includes leadership skills, effective clinical teaching skills, technical teaching skills, as well as feedback and evaluation skills. Evaluations mainly assessed the programs' effects on teaching behaviour, which was generally found to improve following participation in the programs. Evaluations of learner reactions and learning outcomes also suggested that the programs have positive effects. Family medicine residency training programs differ from all other residency training programs in their shorter duration, usually 2 years, and the broader scope of learning within those 2 years. Few studies on teaching-skills training, however, were designed specifically for family medicine residents. Further studies assessing the effects of teaching-skills training in family medicine residents are needed to stimulate development of adapted programs for the discipline. Future research should also assess how residents' teaching-skills training can affect their learners' clinical training and eventually patient care.

20 CFR 628.525 - Limitations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR PROGRAMS UNDER TITLE II OF THE JOB TRAINING PARTNERSHIP ACT Program Design Requirements for Programs Under Title II of the Job Training Partnership Act § 628.525 Limitations. Neither eligibility for nor participation in a JTPA program...

Adult Literacy: Industry-Based Training Programs. Research and Development Series No. 265C.

ERIC Educational Resources Information Center

Fields, Ernest L.; And Others

Nine industry-based adult literacy programs across the country were studied to identify exemplary training programs and practices that business and industry trainers, planners, and policymakers and individuals in the public education sector alike could replicate in designing adult literacy programs. Training programs offered by the following…

A Two-Year Multidisciplinary Training Program for the Frontline Workforce in Community Treatment of Severe Mental Illness.

PubMed

Ruud, Torleif; Flage, Karin Blix; Kolbjørnsrud, Ole-Bjørn; Haugen, Gunnar Brox; Sørlie, Tore

2016-01-01

Since 1999, a national two-year multidisciplinary onsite training program has been in operation in Norway. The program trains frontline workforce personnel who provide community treatment to people with severe mental illness. A national network of mental health workers, consumers, caregivers, and others providing or supporting psychosocial treatment and rehabilitation for people with severe mental illness has organized local onsite part-time training programs in collaboration with community mental health centers (CMHCs), municipalities, and primary care providers. CMHC and primary care staff are trained together to increase collaboration. Nationwide dissemination has continued, with new local programs established every year. Evaluations have shown that the program is successful.

33 CFR 155.5061 - Alternative Training and Exercise Program.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 33 Navigation and Navigable Waters 2 2014-07-01 2014-07-01 false Alternative Training and Exercise... Nontank Vessel Response Plans § 155.5061 Alternative Training and Exercise Program. (a) Owners or... exercise requirements of §§ 155.5055 and 155.5060, may meet an Alternative Training and Exercise Program...

Delta Airlines LOFT training

NASA Technical Reports Server (NTRS)

Whitehead, J.

1981-01-01

A LOFT program was developed as part of the DC-9 training program which serves as a prototype for much of Delta's other aircraft training programs. The LOFT used differs little from the ideology presented in the Advisory Circular. Difficulty and experienced concerns regarding the effectiveness of LOFT as a complete training vehicle are explored.

34 CFR 387.1 - What is the Experimental and Innovative Training Program?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 2 2010-07-01 2010-07-01 false What is the Experimental and Innovative Training... (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EXPERIMENTAL AND INNOVATIVE TRAINING General § 387.1 What is the Experimental and Innovative Training Program? This program is...

34 CFR 387.1 - What is the Experimental and Innovative Training Program?

Code of Federal Regulations, 2012 CFR

2012-07-01

... 34 Education 2 2012-07-01 2012-07-01 false What is the Experimental and Innovative Training... (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EXPERIMENTAL AND INNOVATIVE TRAINING General § 387.1 What is the Experimental and Innovative Training Program? This program is...

34 CFR 387.1 - What is the Experimental and Innovative Training Program?

Code of Federal Regulations, 2013 CFR

2013-07-01

... 34 Education 2 2013-07-01 2013-07-01 false What is the Experimental and Innovative Training... (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EXPERIMENTAL AND INNOVATIVE TRAINING General § 387.1 What is the Experimental and Innovative Training Program? This program is...

14 CFR 142.37 - Approval of flight aircrew training program.

Code of Federal Regulations, 2010 CFR

2010-01-01

... application for training program approval must indicate— (1) Which courses are part of the core curriculum and... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Approval of flight aircrew training program... TRANSPORTATION (CONTINUED) SCHOOLS AND OTHER CERTIFICATED AGENCIES TRAINING CENTERS Aircrew Curriculum and...

Family Therapy Training in Child and Adolescent Psychiatry Fellowship Programs

ERIC Educational Resources Information Center

Rait, Douglas Samuel

2012-01-01

Objective: This study describes the current state of family therapy training in a sample of child and adolescent psychiatry fellowship programs. Method: Child and adolescent psychiatry fellows (N = 66) from seven training programs completed a questionnaire assessing demographics, family therapy training experiences, common models of treatment and…

76 FR 17451 - Online OSHA Outreach Training Programs

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-29

... must submit an application in order to be considered to offer online Outreach Training Program courses... minimum of 3 years training experience; (b) They each are in good standing (not on probation, suspended... Outreach Training Program course would be offered online, and any relevant language or target audience...

Opportunities in Training & Development Careers. VGM Opportunities Series.

ERIC Educational Resources Information Center

Gordon, Edward E.; Petrini, Catherine M.; Campagna, Ann P.

This volume is a resource for those who want to explore opportunities in training and development careers. Chapter 1 covers the evolution of training and the future of education at work. Chapter 2 considers trainers' roles; program design and development; needs assessment; development of program objectives; program content, training methods,…

Report on Employer-Based Training, 1983-84.

ERIC Educational Resources Information Center

Cronin, Doug; Parkison, Teresa

California's Employer-Based Training (EBT) Program focuses on preparing individuals for the new technologies of the future and responding to the real and current skills training needs of business and industry. The three major program components are: new programs in high and emerging technologies; private sector support for worksite-based training;…

45 CFR 83.4 - Coverage.

Code of Federal Regulations, 2010 CFR

2010-10-01

... for admission to an undergraduate training program of such entity. (d) An entity shall not... Coverage. (a) If an entity receives Federal support for any of its training programs, all of its training... enrolled in, a training program is applicable to the same extent to the actions of such entity with respect...

45 CFR 83.4 - Coverage.

Code of Federal Regulations, 2014 CFR

2014-10-01

... for admission to an undergraduate training program of such entity. (d) An entity shall not... Coverage. (a) If an entity receives Federal support for any of its training programs, all of its training... enrolled in, a training program is applicable to the same extent to the actions of such entity with respect...