Novel therapeutic approaches for pediatric diencephalic tumors: improving functional outcomes.

Pediatric diencephalic tumors represent a histopathologically and molecularly diverse group of neoplasms arising in the central part of the brain and involving eloquent structures, including the hypothalamic-pituitary axis (HPA), optic pathway, thalamus, and pineal gland. Presenting symptoms can include significant neurological, endocrine, or visual manifestations which may be exacerbated by injudicious intervention. Upfront multidisciplinary assessment and coordinated management is crucial from the outset to ensure best short- and long-term functional outcomes.

Referral thresholds for an integrated learning disability eye care pathway: a consensus approach.

Introduction: Local Optometric Support Unit (LOCSU) have published their refreshed clinical pathway for eye care for people with a learning disability. The document sets out the adjustments to practice that a community optometrist might make in order to provide optimal care for a person with learning disability attending a primary eye care assessment. The pathway specifically points to the need to retain patients in primary care where appropriate and 'reduce the number of people with learning disability who are inappropriately referred into the Hospital Eye Service (HES).

Pre to post-dialysis plasma sodium change better predicts clinical outcomes than dialysate to plasma sodium gradient in quotidian hemodialysis.

Sodium balance across a hemodialysis treatment influences interdialytic weight gain (IDWG), pre-dialysis blood pressure, and the occurrence of intradialytic hypotension, which associate with patient morbidity and mortality. In thrice weekly conventional hemodialysis patients, the dialysate sodium minus pre-dialysis plasma sodium concentration (δDPNa+) and the post-dialysis minus pre-dialysis plasma sodium (δPNa+) are surrogates of sodium balance, and are associated with both cardiovascular and all-cause mortality. However, whether δDPNa+ or δPNa+ better predicts clinical outcomes in quotidian dialysis is unknown.

Yes, miracles do happen: a story of an infant on peritoneal dialysis.

The purpose of my writing this story is to share an experience I had as a nephrology nurse at the London Health Sciences Centre. I'm sure as nurses we have all been involved with patients whom you know you will never forget and who have influenced your life as a caregiver. Such is the case with Baby M.

Nocturnal but not short hours quotidian hemodialysis requires an elevated dialysate calcium concentration.

Interest in quotidian (daily) hemodialysis (HD) is growing. Some advocate short-hours high-efficiency daily HD (SDH) and others long-hours slow-flow nocturnal HD (NH) while the patient is asleep, both being used 5 to 7 d/week. The London Daily/Nocturnal Hemodialysis Study was the first attempt to obtain data of SDH and NH that may be compared with conventional thrice weekly HD (CH).

Patient monitoring in the London Daily/Nocturnal Hemodialysis Study.

Background: Patient monitoring involves real-time surveillance of patients while they dialyze at home by a staff member ("monitor") at a centralized location. Monitoring is designed to ensure patient safety, patient compliance with treatment, and automatic collection of treatment data.

Methods: In the London Daily/Nocturnal Hemodialysis Study, 14 nocturnal hemodialysis (HD) patients were monitored from 13 to 602 sessions for a total of 4,096 patient-nights.

Nursing issues related to patient selection, vascular access, and education in quotidian hemodialysis.

Background: Increased interest in quotidian hemodialysis (HD) programs requires that nephrology nurses have a larger role in transitioning patients to more frequent HD. Nursing issues include the selection, training, and education of patients before they begin more frequent HD therapy.

Methods: The London Daily/Nocturnal Hemodialysis Study directly compared data from patients undergoing either short daily HD (n = 11) or long nocturnal HD (n = 12) with those undergoing conventional thrice-weekly HD (n = 22).

An operating cost comparison between conventional and home quotidian hemodialysis.

Background: Although several studies have shown that simulated annual direct health care costs are substantially lower for patients undergoing more frequent hemodialysis (HD), there is limited information about the economics of daily HD and nocturnal HD.

Methods: The London Daily/Nocturnal Hemodialysis Study compared the economics of short daily HD (n = 10), long nocturnal HD (n = 12), and conventional thrice-weekly HD (n = 22) in patients over 18 months. A retrospective analysis of patients' conventional HD costs during the 12 months before study entry was conducted to measure the change in cost after switching to quotidian HD.

Calcium and phosphate balance with quotidian hemodialysis.

Background: Conventional hemodialysis (HD) is associated with profound disturbances in calcium and phosphate metabolism and abnormal parathyroid hormone (PTH) levels. Effects of more frequent HD on calcium and phosphate balance have not been fully elucidated.

Methods: The London Daily/Nocturnal Hemodialysis Study examined effects of quotidian HD, either daily HD (n = 11) or nocturnal HD (n = 12), on calcium and phosphate metabolism, bone alkaline phosphatase levels, and intact PTH (iPTH) levels.

The London Daily/Nocturnal Hemodialysis Study--study design, morbidity, and mortality results.

Background: Despite the growing interest in more frequent hemodialysis (HD), to date, there have been no randomized prospective studies comparing outcomes in patients dialyzed using conventional thrice-weekly therapy with either the short hours daily or long slow nocturnal HD modalities.

Methods: The London Daily/Nocturnal Hemodialysis Study, a prospective, comparative, nonrandomized study, directly compared outcomes of quotidian HD patients with conventional thrice-weekly HD patients. Patients were assigned to either daily HD (n = 11) or nocturnal HD (n = 12) and followed up for 5 to 36 months; all data were directly compared with matched control patients receiving conventional HD.

Simulation and the future of military medicine.

The U.S. military currently faces serious difficulties in training medical personnel in peacetime for the tasks of war.

Reduced requirement for erythropoietin with quotidian hemodialysis therapy.

Quotidian (daily) hemodialysis has many potential advantages over conventional three times weekly hemodialysis, including improved control of anemia. However, previous reports do not consistently describe beneficial effects regarding anemia and erythropoietin requirements. We sought to determine whether erythropoietin dose is altered in this form of therapy, and elucidate the potential contributing factors.

Daily hemodialysis: a nursing perspective.

Daily hemodialysis can be performed in the center or at home for varying lengths of time. Short daily hemodialysis (SDHD) can be defined as one and one half- to three-hour treatments performed 6 days per week. Nocturnal hemodialysis (NHD) is performed for 6 to 10 hours, 5 to 7 nights per week.

Military medical modeling and simulation in the 21st century.

As we enter the 21st century, military medicine struggles with critical issues. One of the most important issues is how to train medical personnel in peace for the realities of war. In April, 1998, The General Accounting Office (GAO) reported, "Military medical personnel have almost no chance during peacetime to practice battlefield trauma care skills.

Adolescent males' experience of the counselling process.

This study examines 11 adolescent males' self-reports of their experiences of 23 counselling sessions to identify what they found helpful and unhelpful during key moments in the therapeutic process. The findings suggest that the experiences of the adolescent males in this study are similar in many ways to the to the reported experiences of adults in counselling. In particular, the experience of emotional support and relief appears to be highly significant for adolescent males, who give significantly lesser importance to cognitive task factors.