• Validation of a Core Patient-Reported Outcome Measure for Fatigue in Patients Receiving Hemodialysis: The SONG-HD Fatigue Instrument

      Fluck, Richard (2020-11)
      Background and objectives: Fatigue is a very common and debilitating symptom and identified by patients as a critically important core outcome to be included in all trials involving patients receiving hemodialysis. A valid, standardized measure for fatigue is needed to yield meaningful and relevant evidence about this outcome. This study validated a core patient-reported outcome measure for fatigue in hemodialysis. Design, setting, participants, & measurements: A longitudinal cohort study was conducted to assess the validity and reliability of a new fatigue measure (Standardized Outcomes in Nephrology-Hemodialysis Fatigue [SONG-HD Fatigue]). Eligible and consenting patients completed the measure at three time points: baseline, a week later, and 12 days following the second time point. Cronbach α and intraclass correlation coefficient were calculated to assess internal consistency, and Spearman rho was used to assess convergent validity. Confirmatory factor analysis was also conducted. Hemodialysis units in the United Kingdom, Australia, and Romania participated in this study. Adult patients aged 18 years and over who were English speaking and receiving maintenance hemodialysis were eligible to participate. Standardized Outcomes in Nephrology-Hemodialysis, the Visual Analog Scale for fatigue, the 12-Item Short Form Survey, and Functional Assessment of Chronic Illness Therapy-Fatigue were used. Results: In total, 485 participants completed the study across the United Kingdom, Australia, and Romania. Psychometric assessment demonstrated that Standardized Outcomes in Nephrology-Hemodialysis is internally consistent (Cronbach α =0.81-0.86) and stable over a 1-week period (intraclass correlation coefficient =0.68-0.74). The measure demonstrated convergence with Functional Assessment of Chronic Illness Therapy-Fatigue and had moderate correlations with other measures that assessed related but not the same concept (the 12-Item Short Form Survey and the Visual Analog Scale). Confirmatory factor analysis supported the one-factor model. Conclusions: SONG-HD Fatigue seems to be a reliable and valid measure to be used in trials involving patients receiving hemodialysis.
    • Variations in access to and reimbursement for continuous glucose monitoring systems for people living with Type 1 diabetes across England.

      Wilmot, Emma (2018-06)
      Since the introduction of real-time continuous glucose monitoring (CGM) systems more than 15 years ago and, more recently, flash glucose monitoring (Flash-GM), clinical studies have observed reductions in HbA1c , independent of insulin delivery method, with decreasing time spent in hypoglycaemia [1] and reduction in glycaemic variability [2]. CGM can improve quality of life and reduce diabetes-related distress [3], including fear of hypoglycaemia [4,5]. Despite these benefits, CGM has yet to be fully implemented as part of the standard of care for people living with Type 1 diabetes in England, and there is considerable variation in how it is funded through local payer organizations.
    • Vascular Access Special Interest Group: a Multiprofessional Initiative

      Fielding, Catherine (2016)
      In December 2015, the British Renal Society Vascular Access Specialist Interest Group (BRS VA SIG) was formed. Its purpose is to identify and promote best practice in vascular access care across the UK, and encourage consistency between services. Catherine Fielding, Suzanne Glover and Mick Kumwenda discuss the group's active and forthcoming projects.
    • Volume is not the only key to hypertension control in dialysis patients.

      Odudu, Aghogho; McIntyre, Christopher (2012-07)
      There is a widely held belief that hypervolaemia due to excess intake or inadequate removal of salt and water is the principal cause of hypertension in dialysis patients. The risk of failing to consider additional pathophysiological elements is that inadequate or inappropriate therapeutic strategies may be adopted. This review aims to highlight multiple alternative mechanisms for hypertension in this setting along with the risks of probing for normotension by empirical dry weight reduction if dry weight is imprecisely defined.
    • What every doctor needs to know about chronic kidney disease.

      Taal, Maarten (2018-08)
      Chronic kidney disease is a global health problem that affects over 10% of adults worldwide. All doctors should have a basic knowledge of chronic kidney disease because it may complicate the management of many other medical conditions and is associated with numerous adverse outcomes. Chronic kidney disease should be regarded as a clinical syndrome rather than a specific diagnosis and attempts should always be made to identify the cause. Simple risk prediction tools have been developed to inform management decisions. Management is directed at slowing progression of chronic kidney disease and reducing the associated cardiovascular risk by treating hypertension, use of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers as first-line therapy in high-risk cases, treatment with statins and lifestyle measures. Patients at high risk of rapid progression or requiring specific therapy as well as those with chronic kidney disease stage n4 or 5 should be referred to a nephrology service.
    • What is the value of multidisciplinary care for chronic kidney disease?

      Fluck, Richard; Taal, Maarten (2018-03)
      In a Persepctive, Richard Fluck and Maarten Taal discuss the potential value of implementing multidisciplinary care programs for chronic kidney disease.
    • Which patients are assessed by lung cancer nurse specialists? A national lung cancer audit study of over 128,000 patients across england.

      Beckett, Paul (2016-06)
      BACKGROUND: Lung cancer nurse specialists (LCNS) are integral to the multidisciplinary clinical team, providing personalised physical and psycho-social interventions, and care management for people with lung cancer. The National Institute of Health and Care Excellence (NICE) recommend that all patients have access to a LCNS. We conducted a national study assessing whether there is variation in access to and timing of LCNS assessment. METHODS: The National Cancer Action Team's LCNS workforce census in England was linked with patient and hospital Trust data from the English National Lung Cancer Audit. Multivariate logistic regression was used to assess features associated with LCNS assessment. RESULTS: 128,124 lung cancer patients were seen from 2007 to 2011. LCNS assessment confirmation was 'yes' in 62%, 'no' in 6% and 'missing' in 32%. Where (in clinic versus ward) and when (before versus after diagnosis) patients were assessed by a LCNS also varied. Older patients with poor performance status, early cancer stage, and comorbidities were less likely to be assessed; there was no difference with sex or socioeconomic group. Patients receiving any anti-cancer treatment were more likely to be assessed. Assessment was lower in Trusts with high annual patient numbers (odds ratio=0.58, 95% confidence interval 0.37-0.91) and where LCNS caseload>250 (0.69, 0.41-1.16, although not statistically significant), but increased where workload was conducted mostly by band 8 nurses (2.22, 1.22-4.02). CONCLUSION: LCNS assessment varied by patient and Trust features, which may indicate unmet need for some patients. The current workforce needs to expand as well as retain experienced LCNSs.
    • A wide-spread flagellate dermatitis

      Rabindranathnambi, Rangarajan (2013-06)
      A 45-year-old gentleman presented with an intensely itchy, widespread eruption which had been present for 5 days. He was otherwise fit and well. On examination there was a florid, erythematous, papular, flagellate rash over the trunk and limbs. The gentleman had eaten shiitake mushrooms 10 days earlier. The diagnosis was shiitake dermatitis and the rash settled spontaneously.
    • A year in politics: An update on political influences on rheumatology and its trainees

      Deighton, Chris (2012-05)
      The Health and Social Care Bill sets the triple challenge for the English NHS of the greatest changes in the history of the organization, at a rapid pace (in spite of the pause for the Futures Forum), and against the backdrop of having to save 20 billion by 2015. Furthermore, there is an expectation that the new NHS will have patients at the centre of the reforms, with commissioning driven by quality and outcomes, and that integration which will be achieved across primary and specialist care even though increasing commercialization will be encouraged. Rheumatologists cannot be complacent, because if they are not instrumental in assisting changes to their service to meet these challenges, then changes will inevitably be imposed on them, and in a fashion which may be unpalatable, and potentially decrease the quality of their service. We will present two viewpoints, first from Dr Alan Nye, GP, President Elect of the Primary Care Rheumatology Society and Director of Pennine MSK Partnership which provides community based rheumatology services in Oldham, and Dr Chris Deighton, consultant rheumatologist Royal Derby Hospital and President Elect of the BSR. At the time of writing, it is difficult to predict what the impact of these reforms will be in 6 months time, particularly with the world economy in crisis. These talks will give up-to-date overviews of * The reforms and impact on specialist musculoskeletal care generally and rheumatology particularly: * Examples of where this is working well * Examples of where there are still challenges * What the BSR is doing to influence the process and assist rheumatologists * Tactics for ensuring that integrated care is promoted * Tactics for ensuring that care is patient centred, and quality and outcomes driven * Tactics to demonstrate a specialist service is cost effective At the end of these talks it is hoped that all attendees will better appreciate the challenges that rheumatology faces, but be inspired by the opportunities, and the progress that colleagues have already made around the country.
    • Young adults with Type 1 diabetes: A retrospective observational single-centre study

      Wilmot, Emma; Eaglesfield, Beverley; Idris, Iskandar (2017-03)
      Aims: A retrospective review of clinical outcomes for young adults with Type 1 diabetes from the East Midlands was conducted in 2003. We aimed to explore whether glycaemic control in young adults had improved in 2016. In paediatric diabetes the Best Practice Tariff has been associated with a reduction in HbA1c. Methods: Patients aged 18-25 years with Type 1 diabetes attending Derby Teaching Hospitals were included. Data were collected retrospectively from case notes and computer records on glycaemic control, the prevalence of complications, clinic and structured education attendance. Results: A total of 127 patients were included in this analysis. Mean age of patients was similar between the 2016 and 2003 cohorts (20.9 +/- 2.6 vs 20.3 +/- 2.6 years) but duration of diabetes was less in 2016 (7.9 +/- 5.6 vs 10.0 +/- 5.6 years). Mean HbA1c levels were unchanged between the two cohorts at 80mmol/mol (9.5%) for both. Within the present cohort 4.3% and 12.8% achieved an HbA1c target of < 48mmol/mol (6.5%) and < 58mmol/ mol (7.5%) respectively. The majority used MDI therapy (85%, n = 108), followed by insulin pump therapy (9%, n = 11). Only 6% (n = 4) were on a twice daily mixed insulin. One fifth were DAFNE graduates (20.6%, n = 27). DNA rate was 31.3%. Of those screened, half had retinopathy (48%, n = 42). Conclusion: In contrast to the paediatric population and despite the use of intensified insulin therapy, insulin pumps and DAFNE, glycaemic control in young adults with Type 1 diabetes remains poor. Extension of the Best Practice Tariff to those < 25 years may benefit outcomes in this cohort.