1
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Laico M, Forbes T, Noble H, Sharma S, Greer S, Woywodt A. Beautiful and effective: what art can do for nephrologists and for our patients. Nephrol Dial Transplant 2024; 39:564-568. [PMID: 37873677 DOI: 10.1093/ndt/gfad228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Indexed: 10/25/2023] Open
Affiliation(s)
| | - Trisha Forbes
- School of Nursing and Midwifery Queens University Belfast, Belfast, UK
| | - Helen Noble
- School of Nursing and Midwifery Queens University Belfast, Belfast, UK
| | | | - Stephen Greer
- Artist and transplant recipient, Bangor, Northern Ireland, UK
| | - Alexander Woywodt
- Renal Unit, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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2
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Wu HHL, Leung WY, Ponnusamy A, Woywodt A. Using Digital Health Interventions to Promote Prehabilitation Prior to Kidney Transplantation. Prog Transplant 2024:15269248241237824. [PMID: 38500365 DOI: 10.1177/15269248241237824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
- Henry H L Wu
- Renal Research, Kolling Institute of Medical Research, Royal North Shore Hospital & The University of Sydney, St. Leonards, NSW, Australia
| | - Wing-Yin Leung
- Department of Renal Medicine, Lancashire Teaching Hospitals, NHS Foundation Trust, Preston, Lancashire, UK
| | - Arvind Ponnusamy
- Department of Renal Medicine, Lancashire Teaching Hospitals, NHS Foundation Trust, Preston, Lancashire, UK
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Alexander Woywodt
- Department of Renal Medicine, Lancashire Teaching Hospitals, NHS Foundation Trust, Preston, Lancashire, UK
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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3
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Moore L, Balmer F, Woywodt A. The environmental impact of changing to virtual renal transplant aftercare: 2-year experience with a single outpatient clinic. Future Healthc J 2024; 11:100004. [PMID: 38646053 PMCID: PMC11025045 DOI: 10.1016/j.fhj.2024.100004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Affiliation(s)
- Louise Moore
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, U.K
| | - Frances Balmer
- Sustainability Fellow, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, U.K
| | - Alexander Woywodt
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, U.K
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4
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Woywodt A, Matteson EL. Viewpoint: What's in a name: a reflection 20 years later. Rheumatology (Oxford) 2024; 63:261-263. [PMID: 37589568 DOI: 10.1093/rheumatology/kead411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 08/18/2023] Open
Affiliation(s)
- Alexander Woywodt
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Eric L Matteson
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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5
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Leung WY, Wu HHL, Woywodt A, Ponnusamy A. Prophylactic ultra-low dose rituximab to maintain remission in relapsing adult minimal change disease. Clin Kidney J 2024; 17:sfad270. [PMID: 38186892 PMCID: PMC10768774 DOI: 10.1093/ckj/sfad270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Indexed: 01/09/2024] Open
Affiliation(s)
- Wing Yin Leung
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
| | - Henry H L Wu
- Renal Research, Kolling Institute of Medical Research, Royal North Shore Hospital & The University of Sydney, Sydney, NSW, Australia
| | - Alexander Woywodt
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
- Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
| | - Arvind Ponnusamy
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
- Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
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6
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Stauss M, Floyd L, Woywodt A. Weighing up Open Access Publishing in Nephrology-Bronze, Platinum, or Fools' Gold? Kidney360 2023; 4:1637-1640. [PMID: 37853553 PMCID: PMC10695644 DOI: 10.34067/kid.0000000000000282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023]
Affiliation(s)
- Madelena Stauss
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
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7
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Affiliation(s)
- Alexander Woywodt
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK
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8
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Morris AD, Floyd L, Woywodt A, Dhaygude A. Rituximab in the treatment of primary FSGS: time for its use in routine clinical practice? Clin Kidney J 2023; 16:1199-1205. [PMID: 37529639 PMCID: PMC10387384 DOI: 10.1093/ckj/sfad122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Indexed: 08/03/2023] Open
Abstract
Focal segmental glomerulosclerosis (FSGS) is a common cause of nephrotic syndrome and whilst advances have been made in the pathophysiology, diagnostics and management of other podocytopathies, primary FSGS remains the most elusive. It has been assumed for a long time that a circulatory permeability factor exists that mediates podocyte injury, and the potential for autoantibody-mediated disease therefore raises the question as to whether patients may benefit from targeted B-cell therapy with rituximab. The prospective case series of seven patients by Roccatello et al. adds to the limited but growing evidence suggesting that B-cell depletion therapy can be safe and effective in the treatment of primary FSGS. In this editorial we explore the available evidence that suggests how and in whom rituximab may play a role in the management of primary FSGS, as well as the limitations and other potential future treatments. Further research and randomized controlled trials are needed to include larger numbers of patients, feature genetic screening and incorporate data on B-cell kinetics as a potential guide for dosing and frequency of rituximab.
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Affiliation(s)
| | - Lauren Floyd
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Alexander Woywodt
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Ajay Dhaygude
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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9
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McAdams-DeMarco MA, Thind AK, Nixon AC, Woywodt A. Frailty assessment as part of transplant listing: yes, no or maybe? Clin Kidney J 2023; 16:809-816. [PMID: 37151416 PMCID: PMC10157764 DOI: 10.1093/ckj/sfac277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Indexed: 12/31/2022] Open
Abstract
Frailty, characterized by a decreased physiological reserve and an increased vulnerability to stressors, is common among kidney transplant (KT) candidates and recipients. In this review, we present and summarize the key arguments for and against the assessment of frailty as part of KT evaluation. The key arguments for including frailty were: (i) sheer prevalence and far-reaching consequences of frailty on KT, and (ii) the ability to conduct a more holistic and objective evaluation of candidates, removing the inaccuracy associated with 'eye-ball' assessments of transplant fitness. The key argument against were: (i) lack of agreement on the definition of frailty and which tools should be used in renal populations, (ii) a lack of clarity on how, by whom and how often frailty assessments should be performed, and (iii) a poor understanding of how acute stressors affect frailty. However, it is the overwhelming opinion that the time has come for frailty assessments to be incorporated into KT listing. Although ongoing areas of uncertainty exist and further evidence development is needed, the well-established impact of frailty on clinical and experiential outcomes, the invaluable information obtained from frailty assessments, and the potential for intervention outweigh these limitations. Proactive and early identification of frailty allows for individualized and improved risk assessment, communication and optimization of candidates.
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Affiliation(s)
- Mara A McAdams-DeMarco
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, USA
| | - Amarpreet K Thind
- Division of Immunology and Inflammation, Department of Medicine, Centre for Inflammatory Disease, Imperial College London, London, UK
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Manchester, UK
| | - Andrew C Nixon
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Alexander Woywodt
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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10
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Elsayed ME, Schick B, Woywodt A, Palmer BF. The hypokalaemia that came from the cold. Clin Kidney J 2023; 16:768-772. [PMID: 37151424 PMCID: PMC10157748 DOI: 10.1093/ckj/sfad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Indexed: 03/09/2023] Open
Abstract
While electrolyte disorders are common in nephrologists' clinical practice, hypothermia is a condition that nephrologists rarely encounter. Hypothermia can induce several pathophysiological effects on the human body, including hypokalaemia, which is reversible with rewarming. Despite growing evidence from animal research and human studies, the underlying mechanisms of hypothermia-induced hypokalaemia remain unclear. Boubes and colleagues recently presented a case series of hypokalaemia during hypothermia and rewarming, proposing a novel hypothesis for the underlying mechanisms. In this editorial, we review the current knowledge about hypothermia and associated electrolyte changes with insights into the effects of hypothermia on renal physiology.
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Affiliation(s)
- Mohamed E Elsayed
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
| | - Benedikt Schick
- Department of Anaesthesiology and Intensive Care Medicine, Ulm University Medical Centre, Ulm, Germany
| | - Alexander Woywodt
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
| | - Biff F Palmer
- Department of Internal Medicine, Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, USA
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11
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Wu HH, Woywodt A, Nixon AC, Tennankore KK. Prescribing Immunosuppressive Treatment for Older People with Glomerular Diseases: Time to Assess Frailty? Kidney360 2023; 4:e530-e533. [PMID: 36859365 PMCID: PMC10278775 DOI: 10.34067/kid.0000000000000095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/02/2023] [Indexed: 03/03/2023]
Affiliation(s)
- Henry H.L. Wu
- Renal Research, Kolling Institute of Medical Research, Royal North Shore Hospital & The University of Sydney, Sydney, Australia
| | - Alexander Woywodt
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, United Kingdom
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, United Kingdom
| | - Andrew C. Nixon
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, United Kingdom
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, United Kingdom
| | - Karthik K. Tennankore
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, Canada
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12
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Mesic E, Aleckovic-Halilovic M, Paunovic K, Woywodt A, Pjanic M, Paunovic G. COVID - 19 in two dialysis centers situated in two neighbouring states of the Western Balkans. BMC Nephrol 2023; 24:40. [PMID: 36803693 PMCID: PMC9938731 DOI: 10.1186/s12882-023-03080-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/06/2023] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND Bosnia and Herzegovina (BiH) and Serbia are countries in the Western Balkans that share parts of their social and political legacy from the former Yugoslavia, such as their health care system and the fact that they are not members of European Union. There are very scarce data on COVID - 19 pandemic from this region when compared to other parts of the world and even less is known about its impact on the provision of renal care or differences between countries in the Western Balkans. MATERIALS AND METHODS This observational prospective study was conducted in two regional renal centres in BiH and Serbia, during the COVID - 19 pandemic. We obtained demographic and epidemiological data, clinical course and outcomes of dialysis and transplant patients with COVID - 19 in both units. Data were collected a via questionnaire for two consecutive time periods: February - June 2020 with a total number of 767 dialysis and transplant patients in the two centres, and July - December 2020 with a total number of 749 studied patients, corresponding to two of the largest waves of the pandemic in our region. Departmental policies and infection control measures in both units were also recorded and compared. RESULTS For a period of 11 months, from February to December 2020, 82 patients on in-centre haemodialysis (ICHD), 11 peritoneal dialysis patients and 25 transplant patients who tested positive for COVID-19. In the first study period, the incidence of COVID - 19 positive in Tuzla was 1.3% among ICHD patients, and there were no positive peritoneal dialysis patients, or any transplant patients who tested positive. The incidence of COVID-19 was significantly higher in both centres in the second time period, which corresponds to the incidence in general population. Total deaths of COVID-19 positive patients was 0% in Tuzla and 45.5% in Niš during first, and 16.7% in Tuzla and 23.4% in Niš during the second period. There were notable differences in the national and local/departmental approach to the pandemic between the two centres. CONCLUSION There was poor survival overall when compared to other regions of Europe. We suggest that this reflects the lack of preparedness of both of our medical systems for such situations. In addition, we describe important differences in outcome between the two centres. We emphasize the importance of preventative measures and infection control and highlight the importance of preparedness.
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Affiliation(s)
- Enisa Mesic
- Department of Nephrology, Dialysis and Transplantation, University Hospital Tuzla, Ulica Prof. Dr. Ibre Pašića, 75000 Tuzla, Bosnia and Herzegovina
| | - Mirna Aleckovic-Halilovic
- Department of Nephrology, Dialysis and Transplantation, University Hospital Tuzla, Ulica Prof. Dr. Ibre Pašića, 75000 Tuzla, Bosnia and Herzegovina
| | - Karolina Paunovic
- grid.418653.d0000 0004 0517 2741Nephrology Department, Niš Clinical Centre, Niš, Serbia
| | - Alexander Woywodt
- grid.440181.80000 0004 0456 4815Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire UK
| | - Mirha Pjanic
- Department of Nephrology, Dialysis and Transplantation, University Hospital Tuzla, Ulica Prof. Dr. Ibre Pašića, 75000, Tuzla, Bosnia and Herzegovina.
| | - Goran Paunovic
- grid.418653.d0000 0004 0517 2741Nephrology Department, Niš Clinical Centre, Niš, Serbia
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13
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Stauss M, Htay H, Kooman JP, Lindsay T, Woywodt A. Wearables in Nephrology: Fanciful Gadgetry or Prêt-à-Porter? Sensors (Basel) 2023; 23:1361. [PMID: 36772401 PMCID: PMC9919296 DOI: 10.3390/s23031361] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
Telemedicine and digitalised healthcare have recently seen exponential growth, led, in part, by increasing efforts to improve patient flexibility and autonomy, as well as drivers from financial austerity and concerns over climate change. Nephrology is no exception, and daily innovations are underway to provide digitalised alternatives to current models of healthcare provision. Wearable technology already exists commercially, and advances in nanotechnology and miniaturisation mean interest is also garnering clinically. Here, we outline the current existing wearable technology pertaining to the diagnosis and monitoring of patients with a spectrum of kidney disease, give an overview of wearable dialysis technology, and explore wearables that do not yet exist but would be of great interest. Finally, we discuss challenges and potential pitfalls with utilising wearable technology and the factors associated with successful implementation.
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Affiliation(s)
- Madelena Stauss
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK
| | - Htay Htay
- Department of Renal Medicine, Singapore General Hospital, Singapore 169608, Singapore
| | - Jeroen P. Kooman
- Department of Internal Medicine, Division of Nephrology, Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Thomas Lindsay
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK
| | - Alexander Woywodt
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK
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14
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Storrar J, Kudose S, Woywodt A. Have we missed AINything? Acute interstitial nephritis in SARS-CoV-2 infection and vaccination. Clin Kidney J 2022; 15:1643-1652. [PMID: 35999962 PMCID: PMC9213847 DOI: 10.1093/ckj/sfac147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Acute interstitial nephritis (AIN), defined by the presence of interstitial inflammation accompanied by tubulitis, is an often overlooked cause of acute kidney injury (AKI). It is now well established that SARS-CoV-2 infection can cause a wide variety of kidney injuries, most commonly acute tubular injury and collapsing glomerulopathy. In comparison, AIN is rarely documented in association with SARS-CoV-2 both anecdotally and in larger series of autopsy or biopsy studies. In this issue of the Journal, León-Román describe 5 cases of AIN in patients with a history of COVID-19 and highlight AIN as a possibly under-reported or ignored facet of renal disease associated with SARS-CoV-2. They describe three scenarios in which AIN can be seen: 1) SARS-CoV-2 infection after diagnosis of AIN, 2) AIN followed by SARS-CoV-2 infection in the same admission and 3) Severe SARS-CoV-2 and AIN possibly associated with SARS-CoV-2 itself. Overall, AIN remains rare in SARS-CoV-2 and causality is difficult to ascertain. Interestingly, AIN is not only seen in association with the disease itself but also with SARS-CoV-2 vaccination. This scenario is equally rare and causality is no less difficult to prove. A history of preceding SARS-CoV-2 infection and vaccination should be actively sought when patients present with otherwise unexplained AIN.
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Affiliation(s)
- Joshua Storrar
- Department of Nephrology, Northern Care Alliance NHS Foundation Trust, Salford Royal Hospital, Salford, UK
| | - Satoru Kudose
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, NY, NY, USA
| | - Alexander Woywodt
- Correspondence to: Alexander Woywodt; E-mail: ; Twitter handle: @Pwoywodt
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15
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Stauss M, Keevil B, Woywodt A. Point-of-Care Testing: Home Is Where the Lab Is. Kidney360 2022; 3:1285-1288. [PMID: 35919524 PMCID: PMC9337901 DOI: 10.34067/kid.0000942022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/06/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Madelena Stauss
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Brian Keevil
- Department of Biochemistry, Manchester University Foundation Trust, Wythenshawe, Manchester, United Kingdom
| | - Alexander Woywodt
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
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16
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Affiliation(s)
- Gerren Hobby
- Department of Nephrology, NEA Baptist Clinic, Jonesboro, AR, USA
| | - Rebecca Clark
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
| | - Alexander Woywodt
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
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17
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Floyd L, Stauss M, Woywodt A. Is open access a misnomer? Lancet 2022; 399:1226. [PMID: 35339224 DOI: 10.1016/s0140-6736(22)00107-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/12/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Lauren Floyd
- Department of Renal Medicine, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, PR2 9HT, UK.
| | - Madelena Stauss
- Department of Renal Medicine, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, PR2 9HT, UK
| | - Alexander Woywodt
- Department of Renal Medicine, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, PR2 9HT, UK
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18
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Wu HHL, Alozai A, Li JWC, Elmowafy A, Ponnusamy A, Woywodt A, Jeyalan V. Risk Factors of Venous Thromboembolism in Anti-PLA2R positive and negative Primary Membranous Nephropathy. Clin Kidney J 2022; 15:1636-1638. [PMID: 35892019 PMCID: PMC9308090 DOI: 10.1093/ckj/sfac052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Henry H L Wu
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
- Faculty of Biology, Medicine and Health, The University of Manchester, UK
| | - Abdur Alozai
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
| | - Jennifer W C Li
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
| | - Ahmed Elmowafy
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
| | - Arvind Ponnusamy
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
- Faculty of Biology, Medicine and Health, The University of Manchester, UK
| | - Alexander Woywodt
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
- Faculty of Biology, Medicine and Health, The University of Manchester, UK
| | - Vishnu Jeyalan
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
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19
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Floyd L, Morris AD, Woywodt A, Dhaygude A. Cardiovascular disease and ANCA-associated vasculitis: Are we missing a beat? Clin Kidney J 2022; 15:618-623. [PMID: 35371453 PMCID: PMC8967680 DOI: 10.1093/ckj/sfac009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Indexed: 11/21/2022] Open
Abstract
The association between cardiovascular (CV) disease and anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is well documented. The recent work by Massicotte-Azarniouch et al. confirms the risk and adds to the existing evidence by describing the highest risk in the first 3 months after diagnosis. In this review, we aim to put their findings into perspective and formulate implications for the care of AAV patients. We discuss mechanisms for increased CV disease in AAV, including the impact of traditional risk factors and disease-related risks such as renal impairment and anti-myeloperoxidase (MPO) ANCA serotype. We also provide a brief primer on the impact of inflammatory-driven endothelial dysfunction and platelet activation on accelerated atherosclerosis in AAV patients. These features alongside the impact of disease activity and systemic inflammation provide potential explanations to why the incidence of CV events is highest in the first 3 months from diagnosis. We suggest future avenues of research, provide some suggestions to address and treat CV risk based on current evidence, and highlight the importance of addressing this topic early on. Addressing modifiable risk factors, dialogue with patients, patient information and a structured approach overall will be key to improve CV outcomes in AAV.
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Affiliation(s)
- Lauren Floyd
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Adam D Morris
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Alexander Woywodt
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Ajay Dhaygude
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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Stauss M, Dhaygude A, Ponnusamy A, Myers M, Woywodt A. Remote Digital Urinalysis With Smartphone Technology as Part of Remote Management of Glomerular Disease During the SARS-CoV-2 Virus Pandemic: Single Centre Experience in 25 Patients. Clin Kidney J 2021; 15:903-911. [PMID: 35498887 PMCID: PMC9050594 DOI: 10.1093/ckj/sfab286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Indexed: 11/14/2022] Open
Abstract
Background The COVID-19 pandemic has necessitated the provision of healthcare through remote and increasingly digitalized means. The management of glomerular pathology, for which urinalysis is crucial, has been notably affected. Here we describe our single-centre experience of using remote digital urinalysis in the management of patients with glomerular disease during the COVID-19 pandemic. Method All patients with native kidney glomerular disease who consented to participate in digital smartphone urinalysis monitoring between March 2020 and July 2021 were included. Electronic health records were contemporaneously reviewed for outcome data. Patient feedback was obtained through the testing portal. Results Twenty-five patients utilized the digital urinalysis application. A total of 105 digital urinalysis tests were performed for a wide variety of indications. Four patients experienced a relapse (detected remotely) and two patients underwent three successful pregnancies. The majority of patients were managed virtually (60%) or virtually and face to face (F2F) combined (32%). The average number of clinic reviews and urine tests performed during the pandemic either virtually and/or F2F was comparable to levels pre-pandemic and the ratio of reviews to urinalysis (R:U) was stable (pre-pandemic 1:0.9 versus during the pandemic 1:0.8). Patients seen exclusively F2F with supplementary home monitoring had the highest R:U ratio at 1:2.1. A total of 95% of users provided feedback, all positive. Conclusion Remote urinalysis proved a safe and convenient tool to facilitate decision-making where traditional urinalysis was difficult, impractical or impossible. Our approach allowed us to continue care in this vulnerable group of patients despite a lack of access to traditional urinalysis.
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Affiliation(s)
- Madelena Stauss
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
- Division of Medical Education, School of Medical Sciences, University of Manchester
| | - Ajay Dhaygude
- Division of Medical Education, School of Medical Sciences, University of Manchester
| | - Arvind Ponnusamy
- Division of Medical Education, School of Medical Sciences, University of Manchester
| | - Martin Myers
- Department of Clinical Biochemistry, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Alexander Woywodt
- Division of Medical Education, School of Medical Sciences, University of Manchester
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21
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Wu HHL, Li JWC, Bow A, Woywodt A, Ponnusamy A. Acute interstitial nephritis following SARS-CoV-2 vaccination. Clin Kidney J 2021; 15:576-581. [PMID: 35211313 PMCID: PMC8862040 DOI: 10.1093/ckj/sfab253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Henry H L Wu
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Jennifer W C Li
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Andrew Bow
- Department of Renal Medicine, North Cumbria Integrated Care NHS Foundation Trust, Carlisle, UK
| | - Alexander Woywodt
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Arvind Ponnusamy
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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22
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Spiers HVM, Sharma V, Woywodt A, Sivaprakasam R, Augustine T. Robot-assisted kidney transplantation: an update. Clin Kidney J 2021; 15:635-643. [PMID: 35371439 PMCID: PMC8967665 DOI: 10.1093/ckj/sfab214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Indexed: 11/14/2022] Open
Abstract
Renal transplantation has become the gold-standard treatment for the majority of patients with established renal failure. Recent decades have seen significant progress in immunosuppressive therapies and advances in post-transplant management of recipients, resulting in improved graft and patient outcomes. However, the open technique of allograft implantation has stood the test of time, remaining largely unchanged. In a world where major advances in surgery have been facilitated by innovations in the fields of biotechnology and medical instrumentation, minimally invasive options have been introduced for the recipient undergoing kidney transplantation. In this review we present the evolution of minimally invasive kidney transplantation, with a specific focus on robot-assisted kidney transplant and the benefits it offers to specific patient groups. We also discuss the ethical concerns that must be addressed by transplant teams considering developing or referring to robotic programs.
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Affiliation(s)
- Harry V M Spiers
- Department of Transplantation, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Videha Sharma
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
- Faculty of Biology, Medicine and Health, Centre for Health Informatics, Division of Informatics, Imaging and Data Science, University of Manchester, Manchester, UK
| | - Alexander Woywodt
- Department of Renal Medicine, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Rajesh Sivaprakasam
- Department of Transplant and Robotic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Titus Augustine
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
- Faculty of Biology, Medicine and Health, Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
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23
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Kumar M, van Dellen D, Loughton H, Woywodt A. Time to press the reset button-can we use the COVID-19 pandemic to rethink the process of transplant assessment? Clin Kidney J 2021; 14:2137-2141. [PMID: 34603690 PMCID: PMC8344542 DOI: 10.1093/ckj/sfab118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Indexed: 11/24/2022] Open
Abstract
Coronavirus disease 2019 has taken a severe toll on the transplant community, with significant morbidity and mortality not just among transplant patients and those on the waiting list, but also among colleagues. It is therefore not surprising that clinicians in this field have viewed the events of the last 18 months as predominantly negative. As the pandemic is gradually ebbing away, we argue that this is also a unique opportunity to rethink transplant assessment. First, we have witnessed a step-change in the use of technology and virtual assessments. Another effect of the pandemic is that we have had to make do with what was available-which has often worked surprisingly well. Finally, we have learned to think the unthinkable: maybe things do not have to continue the way they have always been. As we emerge on the other side of the pandemic, we should rethink which parts of the transplant assessment process are necessary and evidence-based. We emphasize the need to involve patients in the redesign of pathways and we argue that the assessment process could be made more transparent to patients. We describe a possible roadmap towards transplant assessment pathways that are truly fit for the 21st century.
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Affiliation(s)
- Mukesh Kumar
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - David van Dellen
- Manchester Centre for Transplantation, Manchester University NHS Foundation Trust, Manchester, UK
- University of Manchester, Manchester, UK
| | | | - Alexander Woywodt
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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24
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Wu H, Rushton L, Biggins F, Woywodt A, Ahmed A. MO1039HEALTH PROFESSIONAL PERSPECTIVES OF FRAILTY STATUS EVALUATION DURING PRE-TRANSPLANT ASSESSMENT. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab109.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
The concept of frailty has garnered increased attention within nephrology in recent years, and there is increased debate on how frailty assessment could be utilized to inform shared decision-making around renal transplantation. A gold standard framework for frailty status workup in pre-transplant assessment remains unestablished. There are significant variations from the methods conducted by clinicians to determine frailty status during pre-transplant assessment. Our study aims to explore the perspectives of nephrology health professionals on frailty assessment in the pre-transplant clinic.
Method
A 5-item online survey was designed and sent through electronic mail to nephrology consultants, specialist registrars and specialist renal transplant nurses at a tertiary hospital in North West UK. Prior to survey distribution, the final edition was piloted by the authors. Study participants were given 3 weeks during Nov and Dec 2020 to respond. The survey was closed on 16 December 2020. In question 1, respondents are requested to comment on their current practices of frailty assessment in the pre-transplant clinic. Question 2 asked respondents to provide opinion whether frailty screening assessment tools - the Clinical Frailty Scale (CFS) and Fatigue, Resistance, Ambulation, Illnesses and Loss of Weight (FRAIL) questionnaire are useful to help with decisions on patient suitability to progress with pre-transplant assessment. In question 3, respondents are asked to use the CFS and/or FRAIL questionnaire to provide score(s) if applicable, in which they feel a patient would be contraindicated to progress further in pre-transplant assessment. Question 4 asked respondents to share their opinion on whether frailty assessment should be formalized in pre-transplant clinic. Question 5 requested respondents to comment how pre-transplant frailty assessment could be further developed. Survey results were imported into a MS Excel Spreadsheet for analysis. Simple descriptive statistics were used for categorical data. Free text responses were grouped into themes and analyzed using simple qualitative techniques.
Results
31 staff members (16 consultants, 10 specialty registrars and 5 specialist renal transplant nurses) were invited to participate in the survey. 26 responses were received by 16 December 2020. 96% (25/26) of respondents commented that medical history gathered on a patient’s ability to perform activities of daily living is the main source used to obtain a general impression and estimate frailty status in the pre-transplant clinic. For 81% (21/26) of respondents, observation of mobility in clinic is also useful to help them determine a patient’s frailty status. While 85% (22/26) of respondents felt the FRAIL questionnaire was not suitable for pre-transplant assessment, 96% (25/26) of respondents agreed that the CFS is an appropriate and applicable frailty screening tool in this context. 92% (24/26) of respondents concur that a CFS score of 6 or higher suggests contraindication for renal transplantation. All 26 respondents agreed that frailty status evaluation should be a formalized process to determine suitability for transplant waitlisting. Popular suggestions to develop frailty assessment in pre-transplant clinic include setting up a frailty multidisciplinary team and frailty scoring system specific for pre-transplant assessment.
Conclusion
Our survey results suggest nephrology health professionals continue to rely heavily on medical history to evaluate frailty status. Incorporating frailty screening assessment tools such as the CFS prior to comprehensive geriatric assessment may be an option to assist shared decision-making of whether to proceed with next steps of the pre-transplant assessment. Future research initiatives could explore ways towards a systematic approach to frailty status workup and improve cost-effectiveness of the pre-transplant evaluation process.
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Affiliation(s)
- Henry Wu
- Lancashire Teaching Hospitals NHS Foundation Trust, Department of Renal Medicine , Preston, United Kingdom
- University of Manchester, Faculty of Medical and Human Sciences, Manchester, United Kingdom
| | - Lyndsey Rushton
- Lancashire Teaching Hospitals NHS Foundation Trust, Department of Renal Medicine , Preston, United Kingdom
| | - Fiona Biggins
- Lancashire Teaching Hospitals NHS Foundation Trust, Department of Renal Medicine , Preston, United Kingdom
| | - Alexander Woywodt
- Lancashire Teaching Hospitals NHS Foundation Trust, Department of Renal Medicine , Preston, United Kingdom
- University of Manchester, Faculty of Medical and Human Sciences, Manchester, United Kingdom
| | - Aimun Ahmed
- Lancashire Teaching Hospitals NHS Foundation Trust, Department of Renal Medicine , Preston, United Kingdom
- University of Manchester, Faculty of Medical and Human Sciences, Manchester, United Kingdom
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25
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Sharma V, Piscoran O, Summers A, Woywodt A, van der Veer SN, Ainsworth J, Augustine T. The use of health information technology in renal transplantation: A systematic review. Transplant Rev (Orlando) 2021; 35:100607. [PMID: 33607425 DOI: 10.1016/j.trre.2021.100607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/04/2021] [Accepted: 02/06/2021] [Indexed: 10/22/2022]
Abstract
Renal transplantation is a complex, multi-disciplinary and cross-center service. Clinical pathways naturally traverse specialty and organizational boundaries as patients transition from chronic kidney disease to renal failure and ultimately transplantation. Health information technology (IT) has the potential to support transplant care by improving access to data, information sharing and communication. This novel review aimed to identify and characterize health IT solutions in renal transplantation, and where possible evaluate any intended benefits. A systematic literature review was conducted of studies covering any part of the clinical pathway, with end-users being clinical staff or patients. Interventions were characterized and evaluated for achieved benefits using the World Health Organization (WHO) Classification of Digital Health Interventions and the mixed methods assessment tool (MMAT) was used to determine the quality of experimental studies. Of 4498 articles, 12 descriptive and 6 experimental studies met the inclusion criteria. Median MMAT percentage score of experimental studies was 64 (i.q.r. 57 to 74.8). The most frequent functionality of technology involved overcoming communication roadblocks and improving access to data. Intended benefits included improving information management and supporting workflow, however only one study reported evaluated results. Six patient-facing applications that primarily addressed adherence-to-treatment were identified, five of which were evaluated for intended benefits, showing overall positive results. Overall, despite transplantation being well suited to health IT interventions, this review demonstrates a scarcity of literature in this field. A small number of clinician- and patient-facing IT solutions have been reported, albeit mostly in non-experimental studies. Due to this lack of formal evaluation, the effectiveness of solutions remains unclear. High-quality evaluative studies are required to develop effective IT solutions that improve clinical care.
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Affiliation(s)
- Videha Sharma
- Manchester University Hospitals NHS Foundation Trust, Department of Renal and Pancreatic Transplantation, Manchester Academic Health Science Centre, Manchester, Greater Manchester, M13 9WL, UK; Centre for Health Informatics, Division of Informatics, Imaging and Data Science, University of Manchester Faculty of Biology, Medicine and Health, Manchester, Greater Manchester, M13 9PT, UK.
| | - Oana Piscoran
- Manchester University Hospitals NHS Foundation Trust, Department of Renal and Pancreatic Transplantation, Manchester Academic Health Science Centre, Manchester, Greater Manchester, M13 9WL, UK
| | - Angela Summers
- Manchester University Hospitals NHS Foundation Trust, Department of Renal and Pancreatic Transplantation, Manchester Academic Health Science Centre, Manchester, Greater Manchester, M13 9WL, UK; University of Manchester Faculty of Biology, Medicine and Health, Division of Diabetes, Endocrinology and Gastroenterology, Manchester, Greater Manchester, M13 9PT, UK
| | - Alexander Woywodt
- Lancashire Teaching Hospitals NHS Foundation Trust, Department of Nephrology, Royal Preston Hospital, Preston, Lancashire, PR2 9HT, UK
| | - Sabine N van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, University of Manchester Faculty of Biology, Medicine and Health, Manchester, Greater Manchester, M13 9PT, UK
| | - John Ainsworth
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, University of Manchester Faculty of Biology, Medicine and Health, Manchester, Greater Manchester, M13 9PT, UK
| | - Titus Augustine
- Manchester University Hospitals NHS Foundation Trust, Department of Renal and Pancreatic Transplantation, Manchester Academic Health Science Centre, Manchester, Greater Manchester, M13 9WL, UK; University of Manchester Faculty of Biology, Medicine and Health, Division of Diabetes, Endocrinology and Gastroenterology, Manchester, Greater Manchester, M13 9PT, UK
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26
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Stauss M, Floyd L, Becker S, Ponnusamy A, Woywodt A. Opportunities in the cloud or pie in the sky? Current status and future perspectives of telemedicine in nephrology. Clin Kidney J 2021; 14:492-506. [PMID: 33619442 PMCID: PMC7454484 DOI: 10.1093/ckj/sfaa103] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Indexed: 12/15/2022] Open
Abstract
The use of telehealth to support, enhance or substitute traditional methods of delivering healthcare is becoming increasingly common in many specialties, such as stroke care, radiology and oncology. There is reason to believe that this approach remains underutilized within nephrology, which is somewhat surprising given the fact that nephrologists have always driven technological change in developing dialysis technology. Despite the obvious benefits that telehealth may provide, robust evidence remains lacking and many of the studies are anecdotal, limited to small numbers or without conclusive proof of benefit. More worryingly, quite a few studies report unexpected obstacles, pitfalls or patient dissatisfaction. However, with increasing global threats such as climate change and infectious disease, a change in approach to delivery of healthcare is needed. The current pandemic with coronavirus disease 2019 (COVID-19) has prompted the renal community to embrace telehealth to an unprecedented extent and at speed. In that sense the pandemic has already served as a disruptor, changed clinical practice and shown immense transformative potential. Here, we provide an update on current evidence and use of telehealth within various areas of nephrology globally, including the fields of dialysis, inpatient care, virtual consultation and patient empowerment. We also provide a brief primer on the use of artificial intelligence in this context and speculate about future implications. We also highlight legal aspects and pitfalls and discuss the 'digital divide' as a key concept that healthcare providers need to be mindful of when providing telemedicine-based approaches. Finally, we briefly discuss the immediate use of telenephrology at the onset of the COVID-19 pandemic. We hope to provide clinical nephrologists with an overview of what is currently available, as well as a glimpse into what may be expected in the future.
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Affiliation(s)
- Madelena Stauss
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Lauren Floyd
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Stefan Becker
- DaVita Dialysis Centre Duisburg, Duisburg, Germany
- Department of Nephrology, University Hospital Essen, Essen, Germany
| | - Arvind Ponnusamy
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Alexander Woywodt
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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27
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Morris AD, Rowbottom AW, Martin FL, Woywodt A, Dhaygude AP. Biomarkers in ANCA-Associated Vasculitis: Potential Pitfalls and Future Prospects. Kidney360 2021; 2:586-597. [PMID: 35369011 PMCID: PMC8785998 DOI: 10.34067/kid.0006432020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/18/2021] [Indexed: 02/04/2023]
Abstract
Over the past 3 decades, significant advancements in the understanding of the pathophysiology of ANCA-associated vasculitis has led to the development of a multitude of potential candidate biomarkers. Accompanied by the advent of increasingly effective therapeutic strategies, the need for a dependable biomarker to help determine the extent of disease activity and risk of relapse is ever present. Implementation of such a biomarker would enable tailored therapy, optimizing disease control while helping to mitigate unnecessary exposure to therapy and potential treatment-related damage. Although far from perfect, ANCA serology and B-cell population are the two main staple biomarker tools widely used in practice to help supplement clinical assessment. Over recent years, the application and progress of more novel biomarker tools have arisen in both organ-limited and multisystem disease, including genomics, urinary proteins, degradation products of the alternative complement system, cytokines, metabolomics, and biospectroscopy. Validation studies and clinical translation of these tools are required, with serial assessment of disease activity and determination of therapy according to biomarker status correlated with patient outcomes.
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Affiliation(s)
- Adam D. Morris
- Renal Medicine, Royal Preston Hospital, Preston, United Kingdom
| | - Anthony W. Rowbottom
- Department of Immunology, Royal Preston Hospital, Preston, United Kingdom,School of Medicine, University of Central Lancashire, Preston, United Kingdom
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28
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Boss K, Woywodt A, Kribben A, Mülling N, Becker S. Digitale Nephrologie. Nephrologe 2021; 16:57-61. [PMID: 33425034 PMCID: PMC7784214 DOI: 10.1007/s11560-020-00478-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/08/2020] [Indexed: 10/31/2022]
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29
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Stauss M, Breed H, Chatfield K, Madhavi P, Zelhof B, Woywodt A. Bedside teaching during the COVID-19 pandemic. Clin Teach 2020; 18:367-369. [PMID: 33319476 DOI: 10.1111/tct.13322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Madelena Stauss
- Department of Undergraduate Medical Education, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Hetty Breed
- Intercalating Medical Student, University of Manchester, Manchester, UK
| | - Kate Chatfield
- Centre for Professional Ethics, University of Central Lancashire, Preston, UK
| | - Paladugu Madhavi
- Department of Undergraduate Medical Education, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Bachar Zelhof
- Department of Urology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Alexander Woywodt
- Department of Undergraduate Medical Education, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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30
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Woywodt A, Forman L, Hawes C, Singh M, Thomson Y, Paladugu M. Paper‐based signatures for attendance verification. Clin Teach 2020; 17:560-562. [DOI: 10.1111/tct.13139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Alexander Woywodt
- Undergraduate Medical Education Lancashire Teaching Hospitals NHS Foundation Trust Preston UK
- Renal Medicine Lancashire Teaching Hospitals NHS Foundation Trust Preston UK
| | - Louise Forman
- Undergraduate Medical Education Lancashire Teaching Hospitals NHS Foundation Trust Preston UK
| | - Claudia Hawes
- Undergraduate Medical Education Lancashire Teaching Hospitals NHS Foundation Trust Preston UK
| | - Manjinder Singh
- Renal Medicine Lancashire Teaching Hospitals NHS Foundation Trust Preston UK
| | - Yvonne Thomson
- Undergraduate Medical Education Lancashire Teaching Hospitals NHS Foundation Trust Preston UK
| | - Madhavi Paladugu
- Undergraduate Medical Education Lancashire Teaching Hospitals NHS Foundation Trust Preston UK
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31
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Wu HH, Woywodt A, Nixon AC. Frailty and the Potential Kidney Transplant Recipient: Time for a More Holistic Assessment? Kidney360 2020; 1:685-690. [PMID: 35372945 PMCID: PMC8815542 DOI: 10.34067/kid.0001822020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/22/2020] [Indexed: 06/14/2023]
Affiliation(s)
- Henry H.L. Wu
- Department of Renal Medicine, Lancashire Teaching Hospitals National Health Service Foundation Trust, Royal Preston Hospital, Preston, United Kingdom
- Faculty of Medical and Human Sciences, University of Manchester, Manchester, United Kingdom
| | - Alexander Woywodt
- Department of Renal Medicine, Lancashire Teaching Hospitals National Health Service Foundation Trust, Royal Preston Hospital, Preston, United Kingdom
- Faculty of Medical and Human Sciences, University of Manchester, Manchester, United Kingdom
| | - Andrew C. Nixon
- Department of Renal Medicine, Lancashire Teaching Hospitals National Health Service Foundation Trust, Royal Preston Hospital, Preston, United Kingdom
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
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32
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Aleckovic-Halilovic M, Pjanic M, Mesic E, Storrar J, Woywodt A. From quail to earthquakes and human conflict: a historical perspective of rhabdomyolysis. Clin Kidney J 2020; 14:1088-1096. [PMID: 33841854 DOI: 10.1093/ckj/sfaa075] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/13/2020] [Indexed: 12/19/2022] Open
Abstract
Rhabdomyolysis is a common cause of acute kidney injury, featuring muscle pain, weakness and dark urine and concurrent laboratory evidence of elevated muscle enzymes and myoglobinuria. Rhabdomyolysis is often seen in elderly and frail patients following prolonged immobilization, for example after a fall, but a variety of other causes are also well-described. What is unknown to most physicians dealing with such patients is the fascinating history of rhabdomyolysis. Cases of probable rhabdomyolysis have been reported since biblical times and during antiquity, often in the context of poisoning. Equally interesting is the link between rhabdomyolysis and armed conflict during the 20th century. Salient discoveries regarding the pathophysiology, diagnosis and treatment were made during the two world wars and in their aftermath. 'Haff disease', a form of rhabdomyolysis first described in 1920, has fascinated scientists and physicians alike, but the marine toxin causing it remains enigmatic even today. As a specialty, we have also learned a lot about the disease from 20th-century earthquakes, and networks of international help and cooperation have emerged. Finally, rhabdomyolysis has been described as a sequel to torture and similar forms of violence. Clinicians should be aware that rhabdomyolysis and the development of renal medicine are deeply intertwined with human history.
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Affiliation(s)
- Mirna Aleckovic-Halilovic
- Department of Nephrology, Dialysis and Transplantation, University Hospital Tuzla, Tuzla, Bosnia and Herzegovina
| | - Mirha Pjanic
- Department of Nephrology, Dialysis and Transplantation, University Hospital Tuzla, Tuzla, Bosnia and Herzegovina
| | - Enisa Mesic
- Department of Nephrology, Dialysis and Transplantation, University Hospital Tuzla, Tuzla, Bosnia and Herzegovina
| | - Joshua Storrar
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Alexander Woywodt
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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Abstract
This article was migrated. The article was marked as recommended. Coronavirus disease 2019 (COVID-19) has influenced undergraduate medical education in various ways already. In affected countries, educators and their teams were faced with a rapidly changing situation that made traditional ways of curriculum delivery impossible and required alternative approaches. Exams have also been affected and a cohort of students has graduated early and now joins the workforce. There is also concern for the next academic year should the pandemic last longer. In this paper we aim to describe wider implications of the pandemic beyond current curriculum delivery, exams and planning. We describe how our own clinical and educational environment has been utterly transformed within weeks and speculate how much these changes will persist after the pandemic. We also describe student concerns and introduce the thought that the pandemic may have positive long term effects as well. Finally, we speculate how COVID-19 may affect student recruitment, multi-professional learning and the current and future undergraduates' view of the profession. Our aim is to share our experience in the UK, reflect on the direction and magnitude of change seen in our own local and regional practice, and provide food for thought for educators and their teams who find themselves in a similar situation.
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Singh H, Thomson Y, Paladugu M, Wood N, Woywodt A. Integrating suitability for teaching into an electronic health record - A novel and versatile tool for medical education. MedEdPublish (2016) 2020; 8:126. [PMID: 38089349 PMCID: PMC10712509 DOI: 10.15694/mep.2019.000126.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
This article was migrated. The article was marked as recommended. The educational literature has noted the implications of electronic health records (EHR) for patient care and discussed various implications for the learner-teacher relationship but it has so far not viewed EHR as an educational tool. We wondered whether we could use EHR to facilitate undergraduate medical students' exposure to hospital in-patients with an interesting history or findings on clinical examination. As clinicians, we encounter such patients on a regular basis during ward rounds and referrals but students are often absent during these encounters, leading to a loss of learning opportunities. Our aim was therefore to harness the EHR and create an electronic "flag" that would, following consent, document suitable inpatients and thus maximise the students' exposure to patients who present learning opportunities. With help from our IT department we developed a simple add on to our existing EHR that allows any clinician to electronically highlight and document such patients during inpatient encounters. A member of the educational faculty can, whenever required, interrogate the EHR for the presence of inpatients with interesting findings on examination in the hospital and facilitate contact with our medical students. We report details of our approach, describe early experience and potential pitfalls and suggest future applications.
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Affiliation(s)
- Himanshu Singh
- Lancashire Teaching Hospitals NHS Foundation Trust
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - Yvonne Thomson
- Lancashire Teaching Hospitals NHS Foundation Trust
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - Madhavi Paladugu
- Lancashire Teaching Hospitals NHS Foundation Trust
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - Nick Wood
- Lancashire Teaching Hospitals NHS Foundation Trust
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - Alexander Woywodt
- Lancashire Teaching Hospitals NHS Foundation Trust
- Lancashire Teaching Hospitals NHS Foundation Trust
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Woywodt A, Meier M, Kaiser D, Schneider G, Haller H, Hiss M. In-Center Intermittent Peritoneal Dialysis: Retrospective Ten-Year Single-Center Experience with Thirty Consecutive Patients. Perit Dial Int 2020. [DOI: 10.1177/089686080802800516] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BackgroundIn-center intermittent peritoneal dialysis (IPD) is sometimes performed in elderly and multimorbid patients that have failed hemodialysis and that are unable to perform peritoneal dialysis (PD) at home. Complications, frequency of hospital admission, and survival are often claimed to be dismal although current data are lacking.MethodsWe performed a retrospective cohort study of patients that underwent IPD at Hannover Medical School, Germany, between 1997 and 2007. Underlying renal disorders, comorbidity, and circumstances that precluded hemodialysis and home PD were recorded. Survival, cause of death, episodes of hospitalization, and episodes of peritonitis were calculated. Laboratory values at baseline and after 3 months of IPD were also retrieved.ResultsWe identified 30 patients with severe comorbidity (median Charlson Comorbidity Index of 6; n = 30) who underwent IPD for 439 months in total. The majority of patients had vascular/hypertensive nephropathy ( n = 12; 40%); congestive heart failure was the leading cause for choosing PD ( n = 13; 43.3%); 73.3% of our patients had either no partner or at least one disease that precluded home therapy. Hospitalization rate was 1.39 admissions per patient-year and there was 1 episode of peritonitis per 48.8 IPD-months. Mean survival was 26.6 months (median 17 months; n = 30); sepsis was the leading cause of death ( n = 13; 59.1%).ConclusionsIPD is associated with fewer episodes of peritonitis, fewer admissions, and longer survival than is often believed. Suitable patients in whom palliative care alone seems inappropriate should not be denied a trial of IPD if they so choose.
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Affiliation(s)
- Alexander Woywodt
- Division of Nephrology, Department of Medicine, Hannover Medical School, Hannover, Germany
| | - Matthias Meier
- Division of Nephrology, Department of Medicine, Hannover Medical School, Hannover, Germany
| | - Doris Kaiser
- Division of Nephrology, Department of Medicine, Hannover Medical School, Hannover, Germany
| | - Gabriele Schneider
- Division of Nephrology, Department of Medicine, Hannover Medical School, Hannover, Germany
| | - Hermann Haller
- Division of Nephrology, Department of Medicine, Hannover Medical School, Hannover, Germany
| | - Marcus Hiss
- Division of Nephrology, Department of Medicine, Hannover Medical School, Hannover, Germany
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Storrar J, Woywodt A, Arunachalam C. AIN’t got no easy answers: recent advances and ongoing controversies around acute interstitial nephritis. Clin Kidney J 2019. [DOI: 10.1093/ckj/sfz138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Abstract
Acute interstitial nephritis (AIN) is a common cause of acute kidney injury that was first described in 1898. It is most commonly caused by drugs and infections, although other aetiologies are implicated. Here we review two papers published in this issue of Clinical Kidney Journal and provide an update on current advances and controversies relating to AIN. Nussbaum and Perazella describe the diagnostic tools (namely urinary and serum biomarkers) available for AIN and highlight that there is no single test that can accurately predict the diagnosis. As such, renal biopsy remains the gold standard. Wendt et al. present findings from a 20-year retrospective study of biopsy-proven AIN. They found that a high degree of inflammation was associated with a greater chance of renal recovery, in contrast to the presence of cortical scars, which were associated with a worse outcome. There was also a significant number who required renal replacement therapy. They advocate the use of a scoring system for AIN to help direct management. We also discuss new drugs associated with AIN (in particular new anticancer drugs) and unusual forms including granulomatous AIN. Finally, we discuss the opportunities for future research and how this may impact clinical practice.
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Affiliation(s)
- Joshua Storrar
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Alexander Woywodt
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Cheralathan Arunachalam
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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Singh H, Thomson Y, Paladugu M, Wood N, Woywodt A. Integrating suitability for teaching into an electronic health record - A novel and versatile tool for medical education. MedEdPublish 2019. [DOI: 10.15694/mep.2019.000126.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This article was migrated. The article was not marked as recommended. The educational literature has noted the implications of electronic health records (EHR) for patient care and discussed various implications for the learner-teacher relationship but it has so far not viewed EHR as an educational tool. We wondered whether one could use EHR to facilitate undergraduate medical students' exposure to hospital in-patients with an interesting history or findings on clinical examination. As clinicians, we encounter such patients on a regular basis during ward rounds and referrals but students are often absent during these encounters, leading to a loss of learning opportunities. Our aim was therefore to harness the EHR and create an electronic "flag" that would, following verbal consent, document suitable inpatients and thus maximise the students' exposure to interesting findings on clinical examination. With help from our IT department we developed a simple add on to our existing EHR that allows any clinician to electronically highlight and document such patients during inpatient encounters. A member of the educational faculty can, whenever required, interrogate the EHR for the presence of inpatients with interesting findings on examination in the hospital and facilitate contact with our medical students. We report details of our approach, describe early experience and potential pitfalls and suggest future applications.
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Nixon AC, Bampouras TM, Pendleton N, Woywodt A, Mitra S, Dhaygude A. Frailty and chronic kidney disease: current evidence and continuing uncertainties. Clin Kidney J 2018; 11:236-245. [PMID: 29644065 PMCID: PMC5888002 DOI: 10.1093/ckj/sfx134] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 10/16/2017] [Indexed: 12/12/2022] Open
Abstract
Frailty, the state of increased vulnerability to physical stressors as a result of progressive and sustained degeneration in multiple physiological systems, is common in those with chronic kidney disease (CKD). In fact, the prevalence of frailty in the older adult population is reported to be 11%, whereas the prevalence of frailty has been reported to be greater than 60% in dialysis-dependent CKD patients. Frailty is independently linked with adverse clinical outcomes in all stages of CKD and has been repeatedly shown to be associated with an increased risk of mortality and hospitalization. In recent years there have been efforts to create an operationalized definition of frailty to aid its diagnosis and to categorize its severity. Two principal concepts are described, namely the Fried Phenotype Model of Physical Frailty and the Cumulative Deficit Model of Frailty. There is no agreement on which frailty assessment approach is superior, therefore, for the time being, emphasis should be placed on any efforts to identify frailty. Recognizing frailty should prompt a holistic assessment of the patient to address risk factors that may exacerbate its progression and to ensure that the patient has appropriate psychological and social support. Adequate nutritional intake is essential and individualized exercise programmes should be offered. The acknowledgement of frailty should prompt discussions that explore the future care wishes of these vulnerable patients. With further study, nephrologists may be able to use frailty assessments to inform discussions with patients about the initiation of renal replacement therapy.
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Affiliation(s)
- Andrew C Nixon
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | | | - Neil Pendleton
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Alexander Woywodt
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Sandip Mitra
- Manchester Academy of Health Sciences Centre and NIHR Devices for Dignity, Health Technology Cooperative, Manchester, UK
| | - Ajay Dhaygude
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
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Affiliation(s)
- Alexander Woywodt
- Department of Surgery, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Gauteng Province, Republic of South Africa.
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Aleckovic-Halilovic M, Zelhof B, Solomon L, Ahmed A, Woywodt A. Screening for prostate cancer in renal transplant candidates: Single-centre experience over 10 years. Journal of Clinical Urology 2017. [DOI: 10.1177/2051415817693994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: The purpose of this article is to report 10 years of single-centre experience with prostate cancer screening in renal transplant candidates. Patients and methods: This is a single-centre retrospective analysis of results of prostate cancer screening as a part of renal pre-transplant workup. We included all male patients suitable for transplant workup over 10 years. Patients with persistently elevated prostate specific antigen were considered for prostate biopsy. Biopsy results, treatment data and short-term outcomes for patients diagnosed with prostate cancer were collected. Results: We identified 542 patients with a mean age of 52 years. Thirty-one (5.7%) patients were referred to a urologist. Twenty-three (74%) of those referred were biopsied. Histological findings for 10 biopsies (44%) were normal, three (13%) had prostatic intraepithelial neoplasm and nine patients (39%) had invasive adenocarcinoma. One case (4%) was inconclusive. All patients with a normal biopsy proceeded with pre-transplant workup. Out of nine patients diagnosed with prostate cancer, five were transplant listed, two were receiving treatment and two were subsequently deceased. Conclusion: Prostate specific antigen screening with repeat testing and the use of age-adjusted normal values led to the diagnosis of prostate cancer that had major implications for transplant listing. For the majority of cancers the diagnosis did not deny transplant surgery to patients but only delayed listing for transplant.
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Affiliation(s)
- Mirna Aleckovic-Halilovic
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, UK
- Department of Nephrology, Dialysis and Transplantation, University Clinical Hospital Tuzla, Bosnia and Herzegovina
| | - Bachar Zelhof
- Department of Urology, Lancashire Teaching Hospitals NHS Foundation Trust, UK
| | - Laurie Solomon
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, UK
| | - Aimun Ahmed
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, UK
| | - Alexander Woywodt
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, UK
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Nixon A, Ogden L, Woywodt A, Dhaygude A. Infectious complications of rituximab therapy in renal disease. Clin Kidney J 2017; 10:455-460. [PMID: 28852481 PMCID: PMC5570071 DOI: 10.1093/ckj/sfx038] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/10/2017] [Indexed: 11/29/2022] Open
Abstract
Rituximab, an anti-CD20 monoclonal antibody, was originally used to treat B-cell malignancies. Its use has significantly increased in recent years, as it is now also used to treat a variety of autoimmune diseases including rheumatoid arthritis and ANCA-associated vasculitis (AAV). Initial studies suggested that the adverse effects of rituximab were minimal. Though the risk of malignancy with rituximab-based immunosuppressive regimens appears similar to that of the general population, there are now concerns regarding the risk of infectious complications. Rituximab has been associated with serious infections, including Pneumocystis jiroveci pneumonia (PJP) and the reactivation of hepatitis B virus (HBV) and tuberculosis (TB). The risk of infection appears to be the result of a variety of mechanisms, including prolonged B-cell depletion, B-cell–T-cell crosstalk, panhypogammaglobulinaemia, late-onset neutropenia and blunting of the immune response after vaccination. Importantly, the risk of infectious complications is also related to individual patient characteristics and the indication for rituximab. Individualization of treatment is, therefore, crucial. Particular attention should be given to strategies to minimize the risk of infectious complications, including vaccinating against bacterial and viral pathogens, monitoring white cell count and immunoglobulin levels, prophylaxis against PJP and screening for HBV and TB.
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Affiliation(s)
- Andrew Nixon
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Leanne Ogden
- Department of Renal Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Alexander Woywodt
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Ajay Dhaygude
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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Hossain M, Woywodt A, Augustine T, Sharma V. Obesity and listing for renal transplantation: weighing the evidence for a growing problem. Clin Kidney J 2017; 10:703-708. [PMID: 28979783 PMCID: PMC5622900 DOI: 10.1093/ckj/sfx022] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 02/24/2017] [Indexed: 12/20/2022] Open
Abstract
A 56-year-old female patient was referred to the transplant assessment clinic in July 2016. She started haemodialysis in 2012 for renal failure due to urinary tract infections. She is doing very well on dialysis and has an excellent exercise tolerance without shortness of breath or angina. She has had no infections since starting dialysis and no other comorbidity, except well-controlled hypertension and hyperparathyroidism requiring treatment with cinacalcet. Clinical examination is essentially normal except for truncal obesity with height 167 cm and weight 121 kg, giving her a body mass index of 43.4. Can she be listed for a renal transplant? If not, which target weight should be given to the patient before she can be transplant listed? Which interventions, if any, should be recommended to achieve weight loss?
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Affiliation(s)
- Mohammed Hossain
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Alexander Woywodt
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Titus Augustine
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Videha Sharma
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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Cartwright K, Madhavi P, Kazemi-Jovestani K, Maxwell S, Wilson M, Woywodt A. Twelve Tips to implement Curriculum Changes in times of Economic Austerity. MedEdPublish (2016) 2017; 6:47. [PMID: 38406442 PMCID: PMC10885242 DOI: 10.15694/mep.2017.000047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Curriculum change is a recurring challenge facing most educational teams. Economic austerity has an impact on these processes in that clinical workloads increase and additional funds to drive curriculum change are lacking. We faced significant challenges having to implement substantial changes to the Year 3 and 4 undergraduate curricula in a large teaching hospital in the United Kingdom. The changes are now implemented successfully and we have taken the opportunity to identify factors that allowed us to drive change and achieve our aims. Much has been written about curriculum change as an academic challenge but comparatively little is known about how to drive such change on the ground and strategies to drive curriculum change during times of ongoing financial austerity are lacking. Here, we reflect on our experience and provide tips for educational teams on how to turn change into an opportunity, despite economic austerity and ever-increasing clinical workload.
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Khan N, Jovestani K, Spencer C, Man R, Pugh M, Woywodt A. Twelve tips on how to establish a new undergraduate firm on a critical care unit. Med Teach 2017; 39:244-249. [PMID: 28024427 DOI: 10.1080/0142159x.2017.1266314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Little is known about undergraduate teaching in critical care unit (CrCU) and many undergraduate curricula lack placements in CrCU. AIMS To describe how our CrCU succeeded in developing a novel placement for Year 3 undergraduate medical students. METHODS Particular emphasis was placed on a robust timetable incorporating a variety of activities, a dedicated and thorough induction, and a mix of teaching methods such as formal and informal, consultant-led, and skills. Services allied to CrCU were also utilized. RESULTS Our new firm has exceeded all expectations and, based on student feedback, received the "Firm of the Year" award for several years in succession. It now serves as a model of undergraduate teaching in our hospital. CONCLUSIONS Educationalists and intensivists should work together to unlock the full potential of this rich learning environment. Professional societies in critical care medicine should take the opportunity to develop more interest in undergraduate medical education.
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Affiliation(s)
- Nasser Khan
- a Department of Intensive Care Medicine , Lancashire Teaching Hospitals NHS Foundation Trust , Preston , UK
| | - Keiarash Jovestani
- a Department of Intensive Care Medicine , Lancashire Teaching Hospitals NHS Foundation Trust , Preston , UK
- b Undergraduate Medical Education , Lancashire Teaching Hospitals NHS Foundation Trust , Preston , UK
| | - Craig Spencer
- a Department of Intensive Care Medicine , Lancashire Teaching Hospitals NHS Foundation Trust , Preston , UK
| | - Raymond Man
- a Department of Intensive Care Medicine , Lancashire Teaching Hospitals NHS Foundation Trust , Preston , UK
| | - Mark Pugh
- a Department of Intensive Care Medicine , Lancashire Teaching Hospitals NHS Foundation Trust , Preston , UK
- b Undergraduate Medical Education , Lancashire Teaching Hospitals NHS Foundation Trust , Preston , UK
| | - Alexander Woywodt
- b Undergraduate Medical Education , Lancashire Teaching Hospitals NHS Foundation Trust , Preston , UK
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Newton K, Lewis H, Pugh M, Paladugu M, Woywodt A. Twelve tips for turning quality assurance data into undergraduate teaching awards: A quality improvement and student engagement initiative. Med Teach 2017; 39:141-146. [PMID: 27832725 DOI: 10.1080/0142159x.2016.1248912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Data on teaching awards in undergraduate medical education are sparse. The benefits of an awards system may seem obvious at first glance. However, there are also potential problems relating to fairness, avoidance of bias, and alignment of the awards system with a wider strategy for quality improvement and curriculum development. Here, we report five- year single center experience with establishing undergraduate teaching awards in a large academic teaching hospital. Due to lack of additional funding we based our awards not on peer review but mainly on existing and very comprehensive quality assurance (QA) data. Our 12 tips describe practical points but also pitfalls with awards categories and criteria, advertising and disseminating the awards, the actual awards ceremony and finally embedding the awards in the hospital's wider strategy. To be truly successful, teaching awards and prizes need to be carefully considered, designed and aligned with a wider institutional strategy of rewarding enthusiastic educators.
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Affiliation(s)
- Kate Newton
- a Department of Undergraduate Medical Education , Lancashire Teaching Hospitals NHS Foundation Trust , Preston , UK
| | - Helen Lewis
- a Department of Undergraduate Medical Education , Lancashire Teaching Hospitals NHS Foundation Trust , Preston , UK
| | - Mark Pugh
- a Department of Undergraduate Medical Education , Lancashire Teaching Hospitals NHS Foundation Trust , Preston , UK
| | - Madhavi Paladugu
- a Department of Undergraduate Medical Education , Lancashire Teaching Hospitals NHS Foundation Trust , Preston , UK
| | - Alexander Woywodt
- a Department of Undergraduate Medical Education , Lancashire Teaching Hospitals NHS Foundation Trust , Preston , UK
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Aleckovic-Halilovic M, Nel D, Woywodt A. Granulomatous interstitial nephritis: a chameleon in a globalized world. Clin Kidney J 2015; 8:511-5. [PMID: 26413274 PMCID: PMC4581397 DOI: 10.1093/ckj/sfv092] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 08/31/2015] [Indexed: 02/05/2023] Open
Affiliation(s)
- Mirna Aleckovic-Halilovic
- Department of Nephrology, Dialysis and Transplantation , University Clinical Hospital Tuzla , Tuzla , Bosnia and Herzegovina
| | - Debbie Nel
- University of Cape Town , Cape Town , South Africa
| | - Alexander Woywodt
- Department of Renal Medicine , Lancashire Teaching Hospitals NHS Foundation Trust , Preston, Lancashire , UK
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Abstract
The role of the problem-based learning (PBL) facilitator has seen different interpretations ever since PBL first gained widespread use. What has remained unchanged is the challenge for facilitators to use their knowledge and expertise sparingly and to use their interpersonal skills to improve group dynamics. Medical undergraduates attending PBL sessions have also changed in their skill sets, expectations and the use of technology. Based on the published literature and a recent faculty workshop, we provide PBL facilitators and institutions with 12 tips on how to make PBL more vibrant and interesting. We discuss our tips with reference to published literature and International Academy of Medical Education (AMEE) guidance. Our tips help students to engage with PBL, avoid monotony and make this teaching format more vibrant and fun for all involved. Introducing greater variety to the PBL process may also help with group dynamics by catering for a broader audience with different learning styles.
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Affiliation(s)
- Sarah J Wood
- a The University of Manchester , UK
- b Lancashire Teaching Hospitals NHS Foundation Trust , UK
- c Royal Manchester Children's Hospital , UK
| | | | - Mark Pugh
- b Lancashire Teaching Hospitals NHS Foundation Trust , UK
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Affiliation(s)
- Roshni Rathore
- Department of Renal Medicine , Lancashire Teaching Hospitals NHS Foundation Trust , Preston, Lancashire , UK
| | - Robert A Coward
- Department of Renal Medicine , Lancashire Teaching Hospitals NHS Foundation Trust , Preston, Lancashire , UK
| | - Alexander Woywodt
- Department of Renal Medicine , Lancashire Teaching Hospitals NHS Foundation Trust , Preston, Lancashire , UK
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Nazir T, Wallis S, Higham J, Newton K, Pugh M, Woywodt A. How we established a new undergraduate firm on a Medical Admissions Unit. Med Teach 2014; 36:940-944. [PMID: 24593270 DOI: 10.3109/0142159x.2014.886769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Medical Admission Units (MAUs) were introduced in the UK in the 1980s primarily driven by a governance and service improvement agenda. In the UK this has led to the development of Acute Medicine as a specialty in its own right, together with a strong role of this specialty in postgraduate teaching. In contrast, the role of MAUs, if any, in undergraduate medical education is currently unclear. Prompted by an expansion of our undergraduate student numbers, our aim was to establish a Year 3 undergraduate firm on a 33-bedded MAU in a large academic teaching hospital in the National Health Service (NHS). Despite initial scepticism from clinicians, managers, and educators, the new firm placement on MAU became an instant success and continues to attract excellent feedback from our Year 3 undergraduate students. Students enjoy the bedside teaching with a high percentage of consultant-delivered teaching and also liked the involvement of Foundation Doctors. Here, we report our experience on how to make such a firm work, based on student feedback and the tutors' experience. We provide an overview and a step-by-step guide of how to construct a successful new undergraduate firm on a busy MAU. We also discuss opportunities and challenges and discuss the relevant literature. We conclude that undergraduate teaching is feasible and rewarding in an extremely busy MAU setting. We note that identifying enthusiastic educators within the MAU team, utilisation of peripheral learning opportunities, structured timetables and induction, and a robust framework for quality assurance are all crucial to success.
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Affiliation(s)
- Tahir Nazir
- Lancashire Teaching Hospitals NHS Foundation Trust , UK
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Thanaraj V, Topping K, Cheesbrough J, Woywodt A. A day in the zoo. Clin Kidney J 2014; 7:318-9. [PMID: 25852899 PMCID: PMC4377745 DOI: 10.1093/ckj/sfu023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 02/20/2014] [Indexed: 11/14/2022] Open
Affiliation(s)
- Vijay Thanaraj
- Department of Renal Medicine , Lancashire Teaching Hospitals NHS Foundation Trust , Preston, Lancashire , UK
| | - Kate Topping
- Department of Renal Medicine , Lancashire Teaching Hospitals NHS Foundation Trust , Preston, Lancashire , UK
| | - John Cheesbrough
- Department of Renal Medicine , Lancashire Teaching Hospitals NHS Foundation Trust , Preston, Lancashire , UK
| | - Alexander Woywodt
- Department of Renal Medicine , Lancashire Teaching Hospitals NHS Foundation Trust , Preston, Lancashire , UK
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