Shared Decision Making

So what’s the problem? Well, patients in England now say they are being seen quickly – a major improvement from only 5 years ago: they also still have a high level of trust in their doctors but they’re getting less information about medicines than previously and do not feel involved in decisions about their treatments.We don’t yet have data from primary care about the discussions that take place...

Q & A: Transplant work up costs

Q: Dear Donal, I would be grateful for guidance on this which has some bearing on the (otherwise welcome) recent proposals for more explicit remuneration of dialysis services. There is a potential serious funding shortfall likely to occur in non-transplanting renal centres, who currently bear the cost of transplant work up and follow up from savings from the HD budget. I have discussed this at a...

STOP PRESS: Raised urinary albumin predicts death

Two simple tests of kidney function and damage predict total and cardiovascular mortality risk in a wide range of populations according to a systematic analysis of 21 studies including more than 1.2 million participants in Europe, USA, Australia and Asia. One measure estimates the kidneys’ filtration function (the eGFR) using a blood test and the other estimates kidney damage using a urine test...

Driving up quality while encouraging innovation? Yes we can!

Quality in healthcare has moved centre stage in the past few years. Quality healthcare isn’t just about treating diseases, it’s about treating people and indeed populations with or at risk of disease. Quality can be defined, it can be measured and it can be improved. The Institute of Medicine , in 2001 , proposed 6 specific aims for improvement. Healthcare should be: safe, effective,...

Q & A: Asylum seekers who need dialysis

Q: Dear Donal, I would be grateful for guidance on this issue. In recent years, and perhaps as a function of the proximity of Yarls Wood detention centre and Luton and Stansted airports, we are seeing increasing numbers of foreign asylum and residency seekers with established renal failure presenting for dialysis. The problem is however that these people are not entilted to full NHS services,...

What the future may hold for kidney care

“Prediction is very difficult, especially about the future” Niels Bohr.We live in changing times and there is much talk of uncertainty. Globally healthcare demands are rising and in the UK the bank bail out has left our government with a large debt one consequence of which is reduced public service finance. The Kings Fund has predicted that the National Health Service will have to make 26...

Can there be too much patient empowerment?

Listening to patients and carers always brings new insights. Many patients on home dialysis are real experts and can troubleshoot many of the problems they encounter often having had years of experience. Some have built up a network of patient colleagues that they can bounce ideas off, that’s one thing we should certainly encourage.However, a sense of isolation can also often be heard in the...