Developing a Novel Dialysis Educational Resource for Nephrology Fellows:  The Vital Signs of Dialysis Karla N. Vital, MD A...
Background <ul><li>Dialysis: renal replacement therapy used when kidney function is lost </li></ul><ul><li>Comprised of se...
Nephrology Fellowship Program <ul><li>Two-year fellowship after completion of Internal Medicine residency program </li></u...
Web-based resources <ul><li>Numerous web-based resources exist for healthcare professionals specialized in kidney disease ...
Vital Signs of Dialysis <ul><li>Educational resource that covers the basics of dialysis </li></ul><ul><li>Extremely portab...
Research Questions <ul><li>Does this resource make learning about dialysis easier? </li></ul><ul><li>Does the utility of t...
Table of Contents <ul><li>1)  Indications for Dialysis </li></ul><ul><li>2)  Vascular Access for Dialysis </li></ul><ul><l...
Table of Contents <ul><li>8)  Dialysis Complications (Acute/Chronic) </li></ul><ul><li>9)  Nutrition & Other Special Consi...
(2) Vascular Access <ul><li>Arteriovenous Fistula is the preferred access  </li></ul><ul><li>Fistula First campaign </li><...
(2) Vascular Access <ul><li>AV graft (synthetic) </li></ul><ul><li>Ready for use in 2-3 weeks </li></ul><ul><li>Useful  if...
(2) Vascular Access <ul><li>Tunneled Dialysis Catheter into tip of Right Atrium (Permcath) </li></ul><ul><li>Used as tempo...
(10) Frequently Used Calculations <ul><li>URR  = (1 – {post dialysis BUN /predialysis BUN}) </li></ul><ul><li>Free H20 Def...
(11) Physician Resources <ul><li>Downloadable GFR Calculators at  www.nkdep.nih.gov/professionals/gfrcalculators </li></ul...
(12) Patient Education Resources <ul><li>Information & free resources on kidney disease & dialysis   </li></ul><ul><li>htt...
Methodology <ul><li>A confidence assessment questionnaire </li></ul><ul><ul><li>assess user-rated improvements upon comple...
Sample Questionnaire <ul><li>Overall, this resource was useful to my learning </li></ul><ul><li>This resource was a useful...
Sample Questionnaire <ul><li>This resource was too comprehensive </li></ul><ul><li>This resource was more useful than othe...
Evaluation <ul><li>The confidence assessment questionnaire will be administered annually, at the completion of the first a...
Considerations <ul><li>Small sample size  </li></ul><ul><li>Variation of knowledge base  between 1 st - and 2 nd -year fel...
Suggestions to Date <ul><li>Nephrology Phone Number and Pager List </li></ul><ul><li>Kidney Biopsy Assembly List </li></ul...
Conclusions <ul><li>Preliminary data will be available when the graduating fellows complete their clinical duties in June ...
The Evolution
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  • -especially references to existing literature concerning indications for dialysis and benefits specific to each modality -
  • when facing new and increased clinical responsibilities
  • . All fellows have access to web-based, printed materials, and lectures. It can often be overwhelming to determine what are appropriate resources to forward to patients and to look for information.
  • The questions I sought to answer by undertaking this project are the following:
  • Create fistulas in all eligible hd patients goals for AVF use (50% incidence; 40% prevalence As of January 2006, the prevalent rate is 41%.
  • Typically gortex / PTFE
  • Websites with information on kidney disease, dialysis methods, and free books/brochures
  • The scale is named after Rensis Likert , who published a report describing its use (Likert, 1932). the most widely used scale in survey research.
  • This resource is presently only available in print, but soon will be available in PDA format. This will allow faster revisions and updates of new data
  • Overall, the initial feedback has been excellent and has even brought out a few suggestions into broadening the scope of this project
  • The Kolff-Brigham dialyser in 1950, a modified version of the original rotating drum kidney. Willem Kolff who had performed the first successful human dialysis in Holland in 1943. Blood ran through cellophane tubing wound around the central drum which rotated in a temperature-controlled bath containing 100 litres of dialysing fluid. vs. NxStage System One, the first truly portable hemodialysis system cleared for home use
  • Developing a Novel Dialysis Educational Resource for ...

    1. 1. Developing a Novel Dialysis Educational Resource for Nephrology Fellows: The Vital Signs of Dialysis Karla N. Vital, MD Assistant Professor, Department of Internal Medicine Associate Director, Nephrology Fellowship Program University of Texas Medical Branch, Galveston
    2. 2. Background <ul><li>Dialysis: renal replacement therapy used when kidney function is lost </li></ul><ul><li>Comprised of several different modalities </li></ul><ul><li>Subject of dialysis not typically emphasized during medical school or residency </li></ul><ul><li>Nephrology Fellows asked for pocket-sized references to help guide them in the area of dialysis </li></ul>
    3. 3. Nephrology Fellowship Program <ul><li>Two-year fellowship after completion of Internal Medicine residency program </li></ul><ul><li>Five fellows at a time, alternating between two and three new fellows annually </li></ul><ul><li>Trainees with diverse background - from institutions throughout the country and overseas </li></ul><ul><li>Beginning Fellows often experience apprehension </li></ul>
    4. 4. Web-based resources <ul><li>Numerous web-based resources exist for healthcare professionals specialized in kidney disease </li></ul><ul><li>Organizations provide online tools for: </li></ul><ul><ul><li>frequently used calculations </li></ul></ul><ul><ul><li>patient education </li></ul></ul><ul><ul><li>links to current practice guidelines </li></ul></ul><ul><li>Overwhelming to determine appropriate resources for patients and physicians </li></ul>
    5. 5. Vital Signs of Dialysis <ul><li>Educational resource that covers the basics of dialysis </li></ul><ul><li>Extremely portable </li></ul><ul><li>Details the various dialysis modalities </li></ul><ul><li>Discusses issues unique to patients with kidney failure </li></ul><ul><li>Highlights recommended web-based resources for further review </li></ul>
    6. 6. Research Questions <ul><li>Does this resource make learning about dialysis easier? </li></ul><ul><li>Does the utility of this tool differ depending on the user’s stage of training? </li></ul><ul><li>Is the portability of this resource a feature that distinguishes it from other pre-existing tools? </li></ul><ul><li>Does this resource improve the fellows self- reported level of confidence? </li></ul>
    7. 7. Table of Contents <ul><li>1) Indications for Dialysis </li></ul><ul><li>2) Vascular Access for Dialysis </li></ul><ul><li>3) Hemodialysis </li></ul><ul><li>4) Peritoneal Dialysis </li></ul><ul><li>5) Home Hemodialysis </li></ul><ul><li>6) Slow Dialysis Modalities / CVVHD </li></ul><ul><li>7) Sample Dialysis Prescriptions </li></ul>
    8. 8. Table of Contents <ul><li>8) Dialysis Complications (Acute/Chronic) </li></ul><ul><li>9) Nutrition & Other Special Considerations </li></ul><ul><li>10) Frequently Used Calculations </li></ul><ul><li>11) Web Resources for Physicians </li></ul><ul><li>12) Patient Education Resources </li></ul>
    9. 9. (2) Vascular Access <ul><li>Arteriovenous Fistula is the preferred access </li></ul><ul><li>Fistula First campaign </li></ul><ul><li>Surgical connection between an artery and a vein </li></ul><ul><li>Lowest complication rate </li></ul><ul><li>6-12 week maturation time </li></ul>
    10. 10. (2) Vascular Access <ul><li>AV graft (synthetic) </li></ul><ul><li>Ready for use in 2-3 weeks </li></ul><ul><li>Useful if veins prohibit AV fistula development </li></ul><ul><li>More infections than AV fistulas, but less than permanent catheters </li></ul><ul><li>Tend to clot more often than AV fistulas </li></ul>
    11. 11. (2) Vascular Access <ul><li>Tunneled Dialysis Catheter into tip of Right Atrium (Permcath) </li></ul><ul><li>Used as temporary Access or if permanent access is not an option </li></ul><ul><li>Highest Rates of Infection, and Vessel Stenosis </li></ul>
    12. 12. (10) Frequently Used Calculations <ul><li>URR = (1 – {post dialysis BUN /predialysis BUN}) </li></ul><ul><li>Free H20 Deficit = TBW x {sNa/140}–1} </li></ul><ul><li>GFR/Cockcroft-Gault = {(140-age) x wgt in kg/Scr in mg/dl x 72} x .85 in women </li></ul><ul><li>Change in sNa = {infusate Na + Infusate K} – serum Na/ TBW = 1 </li></ul><ul><li>FeNa = 100 x (U{na}/U{cr})/ (P{na}/ P{cr) </li></ul>
    13. 13. (11) Physician Resources <ul><li>Downloadable GFR Calculators at www.nkdep.nih.gov/professionals/gfrcalculators </li></ul><ul><li>Patient brochures and fact sheets </li></ul><ul><li>Usually free up to 50 copies (Spanish available) </li></ul><ul><li>KDOQI guidelines (dialysis access/adequacy, management of chronic diseases that commonly affect dialysis patients) http://www.kidney.org/professionals/kdoqi/index </li></ul>
    14. 14. (12) Patient Education Resources <ul><li>Information & free resources on kidney disease & dialysis </li></ul><ul><li>http://www.aakp.org/ (American Association of Kidney Patients) </li></ul><ul><li>http://www.akfinc.org/ (American Kidney Foundation) </li></ul><ul><li>http://www.kidney.org/ (National Kidney Foundation) </li></ul><ul><li>http://catalog.niddk.nih.gov/ (NIDDK Clearinghouses Publications Catalog) (Kidney and Urologic Diseases Materials) </li></ul>
    15. 15. Methodology <ul><li>A confidence assessment questionnaire </li></ul><ul><ul><li>assess user-rated improvements upon completion of materials </li></ul></ul><ul><ul><li>agreement or disagreement to 12 questions </li></ul></ul><ul><ul><li>5-pt Likert-scale (pychometric response scale) </li></ul></ul>
    16. 16. Sample Questionnaire <ul><li>Overall, this resource was useful to my learning </li></ul><ul><li>This resource was a useful overview to understanding dialysis </li></ul><ul><li>This resource would have been more helpful if provided earlier during my training </li></ul><ul><li>I have used this resource while performing my clinical duties </li></ul><ul><li>I feel more confident after completing this pamphlet </li></ul><ul><li>This resource was overly simplified </li></ul>Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree
    17. 17. Sample Questionnaire <ul><li>This resource was too comprehensive </li></ul><ul><li>This resource was more useful than other existing handbooks of dialysis </li></ul><ul><li>This resource would be more useful in PDA format </li></ul><ul><li>I would use this resource outside of the UTMB setting </li></ul><ul><li>I would recommend this resource to new fellows entering the program </li></ul><ul><li>I would recommend this resource to residents interested in Nephrology </li></ul>Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree
    18. 18. Evaluation <ul><li>The confidence assessment questionnaire will be administered annually, at the completion of the first and second year of fellowship </li></ul><ul><li>Survey Forms will be provided biannually, </li></ul><ul><li>to assist with content revision based upon the fellow’s feedback </li></ul>
    19. 19. Considerations <ul><li>Small sample size </li></ul><ul><li>Variation of knowledge base between 1 st - and 2 nd -year fellows </li></ul><ul><li>Does this educational resource transfer to various system-based practices? </li></ul><ul><li>Is the data easily viewed in print as well as PDA format ? </li></ul>
    20. 20. Suggestions to Date <ul><li>Nephrology Phone Number and Pager List </li></ul><ul><li>Kidney Biopsy Assembly List </li></ul><ul><li>Procedural Log </li></ul><ul><li>Commonly Used Nephrology ICD-9 Codes </li></ul><ul><li>Outpatient Dialysis Unit Considerations </li></ul>
    21. 21. Conclusions <ul><li>Preliminary data will be available when the graduating fellows complete their clinical duties in June 2007 </li></ul><ul><li>Data from the first year fellows will be available in July 2007 when they transition into their second year of fellowship training </li></ul>
    22. 22. The Evolution

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