The role of specialists in managing the health of populations with chronic illness: the example of chronic kidney disease
Turning the traditional referral system on its head by providing unsolicited, risk driven nephrology consultations is an effective strategy for increasing the quality of medical management of patients with chronic kidney disease in the primary care setting and improving the cost effective use of nephrology services. This approach may be broadly applicable to other specialty areas, say nephrologist Brian J Lee and care management analyst Ken Forbes in this quality improvement report from US healthcare delivery system Kaiser Permanente Hawaii.
Also published on 8 July:
Cell-free fetal DNA and RNA in maternal blood: implications for safer antenatal testing
The potential applications of these tests of maternal blood include determining fetal sex, diagnosing certain single gene disorders, fetal blood genotyping, and screening for Down's syndrome. This technology offers safer, earlier, and easier antenatal testing than current standard practice but raises ethical, legal, and social concerns. An accompanying commentary argues that a closer look shows that this technique may have "side effects", most importantly problems with autonomy.
Lithium and chronic kidney disease
Lithium use is associated with renal disorder and renal failure; this practice pointer offers guidance on monitoring, drug interactions, and when to consider stopping the drug.
Also published on 3 July:
Measuring patients' experiences and outcomes
Increasing importance is being given to patients' views of the humanity and effectiveness of their care. Nick Black and Crispin Jenkinson consider the challenge of using them to evaluate interventions and assess the quality of services.
Also published on 2 July:
Breaking the mould in patient safety
Most current safety interventions are an ethical, emotional, and insurance driven response to specific incidents in hospitals. We need to move from this reactive approach to a more proactive and integrated approach. To achieve real improvements in patient safety we need to look at the whole of patients' care not just specific procedures, argue Laurent Degos and colleagues.
Chronic wound sepsis due to retained vacuum assisted closure foam
Vacuum assisted closure therapy is widely used in the management of complex wounds. Although the retention of surgical instruments and swabs inside body cavities after surgery is well recognised, the retention of foam dressings used in vacuum therapy has not been widely reported. Outside the ordered theatre environment, however, dressing counts may be overlooked, and with such foam this can have serious consequences because it is radiolucent.
A case of mistaken mesial temporal identity
The accurate diagnosis and treatment of paroxysmal events can be difficult. It requires a detailed eye witness account and a clear description of the circumstances of the event. Even with this information, a definitive diagnosis may not be attainable. In this lesson of the week, A Neligan and colleagues re-examine a diagnosis of epilepsy when control is worsening and investigations are normal.
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