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Dan Xu,1,2 Shaoting Feng,1 Daya Yang,1 Shuqin Ding,1 Johan B Rosman,2 Ming Kuang,1 Haipeng Xiao1 1First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China; 2Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, AustraliaCorrespondence: Dan Xu; Haipeng Xiao, Email daniel.xu@curtin.edu.au; xiaohp@mail.sysu.edu.cnPurpose: Clinical placement teaching could be challenging due to time constraints, lack of effective teaching models and consensus approaches. Learner-centred approach facilitated deeper learning by demonstrating “seeing-patients-under-supervision” being ideal during Residential-Aged-Care-Facility (RACF)-visit in GP clinical placements. The study aimed to reflect on the students’ experiences in aged-care visits by applying an innovative teaching model of “students-being-the-GP-clinician-in-charge-of-RACF-visit-ward-round-under-the-supervision-of-clinical-supervisor”. Through students’ reflections, this study identified 12 commonly managed RACF problems to be introduced into the curriculum to optimise clinical reasoning learning during RACF-visit.Methods: This qualitative study used online surveys and interviews. All participating students reported all the encountered cases during the RACF visit through an online survey. The participating students acted as GP in charge of all clinical interactions with patients, caregivers, and nurses during RACF visits and final management plan discussions with GP supervisors to ensure clinical-service safety and teaching-and-learning quality. The interview questionnaires applied standard-and-open-ended-questions to examine the impact of this innovative teaching model on clinical-reasoning-learning, clinical-competence-improvement, Objective Structured Clinical Exam (OSCE) preparation, limitations-from-students’-patients’-and-supervisors’ perspectives, and intern readiness.Results: An online survey summarising students’ encountered cases was returned

Aims and objectives To measure the prevalence of symptomatic (S‐IDH) and asymptomatic intradialytic hypotension (A‐IDH) or postdialysis overhydration in a satellite haemodialysis clinic in Western Australia. Background Intradialytic hypotension is one of the most common side effects of haemodialysis caused by ultrafiltration provoking a temporary volume depletion. The prevalence of asymptomatic hypotension during dialysis has been rarely reported, but is considered to have the same negative consequences as symptomatic hypotension on various end organs like the brain and the gastrointestinal tract. Design Observational study on a retrospective 3‐month period of nursing recorded fluid‐related adverse events. Methods Data collection on the occurrence of S‐IDH and A‐IDH during a total of 2,357 haemodialysis treatments in 64 patients. Body weight of patients at the time of cessation of treatment was recorded, and patients, whose weight exceeded their ideal body weight by at least 0.5 kg, were classified as overhydrated. Data analysis was performed using spss version 24 software. Results Symptomatic intradialytic hypotension was the most common adverse event measured in this cohort, and occurred during 221 (9.4%) of all treatments, whereas asymptomatic intradialytic hypotension occurred in 88 (3.7%) of all treatments. The total occurrence of intradialytic hypotension was 13.1%, and symptomatic was observed in 30 patients, implying that nearly every second patient had at least one symptomatic episode within 3 months. Overhydration occurred in a total of 103 (4.4%) of all treatments, and involved 17 patients. Conclusions Symptomatic and asymptomatic intradialytic hypotension were the most commonly observed adverse events in this cohort; overhydration occurrence was considerably less common. Relevance to clinical practice The high occurrence of hypotension‐related events demonstrates that ultrafiltration treatment goals in satellite dialysis clinics are sometimes overestimat

Aim: Volume status of haemodialysis patients can be evaluated by trained doctors using ultrasound (US) of the inferior vena cava (IVC). To date, renal nurses have not been taught this skill. As part of a larger study exploring the use of US by renal nurses we developed an educational program to ensure that renal nurses received adequate US training to attain competence in IVC ultrasound (IVC-US). Methods: The educational program was divided into four parts. Initially a clinical US expert delivered the necessary theoretical and then practical components of the program. After this the nurse undertook a period of self-directed US practice (100 scans). During this period three formative reviews of the recorded scan clips with feedback occurred. Specific feedback covered US technique, image optimisation and acquisition and image interpretation. Finally, as a summative assessment the nurse performed and interpreted 60 scans on 10 dialysis patients. These scans were independently assessed for quality and the nurse interpretations reviewed for accuracy, prior to deeming the candidate competent to independently perform IVC-US. Findings: Ultrasound education involves knowledge and skill acquisition. Initial theoretical and practical education must be translated into competence through task repetition and targeted feedback. A staged educational program that involves these components is likely to be successful. The rate for US skill acquisition varies and a summative assessment ensuring competence prior to independent scanning is important. Conclusions: This four-step program demonstrated that it is feasible to educate a renal nurse in IVC-US for intravascular volume assessment.

Introduction: Ultrasound of the inferior vena cava (IVC-US) has been used to estimate intravascular volume status and fluid removal during a hemodialysis session. Usually, renal nurses rely on other, imprecise methods to determine ultrafiltration. To date, no study has examined whether renal nurses can reliably perform ultrasound for volume assessment and for potential prevention of intradialytic hypotension. This pilot study aimed to determine if a renal nurse could master the skill of performing and correctly interpreting Point of Care Ultrasound on patients receiving hemodialysis. Methods: After receiving theoretical training and performing 100 training scans, a renal nurse performed 60 ultrasound scans on 10 patients. These were categorized by the nurse into hypovolemic, euvolemic, or hypervolemic through measurement of the maximal diameter and degree of collapse of the IVC. Scans were subsequently assessed for adequacy and quality by two sonologists, who were blinded to each other's and the nurse's results. Findings: The interrater reliability of 60 scans was good, with intraclass correlation 0.79 (95% confidence interval (CI) =0.63–0.87) and with a good interrater agreement for the following estimation of intravascular volume (Cohen's weighted Kappa ?w = 0.62), when comparing the nurse to an expert sonographer. Discussion: A renal nurse can reliably perform ultrasound of the IVC in hemodialysis patients, obtaining high quality scans for volume assessment of hemodialysis patients. This novel approach could be more routinely applied by other renal nurses to obtain objective measures of patient volume status in the dialysis setting.

© 2017, Springer Science+Business Media New York. Resistant hypertension (RH) is defined as blood pressure (BP) that remains above target levels despite adherence to at least three different antihypertensive medications, typically including a diuretic. Epidemiological studies estimate that RH is increasing in prevalence, and is associated with detrimental health outcomes. The pathophysiology underlying RH is complex, involving multiple, overlapping contributors including activation of the renin-angiotensin aldosterone system and the sympathetic nervous system, volume overload, endothelial dysfunction, behavioural and lifestyle factors. Hypertension guidelines currently recommend specific pharmacotherapy for 1st, 2nd and 3rd-line treatment, however no specific fourth-line pharmacotherapy is provided for those with RH. Rather, five different antihypertensive drug classes are generally suggested as possible alternatives, including: mineralocorticoid receptor antagonists, a1-adrenergic antagonists, a2-adrenergic agonists, ß-blockers, and peripheral vasodilators. Each of these drug classes vary in their efficacy, tolerability and safety profile. This review summarises the available data on each of these drug classes as a potential fourth-line drug and reveals a lack of robust clinical evidence for preferred use of most of these classes in the setting of RH. Moreover, there is a lack of direct comparative trials that could assist in identifying a preferred fourth-line pharmacologic approach and in providing evidence for hypertensive guidelines for adequate treatment of RH.

© 2017 European Dialysis and Transplant Nurses Association/European Renal Care Association Background: In Western Australia (WA), most stable patients undergoing haemodialysis receive treatment in a satellite setting where no doctors are on-site during treatment hours, so nurses must make critical decisions about fluid removal. Some patients regularly experience adverse events during dialysis (intradialytic), often due to excessive ultrafiltration goals, with intradialytic hypotension being particularly challenging. Ultrasound of the inferior vena cava has been previously demonstrated being a rapid and non-invasive method for volume assessment on haemodialysis patients, thus could hold valuable information for the treating nurse. Aim: This paper examines the existing literature in regards to the use of ultrasound measurements of the inferior vena cava in patients on haemodialysis for objective assessment of their intravascular volume status by renal nurses. Method: A systematic literature review was performed within medical and nursing databases including CINAHL Plus with Full Text, SCOPUS, Web of Science and MEDLINE. Results: Renal nurses are conscious of the significance of intradialytic hypotension and have only limited options for its prevention. Ultrasound of the inferior vena cava could add another objective dimension for intravascular volume assessment and prevention of intradialytic hypotension, but to date renal nurses have not been using this technique. Conclusions: Ultrasound of the inferior vena cava has the potential to assist in defining the ultrafiltration goal for that particular dialysis session, thus reducing the risk of intradialytic hypotension. Additionally, it has potential to change current renal nursing practice when added to clinical nursing assessment methods. Further studies are required to validate this assessment tool carried out by a renal nurse compared with a skilled ultrasonographer.