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Background: Nursing, between healthcare professions, is the most at risk of violence and aggression. Most healthcare organizations rely on training as the primary strategy for the prevention of violence. Very little is known about the key factors for prevention against nurses: staff education, training and risk assessment. Objectives: The aim is to verify if the number of observed episodes of violence and aggression in renal units are associated with structural and prevention managerial strategies. Design: An observational, cross‐sectional study. Participants: They were part of a convention sample of participants in the European Dialysis and Transplant Nurses Association/European Renal Care Association Conference of 2019, who understood the English Language and had a smartphone or tablet. Measurements: The tool used was a questionnaire developed by Zampieron in 2010, with closed questions, focused on violence and aggression's prevention and management. Conclusions: In conclusion our study found that organizational and managerial strategies to address violence and aggression are highly correlated with observed violence in unit. Nurses are encouraged to become proactive by participating in prevention committees and policies, attending prevention training offered by unit, and reporting all incidents including those witnessed. [ABSTRACT FROM AUTHOR]

Background: Nursing is considered the healthcare profession at most risk of violence. Violence in the workplace is a complex construct difficult to manage and against health workers has implications for the entire health system. A limited number of studies have evaluated this phenomenon in renal units, and there has been little related work since Zampieron's study of 2010. Objectives: To describe prevention and management strategies 10 years after the last survey of Zampieron and to identify what has changed in the management of violence. Design: An observational, cross‐sectional study. Participants: A convenience sample including all nurses participating in the European Dialysis and Transplant Nurses Association/European Renal Care Association Conference of 2019, who understand the English language and have a smartphone or tablet. Measurements: A questionnaire developed by Zampieron was used. The first part collected data concerning the characteristics of the participants' workplace; the second part included closed questions focused on the strategies of management and prevention of violence. Results: Violence is still a frequent event in renal units, despite measures adopted as education, training, formal incident reporting procedures and indoor safety measures. Much more has been invested in recent years in the prevention of violence in the workplace through specific courses, which have led to greater complaints and reporting of episodes. Conclusions: This study shows how actions regarding prevention and management of violence towards nurses have been implemented in renal units over the last 10 years and it suggests the greatest investment in recent years has been made in terms of staff training and education. [ABSTRACT FROM AUTHOR]

Background: The palliative care phenomenon is increasingly invested in all medicine and nursing fields, as care for people with kidney disease who do not wish to embark on dialysis: it encompasses a palliative approach to shared decision‐making. To deliver patient‐centred optimal care, nephrology healthcare staff should be knowledgeable about palliative care and the appropriate conservative management approach. Objective: This paper aimed to explore, using a Delphi survey, the barriers and facilitators to palliative care in patients with kidney disease. Design: An e‐Delphi technique with three questionnaire rounds was performed; statements were generated using Likert scales. Participants and Measurements: A list of 80 statements related to palliative care in patients with kidney disease was divided into facilitators and barriers. Questionnaires were administered to 13 nephrology nurse experts in some European countries. Results: Seven items were removed from the list of 80 statements after the first round of the Delphi study; eight items achieved a significant change of the mean between round two and three, whereas internal stability emerged in all the remaining items. Conclusions: Specific training and education in palliative care emerged as a facilitator, as well as the role of spiritual and beliefs and the role of family and caregiver. The main barriers were represented by the differences in cultures, beliefs, and practices and by the lack of experience in the role of the staff in palliative care. These statements provide a platform for future research to improve palliative care practice in patients with kidney disease. [ABSTRACT FROM AUTHOR]

Background: Children who develop Acute Kidney Injury may start renal replacement therapy (RRT) in Paediatric or Neonatal Intensive Care Units (hereafter PICU or NICU); RRT can be delivered either by paediatric dialysis nurses or by critical care nurses. In both case, nurses devoted to this task must have a high level of competence in providing care to children receiving haemodialytic treatment in a specific technological environment. Aim: The objective of this research was to investigate which models have been adopted to organize nursing care in RRT management in different Italian PICU and NICU, and to explore the training of ICU nurses on the management of RRT. Methods: A multi‐centre survey was conducted through an online questionnaire directed to the Italian PICU and NICU nurse coordinators. Results: A total of 15 Intensive Care Units (12 PICU and 3 NICU) in 12 hospitals were involved. The mean nurse/patient ratio in these units is 1:3. In 72.7% of critical care units, dialysis treatment is delivered by critical care nurses belonging to the unit itself, while in 27.3% of units paediatric dialysis nurses are in charge of dialysis treatment in collaboration with critical care nurses. In 25% of surveyed units there is some structured form of collaboration between Paediatric Dialysis nurses and critical care nurses. However, 75% of units did not respond to this specific question. The different units adopt various forms of RRT training for nursing staff. Conclusion: The scenario resulting from this analysis showed how in our sample of Italian hospitals there is no standard practice for RRT nursing management. In addition, although various forms of training for nursing staff exist, a proper educational programme and/or a standardized specific training about RRT management for nursing staff is not in place in the surveyed hospitals. Relevance to clinical practice: The lack of standardized protocols or guidelines for RRT delivery to critically ill children can compromise their safety. The structuring of these protocols and the production of best clinical practice guidelines would allow standardization of the nursing management of the RRT and of the corresponding training. This may help to provide the proper care and to guarantee the patients' safety. [ABSTRACT FROM AUTHOR]

SUMMARY: Background: Cachexia is a wasting syndrome found within a range of chronic illnesses/life‐limiting conditions, however awareness and understanding of cachexia amongst renal Health Care Professionals has not been investigated. Objectives: To ascertain the awareness, understanding and treatment practices of Health Care Professionals who provide care for people with cachexia and end‐stage renal disease. Methods: Health Care Professionals were recruited via the European Dialysis and Transplant Nurses Association/European Renal Care Association in September 2018. This was an exploratory study using a mixed‐methods approach with those who provide care for patients with end‐stage renal disease and cachexia. An online survey and two focus groups were conducted. Descriptive statistics and inductive thematic analysis were used to explore current knowledge and practices in renal cachexia. Results: A total of 93 participants from 30 countries completed the online survey. Twelve Health Care Professionals agreed to participate in the focus groups. Reduced appetite, weight loss and muscle loss in relation to cachexia were accurately described, but the percentage of weight loss was unknown. The importance of multi‐professional collaboration was recognised, however, the current management of cachexia was wide‐ranging. Quality of life, patient‐clinician communication and specialist support for carers were regarded as vital. Conclusion: Timely identification and management of cachexia are needed to improve the quality of life for patients and appropriately support families. In order for these goals to be achieved, there is a need to increase awareness and understanding of cachexia amongst renal nurses. [ABSTRACT FROM AUTHOR]

SUMMARY Background Nurses have an important role to play in the management of secondary hyperparathyroidism (SHPT). An online survey conducted by the European Dialysis and Transplant Nurses Association/European Renal Care Association (EDTNA/ERCA) in conjunction with Amgen (Europe) GmbH surveyed nephrology nurses' knowledge of secondary hyperparathyroidism, treatment targets, current treatments, patient adherence and nephrology nurse training education needs. The survey's aim was to establish common practices being used by nurses in the management of secondary hyperparathyroidism and to identify nephrology nurses' training and educational needs in order to improve patient care. Methods Design: Descriptive study. Measurements: An online survey of multiple choice and closed questions. Participants: A sample of nephrology nurses from Spain, Italy, France and the Netherlands. Results A total of 111 nurses completed the questionnaire (98% response rate, 82% of which were fully completed). Collected data revealed that there were specific aspects of SHPT patient management where nurses lacked confidence, despite the majority of respondents having 15 years nephrology nursing experience. These aspects included explaining the disorder and therapies to patients, managing side effects of drugs and appreciating the significance of controlling biochemical targets. Over 40% of the respondents felt they did not have sufficient training to support patients who were non-compliant. Conclusion Nursing skills are integral to SHPT patient management as part of the multidisciplinary approach. The nurse's role is particularly important in patient assessment and monitoring, and in the provision of patient education and support, particularly with treatment adherence. Nephrology nurses who are better informed about SHPT and who receive training on practical patient care may improve the care of patients. [ABSTRACT FROM AUTHOR]

AbstractInterleukin-10 (IL-10) is a powerful suppressor of cellular immune responses, with a postulated role in brain inflammation. First, we have evaluated the role of this cytokine in ischaemic brain damage using IL-10 knockout (IL-10–/–) mice. The middle cerebral artery (MCA) was occluded in either IL-10–/– or wild-type animals of corresponding strain (C57Bl/6) and age. Infarct volume was assessed 24 h later in serial brain sections. Brain infarct produced by MCA occlusion was 30% larger in the IL-10–/– than in wild-type mice (21.8 ± 1.2 vs. 16.9 ± 1.0 mm3, respectively; P < 0.01; Student's t-test). To further characterize these findings, studies were extended to in vitro models. Primary neuronal cortical cultures derived from IL-10–/– animals were more susceptible to both excitotoxicity and combined oxygen–glucose deprivation compared with cell cultures from wild-type mice. Moreover, when added to the culture medium, recombinant murine IL-10 (0.1–100 ng/mL) exerted a concentration-dependent prevention of neuronal damage induced by excitotoxicity in both cortical and cerebellar granule cell cultures taken from either strain. The accordance of in vivo and in vitro data allows us to suggest a potential neuroprotective role of IL-10 against cerebral ischaemia when administered exogenously or made available from endogenous sources. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about the existence of porcine respiratory and reproductive syndrome virus in a wild boar in Italy.