Evidence is provided for that it is urgent to elaborate a problem of hemoblastosis and hemopoietic depressions within the framework of a special federal research and technological programme. Priorities of research lines in this areas, trends of their development till 2005 are presented.
Since continuous ambulatory peritoneal dialysis (PD) was introduced in 1978 by Popovich and Moncrief, the use of peritoneal dialysis as effective renal replacement therapy has expanded on an international level. Improvements in technology and technique have lessened the incidence of infectious complications, although strategies continue to evolve to improve technical success. As technical challenges have been met, increasing attention has been turned to PD dose. Retrospective studies have strongly suggested that patient outcome is related to the amount of toxin removal. Recently, prospective data confirm that morbidity and mortality are strongly associated with dialysis adequacy. The important contribution of residual renal function to total toxin clearance is now recognized and implies a need to adjust dialysis dose to maintain adequate clearance as residual renal function declines. Reasonable, yet arbitrary, targets for dialysis clearances can now be asserted as Kt/V of 2.0 per week and weekly creatinine clearance of 60 L/wk. These current guidelines indicate a need to individualize dialysis dose to achieve target clearances and improved outcome. Current data also indicate that malnutrition is highly prevalent in the PD population and is associated with poor clinical outcomes, including decreased survival. Deterioration in nutritional status begins before the initiation of dialysis, and it seems that worse nutritional status at the start of dialysis is a strong predicator of poor outcome. These findings suggest that earlier initiation of dialysis, before a significant decline in nutritional status occurs, is warranted to maintain good nutrition and optimize outcome.
This paper describes the development and characteristics of a comprehensive, integrated and sustained program for the education, recruitment and retention of physicians for rural practice in Alberta--the Rural Physician Action Plan. The participation of key stakeholders (including government, the provincial medical association, the licensing authority, faculties of medicine, practising rural physicians and regional health authorities) and a sustained program budget have been key organizational issues for success. Critical to the effectiveness of this program has been the focus on professional and lifestyle issues targeting 3 distinct groups: physicians in training, physicians in practice, and rural communities and health authorities. Substantial program funding since 1991-92 of up to $3 million per year has increased rural-based activities significantly. For example, 87% of medical students and 91% of residents in family medicine in Alberta now experience 4 weeks or more of rural practice. The authors believe that the historic issues and recent trends militating against recruitment and retention of rural physicians will continue unchecked without comprehensive and sustained approaches such as Alberta's Rural Physician Action Plan.
Cites: CMAJ. 1992 Sep 1;147(5):617-231521207
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Comment In: CMAJ. 1998 May 19;158(10):1269; author reply 1269-709614816
Comment In: CMAJ. 1998 May 19;158(10):1269; author reply 1269-709614817