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Laura Ducros

Laura Ducros

EC Institute:  Arabkir Medical Center 

EC Liaison officer: Ashot Sarkissian 

SC Institute: Guy's hospital 

SC Liaison Officer: Nizam Mamode 

 

Name of STC-TTC Pair: Armenia - UK 

Pair Level: C

 

Learning Objectives :

The Nephrology Unit of Arabkir Medical Centre is the national reference Centre for Nephrology and only the institution in Armenia where kidney transplantation is performed. Despite having experience of living donor kidney transplantation for over 20-years and big effort applied, we have not been successful in developing deceased donor transplantation program for many reasons. One of most important ones is the national economic situation and deficit of funds covering needs of renal patients. Therefore, new and effective methods of pre-transplant evaluation and further management of transplant patients are poorly known and not available. Beside the aforementioned economic and cultural difficulties, there is also a complete absence of knowledge in transplant coordination, diagnosis of brain death, organ allocation and procurement which have all contributed to difficulties in implementing a deceased donor transplant program

 

Program: 

In the initial phase (2 years) of this collaboration, we propose to invite Prof Ashot Sarkissian to Guy’s Renal Transplant Unit in order to expose him to our program of deceased and living donation. As well as attending multi-disciplinary listing meetings, pre- & post-transplant clinical activities, and experiencing day to day management of the on call team with respect to the organ donor acceptance decision making, and recipient preparation, we will also ensure that he has access to all teaching sessions, and King’s College, London academic library access. In addition, by shadowing the specialist nurses of organ donation (SNODs) based at Guy’s & St Thomas’, he will gain exposure to all steps of deceased donor management, from the intensive care to the operating theatre. In conjunction, there are opportunities to work with our National Organ Retrieval (NORS) team based at King’s College Hospital, to learn optimal organ procurement methods. .

 

 

EC Institute: Mandalay General Hospital 

EC Liaison officer: Kyaw San Lin 

SC Institute: Seoul National University Hospital 

SC Liaison Officer: Jaeseok Yang 

 

Name of STC-TTC Pair: Myanmar - South Korea 

Pair Level: C

 

Learning Objectives: Upcoming 

Program: Upcoming 

EC Institute: Human Organ Transplant Center

EC Liaison officer: Pukar Chandra Shrestha 

SC Institute: Freeman Hospital 

SC Liaison Officer: Alison Brown 

 

Name of STC-TTC Pair: Nepal - UK 


Pair Level: C

 

Learning Objectives : 

The Renal Transplant programme in Nepal is in relatively new. The Human Organ Transplant Center(HOTC), Bhatkapur is a newly established dedicated government center for the development of kidney and other organ transplantation. The center has been doing renal transplant regularly for the last 42 months with limited human resources. Even with the current limited resources, the outcomes are comparable to that of the world's best transplant centers. At present in Nepal, the government can only provide funding for a maximum of 2 years dialysis support. If patients with renal failure cannot identify a suitable live kidney donor in that time, young patients who may be the main support for their family will die. It is therefore urgent to expand the live donor programme and to develop a deceased donor transplant programme, which could be achieved in the near future. This would allow utilisation of the many organs that currently cannot be utilised following deaths of potentially suitable donors, with many young people, in road traffic accidents within Kathmandu. We have identified that transplant immunology is the first key area to address as there is no 6 of 9
transplant immunologist in Nepal at present. Secondly, we need to train our locally selected staff as transplant coordinators. This is a vital role in the whole process of transplant, especially to initiate deceased donor transplants. Co-ordinators require training in tackling sensitive issues and also the practicalities of coordinating various multidisciplinary teams at different locations contributing to organ transplant.

 

Program: 

We propose that one senior Nephrologist is sent from Kathmandu to be trained in transplant immunology for the period of one month in the Institute of Transplantation in Freeman Hospital, Newcastle upon Tyne UK, and also at our local tissue typing laboratory. Furthermore, we propose setting up a regular teaching session via Skype for nephrologists, transplant histopathologists, co-ordinators and nurses with their opposite numbers in Freeman Hospital, Newcastle upon Tyne, UK. Experienced transplant coordinators in Newcastle will provide teaching on how deceased donor transplantation and low titre ABO incompatible transplants are carried out in Newcastle, and will lead virtual workshops to explore how these processes can be adapted for use in the very different health care system in Nepal. This will help facilitate both heart beating and non heart beating donor transplantation as well as low titre ABO incompatible transplants. The necessary legislation to permit deceased donor transplants has already been passed in Nepal.

EC Institute: Southern Philippines Medical Center 

EC Liaison officer: Franklin Britan Guillano

SC Institute: Singapore General Hospital 

SC Liaison Officer: Marjorie Foo Wai Yin

 

Name of SRC Pair : Philippines - Singapore

SRC Level :

 

Learning Objectives: 

The SPMC is a big hospital (1,200 beds) operating more than its capacity. We have 55 HD machines with 5 back ups, operating 3 sessions a day, 6 days a week. We have an average HD treatment per week of about 1,000. There are 9 Nehrologists Consultant (all trained in Manila). Although we have a residency training program for internal medicine accredited by the Philippine College of Physicians, with 50 residents on training, we don't have a fellowship training for nephrology.
We have just started our PD program. To date, we only have less than 10 PD patients. One problem is we don't have adequate training in PD catheter insertion. We have 15-20 kidney transplant per year but we hope to increase this since we are already working with University of Barcelona to enchance our Deceased Donor Program. Since we already started our Sister Transplant Center Partnership with Barcelona, we hope to improve our transplant program. We are also in the process of applying for accreditation in Adult Nephrology Fellowship so that we can enhance our training and education program.
Most of our HD patients nowadays are covered by the Philippine Health Insurance (PHILHEALTH) so almost all of them are having free dialysis sessions. Because of this, our patient's survival significantly increased since the implementation of the Philhealth program. Then, we started to see problems associated with long term dialysis like CKD-MBD and hemodialysis access problems. Some patients died because we cannot give them adequate access.

 

Program: 

We have plenty of patients but we don't have enough training to answer thier growing needs. Most of our patients are on Hemodialysis since this is the easiest (for us) to start them with dialysis. Most of our surgeons are doing IJ cath insertion under blind procedure (without ultrasound). Nowadays,once we start them on HD, we refer them to free standing dialysis centers for their maintenance HD. We also don't have enough training for PD cath insertion.
We need to train our young nephrologists for the interventional nephrology, which Singapore General Hospital is offering. We can also send our surgeons if they are interested. The SGH expertise in interventional nephrology is amazing since a lot of patients can be saved or a lot can have improvement in their quality of life, if we can provide a very good dialysis access. As of this time, if we have problems in their AV fistula, we use permcath as a long term access.
We abandon access which I think can still be saved, if we do have interventional training. Our PD program can also be improved if we do have people who knows how to manage PD access. It is easy to communicate with Singapore and we believe that by sending people there to train, and by having regular teleconference with them, we can be able to deliver much improved renal services, not only at SPMC but for the whole Mindanao as well.

 

EC Institute: Kidney Care Center 

EC Liaison officer: Akinbodewa Ayodeji Akinwumi

SC Institute: Sheffield Kidney Institute

SC Liaison Officer: Ahmed Halawa

 

Name of SRC Pair: Nigeria - UK 

SRC Level: C

 

Learning objectives: 

A. Peritoneal dialysis:
- how to establish a peritoneal dialysis unit
- techniques for insertion of acute and chronic catheters
- techniques for nursing processes during peritoneal dialysis care
- prevention of infection related to peritoneal dialysis

B. Haemodialysis: 
- Techniques for arteriovenous fistula (AVF) creation
- Identifying best vessel sites for AVF creation
- Safe use of AVF intradialysis in order to prolong its lifespan
- Early identification of common intravascular complications
- Managing unstable patients intradialysis
- The sodium remodelling techniques
- Infection prevention intradialysis
- Reduction of cardiovascular related mortality among dialysis patients especially among diabetics.
- Training for dialysis nurses and technicians

C. Transplantation:
- Procedure for pre-operative, intra-operative and post-operative care of the allograft recepient
- Reducing ischaemic damage to renal graft
- Immunosuppressive therapy protocols for graft recepient
- Techniques for protocol biopsies
- Standard follow up of graft recepient after renal transplant

D. Training for Renal dietician:
- Selecting the appropriate diets for categories of patients with CKD

E. Training for Clinical Psychologists:
- Practical application and interpretation of newer and more effective methods and tools for care of the renal patients

F. Training for Medical Social Workers:
- Identifying core roles and practical approach to social problems of the CKD patients

 

Program: 

  • Exchange programs
  • Scheduled visits by trained personel to our center
  • Provision of relevant books, conference and seminar materials
  • Visits of our staff to the supporting center for practical hands-on training
  • On-line training

 

EC Institute: Renal Unit, Department of internal Medicine University of Port Harcourt Teaching Hospital (UPTH)

EC Liaison officer: Pedro Emem-Chioma

SC Institute: Salford Royal Hospital, Salford Manchester

SC Liaison Officer: Ibiwari Erekosima

 

Name of SRC Pair: Nigeria - UK 

SRC Level: C

 

Learning Objectives: 

The renal unit was created in 1992, following the appointment of the first lecturer in renal medicine by the affiliate University of Port Harcourt . The state of renal service today is:

  • Provision of PD for adults is poor therefore the modality of choice is HD which severely restricted program expansion to meet needs
  • The mean age for patients with ESRF requiring haemodialysis is early 40s
  • Only 3-5% of all patients with ESRD get some form of HD treatment HAEMODIALYSIS SERVICE (2015)
  • Number of functional haemodialysis stations – 4Average no of HD per week 0.18 Averager duration of patients on HD 4 months, Case Fatality within 6 months of 90%, Therefore the principal areas that need support
    1. Acute PD service provision : Through the ISN fellow program, doctors will offered the opportunity of hands on training and acquisition of skills to set up a PD program to manage AKI. Salford Royal Hospital has the largest PD program in the North West of England (115 patients) with 4 edacades of experience.
    2. Interventional Nephrology: Insertion of permanent HD CVC, Renal Biopsy, Insertion of PD cannula
    3. Support continuous medical education including via fellowships, exchange programmes, web cas. 

 

Program: 

The proposed measures are the development of PD program through capacity building by training ISN fellows and nurses.
Organising CME through the ISN Educational Ambassador program AKI preventive initiative : As acute kidney injury contributes to high mortality and emerging evidence suggests can be prevented by better recognition and basic medical care. Studies by Emem-Chioma et 2012 suggest a mortality of 43.5%

 

EC Institute: Yashoda Hospitals Hyderabad

EC Liaison officer: Urmila Anandh

SC Institute: Heartlands Hospital Birmingham

SC Liaison Officer: Indranil Dasgupta

 

Name of SRC Pair: India - UK 

SRC Level: C

 

Learning Objective

The Emerging Center is a tertiary care nephrology hospital where a majority of the time is spent on clinical care. The majority of the patients are of advanced chronic kidney disease secondary to diabetes mellitus and hypertension. In a developing country, most of the scant resources are utilised for irreversible kidney disease secondary to lifestyle issues. Also, being a tertiary care center caters to a large number of poor and rural population for whom access to nephrology services are a major issue.The center wishes to develop a robust preventive nephrology services with an emphasis on prevention of diabetic kidney disease. We wants to enhance its clinical services for patients of diabetic kidney disease not only in Hyderabad but in the districts of Telangana. The center also wishes to dedicate time and funding in some basic research on the progression of kidney disease in diabetics. As a large percentage of rural population have kidney disease not due to diabete, the center wants to learn about pathophysiology.

 

Program: 

The nephrologists in this center are developing outreach clinics in the district town for early detection of diabetic kidney disease in rural population. A dedicated clinic for preventive nephrology with an emphasis on diabetic kidney disease is being set up.Trainee nephrologists have been assigned dissertation to understand the pathology of non diabetic kidney disease. In association with the Indian Institute of Science (Center for Nanotechnology), Bangalore, the Liason officer is developing a Point of Care device to look for albumin, hemoglobin, urea and creatinine in a single blood sample. This device is already patented and is undergoing trials. The center will be using this point of care device for early detection of diabetic kidney disease. This device is considered to be useful for the patients who come from remote areas. The device will give them a faster diagnosis and treatment solution saving them time.

 

EC Institute: New Mansoura General Hospital

EC Liaison officer: Osama Ibrahim El-Shahat

SC Institute: Sheffield Teaching Hospitals

SC Liaison Officer: Ahmed Halawa

 

Name of SRC Pair: Egypt - UK 

SRC Level: C

 

Learning Objectives: 

The areas that require attention and improvement are the follow:

  • Train young nephrologists and surgeons in the field of transplantation
  • Support their activity as a leading center in the management of CKD-MBD
  • Establish MDT in different disciplines (renal pathology, renal radiology and infectious disease)
  • Train anaesthetists and intensivists on the peri-operative management of CKD patients
  • Train nurses on bed-side management of CKD patients
  • Establish the principle of mortality and morbidity
  • Support the emerging peritoneal dialysis program
  • Support the emerging CKD prevention program
  • Establish research projects in CKD-MBD

 

Program: 

  • Provide technical advices in various aspects of renal medicine on request (surgical, medical and radiological)
  • Provide leaflets and CD to support high quality care
  • Organize frequent visits between the supporting centre and the emerging center for clinicians, nurses and PD and dialysis coordinators to:
    a- Provide educational support through lectures and seminars
    b- Update the emerging center on recent guidelines and protocols
    c- Provide the training required to support the nephrology program on site and in Sheffield

 

EC Institute: Kidney Foundation Hospital & Research Institute Dhaka.

EC Liaison officer: Mohammad Shakib Uz Zaman Arefin

SC Institute: Royal London Hospital

SC Liaison Officer: Magdi Yaqoob

 

Name of SRC Pair: Bangladesh - UK 
SRC Level: C

 

Learning Objectives: 

Kidney Foundation and Research Institute is a not for profit hospital established in October 2002. With dedication and hard work of the people involved in kidney foundation,it has now developed into an organisation that provide excellent health care to people with kidney disease and kidney failure. People with no resouces receives free traitment. Kidneyfoundation is now running a 150 bed hospital with 60 beds in the dialysis unit,8 beds ICU and HDU for kidney transplant, 3 modern OT,4 beds post operative urology. At present, we need improvement in transplantation deceased donor, ABO incompitable transplantation and renalhistology. We also need improvement in epidemiological,clinical and experimental studies. 

 

Program: 

Our doctor should be trained up for 6 months to 2 years in the transplantation field including:

- Deceased renal transplantation
- ABO incompitable kidney transplant
- Renal histologyand ICU Nephrology

We also intend to train our doctors and nurses in CAPD and improve the training progam with experimental studies. 

Monday, 23 January 2017 10:16

SRC Program Level C : Sudan - Brazil

EC Institute: Soba University Hospital Renal Division

EC Liaison officer: Elwaleed Elhassan

SC Institute: Pontificia Universidade Catolica do Parana

SC Liaison Officer: Roberto Picoits-Filho

 

Name of SRC Pair: Sudan - Brazil

SRC Level: C

 

Learning Objectives: 

Soba University Hospital is the largest open-access academic center in Sudan comprising a free standing hemodialysis unit and two renal units; an adult and pediatric. It is a 500 bed tertiary hospital in Southern Khartoum that serves a large population plus the referrals from other states. Similar to other Sudanese public health institutions, it is suffering from a severe brain drain given the tight economic constraints.
The current needs are:
1. Optimizing HD and PD staff training given the high experienced staff turnover rate.
2. Accepting Sudanese Trainees through ISN and ISPD fellowship programs.
3. Assisting to invigorate adult transplant, and initiate kidney transplantation for children who are less than 15 kg of body weight. A visit from an expert pediatric surgeon would be highly appreciated.
4. Advanced nurse training especially in the fields of continuous renal replacement therapy, renal transplantation, plasmapheresis, PICU and urodynamic studies.
5. Technical assistance to develop renal immune-florescence and EM services. This is not presently available in any public sector hospital in Sudan.
6. Establishing genetic testing given the high noted prevalence of inherited genetic diseases and consanguineous marriage in our community.
7. Setting up electronic medical records to optimize our database, and establish a renal registry.

 

Program: 

In the short term:
1. Begin regular video conferences with the Supporting Center staff, to present and review cases. That would generate a lot of discussion and would improve the staff training.
2. Establish formal nurse training program partly in Sudan and the other part in Brazil. Partially support trainee travel expenses in the allowed range
3. Buy a training manikins for hemodialysis catheter insertion.
4. Invite a visiting expert from the supporting center to guide the transplant service rejuvenation.
5. Send trainee physicians and nurses to the Supporting Center through the ISN and ISPD fellowship grants

 

 

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