Talk:Nephrology

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Nephrology

Please I need some answers for my questions

1)What are nephrologist's duties & responsibilities?

2)How is nephrology expected to change?

3)Any new developments ocurring?

4)Any important research being done?

5)What career or job opportunities are there in this field?

6)What is the relevance or importance of this specialty to the world?

sent me: [REMOVED]

  • In my opinion it's better to ask at the outset what *challenges* do nephrologists now confront (which leads to research), including (a) methods to reduce or overcome rejection, (b) earlier diagnosis, and cardiorenal risk.

MaynardClark (talk) 15:42, 18 April 2014 (UTC)[reply]

Look at the early 4/19/2014 version, which was reverted by Jfdwolff ("Jacob de Wolff, a Dutch doctor") on the basis that it is 'original research' I would think that the content is edifying for the core question, what current challenges does nephrology face. From that, the section could be rethought, reorganized, and rewritten. I don't think that there's a false statement in it, nor is anything misrepresented or improperly emphasized; it's a list (with citations). MaynardClark (talk) 23:06, 19 April 2014 (UTC)[reply]

TV Nephrologists

Instead of having to delete a certain TV character every few days maybe there should be a popular culture section?

Popular culture

Actor Hugh Laurie portrays a nephrologist on the fictional TV show House. BillpSea 01:26, 5 November 2007 (UTC)[reply]

In addition to fictional doctors a popular culture section could address renal myths - for instance the "stolen kidney" plot line, the "will die without a transplant" plot line.

No, I think even in House MD the main character is not famous for being a nephrologist but for being a "diagnostician" (whatever that silly term means). (It is also very odd to combine renal medicine with infectious diseases in one career - unless he wanted to spend his whole life treating pyelonephritis). JFW | T@lk 21:08, 13 December 2007 (UTC)[reply]

Those are compelling reasons to continue the exclusion of that particular TV character. Thanks JFW. The lack of comment in defense by the vandals is also telling BillpSea (talk) 02:44, 16 December 2007 (UTC)[reply]
Dialysis and transplant patients, because of their prolonged hospital contact and predisposition to infection, are prone to development of antibiotic resistant infections. Further, renal injury is a common complication of sepsis and antibiotic therapy. For this reason, combined training and experience in nephrology and infectious disease is not without its benefits. Medgeek (talk) 06:08, 18 November 2012 (UTC)[reply]

The vandalism is from two IPs, both of whom have liberally exceeded the 3RR rule. I have locked the article for four days and blocked both House fans for three. I have asked them to discuss their addition here before attempting to reinsert it against consensus. JFW | T@lk 08:52, 16 December 2007 (UTC)[reply]

I noticed this article gets a bit for Gregory House vandalism. Over at Talk:Gregory_House#Georg_Haas.3F, an IP left the most bizarre comment. He basically casually mentioned how he just vandalized this article and now wanted to ask a stupid question. What went through his head? Deamon138 (talk) 21:57, 9 July 2008 (UTC)[reply]

Merge with Nephrologist

I just stumbled across Nephrologist, and it seems to be the only article about a specialized physician. All other specialists (-ist) redirect to the article of the specialty (-ology). I do not think there needs to be separate articles for the physician and the specialty. Nephrologist is short, and could easily be merged with nephrology. --Scott Alter 16:04, 8 December 2007 (UTC)[reply]

I agree the articles should be merged.BillpSea (talk) 19:46, 8 December 2007 (UTC)[reply]
I also agree. King Spook 09:48, 28 May 2008 (UTC) —Preceding unsigned comment added by Kngspook (talk • contribs)

History

I had been hoping to see some history of the development of Nephrology. When was the small-scale structure of the kidney, e.g. the glomerulus, the proximal and distal convoluted tubes, and the loop of Henle discovered? I suppose, I could look up Henle and Bowman for when they did their work, but I think that some of that should appear here, and that would be only part of the story. Sterrettc (talk) 01:31, 3 May 2012 (UTC)[reply]

Pediatric nephrology

this article needs to have a section which mentions pediatric nephrology, which is the equivalent subspecialty in pediatric medicine. It could also describe some of the common conditions seen in a pediatric nephrology practice which differ from that seen in an adult nephrology practice. Alpha centauri b (talk) 02:51, 18 April 2014 (UTC)[reply]

Thanks for your comment, Alpha centauri b. Wikipedia is an open encyclopedia, and anyone can contribute. The best person to make the changes you think are needed is... you! So I'd encourage you to try editing the article. It doesn't have to be perfect, and other users will improve on what you wrote in time. If you need any help please feel to contact me at my talk page. Cheers, --LT910001 (talk) 22:32, 18 April 2014 (UTC)[reply]
Thanks. I will work on that article. I just added myself to the WP Med page. Alpha centauri b (talk) 22:35, 18 April 2014 (UTC)[reply]

Industry Support

I'd like to see (more?) discussion on the industries which support nephrology, imcluding device manufacturers and scientific publishers. MaynardClark (talk) 15:54, 18 April 2014 (UTC)[reply]

Thanks MaynardClark. As I've said above, there are not that many active editors, and the best way to get these changes is to make them yourselve -- be brave! Other editors will always be around to improve any content you add. If you need any help feel free to contact me. Kind regards, --LT910001 (talk) 00:50, 19 April 2014 (UTC)[reply]

Challenges in Nephrology

MaynardClark added a long list of "challenges in nephrology". I am of the view that the list in its own right is a form of original research. The individual items are of course genuine, but I don't think they should be presented in the form of a list. I would encourage the contributor to prosaify this, based on secondary sources at every step of the way. Also, one man's challenge is another's opportunity, and it might be better to strive for even more neutrality. JFW | T@lk 22:38, 19 April 2014 (UTC)[reply]

In the course of the project, as all can see, I was urged to work on a way to address the future directions of nephrology (not my field, but I work closely with it) as another person at the top of the talk page had requested. Look at the early 4/19/2014 version, which was reverted by Jfdwolff ("Jacob de Wolff, a Dutch doctor") on the basis that it is 'original research' I would think that the content is edifying for the core question, what current challenges does nephrology face. From that, the section could be rethought, reorganized, and rewritten. I don't think that there's a false statement in it, nor is anything misrepresented or improperly emphasized; it's a list (with citations).

However, if the quibble is the usefulness in this article of a section on 'Challenges' in the field, we ought to discuss that issue. I'm out' as the 'Sharks' say (it's not a life-critical issue for me). MaynardClark (talk) 23:03, 19 April 2014 (UTC)[reply]

Hi MaynardClark, try not to be disheartened. Like any organisation, Wiki has its own style and make take some getting used to. I've copied what was removed below, and I hope we can work to "Wikify" it, and then put it back in the page. --LT910001 (talk) 23:30, 19 April 2014 (UTC)[reply]

Thank you. MaynardClark (talk) 00:06, 20 April 2014 (UTC)[reply]

Text that was removed

Publications Focusing upon Nephrology

Refereed English-language journals devoted to nephrology include:

Nephrology News Searching for nephrology news is notably feasible with the following refereed English-language medical journals:

There are several sources of medical device information.

Specialty scientific publishers targeting nephrology

Current Challenges Facing Nephrology

As of 2014 a number of contentious issues affect the field of nephrology.

Workforce

There is a global medical workforce shortage, and a growing demand for nephrologists, requiring increased training of adequate numbers of nephrologists to meet patient care and research needs, and therefore funding for building institutional capacity for that professional education.[1] The workforce is also changing, with industry–Physician relationships more prevalant. This engenders regulatory concerns, protecting the public's interest while promoting private/academic partnerships while private-sector research spending has been increasing rapidly in the United States and the European Union, and federal research funding has increased only modestly. [citation needed]

Practice

The continued subspecialization of nephrology] has become fragmentation in nephrology, which resulted in ceding areas of nephrology to other specialties — areas that could be attractive to new trainees. Examples from other encroaching specialties are onco-nephrology, geriatric nephrology, and nephrology issues in critical care medicine. Reintegrating these subdisciplines, nephrology is an enriched environment for its practitioners; ceding them uncritically risks a number of future challenges (especially for medical educators). A number of medical fields have been profoundly redefined in medical history. [2]

  • Globalization: Biomedicine is becoming increasingly globalized, with the participation of Brazil, China, Europe, India, and the United Kingdom. Publications with authorship from more than 1 country are more often cited. Differences between patients with and without access to high-quality kidney care, both on the local and the global level, must be minimized as calls for equity in global health are increasing. * Studying abroad: A recent movement within drug development programs is to conduct pharmaceutical research in developing (and thus resource-poor) nations, where cost per subject is lower, reducing drug trial expenditures directly through decreased payments and indirectly through shorter trials. Faster startup and enrollment reduces times needed for each drug trial and phase, reducing costs for study staff, a expenditure in trial budgets.
  • Recent redefinition of nephropathy (kidney disease) chronic kidney disease (CKD) as a progressive condition that culminates in Stage 5 kidney disease, ESRD (end-stage renal disease, which often can be effectively treated in its earlier stages). Since prevention is now a realistic possibility, the clinical role of nephrologists and other medical practitioners, including general practitioners, may shift to reflect new understandings emerging from new results of kidney research.[3]
  • Renal nursing and renal nutrition face their own challenges.[4]
    • Evidence-based practice requires time, and information seeking is discouraged by professional time constraints, limited access to the literature, lack of training in interpretation of research, and professional work environment.[5]
    • Staffing mobility: Licensure requirements for nurses are different in each state, and shifting employment demands call sometimes for crossing state borders. The Nurse Licensure Compact allows a nurse to practice in any Compact-participating state on the home-state license, but only 24 of 50 US states belong to that Compact group.
    • Nursing-sensitive outcomes (reflecting structure, process, and outcomes of nursing care): number of nursing staff on duty, skill levels of those nursing staff, their education/certifications


Identifying challenges will often leads to research, both biomedical and clinical research and economic and healthcare delivery research. Such challenges include:

  • Exorbitant and growing cost of caring for patients with kidney disease
  • Shift in the management of healthcare from individual physicians to large centralized organizational entities such as accountable care organizations (ACOs), patient-centered homes or neighborhoods (PCMHs), and healthcare innovation zones (HIZs): To counter the potential loss of autonomy, physicians need to help shape the public policy agenda.[6]
  • Cardiorenal risk[7][8]
  • Renal Mass Biopsy (RMB)[9]
  • Fewer new drugs have approved by the US Food and Drug Administration (FDA), and the rate of approval has been dropping, with few of those recently-approved drugs relating to kidney diseases
    • Rigorous, well-designed studies able to establish and define therapeutic efficacy have been limited to an all-comers approach. Powering a study to find a difference among un-selected patients who actually have CKD or ESRD enhances the study's generalizability but fails to incorporate the heterogeneity of the disease processes and clinical scenarios which are commonly observed in these patient populations.
    • Expense of bringing new drugs to market is related to the costs of clinical trials; expenditures required to conduct good clinical studies is not unique, but the additional costs that dialysis companies impose for conducting research in their facilities may be unique.
  • Risks of delayed diagnosis, leading to search for reliable methods for earlier diagnosis
  • Behavioral dimensions of pathology and patients resistance to preventive and clinical medical advice
  • Transplantation issues:
    • Availability of organs for transplant, and their procurement
    • Ethical issues in organ transplantation: fairness, power relationships between the advantaged and disadvantaged, calls for 'markets' in organ procurement.
    • Organ transplant rejection: Bodily rejection of transplanted organs, leading to search for methods to reduce or overcome rejection, such as stem-cell treatment

References

  1. ^ Kohan DE1, Rosenberg ME. The chronic kidney disease epidemic: a challenge for nephrology training programs. Semin Nephrol. 2009 Sep;29(5):539-47. doi: 10.1016/j.semnephrol.2009.06.011
  2. ^ http://jasn.asnjournals.org/content/18/4/1027.long
  3. ^ Rand Corporation, A “Quiet Revolution” in Nephrology: Challenges and Opportunities for Advancing the Treatment of Chronic Kidney Disease
  4. ^ Gomez NJ. Five challenges impacting nephrology nursing. Nephrology Nursing/NNI 2013(October)/Top News Stories/Kidney Care 101, accessed April 18, 2014.
  5. ^ Gomez NJ. Five challenges impacting nephrology nursing. Nephrology Nursing/NNI 2013(October)/Top News Stories/Kidney Care 101, accessed April 18, 2014.
  6. ^ Keller DM. Nephrology Society Faces Many Challenges -- All Surmountable. Medscape Medical News
  7. ^ McCullough PA. Cardiorenal risk: an important clinical intersection. Rev Cardiovasc Med. 2002 Spring;3(2):71-6
  8. ^ Harley C, Wagner S. The prevalence of cardiorenal risk factors in patients prescribed nonsteroidal anti-inflammatory drugs: data from managed care. Clin Ther. 2003 Jan;25(1):139-49
  9. ^ Leppert JT, Hanley JM, Wagner TH, Chung BI, Srinivas S, Chertow GM, Brooks JD, Saigal CS. Utilization of Renal Mass Biopsy in Patients with Renal Cell Carcinoma. Urology, 83(4), Apr. 2014, 774-780

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