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A desperate need for good leaders

Shahid Nazir Muhammad, a Specialist Biomedical Scientist, looks at chronic kidney disease and the need for compassionate, nurturing leaders in the field.

Scientists: iStock

Chronic kidney disease (CKD) is defined as the existence of kidney damage for three months or more or an estimated glomerular filtration rate <60mL/min/1.73 m2 for three months or longer, with or without kidney damage (1). There has been developing research relating to health inequality and CKD (2-4). A review in 2013 identified 30 symptoms associated with CKD and reported that the overall symptom burden is high, regardless of disease stage (5). This symptom burden is acknowledged as the most important predictor of diminished health in patients with CKD (6).

Biomedical science is a dynamic and challenging profession, requiring engaging and inspiring role models and leaders. Identifying and developing scientist leaders is one of the greatest challenges faced by the profession.

 

Aims

The aim here is to formulate a biomedical stance on leadership and management in health today using a CKD and Red Cell Transfusion (RBT) descriptive to highlight importance of integrating knowledge and skills. Also, to highlight why Patient Reported Outcome Measures (PROMs) are going to become important and why Continuing Professional Development (CPD) is important to improve foundations of learning.

 

Biomedical science today

The IBMS aim is to “promote biomedical science and those who practise biomedical science” through a variety of activities based on the premise that within its membership there is a unique body of knowledge that informs an examination and award framework for facilitating development and recognising professional excellence (7). This enables the IBMS to respond and adapt to changing environments, scientific and technological advances, new legislation and evolving roles. The IBMS fosters a culture of partnership and excellence to preserve a high-quality and enthusiastic workforce that continues to advance biomedical science (7).

 

CKD and RBT

Patients with CKD often suffer simultaneously from multiple symptoms related to the condition, or side effects of medical treatment (8). These clusters of symptoms may exert an adverse effect not only on their physical health, but also on their psychological and emotional wellbeing; giving rise to what is described as a “symptom burden” (9).

While RBTs were the principle therapy in patients who may be known to have renal insufficiency to treat anaemia, their use is becoming less predominant (10). With renal function decline, this has an impact on overall treatment and care plans (11-12) – patients then potentially become “untransfusable”.

Having a good knowledge-base is critical, bearing in mind there are now more restraints in everyday practice. Recent evidence has emerged that more restrictive RBTs are safe and avert the potential harm associated with more liberal transfusion strategies (13-14). Now there should be scope to integrate use of PROMs to help support and develop future scientist leaders and managers, thus bringing biomedical practice more to the forefront (15-18).

 

What are PROMS?

In routine health practices, PROMs are used as tools for benchmarking and hospital performance assessment (19-20). PROMs also have the potential to assist in the delivery of healthcare. In the UK, primary and secondary care records are being linked together so that patient background is more readily available to clinicians, when required (21).

The integration of PROMs data with routinely collected clinical data can provide an opportunity for revolutionising the healthcare system, enhancing clinical audits and assisting with the designing of pragmatic trials (22-23).

Given the vast array of PROMs in existence (24-26), it is crucial that decisions are backed by the best evidence available, and this is where biomedical scientists can have a more integrated role with respect to leadership and management by understanding PROMs in context to biomedical science.

 

Leadership and management

Being a leader in the biomedical profession requires scientists to demonstrate integrity, but equally scientists should be encouraged to have more constructive dialogue with their multidisciplinary colleagues, so those who make RBT requests, for example, know when it is safe to transfuse patients who may have renal insufficiency or at risk of acute kidney injury.

Leadership is also knowing when patients may benefit with alternative treatment or care pathways; there need to be good examples in practice, so colleagues can gain firsthand experience of what works and what doesn’t. There needs to be more compassion through mentoring and training, otherwise the motivation relating to training and development lacks enthusiasm.

Management alone does not allow a pathway in practice for fellow colleagues to follow. There is a desperate need for good leaders to link SOPs and encourage evidence-based learning and practice. Perhaps another example of where leadership is required is highlighting CKD, and the science behind blood and organ donation and transplantation to the general public (27-38).

 

Importance of CPD

CPD perhaps forms the backbone to all major health professions. Scientists should also contemplate being involved in advisory and steering groups, to help enhance healthcare more widely and provide best practice for patients – scientists must be thinking unilaterally, especially now with the emphasis on PROMs. CPD is also about how scientists should seek to highlight and publish their efforts. It is important to improve the foundations of learning and this should be encouraged at all grades.

 

Discussion

Scientists are needed who can contribute through multidisciplinary efforts using evidence-based practices, thus shifting the paradigm of leadership and management wherein future practice is destined to grow. It is essential to future success that leaders possessing “positive qualities” are identified and nurtured to lead and manage the profession.

 

Conclusion

It is obvious that CKD is increasing owing to health and social concerns (39-43) and certainly more balance, equity and impartiality are required. Thinking more unilaterally, there is an increasing need for good leaders in science. In today’s ever changing and demanding healthcare, it is important to appreciate that PROMs will be increasingly important and integrated in future biomedical sciences, supporting care of patients with long-term conditions and chronic illnesses.

 

Shahid Nazir Muhammad is a Specialist Biomedical Scientist and Co-founder of Renal Patient Support Group

ℹ References can be found at: bit.ly_BMSrefs_March

 

This article is dedicated in loving memory to a dear friend, Maureen Omondi (1979 to 2016). Maureen campaigned tirelessly for blood and organ donation awareness and fought her life through chronic kidney disease.

 

REFERENCES

  1. ABPI, Big data road map. Association of the British Pharmaceutical Industry (2013) (available at http://www.abpi.org.uk/our-work/library/industry/ Documents/ABPI%20big%20data%20road%20map.pdf) (accessed December 2016)
  2. Aiyegbusi, O.L., Kyte, D., Cockwell, P., Marshall, T., Keeley, T., Gheorghe, A., & Calvert, M. 2016. Measurement properties of patient-reported outcome measures (PROMs) used in adult patients with chronic kidney disease: a systematic review protocol. BMJ Open., 6, (10) e012014
  3. Almutary H, Bonner A, Douglas C (2013). Symptom burden in chronic kidney disease: a review of recent literature. J Ren Care; 39:140–50
  4. Arroliga, A.C., Guntupalli, K.K., Beaver, J.S., Langholff, W., Marino, K., & Kelly, K. (2009). Pharmacokinetics and pharmacodynamics of six epoetin alfa dosing regimens in anemic critically ill patients without acute blood loss. Crit Care Med., 37, (4) 1299-1307
  5. Black N (2013). Patient reported outcome measures could help transform healthcare. BMJ; 346:f167
  6. Black, N., Burke, L., Forrest, C.B., Sieberer, U.H., Ahmed, S., Valderas, J.M., Bartlett, S.J., & Alonso, J. (2016). Patient-reported outcomes: pathways to better health, better services, and better societies. Qual.Life Res., 25, (5) 1103-1112
  7. Bryan S, Davis J, Broesch J, et al. (2014). Choosing your partner for the PROM: a review of evidence on patient-reported outcome measures for use in primary and community care. Healthc Policy;10:38 –51
  8. Calvert M, Thwaites R, Kyte D, et al (2015). Putting patient-reported outcomes on the ‘Big Data Road Map’. J R Soc Med;108:299–303
  9. Chris Ham CI, Nick G, Anna D, et al. (2011).  Where next for the NHS reforms? The case for integrated care. The King’s Fund
  10. Daily Telegraph, (2010). Altruistic Donation I Could Save a  Life and that’s all that  that matters
    (available at http://www.telegraph.co.uk/health/8147224/Altruistic-donation-I-could-sa...) (accessed September 2015)
  11. Davison SN, Jhangri GS, Johnson JA (2006). Cross-sectional validity of a modified Edmonton symptom assessment system in dialysis patients: a simple assessment of symptom burden. Kidney Int; 69:1621–5
  12. Fraser, S.D., Parkes, J., Culliford, D., Santer, M., & Roderick, P.J. (2015a). Timeliness in chronic kidney disease and albuminuria identification: a retrospective cohort study. BMC.Fam.Pract.
  13. Fraser, S.D., Roderick, P.J., Aitken, G., Roth, M., Mindell, J.S., Moon, G., & O'Donoghue, D. (2014). Chronic kidney disease, albuminuria and socioeconomic status in the Health Surveys for England 2009 and 2010. J.Public Health (Oxf), 36, (4) 577-586
  14. Fraser, S.D., Roderick, P.J., May, C.R., McIntyre, N., McIntyre, C., Fluck, R.J., Shardlow, A., & Taal, M.W. (2015b). The burden of comorbidity in people with chronic kidney disease stage 3: a cohort study. BMC.Nephrol., 16, 193
  15. Fraser, S.D., Roderick, P.J., & Taal, M.W. (2016). Where now for proteinuria testing in chronic kidney disease?: Good evidence can clarify a potentially confusing message. Br.J.Gen.Pract., 66, (645) 215-217
  16. Gapstur RL (2007). Symptom burden: a concept analysis and implications for oncology nurses.
  17. Oncol Nurs Forum; 34:673–80
  18. Garcia-Garcia, G. & Jha, V. (2015a). Chronic kidney disease in disadvantaged populations. Curr.Opin.Nephrol.Hypertens., 24, (3) 203-207 available from: PM:26066471
  19. Garcia-Garcia, G. & Jha, V. (2015b). World Kidney Day 2015: CKD in disadvantaged populations. Am.J.Kidney Dis., 65, (3) 349-353
  20. Hossain, M.P., Goyder, E.C., Rigby, J.E., & El, N.M. (2009). CKD and poverty: a growing global challenge. Am.J.Kidney Dis., 53, (1) 166-174
  21. Hossain, M.P., Palmer, D., Goyder, E., & El Nahas, A.M. 2012a. Association of deprivation with worse outcomes in chronic kidney disease: findings from a hospital-based cohort in the United Kingdom. Nephron Clin.Pract., 120, (2) c59-c70
  22. Hossain, M.P., Palmer, D., Goyder, E., & El Nahas, A.M. 2012b. Social deprivation and prevalence of chronic kidney disease in the UK: workload implications for primary care. QJM., 105, (2) 167-175
  23. Holst LB, Petersen MW, Haase N, Perner A, Wetterslev J (2015). Restrictive versus liberal transfusion strategy for red blood cell transfusion: a systematic review of randomized trials with meta-analysis and sequential analysis. BMJ; 350: h1354
  24. Jablonski A (2007). The multidimensional characteristics of symptoms reported by patients on hemodialysis. Nephrol Nurs J;34:29–37; quiz 38
  25. Jha, V., Garcia-Garcia, G., Iseki, K., Li, Z., Naicker, S., Plattner, B., Saran, R., Wang, A.Y., & Yang, C.W. 2013. Chronic kidney disease: global dimension and perspectives. Lancet, 382, (9888) 260-272
  26. Jochmans, I., Darius, T., Kuypers, D., Monbaliu, D., Goffin, E., Mourad, M., Ledinh, H., Weekers, L., Peeters, P., Randon, C., Bosmans, J.L., Roeyen, G., Abramowicz, D., Hoang, A.D., De, P.L., Rahmel, A., Squifflet, J.P., & Pirenne, J. (2012). Kidney donation after circulatory death in a country with a high number of brain dead donors: 10-year experience in Belgium. Transpl.Int., 25, (8) 857-866
  27. Jochmans, I., Moers, C., Smits, J.M., Leuvenink, H.G., Treckmann, J., Paul, A., Rahmel, A., Squifflet, J.P., van, H.E., Monbaliu, D., Ploeg, R.J., & Pirenne, J. (2010). Machine perfusion versus cold storage for the preservation of kidneys donated after cardiac death: a multicenter, randomized, controlled trial. Ann.Surg., 252, (5) 756-764
  28. Jochmans, I. & Pirenne, J. (2011). Graft quality assessment in kidney transplantation: not an exact science yet! Curr.Opin.Organ Transplant., 16, (2) 174-179
  29. Kerr, M., Bedford, M., Matthews, B., & O'Donoghue, D. 2014. The economic impact of acute kidney injury in England. Nephrol.Dial.Transplant., 29, (7) 1362-1368
  30. Kerr, M., Bray, B., Medcalf, J., O'Donoghue, D.J., & Matthews, B. 2012. Estimating the financial cost of chronic kidney disease to the NHS in England. Nephrol.Dial.Transplant., 27 Suppl 3, iii73-iii80
  31. Kyte, D.G., Draper, H., Ives, J., Liles, C., Gheorghe, A., & Calvert, M. 2013. Patient reported outcomes (PROMs) in clinical trials: is 'in-trial' guidance lacking? a systematic review. PLoS.One., 8, (4) e60684
  32. Montgomery, J.R., Berger, J.C., Warren, D.S., James, N.T., Montgomery, R.A., & Segev, D.L. (2012a). Outcomes of ABO-incompatible kidney transplantation in the United States. Transplantation, 93, (6) 603-609
  33. Montgomery, R.A., Lonze, B.E., King, K.E., Kraus, E.S., Kucirka, L.M., Locke, J.E., Warren, D.S., Simpkins, C.E., Dagher, N.N., Singer, A.L., Zachary, A.A., & Segev, D.L. (2011). Desensitization in HLA-incompatible kidney recipients and survival. N.Engl.J Med., 365, (4) 318-326
  34. Montgomery, R.A., Warren, D.S., Segev, D.L., & Zachary, A.A. (2012b). HLA incompatible renal transplantation. Curr.Opin.Organ Transplant., 17, (4) 386-392
  35. ‘My Kidney & Me’, Channel More 4’ (2012). (available at http://www.channel4.com/programmes/my-kidney-and-me/4od) (accessed September 2015)
  36. NHSBT Blood & Transplant Matters, Issue 36 May (2012).
  37. (available at http://www.blood.co.uk/pdf/publications/blood_matters_36.pdf) (accessed September 2015)
  38. NHSBT Blood & Transplant Matters, Issue 40 (2013).
    (available at http://www.blood.co.uk/pdf/publications/blood_matters_40.pdf) (accessed September 2015)

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