Abstract
Do we need a new journal? This is the question I asked myself when I embarked on this challenging new adventure. And yet, how many journals do address the needs of hands-on clinicians?
We frequently read top-quality research papers that have little impact on daily clinical practice due to factors linked to patient compliance, as well as, for example, economic constraints imposed by regulatory bodies. Clinical guidelines are often only partially applicable in clinics, due to the growing complexity of our patients (only rarely mirrored by current randomized controlled trials [RCTs] and available evidence) or the many unanswered questions/aspects that still need to be addressed by future ad hoc studies. Genetic, environmental, nutritional and behavioral factors may significantly interfere with the response of the individual patient to treatment and clearly indicate that the mere application of broad guidelines to an individual patient represents a challenge that will be overcome only with a “personalized” approach at the point of care.
The last few years have also witnessed an exponential growth in the use of technologies that are revolutionizing the way clinicians and other health care practitioners prescribe and deliver treatment. Mobile technology enables novel ways of delivering treatment, monitoring compliance and measuring outcomes. The explosion of social networks has empowered people – especially those patients with rare diseases who have rapidly created strong patient communities. At the same time, the exposure of patients to overwhelming amounts of information leads to what has been defined as “attention obesity” and has somehow weakened the opportunity for standard medical care to be effective, as more and more patients are pushed toward the use of different, often unproven, alternative treatments.
Nephrology@Point of Care (N@PoC) aims to cover simple practical and common issues as well as potential solutions that can easily be implemented in real-world practice, to help clinicians to improve patient care. While collecting information on the many unmet clinical needs, the Journal is designed to help bridge the gap between clinical or basic science research and clinical practice in different regions of the world. Translational medicine with a specific focus on the effectiveness (in real-world applications) rather than the efficacy (in studies) of our interventions is what N@PoC aims for. Too often, clinical research is carried out by researchers who spend too little time with patients, and too often evidence-based medicine (EBM) does not address actual medical needs or it leaves it to hands-on nephrologists to face the challenging task of individualizing clinical trial results for the single patients we meet daily in clinics. N@PoC aims to bridge the expanding gap between research and real-world medicine, helping the hands-on clinician to keep up-to-date with state of the art ideas and to share effective solutions on how to handle common cases in daily practice. The Journal will also cover the impact of new tools such as medical apps or new technologies on patient care as well as new diagnostic/therapeutic algorithms that could be properly tested in future studies.
N@PoC complements other journals in the field of nephrology with a practical approach to translational medicine. It offers the unique opportunity to companies or stakeholders to confront cogent, unmet clinical needs and to express their views and future perspectives in specific domains of interest in the broad field of nephrology.
The open access format and structure of the journal, as well as the composition of the Editorial Board, reflect the nature of the Journal and what N@PoC wants to achieve. It will be led in parallel by a group of expert nephrologists from different geographical regions who have participated in the preparation of clinical practice guidelines in recent years and witnessed their application (or lack of) in actual clinical practice, and by a group of expert young nephrologists who are revamping and revolutionizing treatment approaches by taking advantage of the latest developments in mobile technology, clinical support tools and social networks.
Based on this framework, the aim and scope of N@PoC will be to publish reviews, editorials, points of view, original research articles and case series and reports that will:
Help bridge the gaps between scientific guidelines and their implementation in clinical practice by offering a forum to discuss those gaps and the best way to overcome them;
Bring together clinical excellence and experience with available guidelines to improve and individualize renal patients' care in various clinical settings and for different disease stages;
Identify how new technologies are leading to a significant evolution of diagnostic and therapeutic approaches;
Describe patient series and case reports where the point-of-care approach has been significantly influenced by one or more of the factors described above;
Evaluate how the introduction of point-of-care tools, from electronic patient records to clinical support tools, are changing the management of patients from a clinical and health economics perspective;
Analyze how novel methods of communication with patients, broadly described by the term narrative medicine, may contribute to better patient outcomes.
N@PoC is the first of a series of journals to be designed by Wichtig Publishing to address what I believe is a critical unmet need among physicians in different therapeutic areas, and it aspires to become the reference journal for hands-on nephrologists.