Development of an international standard set of value-based outcome measures for patients with chronic kidney disease : a report of the International Consortium for Health Outcomes Measurement (ICHOM) CKD working group

Value-based health care is increasingly promoted as a strategy for improving care quality by benchmarking outcomes that matter to patients relative to the cost of obtaining those outcomes. To support the shift toward value-based health care in chronic kidney disease (CKD), the International Consortium for Health Outcomes Measurement (ICHOM) assembled an international working group of health professionals and patient representatives to develop a standardized minimum set of patient-centered outcomes targeted for clinical use. The considered outcomes and patient-reported outcome measures were generated from systematic literature reviews. Feedback was sought from patients and health professionals. Patients with very high-risk CKD (stages G3a/A3 and G3b/A2-G5, including dialysis, kidney transplantation, and conservative care) were selected as the target population. Using an online modified Delphi process, outcomes important to all patients were selected, such as survival and hospitalization, and to treatment-specific subgroups, such as vascular access survival and kidney allograft survival. Patient-reported outcome measures were included to capture domains of health-related quality of life, which were rated as the most important outcomes by patients. Demographic and clinical variables were identified to be used as case-mix adjusters. Use of these consensus recommendations could enable institutions to monitor, compare, and improve the quality of their CKD care

Development of an International Standard Set of Value-Based Outcome Measures for Patients With Chronic Kidney Disease

Value-based health care is increasingly promoted as a strategy for improving care quality by benchmarking outcomes that matter to patients relative to the cost of obtaining those outcomes. To support the shift toward value-based health care in chronic kidney disease (CKD), the International Consortium for Health Outcomes Measurement (ICHOM) assembled an international working group of health professionals and patient representatives to develop a standardized minimum set of patient-centered outcomes targeted for clinical use. The considered outcomes and patient-reported outcome measures were generated from systematic literature reviews. Feedback was sought from patients and health professionals. Patients with very high-risk CKD (stages G3a/A3 and G3b/A2-G5, including dialysis, kidney transplantation, and conservative care) were selected as the target population. Using an online modified Delphi process, outcomes important to all patients were selected, such as survival and hospitalization, and to treatment-specific subgroups, such as vascular access survival and kidney allograft survival. Patient-reported outcome measures were included to capture domains of health-related quality of life, which were rated as the most important outcomes by patients. Demographic and clinical variables were identified to be used as case-mix adjusters. Use of these consensus recommendations could enable institutions to monitor, compare, and improve the quality of their CKD care

Factors Affecting Successful use of Erythropoietin in the Treatment of Anemia in Patients on Hemodialysis: Experience in Hajjah Region, Yemen

The use of recombinant human erythropoietin (rHuEpo) became an essential part of the treatment of anemia in patients with end stage renal failure (ESRF). Our experience at the Hajjah region, Yemen, confirms that the use of rHuEpo significantly increases the level of hemoglobin (HB) and hematocrit (Hct), improves work tolerance and overall quality of life of patients on hemodialysis. The observable improvement occurred in 87.5% of patients. The most prominent factors that caused deterioration in the increment of HB and Hct were infection with malaria and chronic infection. Failure of patients′ compliance, largely due to lack of education, was another important factor effecting the results. Many of our patients did not understand the importance of diet and drug regime. It is very important to spend more time on educating such patients

Mothers' and fathers' childcare involvement with young children in rural families in Malaysia

There is a paucity of data on paternal involvement in childcare in traditional Muslim families in Asia. Using culturalecological models of human development that focus on the developmental niche and hegemonic perspectives on masculinity, mothers' and fathers' levels of childcare involvement with infants were examined in 50 twoparent, lowincome, rural Malay Muslim families residing in peninsular Malaysia. The major goals were to examine gender of parent and gender of child differences in involvement in childcare activities. Mothers and fathers were interviewed separately in their homes regarding the amount of time and levels of involvement in bedtime routines, physical care of, playing with, singing to, feeding, and soothing infants. Groupwise comparisons of parental perceptions revealed a marked genderdifferentiated pattern of involvement: Mothers perceived that they were significantly more involved in bedtime routines, physical care, feeding, playing, soothing, and singing to infants than did fathers. On average fathers estimated that they spent 18% as much time cleaning infants (0.63 versus 3.50 hours), 22% as much time feeding infants (0.76 versus 3.49), and 56% as much time playing with infants (2.77 versus 4.92 hours) relative to mothers. These patterns of involvement suggest that in traditional, rural Malay Muslim families, mothers are the primary caregivers to infants, and contrary to the father as play partner hypothesis, mothers engaged in more play with infants than did fathers. Despite divergent levels of involvement, mothers and fathers were equally as inclined to be involved with their male or female infants. Findings are interpreted in terms of traditional Muslim beliefs about gendered ideologies regarding childcare roles and levels of paternal involvement in groups of fathers in rural and urban Malaysia. The limitations, due in part to gathering data from single informants and the nature of the sample, and the implications of the findings for increasing paternal involvement are noted. © 2005 International Union of Psychological Science