Low protein diets in patients with chronic kidney disease: a bridge between mainstream and complementary-alternative medicines?

Dietary therapy represents an important tool in the management of chronic kidney disease (CKD), mainly through a balanced reduction of protein intake aimed at giving the remnant nephrons in damaged kidneys a "functional rest". While dialysis, transplantation, and pharmacological therapies are usually seen as "high tech" medicine, non pharmacological interventions, including diets, are frequently considered lifestyle-complementary treatments. Diet is one of the oldest CKD treatments, and it is usually considered a part of "mainstream" management. In this narrative review we discuss how the lessons of complementary alternative medicines (CAMs) can be useful for the implementation and study of low-protein diets in CKD. While high tech medicine is mainly prescriptive, prescribing a "good" life-style change is usually not enough and comprehensive counselling is required; the empathic educational approach, on which CAMs are mainly, though not exclusively based, may support a successful personalized nutritional intervention.There is no gold-standard, low-protein diet for all CKD patients: from among a relatively vast choice, the best compliance is probably obtained by personalization. This approach interferes with the traditional RCT-based analyses which are grounded upon an assumption of equal preference of treatments (ideally blinded). Whole system approaches and narrative medicine, that are widely used in the study of CAMs, may offer ways to integrate EBM and personalised medicine in the search for innovative solutions respecting individualization, but gaining sound data, such as with partially-randomised patient preference trials

Type 1 diabetes, diabetic nephropathy, and pregnancy: a systematic review and meta-study

BACKGROUND: In the last decade, significant improvements have been achieved in maternal-fetal and diabetic care which make pregnancy possible in an increasing number of type 1 diabetic women with end-organ damage. Optimal counseling is important to make the advancements available to the relevant patients and to ensure the safety of mother and child. A systematic review will help to provide a survey of the available methods and to promote optimal counseling. OBJECTIVES: To review the literature on diabetic nephropathy and pregnancy in type 1 diabetes. METHODS: Medline, Embase, and the Cochrane Library were scanned in November 2012 (MESH, Emtree, and free terms on pregnancy and diabetic nephropathy). Studies were selected that report on pregnancy outcomes in type 1 diabetic patients with diabetic nephropathy in 1980-2012 (i.e. since the detection of microalbuminuria). Case reports with less than 5 cases and reports on kidney grafts were excluded. Paper selection and data extraction were performed in duplicate and matched for consistency. As the relevant reports were highly heterogeneous, we decided to perform a narrative review, with discussions oriented towards the period of publication. RESULTS: Of the 1058 references considered, 34 fulfilled the selection criteria, and one was added from reference lists. The number of cases considered in the reports, which generally involved single-center studies, ranged from 5 to 311. The following issues were significant: (i) the evidence is scattered over many reports of differing format and involving small series (only 2 included over 100 patients), (ii) definitions are non-homogeneous, (iii) risks for pregnancy-related adverse events are increased (preterm delivery, caesarean section, perinatal death, and stillbirth) and do not substantially change over time, except for stillbirth (from over 10% to about 5%), (iv) the increase in risks with nephropathy progression needs confirmation in large homogeneous series, (v) the newly reported increase in malformations in diabetic nephropathy underlines the need for further studies. CONCLUSIONS: The heterogeneous evidence from studies on diabetic nephropathy in pregnancy emphasizes the need for further perspective studies on this issue

Taking Advice from (Dis)Similar Machines: {T}he Impact of Human-Machine Similarity on Machine-Assisted Decision-Making

Machine learning algorithms are increasingly used to assist human decision-making. When the goal of machine assistance is to improve the accuracy of human decisions, it might seem appealing to design ML algorithms that complement human knowledge. While neither the algorithm nor the human are perfectly accurate, one could expect that their complementary expertise might lead to improved outcomes. In this study, we demonstrate that in practice decision aids that are not complementary, but make errors similar to human ones may have their own benefits. In a series of human-subject experiments with a total of 901 participants, we study how the similarity of human and machine errors influences human perceptions of and interactions with algorithmic decision aids. We find that (i) people perceive more similar decision aids as more useful, accurate, and predictable, and that (ii) people are more likely to take opposing advice from more similar decision aids, while (iii) decision aids that are less similar to humans have more opportunities to provide opposing advice, resulting in a higher influence on people’s decisions overall

Business Process Lines and Decision Tables Driving Flexibility by Selection

A major challenge faced by organizations is to better capture business strategies into products and services at an ever-increasing pace as the business environment constantly evolves. We propose a novel methodology base on a Business Process Line (BPL) engineering approach to inject flexibility into process modeling phase and promote reuse and flexibility by selection. Moreover we suggest a decision-table (DT) formalism for eliciting, tracking and managing the relationships among business needs, environmental changes and process tasks. In a real case study we practiced the proposed methodology by leveraging the synergy of feature models, variability mechanisms and decision tables. The application of DT-based BPL engineering approach proves that the Business Process Line benefits from fundamental concepts like composition, reusability and adaptability and satisfies the requirements for process definition flexibility