Identifying critically important vascular access outcomes for trials in haemodialysis : an international survey with patients, caregivers and health professionals

BACKGROUND: Vascular access outcomes reported across haemodialysis (HD) trials are numerous, heterogeneous and not always relevant to patients and clinicians. This study aimed to identify critically important vascular access outcomes. METHOD: Outcomes derived from a systematic review, multi-disciplinary expert panel and patient input were included in a multilanguage online survey. Participants rated the absolute importance of outcomes using a 9-point Likert scale (7-9 being critically important). The relative importance was determined by a best-worst scale using multinomial logistic regression. Open text responses were analysed thematically. RESULTS: The survey was completed by 873 participants [224 (26%) patients/caregivers and 649 (74%) health professionals] from 58 countries. Vascular access function was considered the most important outcome (mean score 7.8 for patients and caregivers/8.5 for health professionals, with 85%/95% rating it critically important, and top ranked on best-worst scale), followed by infection (mean 7.4/8.2, 79%/92% rating it critically important, second rank on best-worst scale). Health professionals rated all outcomes of equal or higher importance than patients/caregivers, except for aneurysms. We identified six themes: necessity for HD, applicability across vascular access types, frequency and severity of debilitation, minimizing the risk of hospitalization and death, optimizing technical competence and adherence to best practice and direct impact on appearance and lifestyle. CONCLUSIONS: Vascular access function was the most critically important outcome among patients/caregivers and health professionals. Consistent reporting of this outcome across trials in HD will strengthen their value in supporting vascular access practice and shared decision making in patients requiring HD

Pragmatic aspects of task performance: The case of argumentation.

The study reported in this paper investigated the pragmatic aspects of task-performance in a series of argumentation tasks that 24 Hungarian learners of English performed over a period of two years. The aim of our research project was to determine how task-repetition, the long-term development of language skills, and a short-term focused intervention influenced various pragmatic measures of task-performance such as the pragmalinguistic markers of argumentation, the number of claims, counterclaims, supports and counter-supports. We also analysed how these variables differed when the participants performed the same type of task in their mother tongue. The results showed that in the repeated version of the task, familiarity with the task structure helped learners pay more attention to the informational content of their message, which was reflected in the higher number of supportive moves they produced. Participants were found to have better argumentation skills in their mother tongue and used a wider variety of pragmalinguistic markers than in L2. The language development assumed to have taken place during one year and the argumentation training, however, did not result in better pragmatic and pragmalinguistic performance