Developing a Set of Core Outcomes for Trials in Haemodialysis: An International Delphi Survey

AIM: To generate a consensus-based, prioritized list of core outcomes for trials in haemodialysis. BACKGROUND: Survival and quality of life for patients on haemodialysis remain poor despite substantial research efforts. Existing trials often report surrogate outcomes that may not be relevant to patients and clinicians. A core outcome set that reflects stakeholder priorities would improve the relevance, efficiency, and comparability of haemodialysis trials. METHODS: In an online Delphi survey, participants rated the importance of outcomes using a 9-point Likert scale. In Round 2 and 3, participants reviewed the scores and comments of other respondents and re-rated the outcomes. For each outcome, we calculated the median, mean, and proportion rating 7-9 (“critically important”). RESULTS: 1,181 participants (202 [17%] patients/caregivers, 979 health professionals) from 73 countries completed Round 1 and 838 (150 [18%] patients/caregivers) completed Round 3 (71% response rate). Outcomes achieving consensus as high priorities across both groups were: vascular access complications, cardiovascular disease, mortality, dialysis adequacy and fatigue. Patients/caregivers rated four outcomes higher than health professionals: ability to travel (mean difference 0.9), dialysis-free time (0.5), dialysis adequacy (0.3), and washed out after dialysis (0.2). Health professionals rated 11 outcomes higher: mortality (1.0), hospitalization (1.0), drop in blood pressure (1.0), vascular access complications (0.9), depression (0.9), cardiovascular disease (0.8), target weight (0.7), infection (0.4), potassium (0.4), ability to work (0.3), and pain (0.3). CONCLUSIONS: The top stakeholder prioritized outcomes were vascular access problems, cardiovascular disease, mortality, dialysis adequacy and fatigue. Patients/caregivers gave higher priority to lifestyle-related outcomes than health professionals. This prioritized set of outcomes can inform the establishment of a core outcome set, to improve the value of trial evidence to support decision-making for people on haemodialysis

Adaptive optics imaging and optical spectroscopy of a multiple merger in a luminous infrared galaxy

(abridged) We present near-infrared (NIR) adaptive optics imaging obtained with VLT/NACO and optical spectroscopy from the Southern African Large Telescope (SALT) of a luminous infrared galaxy (LIRG) IRAS 19115-2124. These data are combined with archival HST imaging and Spitzer imaging and spectroscopy, allowing us to study this disturbed interacting/merging galaxy, dubbed the Bird, in extraordinary detail. In particular, the data reveal a triple system where the LIRG phenomenon is dominated by the smallest of the components. One nucleus is a regular barred spiral with significant rotation, while another is highly disturbed with a surface brightness distribution intermediate to that of disk and bulge systems, and hints of remaining arm/bar structure. We derive dynamical masses in the range 3-7x10^10 M_solar for both. The third component appears to be a 1-2x10^10 M_solar mass irregular galaxy. The total system exhibits HII galaxy-like optical line ratios and strengths, and no evidence for AGN activity is found from optical or mid-infrared data. The star formation rate is estimated to be 190 M_solar/yr. We search for SNe, super star clusters, and detect 100-300 km/s outflowing gas from the Bird. Overall, the Bird shows kinematic, dynamical, and emission line properties typical for cool ultra luminous IR galaxies. However, the interesting features setting it apart for future studies are its triple merger nature, and the location of its star formation peak - the strongest star formation does not come from the two major K-band nuclei, but from the third irregular component. Aided by simulations, we discuss scenarios where the irregular component is on its first high-speed encounter with the more massive components.Comment: 24 pages, 16 figures. Accepted MNRAS version, minor corrections only, references added. Higher resolution version (1.3MB) is available from http://www.saao.ac.za/~petri/bird/ulirg_bird_highres_vaisanen_v2.pd