Outcomes of cardiopulmonary resuscitation in dialysis patients.

Patients with renal failure are believed to have a poor survival rate after cardiopulmonary resuscitation, but there is little specific information about the outcomes of cardiopulmonary resuscitation in dialysis patients. To be better able to inform dialysis patients and assist them in decision making about cardiopulmonary resuscitation, the eight-year experience with cardiopulmonary resuscitation in dialysis patients at a university dialysis program was analyzed and outcomes were compared with those of a control group of nondialysis patients undergoing cardiopulmonary resuscitation during the same time period in the same hospital. Of 221 dialysis patients experiencing cardiopulmonary arrest, 74 (34%) had CPR compared with 247 (21%) of 1,201 control patients (P = 0.0002). Six of 74 (8%; 95% confidence interval, 2 to 14%) dialysis patients survived to hospital discharge compared with 30 of 247 (12%; 95% confidence interval, 8 to 16%) control patients (P = not significant). At 6 months after CPR, 2 (3%) of 74 dialysis patients were still alive compared with 23 (9%) of 247 controls (P = 0.044); this difference was not explained by age or comorbid conditions. Twenty-one (78%) of the 27 successfully resuscitated dialysis patients died a mean of 4.4 days later; 95% were on mechanical ventilation in an intensive care unit at the time of death. It was concluded that cardiopulmonary resuscitation is a procedure that rarely results in extended survival for dialysis patients. In discussions about cardiopulmonary resuscitation with dialysis patients, nephrologists should provide this information.     

Outcomes research in nephrology

The field of clinical research in nephrology should be and is being broadened beyond clinical trials by incorporating epidemiologic designs and subjective patients' assessments of their own health and the degree to which they are satisfied with services they receive. The advantages of these changes include increased relevance to the concerns of patients and increased relevance to the real world of clinical practice.     

Outcomes research in glomerulonephritis

Glomerulonephritis remains the second or third most common primary renal disease type to progress to end-stage renal failure. This disease type is particularly important because its focus is limited to the kidney and its reversal or stabilization ensures a return to a normal quality of life for the individual. Also, because its highest incidence rate is in childhood and early adulthood, the implications of effective therapy in terms of preventing end-stage renal failure costs, benefits not only the individual but also society. We focus on the 3 most common variants that progress to end-stage renal failure (ie, membranous nephropathy [MGN], focal segmental glomerulosclerosis [FSGS], and IgA nephropathy). Together these represent approximately 80% of the primary glomerular diseases known to progress. We discuss the outcome studies published over the past decade in these disorders that permit the best insight into specific immunotherapy. We provide this data in an evidence-based model so the reader can appreciate the strengths and/or weaknesses of the therapies discussed and we provide a framework for clinical management.     

Outcomes research in rheumatoid arthritis

Although rheumatoid arthritis causes significant disability for more than 1 million individuals in the United States, prior research regarding surgical treatment options has been limited by study sample size, study design, and methods of comparison. Furthermore, there is wide variation in the referral pattern for hand surgery consideration and type of surgical treatment of rheumatoid hand disease, yet the reasons for these differences are unclear. This review describes the role of outcomes research in rheumatoid hand disease by summarizing variations in surgical treatment, detailing current outcome assessment strategies, and offering potential strategies for designing future studies for rheumatoid hand disease.     

Outcomes research in acute renal failure

Acute renal failure (ARF) is associated with morbidity and mortality in excess of 50% in the intensive care unit (ICU) setting. A variety of outcome measures have been described in published reports of ARF, however, the studies often do not distinguish between clinical outcomes and surrogate endpoints. Multiple factors can influence these outcomes, including variations in practice. It is important to be aware of the potential effects of these factors when clinical trials are planned and executed for ARF patients. For any intervention trial, knowledge of the natural history of the disease and process of care informs the design and conduct of the trial. Standardization of a definition for ARF and of the criteria for initiation, frequency, duration, and withdrawal of dialysis support would be of great benefit. This article provides a critical appraisal of outcomes research in ARF and describes an approach for selecting appropriate endpoints for future clinical research in ARF.     

Outcomes study of a customer relations educational program in dialysis practice

In the fall of 2003, a customer relations staff educational program was instituted for use throughout Renal Care Group. After 1 year and 4 months, an outcomes study was implemented to evaluate and revise the program. The program is taught by the dialysis social worker to the rest of the dialysis health-care team to increase customer relations skills with the patients, their families, and dialysis coworkers. Today, more than ever, patients are seeking better quality health care not only in technical skills but also in compassionate care. Pretest and posttest scores from each training session indicated the necessity of this training and knowledge gained. Through a survey of instructors, strengths of the program were identified, as well as were areas that needed revision. In addition to providing helpful information, some of the main strengths of the program indicated by instructors were team building and problem solving. Revisions consisted primarily of shortening the modules and simplifying the program's use.     

Outcomes research in head and neck reconstruction

Modern management of advanced upper aerodigestive tract malignancy often results in profound effects on function and appearance. These functions include speech, deglutition, mastication, taste, oral hygiene, and airway maintenance. The most commonly studied site in the head and neck is the oromandibular complex. The primary goals of reconstruction are the preservation and restoration of these functions along with socially acceptable cosmesis. Achieving these objectives is not to be accomplished at the expense of acceptable oncologic principles. With the availability of microvascular free tissue techniques, single-stage oromandibular reconstruction is now commonly performed. Few studies, however, have critically examined the functional outcomes of these techniques. To date, these investigations have been limited and retrospective. Lack of a uniform system for reporting defect size and locations as well as patient function and quality of life has limited the utility of the available data. In this article, outcomes research in head and neck reconstruction is discussed with regard to objective study parameters using the oral cavity as a model. Pertinent current literature is cited.     

腹膜透析滤出液生物标志物的研究进展

长期腹膜透析可导致腹膜形态和功能的改变。腹膜功能评估主要通过小分子溶质和液体清除两方面来评估,相对简单。但形态学上的评估则要依靠腹膜活检,在临床应用中很难施行。如何能准确、方便、无创地评价腹膜的变化,一直备受关注。腹膜组织长期浸泡在腹膜透析液中,必然会分泌或脱落一些物质,是腹膜透析患者独特且方便的检测标本,因此通过回收腹膜透析滤出液,寻找并测定这些物质,将有助于了解腹膜的病理生理变化。因此,本文针对腹膜透析研究中新兴的候选生物标志物进行了汇总,并就其临床应用前景做一综述。     

Outcomes research and facial plastic surgery

Outcomes research examines the delivery of medical care from the patient's perspective, using unique instruments and methodologies. Outcome studies can measure the effectiveness of treatments or interventions in individual patients or in large populations, using prospective observational research designs. The steps in performing outcomes research are as follows: identify and define the disease or procedure of interest, create a staging system for disease severity, identify important co-morbid conditions, choose or design an outcomes instrument to measure treatment outcomes, and design a study to assess outcomes prospectively. Although there is currently a dearth of outcomes instruments available for use in facial plastic and reconstructive surgery, some new instruments are being developed, and even using existing tools outcomes research should prove to be a valuable research tool for facial plastic surgeons to demonstrate improved quality of life and functional status in their patients.     

Outcomes research: a methodologic review

OBJECTIVES: We explored the history and conceptual trends of outcomes research. METHODS: We described different aspects of this field, after dividing it into conceptually distinct strata. RESULTS: Outcomes research can be divided into macro, meso and micro levels. Each level is further subdivided. Macro-level research targets cost and health care utilization, as well as racial, ethnic and geopolitical population health determinants. Meso-level studies address effectiveness, variability, disease impact, clinical modeling and program evaluation studies. Finally, micro-level studies address all aspects of direct patient-clinician decision-making. CONCLUSIONS: An explosion of outcomes research has occurred in the past decades. Wide access to information technology, data sharing and collaborative efforts between researchers represent some of the ingredients that did and will continue to fuel that growth.