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Van Biesen W, Van Craenenbroeck A, Abramowicz D, Els H, Nic V, Glorieux G, Couttenye MM, Eloot S. TO011HEALTH UTILITY BUT NOT UREMIC TOXINS ARE ASSOCIATED WITH ONE YEAR MORTALITY IN HD PATIENTS. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa141.to011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Patient centred care is progressively gaining importance. Standardized outcomes should take into account patient relevant outcomes, such as mortality and quality of life. It is unknown whether the health utility index EQ5D, an objective assessment of quality of life, is associated with mortality in haemodialysis patients. Serum concentrations of different uremic toxins have been associated with survival. We intended to explore whether EQ5D rather than concentrations of representative uraemic toxins (UT) was associated with mortality.
Method
Prospective longitudinal multicentric cohort study of all haemodialysis patients at 5 representative dialysis centres in Flanders. Total and free concentrations of representative uraemic toxins indoxyl sulfate (IxS), p-cresyl sulfate (pCS), p-cresyl glucuronide (pCG), indole acetic acid (IAA), 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid (CMPF), hippuric acid (HA) and uric acid (UA) were determined at baseline. Mini Nutritional Assessment (MNA) and EQ5D were assessed by dedicated nurses. Mortality was assessed from administrative or medical records. A Cox regression model was built, both fixed and as conditional forward including clinical parameters, MNA, EQ5D and serum concentrations of the different uraemic toxins.
Results
216 prevalent patients (62%male, age 67.2 ± 15.7) all on high flux haemodialysis were included. Over the observation period, 59 patients (27%) died. Health utility as assessed by EQ5D was 0.69±0.28; perceived health by visual analogue scale (VAS) (0-100) was 59.6±18.6. Adjusting for age, gender and MNA score, free but not total concentrations of IxS, pCS and IAA and EQ5D score were associated with overall survival in the forced entry model. However, neither in the fixed entry, the forward or backward model were serum concentrations of uraemic toxins retained, and only age, gender, BMI, EQ5D and VAS were consistently associated with survival.
Conclusion
Measures of health utility, such as EQ5D, and quality of life, such as a simple VAS score, are more predictive of survival in patients on regular haemodialysis than serum concentrations of a panel of relevant uraemic toxins. Health utility and QoL are thus not only directly relevant to patients, but also indirectly through an association with improved survival.
The concept of dialysis adequacy has been challenged over the last decade, mainly because it was focusing on small solute clearance. Different authors reported that concentrations of middle molecular and protein bound solutes were more representative. In our study, free but not total solute concentrations were associated with survival. However, adjusting additionally for health utility and/or health perception and/or assessment of nutritional status abolishes this association. Studies assessing interventions to enhance solute removal should not only include solute concentrations as outcome, but also consider EQ5D, VAS and nutritional status as important outcomes to enhance patient centeredness of their findings.
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Affiliation(s)
| | | | | | - Holvoet Els
- Ghent University Hospital, Renal Division, Gent, Belgium
| | - Veys Nic
- Ghent University Hospital, Renal Division, Gent, Belgium
| | - Griet Glorieux
- Ghent University Hospital, Renal Division, Gent, Belgium
| | | | - Sunny Eloot
- Ghent University Hospital, Renal Division, Gent, Belgium
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Els H, Van Biesen W, Van Humbeeck L. P1820THE DEVELOPMENT OF TRANSITION SERVICES IN RENAL CARE IN SYNERGY WITH YOUNG PATIENTS, PARENTS AND PEDIATRIC AND ADULT HEALTH CARE PROVIDERS: A CO-CREATION APPROACH. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Healthcare transition to adulthood is recognised as challenging for adolescents and young adults (AYA’s) diagnosed with chronic kidney disease. Therefore the implementation of a transition programme adjusted to the needs of this patient population is of great importance. However, rarely are the views of young people or their families sought about the process or relevant outcome of their transition process. The aim of this study was to co-develop a transition programme that (1) enables health care providers to facilitate improving transition outcomes from the perspective of all stakeholders, and (2) enhances self-management by young people with chronic kidney disease.
Method
The development of this programme involved (1) an extensive review of currently existing best-practices (published and unpublished), and (2) understanding the current state of transition practice at our centre by means of semi-structured interviews and focus groups with patients, parents and health care providers of both pediatric and adult side.
Results
A working group was established incorporating a reflective process designed to develop a community of practice. During the process, participants’ experiences, lessons learned from the review of current state of evidence and practice, and appreciation of the (changing) context within which participants were working were incorporated. Analysis revealed 6 core elements as the foundation of the transition program: the AYA as the main focus, involvement of the parents, holistic approach, flexibility, forward-looking approach, continuity in guidance and follow-up. We also identified the need to distinguish the difference between transitioning from child to teenager to young adult and the actual transfer between paediatric and adult care. The actual final proposed transition programme can be divided in 4 phases: (1) introduction of the transition process to parents and patients, (2) guiding the patient to become more independent and to gain insight in the disease and related themes, (3) managing the transfer to adult health care and (4) finalizing the transition care plan. Adequate on-going communication and collaboration between paediatric and adult care seems essential for achieving a successful program.
Conclusion
This study addressed the development of a transition programme as a multi-actor process wherein patients, parents and health care providers significantly contribute to the transition to adulthood and transfer to adult care.
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van der Merwe B, Ackermann C, Els H. CT enteroclysis in the developing world: How we do it, and the pathology we see. Eur J Radiol 2013; 82:e317-25. [DOI: 10.1016/j.ejrad.2013.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 03/21/2013] [Accepted: 03/27/2013] [Indexed: 12/20/2022]
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Els H, Andronikou S. Cognitive decline and depressed level of consciousness in AIDS: Diagnosis. SA J Radiol 2011. [DOI: 10.4102/sajr.v15i2.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Cognitive decline and depressed level of consciousness in AIDS: Diagnosis
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Hymon JR, Schmid H, Karrer P, Boller A, Els H, Fahrni P, Fürst A. Die Chemie desWieland-Gumlich-Aldehyds und seiner Derivate [1] 136. Mitteilung über Alkaloide [2]. Helv Chim Acta 2004. [DOI: 10.1002/hlca.19690520617] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Saucy G, Els H, Miksch F, Fürst A. Über 9β, 10α-Steroide. 2. Mitteilung. Strukturaufklärung von mikrobiologischen Umsetzungsprodukten mit Sauerstoff-Funktion in Stellung 11. Helv Chim Acta 2004. [DOI: 10.1002/hlca.19660490514] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
In South Africa, communal rural community development has, for the most part, been viewed as an add-on, rather than as an integral value in the broad spectrum of conservation activities being practised in the country. This paper, therefore, argues for the reality-based adoption of an extension of existing conservation paradigms to incorporate the development of communal rural communities as an integral part of the overall wildlife conservation and management policy in South Africa. The answer to the seeming contradiction in the focus of wildlife conservation and rural development lies in the devel- opment of wildlife management programmes based on multi-disciplinary and multiinstitutional interaction, by also harnessing scientific knowledge and skills found in the social sciences. In this manner, the present largely lip service related to so-called com- munity participation in wildlife management can be changed into programmes which really achieve conservation-based community development enhancing survival for both the communities and their inherent natural resources.
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Englert G, Arnold W, Els H, Fürst A, Meier A, Meister W. Substituent increments for the 1H-NMR. Chemical shifts of the 18- and 19-methyl protons of steroids. Part I: 9beta, 10alpha(retro)-steroids. Helv Chim Acta 1974; 57:1549-58. [PMID: 4465338 DOI: 10.1002/hlca.19740570609] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Els H, Fürst A, Englert G, Reusser P, Schocher AJ. [On 9-beta,10-alpha-steroids. 4. Structure elucidation from microbiological reaction products]. Helv Chim Acta 1969; 52:1157-64. [PMID: 5800423 DOI: 10.1002/hlca.19690520502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Kyburz E, Els H, Majnoni S, Englert G, von Planta C, Fürst A, Plattner PA. Synthese und Eigenschaften von Aziridincarbonsäureestern. Helv Chim Acta 1966. [DOI: 10.1002/hlca.660490142] [Citation(s) in RCA: 39] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Els H, Englert G, Müller M, Fürst A. [On 9-beta, 10-alpha-steroids. 1. Preparation and properties of 6-halogen-9-beta,10-alpha-androstane derivatives]. Helv Chim Acta 1965; 48:989-1001. [PMID: 5858880 DOI: 10.1002/hlca.19650480502] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Els H. Ueber die Giftigkeit und Gerinnungsverzögerung des intraperitonealen Blutergusses nach Tubenruptur. Arch Gynecol Obstet 1913. [DOI: 10.1007/bf01831920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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