Assessment of adult formulas for glomerular filtration rate estimation in children.

BACKGROUND: Estimated glomerular filtration rate (eGFR) is an important diagnostic instrument in clinical practice. The National Kidney Foundation-Kidney Disease Quality Initiative (NKF-KDOQI) guidelines do not recommend using formulas developed for adults to estimate GFR in children; however, studies confirming these recommendations are scarce. The aim of our study was to evaluate the accuracy of the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula, the Modification of Diet in Renal Disease (MDRD) formula, and the Cockcroft-Gault formula in children with various stages of chronic kidney disease (CKD). METHODS: A total of 550 inulin clearance (iGFR) measurements for 391 children were analyzed. The cohort was divided into three groups: group 1, with iGFR >90 ml/min/1.73 m(2); group 2, with iGFR between 60 and 90 ml/min/1.73 m(2); group 3, with iGFR of <60 ml/min/1.73 m(2). RESULTS: All formulas overestimate iGFR with a significant bias (p < 0.001), present poor accuracies, and have poor Spearman correlations. For an accuracy of 10 %, only 11, 6, and 27 % of the eGFRs are accurate when using the MDRD, CKD-EPI, and Cockcroft-Gault formulas, respectively. For an accuracy of 30 %, these formulas do not reach the NKF-KDOQI guidelines for validation, with only 25, 20, and 70 % of the eGFRs, respectively, being accurate. CONCLUSIONS: Based on our results, the performances of all of these formulas are unreliable for eGFR in children across all CKD stages and cannot therefore be applied in the pediatric population group.

Equality Information Steering Group (PDF 10 KB)

Terms of Reference

Le Groupe Prévention et Traitement des Plaies des Hospices-CHUV [The Hospices-CHUV's Wound Prevention and Treatment Group]

The treatment of wounds is a challenge that caregivers of all specialities encounter daily in the care of an ageing population and chronically ill patients. An interdisciplinary group has been created in recent years within the Hospices-CHUV to assist caregivers in their care of patients with wounds. This group has developed a variety of tools to assist decision-making and offers a range of continuing education for those employees involved in wound care. The authors describe the approach of the group and the documents produced during the first two years of experience.

Phytohormone collaboration: zooming in on auxin-brassinosteroid interactions.

Similar to animal hormones, classic plant hormones are small organic molecules that regulate physiological and developmental processes. In development, this often involves the regulation of growth through the control of cell size or division. The plant hormones auxin and brassinosteroid modulate both cell expansion and proliferation and are known for their overlapping activities in physiological assays. Recent molecular genetic analyses in the model plant Arabidopsis suggest that this reflects interdependent and often synergistic action of the two hormone pathways. Such pathway interactions probably occur through the combinatorial regulation of common target genes by auxin- and brassinosteroid-controlled transcription factors. Moreover, auxin and brassinosteroid signaling and biosynthesis and auxin transport might be linked by an emerging upstream connection involving calcium-calmodulin and phosphoinositide signaling.

EORTC Radiation Oncology Group quality assurance platform: establishment of a digital central review facility.

OBJECTIVE: Quality assurance (QA) in clinical trials is essential to ensure treatment is safely and effectively delivered. As QA requirements have increased in complexity in parallel with evolution of radiation therapy (RT) delivery, a need to facilitate digital data exchange emerged. Our objective is to present the platform developed for the integration and standardization of QART activities across all EORTC trials involving RT. METHODS: The following essential requirements were identified: secure and easy access without on-site software installation; integration within the existing EORTC clinical remote data capture system; and the ability to both customize the platform to specific studies and adapt to future needs. After retrospective testing within several clinical trials, the platform was introduced in phases to participating sites and QART study reviewers. RESULTS: The resulting QA platform, integrating RT analysis software installed at EORTC Headquarters, permits timely, secure, and fully digital central DICOM-RT based data review. Participating sites submit data through a standard secure upload webpage. Supplemental information is submitted in parallel through web-based forms. An internal quality check by the QART office verifies data consistency, formatting, and anonymization. QART reviewers have remote access through a terminal server. Reviewers evaluate submissions for protocol compliance through an online evaluation matrix. Comments are collected by the coordinating centre and institutions are informed of the results. CONCLUSIONS: This web-based central review platform facilitates rapid, extensive, and prospective QART review. This reduces the risk that trial outcomes are compromised through inadequate radiotherapy and facilitates correlation of results with clinical outcomes.

Information Mobility: Information Dissemination in Mobile Networks

En el nostre projecte, considerem un escenari urbà o interurbà on persones amb dispositius mòbils (smartphones) o vehicles equipats amb interfícies de comunicació, estan interessats en compartir fitxers entre ells o descarregar-los al creuar Punts d’Accés (APs) propers a la carretera. Estudiem la possibilitat d’utilizar la cooperació en les trobades casuals entre nodes per augmentar la velocitat de descàrrega global. Amb aquest objectiu, plantejem algoritmes per a la selecció de quins paquets, per a quins destins i quins transportistes s’escullen en cada moment. Mitjançant extenses simulacions, mostrem com les cooperacions carry&forward dels nodes augmenten significativament la velocitat de descàrrega dels usuaris, i com aquest resultat es manté per a diversos patrons de mobilitat, col•locacions d'AP i càrregues de la xarxa. Per altra banda, aparells com els smartphones, on la targeta de WiFi està encesa contínuament, consumeixen l'energia de la bateria en poques hores. En molts escenaris, una targeta WiFi sempre activa és poc útil, perque sovint no hi ha necessitat de transmissió o recepció. Aquest fet es veu agreujat en les Delay Tolerant Networks (DTN), on els nodes intercanvien dades quan es creuen i en tenen l’oportunitat. Les tècniques de gestió de l’estalvi d’energia permeten extendre la duració de les bateries. El nostre projecte analitza els avantatges i inconvenients que apareixen quan els nodes apaguen períodicament la seva targeta wireless per a estalviar energia en escenaris DTN. Els nostres resultats mostren les condicions en que un node pot desconnectar la bateria sense afectar la probabilitat de contacte amb altres nodes, i les condicions en que aquesta disminueix. Per exemple, es demostra que la vida del node pot ser duplicada mantenint la probabilitat de contacte a 1. I que aquesta disminueix ràpidament en intentar augmentar més la vida útil.

Use of Existing Meningococcal Group C Vaccine - Students in Higher Education (PDF 20KB)

This document is also available in the Publications Section of the DHSS website at:www.dhssni.gov.uk åÊ åÊ

Report of the National Joint Steering Group on the Working Hours of Non Consultant Hospital Doctors

The introduction of a maximum 48 hour working week for Non Consultant Hospital Doctors by 2010 will have significant implications for both Doctors in training and service delivery in our hospitals. This report focuses on how this reduction in working hours can be achieved and the many directly related issues that need to be addressed Download the Report here

Protecting Our Future - Report of the Working Group on Elder Abuse

The Working Group on Elder Abuse is pleased to present this Report. It provides a foundation for the development of policy and procedures to respond to actual or alleged cases of elder abuse.  Aim of policy and proceduresThe aim of the policy and procedures presented here is to create a context in which older people and those concerned about the abuse of older people can disclose their concerns and receive an appropriate response. The basis of the policy (and the procedures flowing from it) is the recognition of the right of older people to live independent lives with dignity. Download document here