Fifteen-minute consultation: Empowering children, young people and families through shared decision-making: a practical guide.

Shared decision-making (SDM) is a collaborative approach to healthcare decision-making that involves patients and healthcare professionals working together to make decisions that are informed by the best available medical evidence, as well as the patient's values, preferences and goals. The importance of SDM and the intricate interplay among parents, children and young people (CYP), and healthcare professionals are increasingly acknowledged as the crucial aspects of delivering high-quality paediatric care. While there is a substantial evidence base for SDM improving knowledge and reducing decisional conflict, the evidence for long-term measures such as improved health outcomes is limited and mainly inconclusive.

Patients' and kidney care team's perspectives of treatment burden and capacity in older people with chronic kidney disease: a qualitative study.

Objective: Chronic kidney disease (CKD) is often a multimorbid condition and progression to more severe disease is commonly associated with increased management requirements, including lifestyle change, more medication and greater clinician involvement. This study explored patients' and kidney care team's perspectives of the nature and extent of this workload (treatment burden) and factors that support capacity (the ability to manage health) for older individuals with CKD.

Design: Qualitative semistructured interview and focus group study.

Who benefits most from extending financial protection for cataract surgery in Vietnam? An extended cost-effectiveness analysis of small incision surgery.

Treatment costs remain a barrier for having timely cataract surgery in Vietnam, particularly for females and the poor, despite significant progress in achieving universal health coverage (UHC). This study evaluated the potential impact, on health and financial protection, of eliminating medical and non-medical out-of-pocket costs associated with cataract surgery. An extended cost-effectiveness analysis (ECEA) was conducted with a societal perspective.

The global cost of eliminating avoidable blindness.

Aims: To complete an initial estimate of the global cost of eliminating avoidable blindness, including the investment required to build ongoing primary and secondary health care systems, as well as to eliminate the 'backlog' of avoidable blindness. This analysis also seeks to understand and articulate where key data limitations lie.

Materials And Methods: Data were collected in line with a global estimation approach, including separate costing frameworks for the primary and secondary care sectors, and the treatment of backlog.

Evaluation of dietetic advice for modification of cardiovascular disease risk factors in renal transplant recipients.

Objective: To investigate the effect of dietitian involvement in a multidisciplinary lifestyle intervention comparing risk factor modification for cardiovascular disease with standard posttransplant care in renal transplant recipients (RTR) with abnormal glucose tolerance (AGT).

Design: Randomized controlled trial.

Setting: Hospital outpatient department.

Higher levels of physical activity are associated with a lower risk of abnormal glucose tolerance in renal transplant recipients.

Objective: We investigated and compared diets and physical activity levels of renal transplant recipients (RTRs) with normal glucose tolerance (NGT) and abnormal glucose tolerance (AGT), and we identified clinical risk factors for AGT.

Design: This study was cross-sectional and observational.

Setting: This study took place in a hospital's renal outpatient department.

Cardiorespiratory fitness is related to physical inactivity, metabolic risk factors, and atherosclerotic burden in glucose-intolerant renal transplant recipients.

The mechanisms of reduced cardiorespiratory fitness (CF) in renal transplant recipients (RTR) have not been studied closely. This study evaluated the relationships between CF and specific cardiovascular risk factors (metabolic syndrome [MS], physical inactivity, myocardial ischemia, and atherosclerotic burden) in glucose-intolerant RTR. Data were recorded on 71 glucose-intolerant RTR (mean age 55 yr; 55% male; median transplant duration 5.

Should an oral glucose tolerance test be performed routinely in all renal transplant recipients?

Posttransplantation diabetes (PTD) contributes to cardiovascular disease and graft loss in renal transplant recipients (RTR). Current recommendations advise fasting blood glucose (FBG) as the screening and diagnostic test of choice for PTD. This study sought to determine (1) the predictive power of FBG with respect to 2-h blood glucose (2HBG) and (2) the prevalence of PTD using FBG and 2HBG compared with that using FBG alone, in prevalent RTR.

Metabolic syndrome in severe chronic kidney disease: Prevalence, predictors, prognostic significance and effects of risk factor modification.

Background: Metabolic syndrome (MS) is a significant risk factor for cardiovascular disease, mortality and chronic kidney disease (CKD) in the general population. However, the prevalence, predictors, prognostic value and treatment of MS in the CKD population have not been rigorously studied.

Methods: The study involved 200 stages 4 and 5 CKD patients enrolled in a randomized controlled trial of intensive multiple risk factor modification (targeting hypercholesterolaemia, hyperhomocysteinaemia, anaemia and disordered bone mineral metabolism) versus usual care.

Prognostic role of subclinical left ventricular abnormalities and impact of transplantation in chronic kidney disease.

Objective: The outcome of patients with chronic kidney disease (CKD) is influenced by overt left ventricular (LV) abnormalities. We sought the predictive value and treatment response of subclinical LV dysfunction in CKD.

Method: Resting and dobutamine stress echocardiography were used to identify LV enlargement, dysfunction, or ischemia in 176 patients with CKD.

Risk stratification of patients with chronic kidney disease: results of screening strategies incorporating clinical risk scoring and dobutamine stress echocardiography.

Background: Cardiac disease is the principal cause of death in patients with chronic kidney disease (CKD). Ischemia at dobutamine stress echocardiography (DSE) is associated with adverse events in these patients. We sought the efficacy of combining clinical risk evaluation with DSE.

Does uric acid have a pathogenetic role in graft dysfunction and hypertension in renal transplant recipients?

Background: Uric acid (UA) may play a pathogenetic role in hypertension and kidney disease. We explored the prevalence of hyperuricemia and the relationship of UA to graft function and hypertension in prevalent renal transplant recipients (RTR).

Methods: Baseline and follow-up data were collected on 90 RTR (mean age 51 yrs, 53% male, median transplant duration 7 years).

Free fatty acids are associated with obesity, insulin resistance, and atherosclerosis in renal transplant recipients.

Background: Insulin resistance (IR) may be implicated in the pathogenesis of atherosclerosis in renal transplant recipients (RTRs) and be contributed to, in part, by free fatty acids (FFAs), produced in excess in centrally obese individuals. The aim of this study was to determine the prevalence of IR and the relationships between FFAs, central obesity, and atherosclerosis in a cohort of prevalent RTRs.

Methods: Observational data were collected on 85 RTRs (mean age 54 years; 49% male, 87% Caucasian).

Obesity is associated with worsening cardiovascular risk factor profiles and proteinuria progression in renal transplant recipients.

Obesity is associated with adverse cardiovascular (CV) parameters and may be involved in the pathogenesis of allograft dysfunction in renal transplant recipients (RTR). We sought the spectrum of body mass index (BMI) and the relationships between BMI, CV parameters and allograft function in prevalent RTR. Data were collected at baseline and 2 years on 90 RTR (mean age 51 years, 53% male, median transplant duration 7 years), categorized by BMI (normal, BMI < or = 24.

Impact of obesity on renal transplant outcomes.

Obesity is a frequent and important consideration to be taken into account when assessing patient suitability for renal transplantation. In addition, posttransplant obesity continues to represent a significant challenge to health care professionals caring for renal transplant recipients. Despite the vast amount of evidence that exists on the effect of pretransplant obesity on renal transplant outcomes, there are still conflicting views regarding whether obese renal transplant recipients have a worse outcome, in terms of short- and long-term graft survival and patient survival, compared with their non-obese counterparts.

Derivation and validation of a disease-specific risk score for cardiac risk stratification in chronic kidney disease.

Objective: Cardiac events (CE; cardiac death, non-fatal myocardial infarction and acute coronary syndrome) are the principal causes of death in patients with chronic kidney disease (CKD). We sought to devise and validate a cardiac risk score to risk-stratify patients with CKD.

Methods: Clinical history and biochemical data were obtained in 167 CKD patients.