Individualised and personalised QALYs in exceptional treatment decisions.

Quality-adjusted life years (QALYs) are used to determine how to allocate resources to health programmes or to treatments within those programmes in order to gain maximum utility from those limited, shared healthcare resources. However, if we use those same population- based QALYs when faced with individual treatment decisions we may act unjustly in relation to that individual or in relation to the wider population. A treatment with a population-based incremental cost-effectiveness ratio beyond our willingness to pay threshold may be denied to a patient even if, for that particular patient, the QALYs gained for the cost would fall within that threshold.

Anti-glomerular basement membrane (GBM)-antibody-mediated disease with normal renal function.

Background: This study compared the clinical and laboratory characteristics of patients with anti-glomerular basement membrane (GBM) disease and normal renal function, with those of patients with anti-GBM disease where there was renal impairment.

Methods: The medical records of the 14 patients who had presented with anti-GBM disease to our hospital in the past 20 years were reviewed.

Results: Five (36%) had a normal serum creatinine or creatinine clearance at presentation.

Hereditary vesicoureteric reflux: phenotypic variation and family screening.

Family screening programs offer the prospect of detecting hereditary vesicoureteric reflux before scars develop with urinary infections. This review describes minor to severe reflux and reflux nephropathy (RN) in five families where a member developed renal failure, including 3 children who developed both scars and renal failure. Analysis of families in the literature demonstrated similar phenotypic variation and the regular detection of both sterile reflux and RN by screening.

Classical polyarteritis nodosa and microscopic polyarteritis with medium vessel involvement--a comparison of the clinical and laboratory features.

Microscopic polyarteritis may involve medium-sized and small blood vessels as well as arterioles, venules and capillaries. We have compared the clinical and laboratory features in patients with microscopic polyarteritis and medium vessel involvement, with the features found in patients with polyarteritis nodosa affecting medium vessels alone. In a 9-year period, 21 patients presented to our hospital with a form of polyarteritis.

Body composition following hemodialysis: studies using dual-energy X-ray absorptiometry and bioelectrical impedance analysis.

The detection, prevention and treatment of disease is greatly facilitated by the availability of accurate and non-invasive techniques for measuring the amount and regional distribution of fat mass and fat-free mass. As differing degrees of hydration may influence these measurements, we used dual-energy X-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA) to detect changes in hydration following hemodialysis, and to determine whether fat mass, fat-free mass and bone density measurements were affected by these fluid changes. Ten subjects (7 men, 3 women) mean age 46.