ABSTRACT
Since its publication in 2003, the K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease (CKD) have become a worldwide reference. The aim of this study was to analyze the observance to these guidelines in patients with a glomerular filtration rate < 60 ml/min/1,73m2 not yet included in dialysis in a Spanish multicenter cohort. A questionnaire by investigator/centre was completed by 32 different nephrologists participating in the OSERCE study and representing the overall Spanish public health net. We observed that biochemical parameters were measured less frequently than recommended, except in CKD stage 3. The therapeutic goals for intact PTH were not properly reported by 59 % of the consulted nephrologists for stages 3 and 4, whereas only 22% did not report them properly for stage 5. The goals for phosphorus were not adequately reported in 50 % of cases (stages 3 y 4) and 60 % (stage 5). For calcium, these values were 70 %, 73.3 % and 65.5 % for stages 3, 4 and 5, respectively. A corrected plasma calcium between 9.5 and 10.2 mg/dl is still considered adequate for 31%. As much as 87% nephrologists stated that they did not sistematically measure calcidiol plasma levels. In general, these results demonstrate that there is a great degree of unawareness of K/DOQITM predialysis guidelines. Thus, their poor implementation is probably not only due to the lower availability of approved therapeutic agents, the difficult achievement of goals or the disbelief on current recommendations. It would be desirable that forthcoming guidelines such as the KDIGO could also consider the need of educational efforts for CKD-Mineral and Bone Disorder.
Subject(s)
Bone and Bones/metabolism , Health Knowledge, Attitudes, Practice , Kidney Diseases/metabolism , Minerals/metabolism , Nephrology , Practice Guidelines as Topic , Chronic Disease , Humans , Kidney Diseases/therapy , Surveys and QuestionnairesABSTRACT
El objetivo de esta revisión es proporcionar un guía sencilla de la terminología, los conceptos y la metodología utilizados en los metaanálisis, que pueda servir tanto para facilitar la comprensión del lector que estudia una revisión sistemática como para ayudar a quien decide llevar a cabo su propia revisión sobre algún tema de su interés. Con ese objetivo a la vista es muy importante proporcionar una bibliografía esencial, a juicio del autor, que permita una profundización gradual en la materia, así como las referencias básicas de los programas informáticos disponibles, que pueden servir no sólo para llevar a cabo un nuevo metaanálisis, sino también para analizar los resultados que se publican o simplemente para profundizar en el estudio de esta materia. Se comentarán las listas de comprobación que hay propuestas en la literatura para autores, revisores y editores de metaanálisis. Asimismo se resaltarán los asuntos controvertidos de esta técnica, propugnando siempre, como en cualquier otro asunto científico, la ineludible importancia de una lectura crítica. Para facilitar la comprensión se ha evitado en todo momento la utilización de fórmulas numéricas, remitiendo al lector interesado en los cálculos a otros artículos con finalidad más matemática que el que aquí se presenta o incluso a la propia página web de la SEH-LELHA, donde en la sección estadística hay dos artículos publicados sobre este tema con numerosas referencias
This review aims to provide a simple guideline of the terminology, concepts and methodology used in meta-analyses that help to facilitate the understanding of the reader who studies a systematic review and to help those who decide to conduct their own review on any subject of their interest. With this purpose in mind, it is very important to provide an essential bibliography, according to the author's opinion, that makes it possible to gradually go into the material in depth and the basic reference of the software available, that may not only help to conduct a new meta-analysis but also to analyze the results that are published or simply to study this material more in depth. The check lists proposed in the literature for the authors, reviewers and publishers of meta-analyses are discussed. Furthermore, the debatable questions of this technique are stressed, always advocating, as in any other scientific matter, the unavoidable importance of critical reading. To facilitate understanding, the use of numeric formulas has been avoided at all times, referring the reader who is interested in the calculations to other articles that have a more mathematical purpose than that presented herein or even to the web page itself of SEH-LELHA, two articles published on this subject, with many references, is found in the statistical section (AU)
Subject(s)
Meta-Analysis , Biomedical Research/methods , 28599 , 51706 , 28423ABSTRACT
BACKGROUND AND METHODS: The Parkinson's Disease Questionnaire (PDQ-39) was the first specific instrument for evaluation of the "health-related quality of life" (QoL) in Parkinson's disease patients. The PDQ-39 has been subjected to adaptation to Spanish language and culture (PDQ-39 Spanish version, PDQ-39SV) and this version has been validated in aspects of internal consistency and construct validity. The present study assess the test-retest reliability and the convergent validity of the PDQ-39SV with a generic QoL instrument (SF-36). RESULTS: Most of the PDQ-39 dimensions showed an adequate consistency-Cronbach's alpha > 0.7 for six dimensions. As a whole, test-retest reliability resulted satisfactory. Two dimensions-activities of daily living and emotional well-being- showed a low grade significant difference (paired Student t-test, p < 0.05) due to improvement in the second survey (at 10 to 14 days from the first one) perhaps related to adjustments of the treatment at the first visit. A strong association (Spearman r, p < 0.001), indicative of convergent validity, was obtained for the PDQ-39 dimensions and the relevant SF-36 scales, as well as for the physical and mental component summary scores of the SF-36. CONCLUSIONS: Taking into account these results and previous studies, it is concluded that the PDQ-39 SV is a reliable measure that has construct validity.
