Should we keep hemoglobin levels as a viable outcome measure?
Identifieur interne : 000181 ( Main/Exploration ); précédent : 000180; suivant : 000182Should we keep hemoglobin levels as a viable outcome measure?
Auteurs : Ajay K. SinghSource :
- Nephrology news & issues [ 0896-1263 ] ; 2010.
Descripteurs français
- KwdFr :
- Antianémiques (économie), Dialyse rénale (économie), Humains (MeSH), Hémoglobines (effets des médicaments et des substances chimiques), Medicare (USA) (organisation et administration), Mécanismes de remboursement (organisation et administration), Réforme des soins de santé (organisation et administration), États-Unis (MeSH).
- MESH :
- effets des médicaments et des substances chimiques : Hémoglobines.
- organisation et administration : Medicare (USA), Mécanismes de remboursement, Réforme des soins de santé.
- économie : Antianémiques, Dialyse rénale.
- Humains, États-Unis.
- Wicri :
- geographic : États-Unis.
English descriptors
- KwdEn :
- Health Care Reform (organization & administration), Hematinics (economics), Hemoglobins (drug effects), Humans (MeSH), Medicare (organization & administration), Outcome Assessment, Health Care (organization & administration), Reimbursement Mechanisms (organization & administration), Renal Dialysis (economics), United States (MeSH).
- MESH :
- chemical , drug effects : Hemoglobins.
- chemical , economics : Hematinics.
- geographic : United States.
- economics : Renal Dialysis.
- organization & administration : Health Care Reform, Medicare, Outcome Assessment, Health Care, Reimbursement Mechanisms.
- Humans.
Abstract
In conclusion, the most important priority is to shift thinking to ESA dose exposure and away from focusing on the target Hb level. More attention needs to be spent on developing strategies to minimize exposure to high doses of ESAs. Possible strategies might include the subcutaneous administration of ESAs, treating a patient with an elevated ferritin, identifying sources of blood losses, treating infections and/or an inflammatory focus, and the use of computerized protocols. An equally important goal should be to change the CMS QIP anemia measure to a target Hb >9 g/dL. This modification in the QIP anemia measure is supported by the evidence from both the Normal Hematocrit trials and TREAT. If one models the effect of this QIP on the dialysis patient population as a whole, the majority of achieved Hb concentrations will likely be <11 g/dL (similar to the reported findings in the Normal Hematocrit study--see Figure 1). Lastly, translational studies and clinical trials are necessary to test whether exposure to high doses of ESAs explains the higher risk observed in CHOIR, TREAT, and the Normal Hematocrit study.
PubMed: 20364493
Affiliations:
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Le document en format XML
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Singh</name><affiliation><nlm:affiliation>Brigham and Women's Hospital in Boston USA.</nlm:affiliation><wicri:noCountry code="no comma">Brigham and Women's Hospital in Boston USA.</wicri:noCountry></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2010">2010</date><idno type="RBID">pubmed:20364493</idno><idno type="pmid">20364493</idno><idno type="wicri:Area/Main/Corpus">000190</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000190</idno><idno type="wicri:Area/Main/Curation">000187</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Curation">000187</idno><idno type="wicri:Area/Main/Exploration">000187</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Should we keep hemoglobin levels as a viable outcome measure?</title><author><name sortKey="Singh, Ajay K" sort="Singh, Ajay K" uniqKey="Singh A" first="Ajay K" last="Singh">Ajay K. Singh</name><affiliation><nlm:affiliation>Brigham and Women's Hospital in Boston USA.</nlm:affiliation><wicri:noCountry code="no comma">Brigham and Women's Hospital in Boston USA.</wicri:noCountry></affiliation></author></analytic><series><title level="j">Nephrology news & issues</title><idno type="ISSN">0896-1263</idno><imprint><date when="2010" type="published">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Health Care Reform (organization & administration)</term><term>Hematinics (economics)</term><term>Hemoglobins (drug effects)</term><term>Humans (MeSH)</term><term>Medicare (organization & administration)</term><term>Outcome Assessment, Health Care (organization & administration)</term><term>Reimbursement Mechanisms (organization & administration)</term><term>Renal Dialysis (economics)</term><term>United States (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Antianémiques (économie)</term><term>Dialyse rénale (économie)</term><term>Humains (MeSH)</term><term>Hémoglobines (effets des médicaments et des substances chimiques)</term><term>Medicare (USA) (organisation et administration)</term><term>Mécanismes de remboursement (organisation et administration)</term><term>Réforme des soins de santé (organisation et administration)</term><term>États-Unis (MeSH)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="drug effects" xml:lang="en"><term>Hemoglobins</term></keywords><keywords scheme="MESH" type="chemical" qualifier="economics" xml:lang="en"><term>Hematinics</term></keywords><keywords scheme="MESH" type="geographic" xml:lang="en"><term>United States</term></keywords><keywords scheme="MESH" qualifier="economics" xml:lang="en"><term>Renal Dialysis</term></keywords><keywords scheme="MESH" qualifier="effets des médicaments et des substances chimiques" xml:lang="fr"><term>Hémoglobines</term></keywords><keywords scheme="MESH" qualifier="organisation et administration" xml:lang="fr"><term>Medicare (USA)</term><term>Mécanismes de remboursement</term><term>Réforme des soins de santé</term></keywords><keywords scheme="MESH" qualifier="organization & administration" xml:lang="en"><term>Health Care Reform</term><term>Medicare</term><term>Outcome Assessment, Health Care</term><term>Reimbursement Mechanisms</term></keywords><keywords scheme="MESH" qualifier="économie" xml:lang="fr"><term>Antianémiques</term><term>Dialyse rénale</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Humans</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Humains</term><term>États-Unis</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>États-Unis</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">In conclusion, the most important priority is to shift thinking to ESA dose exposure and away from focusing on the target Hb level. More attention needs to be spent on developing strategies to minimize exposure to high doses of ESAs. Possible strategies might include the subcutaneous administration of ESAs, treating a patient with an elevated ferritin, identifying sources of blood losses, treating infections and/or an inflammatory focus, and the use of computerized protocols. An equally important goal should be to change the CMS QIP anemia measure to a target Hb >9 g/dL. This modification in the QIP anemia measure is supported by the evidence from both the Normal Hematocrit trials and TREAT. If one models the effect of this QIP on the dialysis patient population as a whole, the majority of achieved Hb concentrations will likely be <11 g/dL (similar to the reported findings in the Normal Hematocrit study--see Figure 1). Lastly, translational studies and clinical trials are necessary to test whether exposure to high doses of ESAs explains the higher risk observed in CHOIR, TREAT, and the Normal Hematocrit study.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">20364493</PMID><DateCompleted><Year>2010</Year><Month>04</Month><Day>30</Day></DateCompleted><DateRevised><Year>2019</Year><Month>12</Month><Day>10</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Print">0896-1263</ISSN><JournalIssue CitedMedium="Print"><Volume>24</Volume><Issue>3</Issue><PubDate><Year>2010</Year><Month>Mar</Month></PubDate></JournalIssue><Title>Nephrology news & issues</Title></Journal><ArticleTitle>Should we keep hemoglobin levels as a viable outcome measure?</ArticleTitle><Pagination><MedlinePgn>15-6, 18</MedlinePgn></Pagination><Abstract><AbstractText>In conclusion, the most important priority is to shift thinking to ESA dose exposure and away from focusing on the target Hb level. More attention needs to be spent on developing strategies to minimize exposure to high doses of ESAs. Possible strategies might include the subcutaneous administration of ESAs, treating a patient with an elevated ferritin, identifying sources of blood losses, treating infections and/or an inflammatory focus, and the use of computerized protocols. An equally important goal should be to change the CMS QIP anemia measure to a target Hb >9 g/dL. This modification in the QIP anemia measure is supported by the evidence from both the Normal Hematocrit trials and TREAT. If one models the effect of this QIP on the dialysis patient population as a whole, the majority of achieved Hb concentrations will likely be <11 g/dL (similar to the reported findings in the Normal Hematocrit study--see Figure 1). Lastly, translational studies and clinical trials are necessary to test whether exposure to high doses of ESAs explains the higher risk observed in CHOIR, TREAT, and the Normal Hematocrit study.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Singh</LastName><ForeName>Ajay K</ForeName><Initials>AK</Initials><AffiliationInfo><Affiliation>Brigham and Women's Hospital in Boston USA.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Nephrol News Issues</MedlineTA><NlmUniqueID>8709753</NlmUniqueID><ISSNLinking>0896-1263</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D006397">Hematinics</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D006454">Hemoglobins</NameOfSubstance></Chemical></ChemicalList><CitationSubset>N</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D018166" MajorTopicYN="N">Health Care Reform</DescriptorName><QualifierName UI="Q000458" MajorTopicYN="N">organization & administration</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006397" MajorTopicYN="N">Hematinics</DescriptorName><QualifierName UI="Q000191" MajorTopicYN="Y">economics</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006454" MajorTopicYN="N">Hemoglobins</DescriptorName><QualifierName UI="Q000187" MajorTopicYN="Y">drug effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006278" MajorTopicYN="N">Medicare</DescriptorName><QualifierName UI="Q000458" MajorTopicYN="Y">organization & administration</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D017063" MajorTopicYN="N">Outcome Assessment, Health Care</DescriptorName><QualifierName UI="Q000458" MajorTopicYN="Y">organization & administration</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D012051" MajorTopicYN="N">Reimbursement Mechanisms</DescriptorName><QualifierName UI="Q000458" MajorTopicYN="Y">organization & administration</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006435" MajorTopicYN="N">Renal Dialysis</DescriptorName><QualifierName UI="Q000191" MajorTopicYN="Y">economics</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D014481" MajorTopicYN="N" Type="Geographic">United States</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2010</Year><Month>4</Month><Day>7</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2010</Year><Month>4</Month><Day>7</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2010</Year><Month>5</Month><Day>1</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">20364493</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list></list><tree><noCountry><name sortKey="Singh, Ajay K" sort="Singh, Ajay K" uniqKey="Singh A" first="Ajay K" last="Singh">Ajay K. 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