KDIGO clinical practice guideline for the care of kidney transplant recipients: a summary

The 2009 Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline on the monitoring, management, and treatment of kidney transplant recipients is intended to assist the practitioner caring for adults and children after kidney transplantation. The guideline development process followed an evidence-based approach, and management recommendations are based on systematic reviews of relevant treatment trials. Critical appraisal of the quality of the evidence and the strength of recommendations followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach. The guideline makes recommendations for immunosuppression and graft monitoring, as well as prevention and treatment of infection, cardiovascular disease, malignancy, and other complications that are common in kidney transplant recipients, including hematological and bone disorders. Limitations of the evidence, especially the lack of definitive clinical outcome trials, are discussed and suggestions are provided for future research. This summary includes a brief description of methodology and the complete guideline recommendations but does not include the rationale and references for each recommendation, which are published elsewhere.

Discipline across generations.

The objective of this qualitative research was to understand how parents decide which discipline practices they will repeat from their childhoods. Participants chose not to repeat punishment practices when a strong, negative effect was remembered. However, some parents repeated physical punishment practices even when a strong, negative effect was remembered if they believed the practices were effective or culturally valued, if they were under stress, or if the parents lacked alternative strategies.

Assessing psychotropic medication side effects among children. A reliability study.

The Dosage Record Treatment Emergent Symptom Scale (DOTES) is a rating scale for measuring the presence and intensity of psychotropic medication side effects. Studies to evaluate its reliability have not been published. The purposes of this pilot study are to (1) develop a protocol for training raters to use the DOTES, (2) assess inter-rater agreement, 3) examine the reasons for disagreement among raters to clarify training procedures and symptom definitions, and (4) further refine this instrument for use in clinical and research settings. Five nurses were trained to use the DOTES to rate the absence or presence and intensity of specific medication side effects. After training, Raters 1, 2, and 3 watched a videotape of a nurse interviewing a 13-year-old child and completed the DOTES rating scale. There was agreement on the intensities of 6 (67%) of the 9 symptoms identified as present and agreement on 17 (89%) of the 19 symptoms identified as absent. Process tracings were conducted on the ratings of Nurses 4 and 5 to elicit the criteria they used to determine their ratings. The results of the process tracings were used to identify ambiguities that led to disagreement among raters so that the training protocol and interview could be improved.