Attitudes of British Isles nephrologists towards dialysis modality selection: a questionnaire study
Bibliographic record
Abstract
BACKGROUND: Dialysis demographics are changing around the world. Within the UK a striking decrease in the overall use of peritoneal dialysis (PD) has been noted. We set out to determine the opinions and attitudes of British Isles nephrologists about dialysis modality decisions and optimal dialysis system design. METHODS: A survey questionnaire was mailed to a random selection of members of the Renal Association of Great Britain and Ireland. RESULTS: A 63% response rate was achieved. Decisions about dialysis modality were based mostly on patient preference (mean score 4.4 on a scale of 1-5), quality of life data (mean score 3.8), and morbidity and mortality data (mean scores for both 3.6). The least important factors when choosing the modality of dialysis care were the treatment costs to either the patient or the health care system. Respondents felt that both PD and hospital-based haemodialysis (HD) were over-utilized in today's practice. They suggested that an 'ideal dialysis system' (based on patient survival, wellness, and quality of life) should have 27% of patients dialysed using hospital-based HD, 24% in a satellite unit, 11% dialysed using home HD, and 38% on some form of PD (19, 16, and 3% for CAPD, automated PD and intermittent PD, respectively). Few differences were identified between an ideal system which optimized patient survival, wellness, and quality of life, compared with one which optimized cost-effectiveness. CONCLUSION: This survey suggests that most nephrologists in the British Isles feel that hospital-based HD and CAPD are being currently overused, and that future dialysis planning should include a higher proportion of patients on satellite dialysis, home HD, and automated PD to optimize both dialysis cost-effectiveness and patient outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".