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PubMed2003

Paradigms of public-private partnerships in end-stage renal disease care: the National Kidney Foundation Singapore.

Novel forms of funding chronic renal replacement therapy and other chronic kidney disease programs are urgently required in order to address the increasing global burden of end-stage renal disease (ESRD). For areas of infectious disease control in less-developed countries, the formation of public-private partnerships has successfully yielded short-term improvement in clinical outcomes. This article reviews the concept of public-private partnerships and its various formats. We argue that similar partnerships play an important role in addressing the public health problem of chronic kidney disease. Through its establishment of numerous paradigms of partnerships with private for-profit corporations in building a nationwide chronic dialysis program and through partnerships with other non-governmental institutions and healthcare institutions in order to create a new entity characterized by a separate management structure, the NKFS has been able to provide chronic dialysis care to over 70% of the country's total ESRD population. This extensive network of partnerships is currently being applied as the NKFS continues to expand its programs to focus on the prevention of chronic kidney disease at a nationwide level.

Foundations↗
PubMed2003

The long-term within- and between-laboratory variability for assay of antithrombin, and proteins C and S: results derived from the external quality assessment program for thrombophilia screening of the ECAT Foundation.

A stable laboratory performance is important for comparability and transferability of laboratory data both within and between laboratories. The lack of a reference system within hemostasis hampers laboratories in establishing their laboratory performance over a prolonged period of time. Therefore, based on data from an external quality assessment program, we evaluated the between laboratory variation (CVBETWEEN) and the long-term within-laboratory variation (LCVa) for antithrombin, and proteins C and S. We evaluated the CVBETWEEN for the period 1996-2001, including the results of 64-240 laboratories from 23 different surveys (protein S activity 15 surveys). We observed a quite high CVBETWEEN and a broad range for each analyte. The CVBETWEEN was significantly higher for antithrombin and protein S for samples with low levels similar to heterozygous deficiencies. We also evaluated the LCVa, including the results of 136 laboratories. The lowest LCVa[median and 95% content interval (CI)] was observed for antithrombin (7.6%; 3.6-35.5%), intermediate values for protein C activity and antigen (8.6%; 3.5-25.3% and 10.8%; 4.8-33.1%, respectively) and highest values for the protein S variables (13.4%; 6.4-50.6% for total protein S antigen, 14.1%; 6.5-79.1% for free protein S antigen and 17.2%; 7.2-84.3% for protein S activity). We concluded that the main reason for the high CVBETWEEN is the long-term within-laboratory variability. Application of linear regression on data of an external quality assessment program is a useful model to demonstrate per analyte per laboratory the long-term variability (LCVa). It is concluded that improvement of the long-term within-laboratory test performance is the first priority in hemostasis to yield important improvements in the comparability and transferability of laboratory data.

Antithrombin III↗