Comparison of donor scores in bilateral lung transplantation—A large single-center analysis

Objectifying donor lung quality is difficult and currently there is no consensus. Several donor scoring systems have been proposed in recent years. They all lack large-scale external validation and widespread acceptance. A retrospective evaluation of 2201 donor lungs offered to the lung transplant program at the Medical University of Vienna between January 2010 and June 2018 was performed. Five different lung donor scores were calculated for each offer (Oto, ET, MALT, UMN-DLQI, and ODSS). Prediction of organ utilization, 1-year graft survival, and long-term outcome were analyzed for each score. 1049 organs were rejected at the initial offer (group I), 209 lungs declined after procurement (group II), and 841 lungs accepted and transplanted (group III). The Oto score was superior in predicting acceptance of the initial offer (AUC: 0.795; CI: 0.776–0.815) and actual donor utilization (AUC: 0.660; CI: 0.618–0.701). Prediction of 1-year graft survival was best using the MALT score, Oto score, and UMN-DLQI. Stratification of early outcome by MALT was significant for length of mechanical ventilation (LMV), PGD3 rates, ICU stay and hospital stay, and in-hospital-mortality, respectively. To the best of our knowledge, this study is the largest validation analysis comparing currently available donor scores. The Oto score was superior in predicting organ utilization, and MALT score and UMN-DLQI for predicting outcome after lung transplantation.     

Identifying gaps in COVID-19 health equity data reporting in Canada using a scorecard approach

ObjectiveTo assess health equity-oriented COVID-19 reporting across Canadian provinces and territories, using a scorecard approach.MethodsA scan was performed of provincial and territorial reporting of five data elements (cumulative totals of tests, cases, hospitalizations, deaths, and population size) across three units of aggregation (province or territory level, health regions, and local areas) (15 “overall” indicators), and for four vulnerable settings (long-term care and detention facilities, schools, and homeless shelters) and eight social markers (age, sex, immigration status, race/ethnicity, healthcare worker status, occupational sector, income, and education) (180 “equity-related” indicators) as of December 31, 2020. Per indicator, one point was awarded if case-delimited data were released, 0.7 points if only summary statistics were reported, and 0 if neither was provided. Results were presented using a scorecard approach.ResultsOverall, information was more complete for cases and deaths than for tests, hospitalizations, and population size denominators needed for rate estimation. Information provided on jurisdictions and their regions, overall, tended to be more available (average score of 58%, “D”) than that for equity-related indicators (average score of 17%, “F”). Only British Columbia, Alberta, and Ontario provided case-delimited data, with Ontario and Alberta providing case information for local areas. No jurisdiction reported on outcomes according to patients’ immigration status, race/ethnicity, income, or education. Though several provinces reported on cases in long-term care facilities, only Ontario and Quebec provided detailed information for detention facilities and schools, and only Ontario reported on cases within homeless shelters and across occupational sectors.ConclusionOne year into the pandemic, socially stratified reporting for COVID-19 outcomes remains sparse in Canada. However, several “best practices” in health equity-oriented reporting were observed and set a relevant precedent for all jurisdictions to follow for this pandemic and future ones.Supplementary InformationThe online version contains supplementary material available at 10.17269/s41997-021-00496-6.     

The reimagination of sustainable integrated care in Ontario,Canada

Purpose/settingTo encourage clinical and financial efficiency, the Canadian province of Ontario initiated an integrated care program – Integrated Funding Models (IFMs) that required collaboration and coordination across acute and post-acute care sectors. This research shows how program implementers went beyond policy-makers’ original designs, to make integrated care sustainable for chronic diseases.MethodsForty-five interviews were conducted with program participants at three chronic disease programs, as well as with policymakers. Interviews were conducted over two phases; during early implementation in 2016, and as programs matured in 2018. Data were analyzed through a cultural constructivist lens to understand how participants shaped programs.FindingsParticipants desired greater accountability and control. Participants in the first program wanted localized control over decision-making. In the second, participants initiated greater control over financial uncertainty. In the third program, hospital participants sought greater control over community care. Participants across programs simultaneously wanted integrated care to be expanded holistically, spatially, and temporally for patients, extending the length of care, and expanding the spaces in which care was provided. Findings also suggest a gap between program implementers’ and policymakers’ conceptualizations of integrated care.ConclusionThis work shows how IFMs were reimagined in ways that transcended their original conceptualization as spatially and temporally delimited initiatives aimed at improving coordination and efficiency. It has practical implications for those facing sustainability challenges in other contexts.     

Alcohol intake in early adulthood and risk of colorectal cancer: three large prospective cohort studies of men and women in the United States

European Journal of Epidemiology - Heavy alcohol consumption in mid-adulthood is an established risk factor of colorectal cancer (CRC). Alcohol use in early adulthood is common, but its association...     

Effects of intravenously administered hypertonic urea solution

Summary and Conclusions In 12 patients with increased intracranial pressure, caused by an expanding process, a hypertonic urea solution was intravenously administered during a craniotomy. At different times before, during and after the operation, the electrolytes, urea, glucose and total protein values were determined in various body fluids and tissues.This study disclosed that the urea administered was distributed through both the intracellular and the extracellular space after 20 minutes. The values of the electrolytes, except the calcium, in the extracellular fluid remained constant after administration of the urea solution; the total protein value, however, showed a considerable decrease.It was established that the blood-brain barrier plays no appreciable role in the mechanism of action of hypertonic urea solutions in dehydrating the brain tissue; the blood-C. S. P. and brain-C. S. F. barriers may do.

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Zusammenfassung Bei 12 Patienten mit intrakranieller Drucksteigerung infolge eines raumbeengenden Prozesses wurde Harnstofflösung intravenös während der Schädeleröffnung gegeben. Zu verschiedenen Zeitpunkten vor, während und nach der Operation wurden Elektrolyt, Harnstoff, Glukose und Gesamteiweiß quantitativ bestimmt und zwar sowohl in verschiedenen Körperflüssigkeiten wie auch in Geweben.Die Untersuchungen ergaben, daß der verabfolgte Harnstoff in 20 Minuten sich sowohl auf den intrazellulären, wie den extrazellulären Raum verteilt hat. Die Elektrolytwerte, mit Ausnahme von Kalzium, blieben nach der Harnstoffinfusion in den extrazellulären Flüssigkeiten unverändert, der Gesamteiweißwert nahm dagegen beträchtlich ab.Es wurde festgestellt, daß die Bluthirnschranke keine wesentliche Rolle für die entwässernde Wirkung des Harnstoffes auf das Hirngewebe spielt, während die Blut-Liquor-Schranke und die Hirn-Liquor-Schranke vielleicht von Bedeutung sind.

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Resumen Después de una craniectomía se administró una solución de urea hipertónica por via intravenosa a 12 pacientes que presentaban una presión intracraneal creciente a causa de una exposición de la hipófisis. Periódicamente, antes, durante y después de la operación se determinaron los valores de los electrolitos, de la urea, de la glucosa y de las proteinas totales en los diferentes líquidos y tejidos del organismo.Este estudio demostróque la urea administrada se distribuia a través del espacio intra y extracelular al cabo de 20 minutos. Los valores de los electrolitos, excepto el calcio, permanecieron constantes en el líquido extracelular después de la administración de la solución de urea; el valor de las proteinas totales, sin embargo, mostró un descenso considerable.Se concluyó que la barrera hemato-encefálica no juega ningún papel apreciable en los mecanismos de acción de las soluciones de urea hipertónica en la deshidratación del tejido cerebral; tal vez lo juegue en las barreras sangre-liquido cofalo-raquídeo y cerebro-líquido cefalo-raquídeo.

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Résumé Lors d'une craniotomie, une solution d'urée hypertonique fut administrée par voie intraveineuse chez 12 patients présentant une pression intracrânienne grandissante causée par une expansion de l'apophyse. De temps en temps, avant, pendant et après l'opération, les valeurs des électrolytes, de l'urée, du glucose et de la protéine totale étaient déterminées dans les différents liquides et tissus du corps.Cette étude démontra que l'urée administrée était distribuée à travers l'espace intra et extraecllulaire au bout de 20 minutes. Les valeurs des électrolytes, excepté le calcium, demeurèrent constantes dans le liquide extracellulaire après l'administration de la solution d'urée; la valeur de la protéïne totale, pourtant, montrait une baisse considérable.Il fut établi que la barrière hémato-encéphalique ne joue aucun rôle appréciable dans le mécanisme d'action des solutions d'urée hypertonique dans la déshydratation du tissu cérébral; les barrières sang-liquide céphalorachidien et cerveau-liquide céphalo-rachidien, peut-être.

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Riassunto In 12 pazienti con ipertensione endocranica, causata da un processo espansivo, è stata somministrata durante la craniotomia dell'urea in soluzione ipertonica per via venosa. A diversi tempi prima, durante e dopo l'intervento, sono stati dosati gli elettroliti, l'urea, il glueosio e le proteine totali in vari fluidi e tessuti corporei. Queste ricerche hanno evidenziato che l'urea viene distribuita tra spazio intracellulare ed extracellulare in 20 minuti. I livelli degli elettroliti, eccetto il calcio, rimangono costanti nel liquido extracellulare dopo la somministrazione di urea, i valori della proteinemia totali invece mostrano una notevole diminuizione.E' stato stabilito che la barriera emato-cerebrale non gioca alcun ruolo apprezzabile nel meccanismo d'azione dell'urea ipertonica nel disidratare il tessuto cerebrale; un ruolo importante potrebbe essere inveoe giocato dalla barriera emato-liquorale e tra liquor e sistema nervoso.

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This study was supported by a grant from the Netherlands Organization for the Advancement of Pure Research (Nederlandse Organisatie voor Zuiver-Wetenschappelijk Onderzoek, Z. W. O.).