Interdepartmental Spread of Innovations: A Multicentre Study of the Enhanced Recovery After Surgery Programme

World Journal of Surgery - Spread of evidence-based innovations beyond pioneering settings is essential to improve quality of care. This study aimed to evaluate the influence of a national project...     

Defining Talar Head and Neck Pathology: The Malvern Classification System

Talar fractures account for <1% of all fractures in the body and 3% to 6% of pedal fractures. Of these fractures, avulsion and neck fractures represent the most and second most common type, respectively. Several classification systems exist for talar fractures of the talar dome (Berndt-Hardy), talar neck dislocation (Hawkins), and talar body (Sneppen) anatomic locations. Although diverse, they are not all encompassing for fracture patterns of the talus. Another set of pathologic issues occur about the talar head and neck region that can be seen in the clinical setting. Thus, a new classification system (Malvern classification system for talar head/neck fractures) was devised and defined for this location. The system represents a comprehensive review of the available published data and synthesis into an organized classification system.     

Kidney Transplant Outcomes for Prior Living Organ Donors

The Organ Procurement and Transplantation Network gives priority in kidney allocation to prior live organ donors who require a kidney transplant. In this study, we analyzed the effect of this policy on facilitating access to transplantation for prior donors who were wait-listed for kidney transplantation in the United States. Using 1:1 propensity score–matching methods, we assembled two matched cohorts. The first cohort consisted of prior organ donors and matched nondonors who were wait-listed during the years 1996–2010. The second cohort consisted of prior organ donors and matched nondonors who underwent deceased donor kidney transplantation. During the study period, there were 385,498 listings for kidney transplantation, 252 of which were prior donors. Most prior donors required dialysis by the time of listing (64% versus 69% among matched candidates; P=0.24). Compared with matched nondonors, prior donors had a higher rate of deceased donor transplant (85% versus 33%; P<0.001) and a lower median time to transplantation (145 versus 1607 days; P<0.001). Prior donors received higher-quality allografts (median kidney donor risk index 0.67 versus 0.90 for nondonors; P<0.001) and experienced lower post-transplant mortality (hazard ratio, 0.19; 95% confidence interval, 0.08 to 0.46; P<0.001) than matched nondonors. In conclusion, these data suggest that prior organ donors experience brief waiting time for kidney transplant and receive excellent-quality kidneys, but most need pretransplant dialysis. Individuals who are considering live organ donation should be provided with this information because this allocation priority will remain in place under the new US kidney allocation system.     

Ossified ligaments in relation to foramina and bony landmarks of the middle cranial fossa

Introduction

Sporadic reports on individual ossified ligaments of the middle cranial fossa (MCF) fail to do justice to their grave clinical consequences. The present study attempts a comprehensive search for all ossified ligaments and associated accessory foramina in relation to MCF, in order to standardize baseline prevalence pertinent for the Indian subcontinent.