Strategies for compensating for the declining numbers of cadaver donor kidney transplants.

BACKGROUND: The living-donor and dual kidney transplantation programmes were initiated in the transplantation centre of Münster (TCM) as two approaches to compensate for the declining numbers of cadaver donor kidney transplants after the implementation of the new Eurotransplant Kidney Allocation System (ETKAS). We analysed the outcome of cadaver, living-donor and dual kidney transplantation and their effects on the waiting list in the TCM. METHODS: Between January 1990 and December 2000, 1184 kidney transplants were performed in the TCM. They were subdivided into cadaver, living-donor and dual kidney transplants and retrospectively analysed in terms of the number of kidney transplants performed, waiting time and waiting coefficient. In addition four representative groups were formed to reflect donor origin (I: cadaver kidney transplants allocated by the old ETKAS, n = 180; II: cadaver kidney transplants allocated by the new ETKAS, n = 139; III: living-donor kidney transplantation, n = 59; IV: dual kidney transplantation, n = 31) and compared according to graft function (initial diuresis, creatinine, 3-year graft function), patient survival and median waiting time. RESULTS: After the implementation of the new ETKAS, the number of cadaver donor kidney transplants at the TCM almost halved, but the proportion of living-donor kidney transplantations increased significantly by 12.8% and of dual kidney transplantations by 8.5%. Patients who had received kidneys from cadaver donors allocated by the new ETKAS (group II) had a better survival rate, short- and long-term function but a longer waiting time than in group I (old ETKAS). Patients with dual kidney transplants (group IV) showed the lowest survival and short-term function rate, but had long-term function equivalent to that of cadaver kidney transplants (groups I and II). Patients who had received kidneys from living donors (group III) had the best survival, and short- and long-term function rate as well as the shortest mean waiting time. CONCLUSIONS: Living-donor and dual kidney transplantation proved to be functionally equivalent alternatives and successful strategies for compensating the declining numbers of cadaver donor kidney transplants.     

Pediatric Transplantation in the United States, 1996–2005

Solid organ transplantation is accepted as a standard lifesaving therapy for end-stage organ failure in children. This article reviews trends in pediatric transplantation from 1996 to 2005 using OPTN data analyzed by the Scientific Registry of Transplant Recipients. Over this period, children have contributed significantly to the donor pool, and although the number of pediatric donors has fallen from 1062 to 900, this still accounts for 12% of all deceased donors. In 2005, 2% of 89 884 candidates listed for transplantation were less than 18 years old; in 2005, 1955 children, or 7% of 28 105 recipients, received a transplant. Improvement in waiting list mortality is documented for most organs, but pretransplant mortality, especially among the youngest children, remains a concern. Posttransplant survival for both patients and allografts similarly has shown improvement throughout the period; in most cases, survival is as good as or better than that seen in adults. Examination of immunosuppressive practices shows an increasing tendency across organs toward tacrolimus-based regimens. In addition, use of induction immunotherapy in the form of anti-lymphocyte antibody preparations, especially the interleukin-2 receptor antagonists, has increased steadily. Despite documented advances in care and outcomes for children undergoing transplantation, several considerations remain that require attention as we attempt to optimize transplant management.     

区域“医疗规模经济”和卫生资源配置理论假说

医疗规模经济的实质是谋求以最低成本提供特定质量的医疗服务。因此，政府及医院管理者就城要掌握关于“医疗规模经济”以及在竞争体系中达到效率的成本资料，在一个限定的区域内，大中小医院都存在着不同程度的“规模经济”。正确地引导和调控医疗经济规模活动的走势，能够推动区域卫生资源的合理配置。     

Young for young! Mandatory age-matched exchange of paediatric kidneys

Some allocation systems include a mandatory donation of paediatric kidneys to children, others do not. Both approaches have medical and organisational advantages and disadvantages for adults and children. This article discusses why “young for young” is the best allocation system for children. Primary age-matched kidney allocation to children is one important factor leading to: (1) higher long-term glomerular filtration rates (GFRs) and graft survival and, thereby, to lesser need for dialysis; (2) better psychosocial rehabilitation, growth and development of children and, last but not least, (3) likely increase of the donor pool. As a consequence, health care costs will be reduced for children with end-stage renal failure. The chance of adults receiving an adequate kidney would be only minimally reduced by this policy. Therefore, we recommend an age-matched allocation programme giving children with end- stage kidney diseases a better prognosis.     

江苏省三级甲等综合医院人力资源配置调查

摘要目的：比较分析江苏省苏南、苏中、苏北3地区三甲综合医院人力资源配置与医院运行情况,分析发展趋势及差异,为政府制定卫生人力发展策略和医院人力资源配置实践提供依据。方法：通过普查,收集江苏省全部23家三甲综合医院2008—2011年相关数据资料。结果：2011年3地区三甲综合医院的职工总数均较2008年有明显增长,苏南地区床人比最高;各地区卫生技术人员的专业构成无差异,医护比有所提高;人均诊疗人次、人均业务收入、人均人员支出方面3地区有差异。结论：江苏卫生人力资源总量不足,地区之间发展不平衡,护理人员总体配置不足。     

Predictive validity of treatment allocation guidelines on drinking outcome in alcohol-dependent patients

The purpose of this study was to establish the predictive validity of guidelines for allocating patients to outpatient or inpatient treatment for an alcohol-use disorder. It was hypothesized that patients who were matched to the recommended level of care would have (a) better outcomes than patients treated at a less intensive level of care, and (b) outcomes equivalent to those of patients treated at a more intensive level of care. Matched patients were allocated according to an algorithm based on their treatment history, addiction severity, psychiatric impairment, and social stability at baseline. Outcome was measured in terms of self-reported alcohol use 30 days prior to follow-up and changes in number of abstinent and heavy drinking days between intake and follow up. Of the 2,310 patients, 65.4% were successfully followed up 9.67 months after intake. Only 22% of the patients were treated according to the level of care prescribed by the guidelines; 49% were undertreated; and 29% were overtreated. The results were not in line with our hypotheses. Patients treated at a more intensive level of care than recommended had favorable outcomes compared to patients treated at the recommended level of care (55.5% vs. 43.9% success). Patients allocated to the recommended level of care did not have better outcomes than those treated at a less intensive level of care (43.9% vs. 38.3% success). Based on these results, we suggest ways to improve the algorithm for allocating patients to treatment.     

微山湖区域免疫规划人力资源现况调查分析与对策

目的为加强免疫规划专业人员队伍建设,为科学配置免疫规划人力资源提供参考依据,对微山湖区域2010年免疫规划的管理和免疫专业技术人员现状进行调查和分析。方法设计了统一的调查表,采用机构调查和个人问卷调查相结合的方法,收集微山湖区域免疫规划人力资源配置情况和工作人员的基本信息,将数据录入数据库后进行统计分析。结果微山湖区域15处乡镇（街道）,17处预防接种门诊,从事免疫规划工作人员为132人。工作人员与人口总数之比为1．79／万。高级职称占0．76％,中级职称占18．94％,初级职称占53．79％,无职称占26．52％。大学本科学历占12．88％,大专学历占34．09％,中专学历占46．97％,无学历者占6．06％。从事免疫规划5年内人员占29．55％,5～9年占31．06％,10～19年占18．94％,20年以上占20．45％。结论微山湖区域免疫规划工作人员现状不适应免疫规划的进程和当前扩大国家免疫规划的发展和需求。为此,卫生行政部门应加强宏观管理,在现有条件下进行适当的调控及合理配置,以满足免疫规划工作的需要。     

上海市医疗机构设置规划研究

在分析上海市医疗资源配置、需求与利用现状的基础上,结合未来发展需求,探讨了上海市"十二五"期间医疗资源配置的总体目标、原则、规划重点及各级卫生行政部门的主导作用.

Abstract：

Based on the current status of allocation, demands and utilization of medical care resources and the needs for future development in Shanghai, the overall objectives, principles, key plans of allocation of medical care resources in the 12th Five-years Plan in Shanghai and the leading role of health bureaus at all levels were discussed.