SRTR Center-Specific Reporting Tools: Posttransplant Outcomes

Measuring and monitoring performance—be it waiting list and posttransplant outcomes by a transplant center, or organ donation success by an organ procurement organization and its partnering hospitals—is an important component of ensuring good care for people with end-stage organ failure. Many parties have an interest in examining these outcomes, from patients and their families to payers such as insurance companies or the Centers for Medicare and Medicaid Services; from primary caregivers providing patient counseling to government agencies charged with protecting patients.
The Scientific Registry of Transplant Recipients produces regular, public reports on the performance of transplant centers and organ procurement organizations. This article explains the statistical tools used to prepare these reports, with a focus on graft survival and patient survival rates of transplant centers—especially the methods used to fairly and usefully compare outcomes of centers that serve different populations. The article concludes with a practical application of these statistics—their use in screening transplant center performance to identify centers that may need remedial action by the OPTN/UNOS Membership and Professional Standards Committee.     

Mass casualty incidents with multiple burn victims: Rationale for a Swiss burn plan

Introduction

Mass casualty incidents involving victims with severe burns pose difficult and unique problems for both rescue teams and hospitals. This paper presents an analysis of the published reports with the aim of proposing a rational model for burn rescue and hospital referral for Switzerland.

Methods

Literature review including systematic searches of PubMed/Medline, reference textbooks and journals as well as landmark articles.

Results

Since hospitals have limited surge capacities in the event of burn disasters, a special approach to both prehospital and hospital management of these victims is required. Specialized rescue and care can be adequately met and at all levels of needs by deploying mobile burn teams to the scene. These burn teams can bring needed skills and enhance the efficiency of the classical disaster response teams. Burn teams assist with both primary and secondary triage, contribute to initial patient management and offer advice to non-specialized designated hospitals that provide acute care for burn patients with Total Burn Surface Area (TBSA) <20–30%. The main components required for successful deployments of mobile burn teams include socio-economic feasibility, streamlined logistical implementation as well as partnership coordination with other agencies including subsidiary military resources.

Conclusions

Disaster preparedness plans involving burn specialists dispatched from a referral burn center can upgrade and significantly improve prehospital rescue outcome, initial resuscitation care and help prevent an overload to hospital surge capacities in case of multiple burn victims. This is the rationale behind the ongoing development and implementation of the Swiss burn plan.     

The emotional motor system and micturition control

Micturition is, similar to all other movements of the body, the result of activation of the motor system in the central nervous system. This review explains how the brain and brainstem control micturition. The basic reflex system begins with a distinct cell group called Gert's Nucleus (GN) in the sacral cord. GN receives information about bladder contents via A‐δ fibers from the bladder and bladder sphincter and relays this information to the central part of the midbrain periaqueductal gray (PAG), but not to the thalamus. The PAG, in turn, in case of substantial bladder filling, excites the pontine micturition center (PMC), which cell group, via its long descending pathways to the sacral cord, induces micturition. Higher brain regions in prefrontal cortex and limbic system, by means of its projections to the PAG are able to interrupt this basic reflex system. It allows the individual to postpone micturition until time and place are appropriate. Lesions in the pathways from prefrontal cortex and limbic system to the PAG probably cause urge‐incontinence in the elderly. Neurourol. Urodynam. 29: 42–48, 2010. © 2009 Wiley‐Liss, Inc.     

人工寰齿关节置换与Magerl经关节螺钉固定的生物力学比较

[目的]测试人工寰椎齿状突关节置换后寰枢椎的稳定性和功能,并与Magerl经关节螺钉固定进行比较.[方法]将12例新鲜的成人头颈部标本随机分为两组,第1组在齿状突切除术后使用人工寰齿关节置换;第2组在齿状突切除术后使用Magerl经关节螺钉固定.对两组的每一标本分别测定完整状态、人工关节置换术后或经关节螺钉固定后的运动范围和中性区.[结果]人工关节置换术后与完整状态相比前屈、后伸、左右侧屈的运动范围和中性区明显减小(P＜0.05),左右旋转的运动范围无显著差异(P＞0.05),中性区增大(P＜0.05).Maged经关节螺钉固定后与完整状态相比前屈、后伸、左右侧屈及左右旋转的运动范围和中性区均明显减小(P＜0.05).人工关节置换术后及Magerl经关节螺钉固定后两组在前屈、后伸及左右侧屈的ROM稳定指数和NZ稳定指数相比均无显著差异(P＞0.05).[结论]实验证实在齿状突切除后,进行自行设计的人工寰椎齿状突关节置换可取得与Magerl经关节螺钉固定相似的前屈、后伸及左右侧屈稳定性,重要的是与完整状态相比左右旋转的运动范围无显著差异,最大限度的保留了寰枢复合体重要的旋转功能,对以往齿状突切除、脊髓减压后需要使用寰枢椎融合的患者,提供了另一种术式的选择.     

Quantification of visits of wild fauna to a commercial free‐range layer farm in the Netherlands located in an avian influenza hot‐spot area assessed by video‐camera monitoring

Free‐range poultry farms have a high risk of introduction of avian influenza viruses (AIV), and it is presumed that wild (water) birds are the source of introduction. There is very scarce quantitative data on wild fauna visiting free‐range poultry farms. We quantified visits of wild fauna to a free‐range area of a layer farm, situated in an AIV hot‐spot area, assessed by video‐camera monitoring. A total of 5,016 hr (209 days) of video recordings, covering all 12 months of a year, were analysed. A total of 16 families of wild birds and five families of mammals visited the free‐range area of the layer farm. Wild birds, except for the dabbling ducks, visited the free‐range area almost exclusively in the period between sunrise and the moment the chickens entered the free‐range area. Known carriers of AIV visited the outdoor facility regularly: species of gulls almost daily in the period January–August; dabbling ducks only in the night in the period November–May, with a distinct peak in the period December–February. Only a small fraction of visits of wild fauna had overlap with the presence of chickens at the same time in the free‐range area. No direct contact between chickens and wild birds was observed. It is hypothesized that AIV transmission to poultry on free‐range poultry farms will predominantly take place via indirect contact: taking up AIV by chickens via wild‐bird‐faeces‐contaminated water or soil in the free‐range area. The free‐range poultry farmer has several possibilities to potentially lower the attractiveness of the free‐range area for wild (bird) fauna: daily inspection of the free‐range area and removal of carcasses and eggs; prevention of forming of water pools in the free‐range facility. Furthermore, there are ways to scare‐off wild birds, for example use of laser equipment or trained dogs.     

Is Abdominal Sonography a Useful Adjunct to Abdominal Radiography in Evaluating Neonates with Suspected Necrotizing Enterocolitis?

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省级中医药数据中心建设现状分析及发展对策研究

以31家省级中医药数据中心建设管理人员为研究对象并采集数据,从组织管理和人员、软硬件建设和应用等方面阐述数据中心信息化建设与应用现状,分析存在问题并提出建议,包括完善组织管理体系、加强专业人才培养、加大经费投入力度、制定互联互通接口开放规范。     

突发公共卫生事件医疗资源调配系统设计

设计突发公共卫生事件医疗资源调配系统,介绍系统设计的总体思想、架构、数据库管理平台、软件开发平台、结构、流程等,阐述系统的功能。该系统科学可行,可减轻突发公共卫生事件对公众健康和生命安全所造成的危害。