Perspectives on Communication Issues among Transplant and Procurement Professionals, Transplant Recipients, and Donor Families

Communication among professionals, donor families, and transplant recipients is a controversial topic. Traditionally, transplant and procurement professionals have made the decision about the type and frequency of information that a donor family and transplant recipient receive regarding one another, and relationships that might develop as a result. Information obtained through questionnaires demonstrated inconsistency in addressing donor family and transplant recipient needs for initial and follow-up information and communication—not only between clinical transplant and procurement donation coordinators, but within organizations involved in the care and support of these people. This wide variance regarding communication among all disciplines demonstrated a need for standardization of practice guidelines. Guidelines are being developed through collaboration of the major organizations involved in the care of donor families and transplant recipients to standardize communication practices throughout the United States.

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The Lifetime Health Burden of Delayed Graft Function in Kidney Transplant Recipients in the United States

MDM Policy & Practice ◽

10.1177/2381468318781811 ◽

2018 ◽

Vol 3 (1) ◽

pp. 238146831878181 ◽

Cited By ~ 2

Author(s):

Devin Incerti ◽

Nicholas Summers ◽

Thanh G. N. Ton ◽

Audra Boscoe ◽

Anil Chandraker ◽

...

Keyword(s):

United States ◽

Transplant Recipient ◽

Kidney Transplant ◽

Graft Function ◽

The United States ◽

Delayed Graft Function ◽

Transplant Recipients ◽

Health Burden

Background. Although delayed graft function (DGF) is associated with an increased risk of acute rejection and decreased graft survival, there are no estimates of the long-term or lifetime health burden of DGF. Objectives. To estimate the long-term and lifetime health burden of DGF, defined as the need for at least one dialysis session within the first week after transplantation, for a cohort representative of patients who had their first kidney transplant in 2014. Methods. Data from the United States Renal Data System (USRDS; 2001–2014) were used to estimate a semi-Markov parametric multi-state model with three disease states. Maximum length of follow-up was 13.7 years, and a microsimulation model was used to extrapolate results over a lifetime. The impact of DGF was assessed by simulating the model for each patient in the cohort with and without DGF. Results. At the end of 13.7 years of follow-up, DGF reduces the probability of having a functioning graft from 52% to 32%, increases the probability of being on dialysis from 10% to 19%, and increases the probability of death from 38% to 50% relative to transplant recipients who do not experience DGF. A typical transplant recipient with DGF (median age = 53) is observed to lose 0.87 quality-adjusted life-years (QALYs). Extrapolated over a lifetime, the same 53-year-old DGF patient is projected to lose 3.01 (95% confidence interval: 2.33, 3.70) QALYs relative to a transplant recipient with the same characteristics who does not experience DGF. Conclusions. The lifetime health burden of DGF is substantial. Understanding these consequences will help health care providers weigh kidney transplant decisions and inform policies for patients in the context of varying risks of DGF.

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Clinical Management of Kidney Transplant Recipients

Mayo Clinic Critical and Neurocritical Care Board Review ◽

10.1093/med/9780190862923.003.0073 ◽

2019 ◽

pp. 457-459

Author(s):

James A. Onigkeit

Keyword(s):

United States ◽

Transplant Recipient ◽

Kidney Transplant ◽

Clinical Management ◽

Living Donor ◽

Kidney Transplant Recipient ◽

Deceased Donor ◽

The United States ◽

Transplant Recipients ◽

Kidney Transplant Recipients

Kidney transplant is common. More than 19,000 kidney transplants were performed in the United States in 2017. About two-thirds were deceased donor transplants, and about one-third were living donor transplants. The clinical management of a kidney transplant recipient begins in the operating room. Posttransplant complications can be divided into 2 categories: surgical and medical.

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Migration and the Internet

MIGRATION LETTERS ◽

10.33182/ml.v14i3.347 ◽

2017 ◽

Vol 14 (3) ◽

pp. 331-342 ◽

Cited By ~ 6

Author(s):

Thomas John Cooke ◽

Ian Shuttleworth

Keyword(s):

United States ◽

Information And Communication Technologies ◽

Unobserved Heterogeneity ◽

Panel Study ◽

The United States ◽

Negative Effect ◽

Information And Communication ◽

Using Data ◽

And Migration ◽

Dynamics Models

It is widely presumed that information and communication technologies, or ICTs, enable migration in several ways; primarily by reducing the costs of migration. However, a reconsideration of the relationship between ICTs and migration suggests that ICTs may just as well hinder migration; primarily by reducing the costs of not moving. Using data from the US Panel Study of Income Dynamics, models that control for sources of observed and unobserved heterogeneity indicate a strong negative effect of ICT use on inter-state migration within the United States. These results help to explain the long-term decline in internal migration within the United States.

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Faculty Opinions recommendation of Voriconazole and the risk of keratinocyte carcinomas among lung transplant recipients in the United States.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.737947238.793578255 ◽

2020 ◽

Author(s):

Desiree Ratner

Keyword(s):

United States ◽

Lung Transplant ◽

The United States ◽

Transplant Recipients ◽

Lung Transplant Recipients

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Secular Trends in Cardiac Transplant Recipient and Donor Management in the United States, 1990 to 1994

Circulation ◽

10.1161/01.cir.94.11.2883 ◽

1996 ◽

Vol 94 (11) ◽

pp. 2883-2889 ◽

Cited By ~ 31

Author(s):

Richard J. Rodeheffer ◽

David C. Naftel ◽

Lynne Warner Stevenson ◽

Charles B. Porter ◽

James B. Young ◽

...

Keyword(s):

United States ◽

Transplant Recipient ◽

The United States ◽

Secular Trends ◽

Cardiac Transplant ◽

Donor Management ◽

Cardiac Transplant Recipient

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Natural History and Evolution of Anti-Interferon-γ Autoantibody-Associated Immunodeficiency Syndrome in Thailand and the United States

Clinical Infectious Diseases ◽

10.1093/cid/ciz786 ◽

2019 ◽

Vol 71 (1) ◽

pp. 53-62 ◽

Cited By ~ 3

Author(s):

Gloria H Hong ◽

Ana M Ortega-Villa ◽

Sally Hunsberger ◽

Ploenchan Chetchotisakd ◽

Siriluck Anunnatsiri ◽

...

Keyword(s):

United States ◽

Natural History ◽

The United States ◽

Interferon Γ ◽

Mycobacterium Abscessus ◽

Annual Data ◽

Persistent Infections ◽

Ifn Γ ◽

Immunodeficiency Syndrome

Abstract Background The natural history of anti-interferon-γ (IFN-γ) autoantibody-associated immunodeficiency syndrome is not well understood. Methods Data of 74 patients with anti-IFN-γ autoantibodies at Srinagarind Hospital, Thailand, were collected annually (median follow-up duration, 7.5 years). Annual data for 19 patients and initial data for 4 patients with anti-IFN-γ autoantibodies at the US National Institutes of Health were collected (median follow-up duration, 4.5 years). Anti-IFN-γ autoantibody levels were measured in plasma samples. Results Ninety-one percent of US patients were of Southeast Asian descent; there was a stronger female predominance (91%) in US than Thai (64%) patients. Mycobacterium abscessus (34%) and Mycobacterium avium complex (83%) were the most common nontuberculous mycobacteria in Thailand and the United States, respectively. Skin infections were more common in Thailand (P = .001), whereas bone (P < .0001), lung (P = .002), and central nervous system (P = .03) infections were more common in the United States. Twenty-four percent of Thai patients died, most from infections. None of the 19 US patients with follow-up data died. Anti-IFN-γ autoantibody levels decreased over time in Thailand (P < .001) and the United States (P = .017), with either cyclophosphamide (P = .01) or rituximab therapy (P = .001). Conclusions Patients with anti-IFN-γ autoantibodies in Thailand and the United States had distinct demographic and clinical features. While titers generally decreased with time, anti-IFN-γ autoantibody disease had a chronic clinical course with persistent infections and death. Close long-term surveillance for new infections is recommended.

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SAT0172 UTILIZATION OF HYDROXYCHLOROQUINE AND CORTICOSTEROIDS AMONG LUPUS PATIENTS WITH INCIDENT END-STAGE RENAL DISEASE (ESRD) ONSET: A LONGITUDINAL STUDY USING USRDS REGISTRY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.5103 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1027.2-1027

Author(s):

A. R. Broder ◽

W. Mowrey ◽

A. Valle ◽

B. Goilav ◽

K. Yoshida ◽

...

Keyword(s):

United States ◽

Lupus Nephritis ◽

Renal Disease ◽

International Classification Of Diseases ◽

The United States ◽

Diagnostic Code ◽

Prescribing Practices ◽

Part D ◽

Stage Renal Disease

Background:The development of ESRD due to lupus nephritis is one of the most common and serious complications of SLE. Mortality among SLE ESRD patients is 4-fold higher compared to lupus nephritis patients with preserved renal function1Mortality in SLE ESRD is also twice as high compared with non-SLE ESRD, even though SLE patients develop ESRD at a significantly younger age. In the absence of ESRD specific guidelines, medication utilization in SLE ESRD is unknown.Objectives:The objective of this study was to investigate the real-world current US-wide patterns of medication prescribing among lupus nephritis patients with new onset ESRD enrolled in the United States Renal Disease Systems (USRDS) registry. We specifically focused on HCQ and corticosteroids (CS) as the most used medications to treat SLE.Methods:Inclusion: USRDS patients 18 years and above with SLE as a primary cause of ESRD (International Classification of Diseases, 9thRevision (ICD9) diagnostic code 710.0, previously validated2). who developed ESRD between January 1st, 2006 and July 31, 2011 (to ensure at least 6 months of follow-up in the USRDS). Patients had to be enrolled in Medicare Part D (to capture pharmacy claims). The last follow-up date was defined as either the last date of continuous part D coverage or the end of the study period, Dec 31, 2013.Results:Of the 2579 patients included, 1708 (66%) were HCQ- at baseline, and 871 (34%) were HCQ+ at baseline. HCQ+ patients at baseline had a slightly lower duration of follow-up compared to HCQ- patients at baseline, median (IQR) of 2.32 (1.33, 3.97) years and 2.55 (1.44, 4.25) years, respectively, p= 0.02. During follow-up period, only 778 (30%) continued HCQ either intermittently or continuously to the last follow-up date, 1306 (51%) were never prescribed HCQ after baseline, and 495 (19%) discontinued HCQ before the last follow-up date. Of the 1801 patients who were either never prescribed or discontinued HCQ early after ESRD onset, 713 (40%) were prescribed CS to the end of the follow-up period: 55% were receiving a low dose <10mg/daily, and 43 were receiving moderate dose (10-20mg daily)Conclusion:HCQ may be underprescribed and CS may be overprescribed in SLE ESRD. Changing the current prescribing practices may improve outcomes in SLE ESRDReferences:[1]Yap DY et al., NDT 2012.[2]Broder A et al., AC&R 2016.Acknowledgments :The data reported here have been supplied by the United States Renal Data System (USRDS). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy or interpretation of the U.S. government.Funding: :NIH/NIAMS K23 AR068441 (A Broder), NIH/NIAMS R01 AR 057327 and K24 AR 066109 (KH Costenbader)Disclosure of Interests: :Anna R. Broder: None declared, Wenzhu Mowrey: None declared, Anna Valle: None declared, Beatrice Goilav: None declared, Kazuki Yoshida: None declared, Karen Costenbader Grant/research support from: Merck, Consultant of: Astra-Zeneca

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Postinterview Communication between Obstetrics and Gynecology Residency Programs and Candidates

Journal of Graduate Medical Education ◽

10.4300/jgme-d-11-00114.1 ◽

2012 ◽

Vol 4 (2) ◽

pp. 165-169 ◽

Cited By ~ 8

Author(s):

Diana S. Curran ◽

Pamela B. Andreatta ◽

Xiao Xu ◽

Clark E. Nugent ◽

Samantha R. Dewald ◽

...

Keyword(s):

United States ◽

Response Rate ◽

Educational Leaders ◽

Program Directors ◽

The United States ◽

Obstetrics And Gynecology ◽

Residency Programs ◽

Ethical Conflicts ◽

Communication Practices ◽

E Mail

Abstract Introduction Residency programs seek to match the best candidates with their positions. To avoid ethical conflicts in this process, the National Residency Matching Program (NRMP or Match) has rules regarding appropriate conduct, including guidelines on contact between candidates and programs. Our study examined communication between obstetrics and gynecology (Ob-Gyn) programs and residency candidates after interviewing and prior to ranking. Methods Ob-Gyn program directors in the United States were sent a self-administered survey via e-mail. Data were collected and analyzed using descriptive methods to examine communication practices of these programs. Results The response rate was 40%. The findings showed that respondents had variable interpretations of the NRMP rules and suggest that programs may be communicating their match intentions especially to favored candidates. Respondents' open text comments highlighted program directors' frustrations with current NRMP rules. Discussion NRMP communication rules are intended to minimize pressure on residency candidates. Our findings suggest they may be leading to unforeseen stresses on program directors and candidates. Conclusions As educational leaders in medicine, we must consider what professional communications are acceptable without increasing the pressure on candidates during the ranking and match process.

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