Approval rates for corneal donation and the origin of donor tissue for transplantation at a university-based tertiary referral center with corneal subspecialization hosting a LIONS Eye Bank

Abstract Background With the increasing demand for corneas, eye banks must optimize the tissue donation, collection, and selection process. This retrospective monocentric study analyzed the approval rates for corneal donation and the origin of and reasons for discarding donor corneas from 2010 to 2019. Methods Data included the number of deceased, approval or rejection by the family for corneal donation and contraindications. Corneal grafts were included from all deceased persons who were full-body and multi-organ donors at the Saarland University Medical Center (UKS) and from external institutions. Additional analyzed parameters included endothelial cell count (ECC), blood sample serology for infections, and conjunctival swab testing . Results A total of 1748 corneoscleral buttons were harvested from 10,265 deceased persons (17% with no contraindication) at the UKS between 2010 and 2019, with a consent rate of 23.3%. The number of keratoplasties increased from 136 in 2010 (15% of the deceased, total = 925) to 251 in 2019 (21%, total = 1214). Both the general and department-specific data showed similar percentages for corneal donation over the years, with intensive care and palliative units recently providing the most corneas. The increase in the number of corneas processed by the cornea bank over the years (368 in 2010 compared with 857 in 2019) was linked both to a better internal supply in 2010 (262, 71.2% of the total) compared with 2019 (519, 60.6%) and to an external supply by reinforcement of cooperation with external hospitals, including Luxembourg in 2010 (106, 28.8% of the total) compared with 2019 (338, 39.4%). A total of 195 of 377 corneas (52%) were discarded in 2009 compared with 260 out of 715 (36%) in 2019. The main reasons for discarding were low ECC (36% of discarded corneas in 2009; 11% in 2019), positive conjunctival swab (11% in 2009; 13% in 2019), and blood sample serology (6% in 2009 and in 2019). Conclusion Despite an increasing number of donors, the demand for corneas is still rising. Improved cooperation with internal departments and with external clinics has led to an increasing number of explanted corneas. The main reason for discarding corneas was low ECC, followed by a positive conjunctival swab for fungal or bacterial contamination and serology. Increased donation rates and continued improvements in collection and selection processes are necessary to cover the high demand for corneas.

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The Ten Point Clock Test: A Quick Screen and Grading Method for Cognitive Impairment in Medical and Surgical Patients

The International Journal of Psychiatry in Medicine ◽

10.2190/5a0f-936p-vg8n-0f5r ◽

1994 ◽

Vol 24 (3) ◽

pp. 229-244 ◽

Cited By ~ 144

Author(s):

Peter J. Manos ◽

Rae Wu

Keyword(s):

Cognitive Impairment ◽

Cognitive Deficits ◽

Neuropsychological Tests ◽

Medical Center ◽

Neuropsychological Test ◽

Hospitalized Patients ◽

Surgical Patients ◽

Tertiary Referral Center ◽

The Mean ◽

State Examination

Objective: The objective of this study was to evaluate the clinical utility of the ten point clock test in screening for and grading cognitive deficits in medical and surgical patients. Method: The setting was the hospital and clinics of Virginia Mason Medical Center, a tertiary referral center. Consecutive samples of hospitalized patients, and clinic outpatients—with and without a dementia—were administered the ten point clock test as well as a number of other neuropsychological tests and measures of cognitive impairment. Results: Clock scores correlated with neuropsychological test scores and with the mini-mental state examination. They were stable from rater to rater, and from day to day in stable patients. The mean clock score of elderly outpatient controls was 8.5, significantly different from the mean of 5.5 scored by patients with a dementia. A cut off score of seven identified 76 percent of outpatients with dementia and 78 percent of elderly controls. Clock scores correlated well with nurses' ratings of their inpatients' cognitive deficits (Spearman's rs = −0.61). The test was easy to administer, even to hospitalized patients. Conclusions: The ten point clock test is reliable, valid, and useful as a quick screen and grading method for cognitive deficits in medical and surgical patients.

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Increasing Referrals and Donations Using the Transplant Center Development Model

Journal of Transplant Coordination ◽

10.1177/090591999600600109 ◽

1996 ◽

Vol 6 (1) ◽

pp. 32-36 ◽

Cited By ~ 2

Author(s):

Mark T Gravel ◽

Penelope Szeman

Keyword(s):

Organ Donation ◽

Organ Procurement ◽

Medical Center ◽

Development Model ◽

Tissue Donation ◽

Staff Education ◽

Organ Procurement Organization ◽

Organ And Tissue Donation ◽

Transplant Center ◽

Donation Process

Although transplantation centers directly benefit from organ and tissue donation, they continue to yield low organ and tissue referral and donation rates. Our medical center and organ procurement organization developed a model to increase referral and donation rates. This model, called the Transplant Center Development Model, facilitates the donation process, specializes staff education, and promotes administrative involvement. After it was was implemented at our medical center in 1991, the referral and donation rates from 1988 to 1990 were compared with those from 1991 to 1993. The results showed that after implementation of the model, the organ referral mean increased 47%; the organ donation mean, 50%; and the tissue donation mean, 117%. These findings suggest that this model may be a valuable tool in transplant center development.

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Prevalence, clinical features and treatment pattern of patients with concurrent diagnoses of rheumatoid arthritis and psoriatic disease: results of a 14-year retrospective study in a tertiary referral center

Therapeutic Advances in Chronic Disease ◽

10.1177/2040622319847900 ◽

2019 ◽

Vol 10 ◽

pp. 204062231984790

Author(s):

Kai-Lung Chen ◽

Hsien-Yi Chiu ◽

Jui-Hsiang Lin ◽

Jian-De Ye ◽

Yi-Hsuan Cho ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Clinical Features ◽

Age Of Onset ◽

Medical Center ◽

Skin Lesions ◽

Tertiary Referral ◽

Female Ratio ◽

Tertiary Referral Center ◽

Referral Center ◽

Psoriatic Disease

Background: Multiple comorbidities, including rheumatoid arthritis (RA), have been reported to be associated with psoriasis. Objective: This study aimed to determine the prevalence and the clinical features of RA among patients with psoriasis in a tertiary referral center. Methods: Between January 2000 and December 2013, all patients coded with psoriatic disease (ICD-9 CM 696.0 OR ICD-9 CM696.1) and RA (ICD-9 CM 714.0) in a tertiary medical center were enrolled. Results: There were 10,844 patients and 9073 patients with psoriatic disease and RA identified by diagnostic codes, respectively. Among patients with psoriasis, 111 patients had claim-based diagnosis of RA (1.02%). By reviewing medical records and telephone interview or clinic visits, 25 of the 111 patients (0.23%) was identified unequivocally as having concurrent RA. Among them, 17 (68%) were female and 16 (64%) patients developed arthritis prior to the onset of psoriasis with a mean lag of 6.3 years (1–19 years); 8 (32%) had psoriasis skin lesions prior to the onset of arthritis with a mean lag of 6.9 years (3–20 years); 1 (4%) had skin lesions and arthritis in the same time; 17 (68%) patients also fulfilled the CASPAR classification criteria for psoriatic arthritis. The mean age of onset for arthritis was 49.6 years old. Conclusions: The prevalence of RA in psoriasis might be overestimated in some previous studies using claimed database. Patients with concurrent RA and psoriasis showed a comparable age of onset and male to female ratio, but had more axial involvements compared to patients without psoriasis.

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QuantiFERON-TB Gold Test Conversion Is Associated with Active Tuberculosis Development in Inflammatory Bowel Disease Patients Treated with Biological Agents: An Experience of a Medical Center in Taiwan

Gastroenterology Research and Practice ◽

10.1155/2019/7132875 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Hsiang-Chun Lai ◽

Chia-Hsi Chang ◽

Ken-Sheng Cheng ◽

Tsung-Wei Chen ◽

Yuan-Yao Tsai ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Biological Treatment ◽

Medical Center ◽

Biological Agents ◽

Baseline Serum ◽

Tertiary Referral Center ◽

Western Countries ◽

Before And After ◽

Inflammatory Bowel

Taiwan has a lower prevalence of inflammatory bowel disease (IBD) and a higher prevalence of tuberculosis (TB) infection than Western countries. The aim of this study was to investigate the prevalence of latent TB (LTB) and active TB infection in IBD patients treated with biological agents. From January 2000 to September 2018, we retrospectively collected data from IBD patients treated with biological agents at a tertiary referral center. Patients underwent a QuantiFERON-TB Gold test (QFT) to screen for TB infection before and after biological treatment courses. The diagnostic age, sex, body mass index, hepatitis B virus infection, biochemistry profile, treatment regimens, and the results of the QFT were analyzed. Overall, 130 IBD patients who received biological treatment were enrolled. The results of the QFT before biological treatment were determined in 120 patients (92%); of these, 10 were positive (8%), 110 were negative (85%), and 10 were indeterminate (9%). Six patients demonstrated seroconversion after biological treatment, as determined by the QFT. Three patients (2.4%) developed active pulmonary TB after biological treatment. In subgroup analysis, the positive QFT patients had a trend of lower baseline serum C-reactive protein and erythrocyte sedimentation rate levels than the negative QFT group. The present study demonstrates that the prevalence of LTB before and after biological treatment is higher in Taiwan than in most Western countries and similar to other Asian countries. Therefore, screening and monitoring of TB infection are necessary for IBD patients before and during biological treatments in Taiwan.

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Postseptic Cognitive Impairment and Expression of APOE in Peripheral Blood: The Cognition After SepsiS (CASS) Observational Pilot Study

Journal of Intensive Care Medicine ◽

10.1177/0885066619897604 ◽

2020 ◽

pp. 088506661989760

Author(s):

Samuel M. Brown ◽

Sarah J. Beesley ◽

Chris Stubben ◽

Emily L. Wilson ◽

Angela P. Presson ◽

...

Keyword(s):

Cognitive Impairment ◽

Executive Function ◽

Peripheral Blood ◽

Medical Center ◽

Executive Dysfunction ◽

Clinical Problem ◽

Primary Analysis ◽

Tertiary Referral Center ◽

Peripheral Leukocytes

Background: Cognitive impairment after sepsis is an important clinical problem. Determinants of postseptic cognitive impairment are not well understood. We thus undertook a systems biology approach to exploring a possible role for apolipoprotein E (APOE) in postseptic cognitive impairment. Design: Prospective, observational cohort. Setting: Intermountain Medical Center, a tertiary referral center in Utah. Patients/Participants: Patients with sepsis admitted to study intensive care units. Interventions: None. Methods: We obtained peripheral blood for deep sequencing of RNA and followed up survivors at 6 months with a battery of cognitive instruments. We defined cognitive impairment based on the 6-month Hayling test of executive function. In our primary analysis, we employed weighted network analysis. Secondarily, we compared variation in gene expression between patients with normal versus impaired cognition. Measurements and Main Results: We enrolled 40 patients, of whom 34 were follow-up eligible and 31 (91%) completed follow-up; 1 patient’s RNA sample was degraded—the final analytic cohort was 30 patients. Mean Hayling test score was 5.8 (standard deviation 1.1), which represented 20% with impaired executive function. The network module containing APOE was dominated by low-expression genes, with no association on primary analysis ( P = .8). Secondary analyses suggested several potential lines of future investigation, including oxidative stress. Conclusions: In this prospective pilot cohort, executive dysfunction affected 1 in 5 survivors of sepsis. The APOE gene was sparsely transcribed in peripheral leukocytes and not associated with cognitive impairment. Future lines of research are suggested.

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Inpatient Urine Cultures Are Frequently Performed Without Urinalysis or Microscopy: Findings From a Large Academic Medical Center

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.311 ◽

2017 ◽

Vol 38 (4) ◽

pp. 455-460 ◽

Cited By ~ 6

Author(s):

Abigail L. Carlson ◽

Satish Munigala ◽

Anthony J. Russo ◽

Kathleen M. McMullen ◽

Helen Wood ◽

...

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Medical Center ◽

Academic Medical Center ◽

Laboratory Data ◽

Surgical Intensive Care ◽

Tertiary Referral Center ◽

Patient Admissions ◽

Academic Medical ◽

Tract Infections

OBJECTIVETo describe the frequency of urine cultures performed in inpatients without additional testing for pyuriaDESIGNRetrospective cohort studySETTINGA 1,250-bed academic tertiary referral centerPATIENTSHospitalized adultsMETHODSThis study included urine cultures drawn on 4 medical and 2 surgical wards from 2009 to 2013 and in the medical and surgical intensive care units (ICUs) from 2012 to 2013. Patient and laboratory data were abstracted from the hospital’s medical informatics database. We identified catheter-associated urinary tract infections (CAUTIs) in the ICUs by routine infection prevention surveillance. Cultures without urinalysis or urine microscopy were defined as “isolated.” The primary outcome was the proportion of isolated urine cultures obtained. We used multivariable logistic regression to assess predictors of isolated cultures.RESULTSDuring the study period, 14,743 urine cultures were obtained (63.5 cultures per 1,000 patient days) during 11,820 patient admissions. Of these, 2,973 cultures (20.2%) were isolated cultures. Of the 61 CAUTIs identified, 31 (50.8%) were identified by an isolated culture. Predictors for having an isolated culture included male gender (adjusted odds ratio [aOR], 1.22; 95%; confidence interval [CI], 1.11–1.35], urinary catheterization (aOR, 2.15; 95% CI, 1.89–2.46), ICU admission (medical ICU aOR, 1.72; 95% CI, 1.47–2.00; surgical ICU aOR, 1.82; 95% CI, 1.51–2.19), and obtaining the urine culture ≥1 calendar day after admission (1–7 days aOR, 1.91; 95% CI. 1.71–2.12; >7 days after admission aOR, 2.81; 95% CI, 2.37–3.34).CONCLUSIONSIsolated urine cultures are common in hospitalized patients, particularly in patients with urinary catheters and those in ICUs. Interventions targeting inpatient culturing practices may improve the diagnosis of urinary tract infections.Infect Control Hosp Epidemiol2017;38:455–460

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How Much Labor Is in a Labor Epidural?

Anesthesiology ◽

10.1097/00000542-200003000-00029 ◽

2000 ◽

Vol 92 (3) ◽

pp. 851-858 ◽

Cited By ~ 15

Author(s):

Elizabeth D. Bell ◽

Donald H. Penning ◽

Edward F. Cousineau ◽

William D. White ◽

Andrew J. Hartle ◽

...

Keyword(s):

Operating Room ◽

Medical Center ◽

Labor Cost ◽

Full Time ◽

Full Time Equivalent ◽

Medicaid Reimbursement ◽

Tertiary Referral Center ◽

Time And Motion ◽

Obstetric Analgesia ◽

Duke University

Background Some anesthesiologists avoid provision of obstetric analgesia services (OAS) because of low reimbursement rates for the work involved. This study defines the manpower costs of operating an OAS in a tertiary referral center and examines reimbursement for this cost. Methods The time spent providing OAS in a total of 55 parturients was studied prospectively using a modification of classic time and motion studies. Results Mean duration of OAS in our population was 412 +/- 313 min. Mean bedside anesthesia staff time was 90 +/- 40 min, and mean number of visits to each patient's bedside was 6.3 +/- 2.0 visits. Assuming staffing on demand for service (intermittent staffing), a minimum of 2.5 full-time equivalent (FTE) attending anesthesiologists was required to meet demand. With intermittent staffing, labor cost was $325 per patient. Actual practice at Duke University Medical Center is around-the-clock (dedicated) staffing, which requires 4.4 FTEs at a cost of $728 per patient. Neither average indemnity reimbursement ($299) nor Medicaid reimbursement ($204) covered the cost per OAS patient. Breaking even is possible under indemnity reimbursement because operating room reimbursement subsidizes OAS costs. Breaking even cannot occur with Medicaid reimbursement under any circumstances. Conclusions Obstetric analgesia services requires a minimum of 2.5 FTE attending anesthesiologists at Duke University Medical Center. With the current payer mix, positive-margin operating room activities associated with the obstetric service are not sufficient to compensate for the losses incurred by an OAS. Around-the-clock dedicated obstetric staffing (4.4 FTEs) cannot operate profitably under any reasonable circumstances at our institution.

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Development of Repository From a Pediatric Gender Clinic

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1621 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A797-A797

Author(s):

Michele Gortakowski ◽

Chelsea C Gordner

Keyword(s):

Health Outcomes ◽

Hormone Therapy ◽

Behavioral Health ◽

Medical Center ◽

Pediatric Population ◽

Gender Diversity ◽

Outcome Data ◽

Long Term Effects ◽

Tertiary Referral Center ◽

The Creation

Abstract Objectives: With the publication of updated guidelines for care of transgender and gender non-conforming individuals, there has been an increase in the presence of gender diversity in both mainstream media and medical literature. Several gaps currently exist in medical knowledge regarding long term effects of gender-affirming therapies. There is a lack of standardization in study design, patient sampling, and outcome measures, and most studies are retrospective. Here we describe the creation of both a retrospective and prospective repository of patients who presented to the Massachusetts Medical School-Baystate Medical Center (UMass-Baystate) pediatric gender program. Methods: Baystate Medical Center is located in western MA and is a tertiary referral center. A pediatric gender clinic was created in 2014. A repository containing both retrospective and prospective data was approved by the UMass-Baystate IRB to include patients ages 2 to 24 years of age who presented to our gender clinic. Retrospective data was obtained using the McKesson billing database. Sociodemographic, clinical and behavioral health data were collected. We are consenting individuals as they present to the clinic for the prospective component. Those that have consented fill out a survey at each visit. The repository has been approved to follow outcome data for 25 years. Results: To date, we have 218 individuals in the repository, 75 of which are in the prospective component. Age of presentation ranged from 6 yrs to 24 yrs with an average age of 15 yrs. 62% identified as transmale, 31% as transfemale and the remainder as gender fluid or other. 75% have been prescribed gender affirming hormone therapy (56% GnRH agonist therapy, 20% estrogen, 58% testosterone). Of those being followed prospectively, 76% identified as white, 19% Hispanic. 79% were satisfied or very satisfied with their care. Conclusions: Here we describe the demographic and clinical characteristics of patients that have presented to our gender clinic since 2014. The creation of our gender repository will allow us to assess sociodemographic, clinical and behavioral health outcomes of treatment, including metabolic parameters, bone health, and mental health outcomes in our pediatric population. Future projects include assessment of the change in cardiovascular risk in individuals on gender-affirming hormone therapy.

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Evaluation of Junior Doctors’ Knowledge of Corneal Donation and the New Opt-Out System in England

10.1101/2021.03.04.21252895 ◽

2021 ◽

Author(s):

Bhavesh Gopal ◽

Owuraku Asiedu Titi-Lartey ◽

Princeton Fernandes ◽

Nur-Emel Noubani ◽

Elizabeth Blatherwick ◽

...

Keyword(s):

Response Rate ◽

Cross Sectional Study ◽

Tissue Donation ◽

Junior Doctors ◽

Cross Sectional ◽

East Midlands ◽

Opt Out ◽

Organ Tissue ◽

Corneal Donation ◽

The Uk

ABSTRACTObjectivesTo evaluate the knowledge of corneal donation and the new opt-out system among junior doctors in the East Midlands, UK.MethodsThis was a cross-sectional study performed during June-September 2020. A 26-item questionnaire-based survey was disseminated to all 340 junior doctors working in the East Midlands, UK. Relevant data, including participants’ background, knowledge of corneal donation and the new opt-out system introduced in England, were analysed.ResultsA total of 143 responses were received (response rate=42.1%). Nineteen (13.3%) junior doctors had previously discussed about corneal donation. The majority (100, 69.9%) of them perceived the importance of obtaining consent for corneal donation as junior doctors, but only 24 (16.8%) felt comfortable in discussing corneal donation. The knowledge of corneal donation was low, with a mean correct response rate of 33.3±20.8%. Only 28 (19.6%) doctors were aware of the 24-hour death-to-enucleation time limit. The majority (116, 81.1%) of doctors would consider certifying a death on the ward quicker if they knew it could potentially compromise the quality of corneas. Most (103, 72%) doctors were aware of the new opt-out system but only 56 (39.2%) doctors correctly stated that donation can only proceed with family consent.ConclusionJunior doctors working at the frontline services serve as valuable members in contributing to the process of obtaining consent for organ/tissue donation. Our study highlights the lack of knowledge of corneal donation and the opt-out system amongst junior doctors in the UK. Targeted postgraduate training during the induction process may potentially enhance the donation rate.

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