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Mulder J, Sonneveld H, Healey A, Van Raemdonck D. The first international roundtable on "organ donation after circulatory death by medical assistance in dying" demonstrates increasing incidence of successful patient-driven procedure. Am J Transplant 2022; 22:999-1000. [PMID: 34706144 PMCID: PMC9297969 DOI: 10.1111/ajt.16879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/14/2021] [Accepted: 10/19/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Johannes Mulder
- Anesthesiologie‐Intensive Care departmentIsala HospitalsZwolleThe Netherlands
| | - Hans Sonneveld
- Anesthesiologie‐Intensive Care departmentIsala HospitalsZwolleThe Netherlands
| | - Andrew Healey
- Trillium Gift of Life donationTorontoOntarioCanada,Intensive care departmentWilliam Osler Health System hospitalsBramptonOntarioCanada
| | - Dirk Van Raemdonck
- Department of Thoracic SurgeryTransplant Centre University Hospitals LeuvenLeuvenBelgium
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Chambers HE, Reinschmidt K, Smith G, Agudelo E, Brodahl K, Herriman E, Hoy H, Pont K, Seawright A, Stearns E, Torres AM, Weldon E, Blackstock DM. Examining the critical role of advanced practice providers on a multidisciplinary transplant team. Am J Transplant 2021; 21:3840-3846. [PMID: 34101989 DOI: 10.1111/ajt.16715] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 01/25/2023]
Abstract
It is well documented that Physician Assistants (PAs) and Nurse Practitioners (NPs), collectively known as Advanced Practice Providers (APPs), have a beneficial role beyond the field of primary care. APPs broad spectrum of knowledge make them particularly well suited for specializing in complex fields such as transplant. Variations in practice across transplant centers lead to questions regarding optimal use of APPs. Using job descriptions from transplant centers currently employing APPs, we sought to examine the critical role of transplant APPs beyond clinical care alone. In this review, we explore not only the general training of APPs and current utilization of APPs in transplant, but also safety, cost effectiveness, and comparison of APPs to other transplant providers. We aimed to highlight the importance of recruitment and retention of transplant specific trained APPs to provide continuity in transplant programs. Additionally, APPs expansion into transplant research, quality improvement, leadership, and management must be considered. We challenge transplant centers utilizing APPs to consider these important aspects when seeking ways to expand and optimize the critical role APPs provide on the transplant team.
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Affiliation(s)
- Heather E Chambers
- Infectious Diseases Program, Alegent Immanuel Medical Center, Omaha, Nebraska, USA
| | - Kristi Reinschmidt
- Transplant Surgery Division, Intermountain Health Care Inc, Salt Lake City, Utah, USA
| | - Georgeine Smith
- Transplant Surgery Division, Penn Transplant Institute, Philadelphia, Pennsylvania, USA
| | - Eliana Agudelo
- Transplant Surgery Division, UCSF, San Francisco, California, USA
| | - Katherine Brodahl
- Transplant Surgery Division, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Emily Herriman
- Transplant Surgery Division, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Haley Hoy
- Transplant Surgery Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kylie Pont
- Transplant Surgery Division, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Ashley Seawright
- Transplant Surgery Division, University of Mississippi, Oxford, Mississippi, USA
| | - Elizabeth Stearns
- Transplant Surgery Division, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Ana-Marie Torres
- Transplant Surgery Division, UCSF, San Francisco, California, USA
| | - Elaina Weldon
- Transplant Surgery Division, NYU Langone Health, New York, New York, USA
| | - Daryle M Blackstock
- Transplant Surgery Division, New York Presbyterian Hospital, New York, New York, USA
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Wadhwani SI, Huang CY, Gottlieb L, Beck AF, Bucuvalas J, Kotagal U, Lyles C, Lai JC. Center variation in long-term outcomes for socioeconomically deprived children. Am J Transplant 2021; 21:3123-3132. [PMID: 33565227 PMCID: PMC8353008 DOI: 10.1111/ajt.16529] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 01/25/2023]
Abstract
Neighborhood socioeconomic deprivation is associated with adverse outcomes after pediatric liver transplant. We sought to determine if this relationship varies by transplant center. Using SRTR, we included patients <18 years transplanted 2008-2013 (N = 2804). We matched patient ZIP codes to a deprivation index (range [0,1]; higher values indicate increased socioeconomic deprivation). A center-level patient-mix deprivation index was defined by the distribution of patient-level deprivation. Centers (n = 66) were classified as high or low deprivation if their patient-mix deprivation index was above or below the median across centers. Center quality was classified as low or high graft failure if graft survival rates were better or worse than the overall 10-year graft survival rate. Primary outcome was patient-level graft survival. We used random-effect Cox models to evaluate center-level covariates on graft failure. We modeled center quality using stratified Cox models. In multivariate analysis, each 0.1 increase in the patient-mix deprivation index was associated with increased hazard of graft failure (HR 1.32; 95%CI: 1.05, 1.66). When stratified by center quality, patient-mix deprivation was no longer significant (HR 1.07, 95%CI: 0.89, 1.28). Some transplant centers care for predominantly high deprivation children and maintain excellent outcomes. Revealing and replicating these centers' practice patterns should enable more equitable outcomes.
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Affiliation(s)
| | | | - Laura Gottlieb
- University of California San Francisco, San Francisco, CA
| | - Andrew F. Beck
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,University of Cincinnati School of Medicine, Cincinnati, OH
| | - John Bucuvalas
- Icahn School of Medicine at Mount Sinai, New York, NY,Kravis Children’s Hospital, New York, NY
| | - Uma Kotagal
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,University of Cincinnati School of Medicine, Cincinnati, OH
| | - Courtney Lyles
- University of California San Francisco, San Francisco, CA
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Merlo CA, Clark SC, Arnaoutakis GJ, Yonan N, Thomas D, Simon A, Thompson R, Thomas H, Orens J, Shah AS. National Healthcare Delivery Systems Influence Lung Transplant Outcomes for Cystic Fibrosis. Am J Transplant 2015; 15:1948-57. [PMID: 25809545 DOI: 10.1111/ajt.13226] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 01/11/2015] [Accepted: 01/15/2015] [Indexed: 01/25/2023]
Abstract
Successful lung transplantation (LTx) depends on multiple components of healthcare delivery and performance. Therefore, we conducted an international registry analysis to compare post-LTx outcomes for cystic fibrosis (CF) patients using the UNOS registry in the United States and the National Health Service (NHS) Transplant Registry in the United Kingdom. Patients with CF who underwent lung or heart-lung transplantation in the United States or United Kingdom between January 1, 2000 and December 31, 2011 were included. The primary outcome was all-cause mortality. Kaplan-Meier analysis and Cox proportional hazards regression evaluated the effect of healthcare system and insurance on mortality after LTx. 2,307 US LTx recipients and 451 individuals in the United Kingdom were included. 894 (38.8%) US LTx recipients had publically funded Medicare/Medicaid insurance. US private insurance and UK patients had improved median predicted survival compared with US Medicare/Medicaid recipients (p < 0.001). In multivariable Cox regression, US Medicare/Medicaid insurance was associated with worse survival after LTx (US private: HR0.78,0.68-0.90,p = 0.001 and UK: HR0.63,0.41-0.97, p = 0.03). This study in CF patients is the largest comparison of LTx in two unique health systems. Both the United States and United Kingdom have similar early survival outcomes, suggesting important dissemination of best practices internationally. However, the performance of US public insurance is significantly worse and may put patients at risk.
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Affiliation(s)
- C A Merlo
- Divisions of Pulmonary and Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD.,The Bloomberg School of Public Health, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - S C Clark
- Department of Cardiothoracic Transplantation and Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - G J Arnaoutakis
- Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - N Yonan
- North West Heart Centre and The Transplant Centre, University Hospital of South Manchester, Manchester, United Kingdom
| | - D Thomas
- Papworth Hospitals, NHS Trust Cambridge, Cambridge, United Kingdom
| | - A Simon
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Middlesex, United Kingdom
| | - R Thompson
- Department of Heart and Lung Transplantation, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - H Thomas
- Department of Heart and Lung Transplantation, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - J Orens
- Divisions of Pulmonary and Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - A S Shah
- Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD
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