The document summarizes the results of a randomized controlled trial comparing hypothermic machine perfusion (MP) to static cold storage (CS) for preserving deceased donor kidneys intended for transplantation. The trial found that MP significantly reduced the risk of delayed graft function (DGF) compared to CS, with DGF occurring in 20.8% of kidneys in the MP arm versus 26.5% in the CS arm. One-year graft survival was also higher in the MP arm, and MP was found to be cost-effective compared to CS due to reductions in post-transplant dialysis and hospital readmissions.
Excerise Tolerance and Post-Operative Outcomes in Patients with Pulmonary Hyp...Aalap Shah
We evaluate the predictive value of patient-reported functional status on hospital length of stay (LOS) and morbidity/mortality for PHTN patients undergoing non-cardiac, non-obstetric procedures at our institution.
This document reports on cardiac surgery outcomes from June 2011 to June 2015 at Penang Adventist Hospital conducted by Dr. John E. Anderson. It provides data on annual and cumulative surgery volumes, mortality rates for various procedures compared to benchmarks, complication rates, and a 4-year summary of outcomes by procedure category and year. The overall mortality rate for the period was 2.02%, within benchmark standards, though some individual categories had higher rates.
This document discusses a case involving a 75-year-old man with heart failure who required percutaneous coronary intervention (PCI) and left ventricular support. The patient had multiple medical issues including hypertension, diabetes, and prior heart attack. He was evaluated at multiple hospitals and found to have severe left ventricular dysfunction. The document discusses the risks and benefits of different percutaneous support devices that were considered for the planned PCI, including intra-aortic balloon pump (IABP) and Impella. It summarizes data from clinical trials comparing outcomes of IABP versus Impella support. The document concludes that combining transradial PCI with femoral placement of an Impella device may optimize outcomes in high-risk patients by reducing bleeding risks while
This document summarizes the results of a clinical trial comparing continuous therapy (CT) to fixed duration therapy (FDT) in multiple myeloma. In the trial, 604 patients received CT and 614 received FDT. For the primary endpoint of progression-free survival at 1 year, CT was superior to FDT, with median progression-free survival of 32 months for CT versus 16 months for FDT and a hazard ratio of 0.47 favoring CT (p<0.001). Overall, CT provided longer disease control compared to FDT based on this meta-analysis of multiple myeloma maintenance trials.
This document summarizes several studies comparing transradial versus transfemoral access for percutaneous coronary interventions (PCI). The studies show that transradial access is associated with lower rates of access site complications and bleeding, shorter hospital stays, lower costs, and improved patient satisfaction compared to transfemoral access. Meta-analyses demonstrate transradial access reduces major bleeding, access site complications, and mortality compared to transfemoral access.
1) The IMPROVE-IT trial investigated whether adding ezetimibe to simvastatin therapy provides additional cardiovascular benefit compared to simvastatin monotherapy in 18,144 high-risk patients who had an acute coronary syndrome.
2) At a median follow-up of 6 years, combination ezetimibe/simvastatin therapy resulted in a statistically significant 9% relative risk reduction in major cardiovascular events compared to simvastatin alone.
3) Combination therapy also significantly reduced the risk of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke by 10% compared to simvastatin monotherapy.
This document discusses the use of transradial access for primary PCI and in patients with cardiogenic shock. It summarizes data showing that transradial access is associated with lower mortality, MACCE, and bleeding rates compared to transfemoral access in these high-risk settings. However, transradial primary PCI requires an experienced team. The document provides tips for a successful transradial program and overcoming challenges in shock patients, such as using left radial access, ultrasound guidance, and single catheter techniques.
Excerise Tolerance and Post-Operative Outcomes in Patients with Pulmonary Hyp...Aalap Shah
We evaluate the predictive value of patient-reported functional status on hospital length of stay (LOS) and morbidity/mortality for PHTN patients undergoing non-cardiac, non-obstetric procedures at our institution.
This document reports on cardiac surgery outcomes from June 2011 to June 2015 at Penang Adventist Hospital conducted by Dr. John E. Anderson. It provides data on annual and cumulative surgery volumes, mortality rates for various procedures compared to benchmarks, complication rates, and a 4-year summary of outcomes by procedure category and year. The overall mortality rate for the period was 2.02%, within benchmark standards, though some individual categories had higher rates.
This document discusses a case involving a 75-year-old man with heart failure who required percutaneous coronary intervention (PCI) and left ventricular support. The patient had multiple medical issues including hypertension, diabetes, and prior heart attack. He was evaluated at multiple hospitals and found to have severe left ventricular dysfunction. The document discusses the risks and benefits of different percutaneous support devices that were considered for the planned PCI, including intra-aortic balloon pump (IABP) and Impella. It summarizes data from clinical trials comparing outcomes of IABP versus Impella support. The document concludes that combining transradial PCI with femoral placement of an Impella device may optimize outcomes in high-risk patients by reducing bleeding risks while
This document summarizes the results of a clinical trial comparing continuous therapy (CT) to fixed duration therapy (FDT) in multiple myeloma. In the trial, 604 patients received CT and 614 received FDT. For the primary endpoint of progression-free survival at 1 year, CT was superior to FDT, with median progression-free survival of 32 months for CT versus 16 months for FDT and a hazard ratio of 0.47 favoring CT (p<0.001). Overall, CT provided longer disease control compared to FDT based on this meta-analysis of multiple myeloma maintenance trials.
This document summarizes several studies comparing transradial versus transfemoral access for percutaneous coronary interventions (PCI). The studies show that transradial access is associated with lower rates of access site complications and bleeding, shorter hospital stays, lower costs, and improved patient satisfaction compared to transfemoral access. Meta-analyses demonstrate transradial access reduces major bleeding, access site complications, and mortality compared to transfemoral access.
1) The IMPROVE-IT trial investigated whether adding ezetimibe to simvastatin therapy provides additional cardiovascular benefit compared to simvastatin monotherapy in 18,144 high-risk patients who had an acute coronary syndrome.
2) At a median follow-up of 6 years, combination ezetimibe/simvastatin therapy resulted in a statistically significant 9% relative risk reduction in major cardiovascular events compared to simvastatin alone.
3) Combination therapy also significantly reduced the risk of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke by 10% compared to simvastatin monotherapy.
This document discusses the use of transradial access for primary PCI and in patients with cardiogenic shock. It summarizes data showing that transradial access is associated with lower mortality, MACCE, and bleeding rates compared to transfemoral access in these high-risk settings. However, transradial primary PCI requires an experienced team. The document provides tips for a successful transradial program and overcoming challenges in shock patients, such as using left radial access, ultrasound guidance, and single catheter techniques.
1) The study compared radiation exposure as measured by fluoroscopy time and dose-area product between different catheter techniques for diagnostic coronary angiograms performed via the transradial approach.
2) Using a multi-catheter technique with both left and right Judkins catheters resulted in lower radiation exposure than using single catheter techniques like the Amplatz left catheter, Barbeau catheter, or multipurpose catheter.
3) The findings suggest that a multi-catheter technique may reduce radiation exposure for patients compared to single catheter techniques when performing diagnostic coronary angiography.
Current status and future perspective of management of heart failure in japan.drucsamal
1) The document summarizes findings from the CHART studies on heart failure management in Japan, showing improved outcomes over time with increased use of evidence-based neurohormonal therapies like RAS inhibitors and beta-blockers.
2) A randomized controlled trial called the SUPPORT trial found that adding olmesartan did not improve outcomes for hypertensive heart failure patients already receiving guideline-directed medical therapy and instead increased risk of renal dysfunction.
3) Overall guideline-directed medical therapies like RAS inhibitors and beta-blockers have improved long-term prognosis of heart failure in Japan, though opportunities remain to optimize treatment.
This document discusses hypoperfusion in acute heart failure. It begins with case examples from Duke Hospital and considerations for diagnosis. It then covers inotropic options and mechanical support devices. Various studies on inotropes, percutaneous support devices, and extracorporeal membrane oxygenation are summarized. The conclusion is that hypoperfusion in acute heart failure presents major challenges for diagnosis and treatment.
1) The document discusses carotid artery stenting (CAS) and carotid endarterectomy (CEA) for treating carotid artery disease. It reviews data from clinical trials comparing the two procedures.
2) Operator experience is an important factor for CAS outcomes, with over 100 cases associated with lower risk. New technologies like mesh-covered stents may further reduce risks of CAS.
3) Future studies like CREST-2 aim to provide more data on CAS and CEA in asymptomatic patients to help guide treatment decisions. Both procedures can effectively treat carotid artery disease when performed by experienced operators.
This document discusses the use of left ventricular support devices for complex percutaneous coronary interventions (PCI). It begins by outlining the types of patients that typically require high-risk PCI, including those with severe diffuse coronary artery disease, significant three-vessel disease, or left main disease. It then reviews various left ventricular support devices like intra-aortic balloon pumps (IABP), Impella, TandemHeart, and extracorporeal membrane oxygenation and the evidence for their use. Finally, it emphasizes that while transradial access is associated with lower bleeding risks, operators must maintain skills in large bore femoral access and closure for cases requiring left ventricular support devices.
This document discusses whether radial centers have better outcomes for femoral access PCI procedures compared to traditional transfemoral centers. It analyzes data from the British Cardiovascular Intervention Society on over 100,000 PCI procedures from 2006-2010. The analysis found that radial centers had no increase in transfemoral complications and that transfemoral procedures in radial centers were associated with a reduction in 30-day mortality compared to transfemoral centers. Therefore, radial centers appear to perform transfemoral PCI procedures safely and with good outcomes.
This document provides disclosure information for John R. Teerlink, the presenter of a study on intravenous omecamtiv mecarbil in patients with acute heart failure. It notes that Dr. Teerlink has received research funding from Amgen, the sponsor of the study, and has consulting fees from several other companies. It also states that the use of omecamtiv mecarbil is investigational. The technical support of Karen Driver, who was also supported by Amgen, is acknowledged.
This document provides guidance on starting a successful transradial cardiac catheterization program. It discusses how the author started their program during fellowship by attending courses and enrolling patients in clinical trials. It highlights advantages of transradial access such as reduced access complications, earlier ambulation, and improved patient comfort. The document also reviews data demonstrating reduced bleeding and improved outcomes with transradial compared to transfemoral access. Overall, it presents a case for transradial access and provides tips for establishing a successful transradial program.
The effective national primary angioplasty network. Petr WidimskýChaichuk Sergiy
The document discusses lessons learned from effective primary angioplasty networks in 5 European countries. It finds that regional networks covering 500,000-1,000,000 people, 24/7 primary PCI services, and bypassing nearest hospitals to limit delays are optimal. Direct transport to the cath lab without going through the emergency room can achieve under 90 minute door-to-balloon times in most patients.
The document summarizes several landmark clinical trials from 2015 related to cardiovascular diseases. It discusses the SPRINT trial which compared intensive vs standard blood pressure control and found lower rates of cardiovascular events with intensive control below 120 mm Hg. It also summarizes the IMPROVE-IT trial which found adding ezetimibe to statin therapy after acute coronary syndrome further lowered cardiovascular risks. The MATRIX program evaluated bivalirudin vs heparin in PCI and found no significant difference in outcomes. The AMBITION trial found initial combination therapy with ambrisentan and tadalafil lowered risks compared to monotherapy in pulmonary arterial hypertension.
The document provides data on outpatient interventional cardiology procedures from January 1, 2009 to December 31, 2009 at Great State University Medical Center and comparison hospitals. It includes information on patient demographics such as age distribution, payer type, race, and gender. It also provides data on the types of cardiology procedures performed at the focus hospital and comparison hospitals, including the top 15 procedures by count. The procedures are categorized into non-invasive, invasive, peripheral vascular, and electrophysiology groups.
Fundación EPIC _ Tratamiento anticoagulante/antiagregante al alta en TAVIFundacion EPIC
Presentación de la ponencia "Tratamiento anticoagulante/antiagregante al alta en TAVI" Por el Dr. Ferreiro en los Diálogos EPIC_Retos Clínicos en Válvulas Transcatéter/ Clinical Challenges in TAVR today, el 10 de Mayo de 2018 en Barcelona (España)
Fundación EPIC _ Transient atrioventricular block after TAVI, what to do?Fundacion EPIC
Presentación de la ponencia "Tratamiento anticoagulante/antiagregante al alta en TAVI" Por la Dra. Ureña en los Diálogos EPIC_Retos Clínicos en Válvulas Transcatéter/ Clinical Challenges in TAVR today, el 10 de Mayo de 2018 en Barcelona (España)
This study compared outcomes of using a primary transpedal (TP) approach versus a dual transpedal-transradial (TP-TR) approach for endovascular intervention of femoropopliteal artery chronic total occlusions. The dual approach had higher crossing and procedural success rates. Both approaches had no deaths or amputations at 3 months follow up, though the dual approach had a higher target vessel revascularization rate. Neither approach resulted in access site complications or loss of patency at 30 days. The study demonstrates that both pedal and dual pedal-radial approaches are feasible and safe options for treating femoropopliteal chronic total occlusions.
1) The IMPROVE-IT trial investigated whether adding ezetimibe to simvastatin therapy provides additional cardiovascular benefit compared to simvastatin monotherapy in 18,144 high-risk patients who recently had an acute coronary syndrome.
2) Patients receiving ezetimibe/simvastatin had a lower rate of major cardiovascular events (32.7% vs 34.7%) over a median follow-up of 6 years, demonstrating the additional clinical benefit of further lowering LDL-C with ezetimibe.
3) Ezetimibe/simvastatin also reduced the rate of the composite endpoint of cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke compared to
This single-center randomized controlled trial compared outcomes of STEMI patients treated with bivalirudin (n=907) versus unfractionated heparin (n=905) during primary percutaneous coronary intervention (PPCI). At 28 days, the primary efficacy outcome (composite of death, stroke, reinfarction, unplanned revascularization) occurred more frequently in the bivalirudin group (8.7% vs 5.7%, p=0.01). The increased risk was driven by a higher rate of stent thrombosis with bivalirudin (3.4% vs 0.9%, p=0.001). Major bleeding rates were similar between groups (3.5% vs
Rutger Ploeg - The Netherlands - Tuesday 29 -Experience in DCD Programs logi...incucai_isodp
The document discusses improving organ transplantation outcomes by focusing on donor organ preservation techniques. It notes that without improvements, transplantation may become limited. It reviews research showing machine perfusion reduces injury compared to cold storage for donation after cardiac death kidneys. Future areas of focus include better donor organ selection and protection from ischemia-reperfusion injury through continuous perfusion and repair strategies in both donors and recipients. The goal is to make currently untransplantable organs transplantable through protective interventions.
This document summarizes key findings from several studies on the treatment of rectal cancer with radiotherapy and chemoradiotherapy. It finds that preoperative chemoradiotherapy reduces local recurrence rates compared to postoperative chemoradiotherapy or no radiotherapy, with increased acute and late toxicity. Several large trials showed no difference in overall survival between treatment groups. Optimal patient selection and a balance between risk reduction and side effects are important considerations.
1) The study compared radiation exposure as measured by fluoroscopy time and dose-area product between different catheter techniques for diagnostic coronary angiograms performed via the transradial approach.
2) Using a multi-catheter technique with both left and right Judkins catheters resulted in lower radiation exposure than using single catheter techniques like the Amplatz left catheter, Barbeau catheter, or multipurpose catheter.
3) The findings suggest that a multi-catheter technique may reduce radiation exposure for patients compared to single catheter techniques when performing diagnostic coronary angiography.
Current status and future perspective of management of heart failure in japan.drucsamal
1) The document summarizes findings from the CHART studies on heart failure management in Japan, showing improved outcomes over time with increased use of evidence-based neurohormonal therapies like RAS inhibitors and beta-blockers.
2) A randomized controlled trial called the SUPPORT trial found that adding olmesartan did not improve outcomes for hypertensive heart failure patients already receiving guideline-directed medical therapy and instead increased risk of renal dysfunction.
3) Overall guideline-directed medical therapies like RAS inhibitors and beta-blockers have improved long-term prognosis of heart failure in Japan, though opportunities remain to optimize treatment.
This document discusses hypoperfusion in acute heart failure. It begins with case examples from Duke Hospital and considerations for diagnosis. It then covers inotropic options and mechanical support devices. Various studies on inotropes, percutaneous support devices, and extracorporeal membrane oxygenation are summarized. The conclusion is that hypoperfusion in acute heart failure presents major challenges for diagnosis and treatment.
1) The document discusses carotid artery stenting (CAS) and carotid endarterectomy (CEA) for treating carotid artery disease. It reviews data from clinical trials comparing the two procedures.
2) Operator experience is an important factor for CAS outcomes, with over 100 cases associated with lower risk. New technologies like mesh-covered stents may further reduce risks of CAS.
3) Future studies like CREST-2 aim to provide more data on CAS and CEA in asymptomatic patients to help guide treatment decisions. Both procedures can effectively treat carotid artery disease when performed by experienced operators.
This document discusses the use of left ventricular support devices for complex percutaneous coronary interventions (PCI). It begins by outlining the types of patients that typically require high-risk PCI, including those with severe diffuse coronary artery disease, significant three-vessel disease, or left main disease. It then reviews various left ventricular support devices like intra-aortic balloon pumps (IABP), Impella, TandemHeart, and extracorporeal membrane oxygenation and the evidence for their use. Finally, it emphasizes that while transradial access is associated with lower bleeding risks, operators must maintain skills in large bore femoral access and closure for cases requiring left ventricular support devices.
This document discusses whether radial centers have better outcomes for femoral access PCI procedures compared to traditional transfemoral centers. It analyzes data from the British Cardiovascular Intervention Society on over 100,000 PCI procedures from 2006-2010. The analysis found that radial centers had no increase in transfemoral complications and that transfemoral procedures in radial centers were associated with a reduction in 30-day mortality compared to transfemoral centers. Therefore, radial centers appear to perform transfemoral PCI procedures safely and with good outcomes.
This document provides disclosure information for John R. Teerlink, the presenter of a study on intravenous omecamtiv mecarbil in patients with acute heart failure. It notes that Dr. Teerlink has received research funding from Amgen, the sponsor of the study, and has consulting fees from several other companies. It also states that the use of omecamtiv mecarbil is investigational. The technical support of Karen Driver, who was also supported by Amgen, is acknowledged.
This document provides guidance on starting a successful transradial cardiac catheterization program. It discusses how the author started their program during fellowship by attending courses and enrolling patients in clinical trials. It highlights advantages of transradial access such as reduced access complications, earlier ambulation, and improved patient comfort. The document also reviews data demonstrating reduced bleeding and improved outcomes with transradial compared to transfemoral access. Overall, it presents a case for transradial access and provides tips for establishing a successful transradial program.
The effective national primary angioplasty network. Petr WidimskýChaichuk Sergiy
The document discusses lessons learned from effective primary angioplasty networks in 5 European countries. It finds that regional networks covering 500,000-1,000,000 people, 24/7 primary PCI services, and bypassing nearest hospitals to limit delays are optimal. Direct transport to the cath lab without going through the emergency room can achieve under 90 minute door-to-balloon times in most patients.
The document summarizes several landmark clinical trials from 2015 related to cardiovascular diseases. It discusses the SPRINT trial which compared intensive vs standard blood pressure control and found lower rates of cardiovascular events with intensive control below 120 mm Hg. It also summarizes the IMPROVE-IT trial which found adding ezetimibe to statin therapy after acute coronary syndrome further lowered cardiovascular risks. The MATRIX program evaluated bivalirudin vs heparin in PCI and found no significant difference in outcomes. The AMBITION trial found initial combination therapy with ambrisentan and tadalafil lowered risks compared to monotherapy in pulmonary arterial hypertension.
The document provides data on outpatient interventional cardiology procedures from January 1, 2009 to December 31, 2009 at Great State University Medical Center and comparison hospitals. It includes information on patient demographics such as age distribution, payer type, race, and gender. It also provides data on the types of cardiology procedures performed at the focus hospital and comparison hospitals, including the top 15 procedures by count. The procedures are categorized into non-invasive, invasive, peripheral vascular, and electrophysiology groups.
Fundación EPIC _ Tratamiento anticoagulante/antiagregante al alta en TAVIFundacion EPIC
Presentación de la ponencia "Tratamiento anticoagulante/antiagregante al alta en TAVI" Por el Dr. Ferreiro en los Diálogos EPIC_Retos Clínicos en Válvulas Transcatéter/ Clinical Challenges in TAVR today, el 10 de Mayo de 2018 en Barcelona (España)
Fundación EPIC _ Transient atrioventricular block after TAVI, what to do?Fundacion EPIC
Presentación de la ponencia "Tratamiento anticoagulante/antiagregante al alta en TAVI" Por la Dra. Ureña en los Diálogos EPIC_Retos Clínicos en Válvulas Transcatéter/ Clinical Challenges in TAVR today, el 10 de Mayo de 2018 en Barcelona (España)
This study compared outcomes of using a primary transpedal (TP) approach versus a dual transpedal-transradial (TP-TR) approach for endovascular intervention of femoropopliteal artery chronic total occlusions. The dual approach had higher crossing and procedural success rates. Both approaches had no deaths or amputations at 3 months follow up, though the dual approach had a higher target vessel revascularization rate. Neither approach resulted in access site complications or loss of patency at 30 days. The study demonstrates that both pedal and dual pedal-radial approaches are feasible and safe options for treating femoropopliteal chronic total occlusions.
1) The IMPROVE-IT trial investigated whether adding ezetimibe to simvastatin therapy provides additional cardiovascular benefit compared to simvastatin monotherapy in 18,144 high-risk patients who recently had an acute coronary syndrome.
2) Patients receiving ezetimibe/simvastatin had a lower rate of major cardiovascular events (32.7% vs 34.7%) over a median follow-up of 6 years, demonstrating the additional clinical benefit of further lowering LDL-C with ezetimibe.
3) Ezetimibe/simvastatin also reduced the rate of the composite endpoint of cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke compared to
This single-center randomized controlled trial compared outcomes of STEMI patients treated with bivalirudin (n=907) versus unfractionated heparin (n=905) during primary percutaneous coronary intervention (PPCI). At 28 days, the primary efficacy outcome (composite of death, stroke, reinfarction, unplanned revascularization) occurred more frequently in the bivalirudin group (8.7% vs 5.7%, p=0.01). The increased risk was driven by a higher rate of stent thrombosis with bivalirudin (3.4% vs 0.9%, p=0.001). Major bleeding rates were similar between groups (3.5% vs
Rutger Ploeg - The Netherlands - Tuesday 29 -Experience in DCD Programs logi...incucai_isodp
The document discusses improving organ transplantation outcomes by focusing on donor organ preservation techniques. It notes that without improvements, transplantation may become limited. It reviews research showing machine perfusion reduces injury compared to cold storage for donation after cardiac death kidneys. Future areas of focus include better donor organ selection and protection from ischemia-reperfusion injury through continuous perfusion and repair strategies in both donors and recipients. The goal is to make currently untransplantable organs transplantable through protective interventions.
This document summarizes key findings from several studies on the treatment of rectal cancer with radiotherapy and chemoradiotherapy. It finds that preoperative chemoradiotherapy reduces local recurrence rates compared to postoperative chemoradiotherapy or no radiotherapy, with increased acute and late toxicity. Several large trials showed no difference in overall survival between treatment groups. Optimal patient selection and a balance between risk reduction and side effects are important considerations.
Preoperative radiotherapy and surgery rectal cancers: optimal intervalGaurav Kumar
Preoperative radiotherapy and surgery rectal cancers: optimal interval between neoadjuvant radiotherapy/chemotherapy and surgery, evidence based approach
This document discusses endovascular thrombolytic therapy for acute deep vein thrombosis (DVT). It provides background on the quality of life issues for DVT patients, including long term complications like post-thrombotic syndrome (PTS). It reviews evidence that immediate clot removal may help prevent PTS by preserving venous valves and function. The document outlines the ATTRACT trial, a large multicenter randomized controlled trial testing whether catheter-directed thrombolysis (CDT) plus standard therapy is more effective than standard therapy alone for reducing PTS in patients with acute proximal DVT. It lists the primary and secondary outcomes that will be assessed to determine if CDT is safer, improves quality of life, and is cost-
Klaus Görlinger is a medical director who has experience in perioperative bleeding management. He discloses past and present conflicts of interest related to companies that produce hemostatic medications and point-of-care testing devices. In his presentation, he discusses different transfusion strategies for managing perioperative bleeding and emphasizes the importance of using point-of-care tests like ROTEM to guide individualized, targeted treatment based on the underlying coagulopathy. Studies show ROTEM-guided management can reduce blood product use, re-exploration rates, and costs compared to conventional laboratory-driven protocols.
1. The document discusses studies comparing adjuvant radiation therapy to salvage radiation therapy for prostate cancer patients with adverse pathological features after radical prostatectomy.
2. The EORTC 22911 trial randomized over 1000 patients to either observation or adjuvant radiation and found significantly improved biochemical progression-free survival with adjuvant radiation.
3. Other large trials including SWOG and ARO 96-02 also found benefits to adjuvant radiation in reducing risks of biochemical recurrence, distant metastases and death from prostate cancer.
Novel strategies to improve diastolic functiondrucsamal
This document summarizes Gerd Hasenfuss's presentation on novel strategies to improve diastolic function and reduce elevated left atrial pressure in patients with heart failure with preserved ejection fraction (HFpEF). It discusses an inter-atrial shunt device that creates a small permanent connection between the atria, baroreceptor activation therapy, the Aldo-DHF trial which found spironolactone improved diastolic function in HFpEF, and a study showing exercise training improved exercise capacity and quality of life in HFpEF. The presentation emphasizes that high left atrial pressure is a key factor in morbidity and mortality for HFpEF and these strategies aim to reduce left atrial pressure.
The document discusses the expanded potential uses of pressure wire for complex coronary angioplasty procedures based on experiments and clinical cases from Gifu Heart Center in Japan.
The experiments showed that pressure wires can accurately monitor pressure beneath balloons during angioplasty without significant drift. Clinical cases demonstrated using pressure wires as workhorse wires to facilitate PCI and optimize results by monitoring pressure during the procedures. A minimum contrast procedure was also achieved using a jailed pressure wire.
The advent of new fiber optic pressure wires allows for pressure monitoring during PCI to make procedures more efficient and optimize outcomes similar to the use of IVUS.
This study analyzed national trends in lymph node dissection (LND) utilization for resectable gallbladder cancer and its impact on outcomes between 2006-2015 using a large national database. The key findings were:
1) LND rates increased slightly over time but remained underutilized, with only 59.1% of patients with pT1b-T3 disease receiving LND.
2) LND was associated with improved survival for patients with pT1b, pT2 and pT3 disease. The highest LND rates and overall survival occurred at academic/research centers.
3) LND improved outcomes by enabling more accurate staging and increasing the likelihood of patients receiving adjuvant chemotherapy, especially for those with
Changing landscape in the treatment of advanced prostate cancer Alok Gupta
This presentation describes how the treatment of stage 4 prostate cancer has improved over last 100 years. This was presented at URO ONCOLOGY UPDATE meeting of Delhi Urological Society on 18th March 2017
he Citrate Story
David Gattas gives an update on today's go-to anti-coagulant for renal replacement therapy: Citrate
David is a key figure in the ANZICS CTG, with a growing list of publications and was involved in the RENAL and POST-RENAL studies.
Long-Term Survival and Dialysis Dependency Following Acute Kidney Injury in Intensive Care: Extended Follow-up of a Randomized Controlled Trial is available free.
This talk was recorded live at an ICN NSW / ANZICS meeting in September 2014.
How to manage delays in stroke treatment Jacek StaszewskiJacek Staszewski
This document discusses strategies to manage delays in stroke treatment. It notes that while thrombolysis and thrombectomy have improved outcomes, time is still critical factor. Various factors can contribute to delays including pre-hospital times, hospital workflows, and patient factors. Studies demonstrate improved outcomes with shorter onset-to-treatment and door-to-needle times. Initiatives like pre-notification, standardized protocols, telemedicine, and programs like Target: Stroke that focus on key strategies have been shown to reduce times and increase treatment rates. While challenges remain, an emphasis on collaboration, continuous quality improvement and learning from initiatives can help further reduce delays to improve patient outcomes.
Kshivets O. Local Advanced Lung Cancer Surgery Oleg Kshivets
The document summarizes research on optimal surgery strategies for patients with local advanced lung cancer. The study analyzed 155 patients who underwent radical combined procedures. Key findings include:
1) Adjuvant chemoimmunoradiotherapy after surgery significantly improved 5-year survival compared to surgery alone or postoperative radiotherapy alone.
2) Factors associated with improved 5-year survival in multivariate analysis included nodal stage, adjuvant therapy, gender, blood markers, and cell ratios.
3) Neural network modeling accurately predicted 5-year survival based on clinicopathological factors, with nodal stage and adjuvant therapy being the top predictors.
Carlo Di Mario - Recent Publications & Research in CTO: 2015-16Euro CTO Club
This document summarizes recent publications and research on chronic total occlusions (CTOs) from 2015-2016. It finds that the number of published manuscripts on CTOs has significantly increased in recent years. Several studies examined outcomes of patients undergoing percutaneous coronary intervention (PCI) on CTOs versus medical therapy or bypass surgery, finding lower mortality and adverse event rates with PCI. Other publications identified predictors of successful CTO recanalization and evaluated new techniques and scoring systems. Additional research investigated the physiological and anatomical changes in CTO arteries pre- and post-PCI using imaging modalities like intravascular ultrasound (IVUS) and computed tomography angiography (CTA).
Gastric Cancer: 10-Year Survival
Kshivets Oleg Surgery Department, Roshal Hospital, Moscow, Russia
CONCLUSIONS: 10-Year survival of GCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) GC characteristics; 9) anthropometric data; 10) surgery type. Optimal diagnosis and treatment strategies for GC are: 1) screening and early detection of GC; 2) availability of experienced abdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunotherapy for GCP with unfavorable prognosis.
SBRT versus Surgery in Early lung cancer : DebateRuchir Bhandari
This document discusses stereotactic body radiation therapy (SBRT) versus surgery for early stage non-small cell lung cancer (NSCLC). SBRT delivers a high dose of precision radiation to the tumor target in 1-5 fractions. Several studies have shown comparable survival and recurrence rates between lobectomy and sublobar resection for stage I lung cancer. SBRT has comparable or better local tumor control and survival rates than conventional radiation therapy for early stage NSCLC, with fewer side effects. While surgery may remain the standard of care, SBRT has emerged as a viable alternative to surgery for medically inoperable early stage NSCLC patients, with some studies investigating its use in operable patients as well.
Dr. Roberto Machado from the University of Illinois at Chicago presented an update on PAH at a Patient Education Conference on March 15, 2014 hosted by the Scleroderma Foundation, Greater Chicago Chapter.
Similar to Rutger Ploeg - The Netherlands - Tuesday 29 - Use of Perfusion Machines or Cold Storage (20)
Jeremy Chapman - Australia - Tuesday 29 - Who Guiding Principles and quest fo...incucai_isodp
The document discusses Australia seeking national self-sufficiency in organ transplantation through various achievements and responsibilities. It outlines capacities needed including legislation, healthcare facilities, human resources, and regional cooperation. It also discusses opportunities for care like education, screening, and prevention for conditions requiring organ transplantation. Charts show the numbers of patients with kidney disease on dialysis, listed for transplant, receiving deceased donor organs, and being transplanted.
Jeremy Chapman - Australia - Tuesday 29 - Hematopoietic Stem Cellsincucai_isodp
This document summarizes research on hematopoietic stem cell transplantation. It finds that only a small percentage of minority patients receive bone marrow transplants due to a lack of compatible donors. Outcomes depend on disease stage and HLA matching, with lower risk disease having better outcomes with a single HLA mismatch. Cord blood transplants show promise as an alternative to bone marrow, especially for children, though cell dose and HLA matching impact outcomes. Larger studies are needed to better understand long-term effects.
Chunhee Bok - Korea - Wednesday 30 - Oral Presentations Misc. Dincucai_isodp
The document contains several charts and graphs showing trends in acceptance of brain death and organ donation in Korea over time. The charts show acceptance has increased from the 1990s to 2010 according to several studies. Additional charts and graphs show regional differences in organ procurement coordinator staffing and the number of education visits to hospitals over time. Final charts examine attitudes toward organ donation among medical professionals, finding neurosurgeons have more positive views while ICU nurses have more negative or unsure views.
Jongwon Ha - Korea - Wednesday 30 - Oral Presentations Misc. Cincucai_isodp
The document discusses the establishment of the Korea Organ Donation Agency (KODA) as the national organ procurement organization in Korea. KODA was established in 2009 to help improve organ donation rates by taking over responsibilities for organ procurement from hospitals and establishing a dedicated network of organ procurement coordinators. Since its founding, KODA has increased education for donation professionals, improved donor identification and management processes, and seen a significant rise in annual organ donors in Korea. However, the document also notes there are still some conflicts around incentives and referral processes that need further improvement.
The document discusses organ donation rates in the Madeira Archipelago from 1995 to 2010. It describes an EU-funded training program implemented from 2007 to 2009 that included seminars on organ donation basics for healthcare professionals. After the training, the number of organ donors increased from 6 in 2009 to 9 by 2010, and the donation rate rose from 12 donors per million people to 36 donors per million people. The training program was effective at increasing organ donation in the region.
This document discusses how an organ procurement organization (OPO) implemented an effective donation after cardiac death (DCD) program, which increased organ donation and transplantation rates. Key aspects of the program included educating hospital staff on DCD policies and procedures, establishing clear donation pathways and communication processes, and responding rapidly to potential DCD cases. As a result of this program, DCD donors increased from 1% of total donors in 1995 to 22% in 2010, demonstrating the positive impact an effective DCD program can have.
This document summarizes the results of a survey of 40 religious officials in Istanbul on their views of organ donation and transplantation. The survey found that the officials had varying levels of knowledge on the topics, with most knowledge coming from television, radio, or publications from the Directorate of Religious Affairs. While 80% said they would not consider organ donation, the majority believed it was acceptable according to Islam. Officials proposed that religious leaders should educate the public and set an example to increase interest in donation. The conclusion calls for more cooperation between health, legal, and religious groups to address religious concerns and increase donations.
1. The document discusses a qualitative study conducted in Rotterdam, Netherlands to investigate views on living kidney donation and transplantation among ethnic minority groups.
2. Focus group discussions and interviews were held with 50 participants from various ethnic backgrounds. Religion was not seen as an obstacle to donation by participants but lack of awareness in their communities was an issue.
3. The study results informed the development of a home-based educational intervention program currently being evaluated in a randomized controlled trial to increase living kidney donation and transplantation among ethnic minorities.
The document analyzes and compares the legal frameworks governing organ and tissue transplantation in Latin American countries. Most countries have laws addressing consent to donation, determining death, living donation, and foreign patients. Consent policies range from familial consent to presumed consent. Death determination policies specify medical diagnostic criteria or rely on medical protocols. Living donation policies allow related or unrelated donors, with some establishing donor preferences. Ecuador uniquely mandates inclusion of foreign patients on waiting lists. Harmonization efforts aim to develop coherent legal frameworks and cooperation agreements across countries.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
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10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
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Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
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Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Rutger Ploeg - The Netherlands - Tuesday 29 - Use of Perfusion Machines or Cold Storage
1. Maximising Kidney Preservation in Transplantation Results of the European MP-Trial Rutger J Ploeg MD PhD FRCS Nuffield Department of Surgical Sciences University of Oxford, UK
3. European Machine Preservation Trial MP vs. CS in Kidney Transplantation in collaboration with Eurotransplant MP-trial included 3 separate RCTs: Overall Study, DCD Study, ECD Study
4. Rutger J Ploeg - Coordinating PI Cyril Moers - Secretary Hugo Maathuis - RPC Liaison Jaap Homan v/d Heide - Member Ernst van Heurn - Member Andreas Paul - Principal Investigator Jürgen Treckmann - Member Jacques Pirenne - Principal Investigator Frank van Gelder - Member Jean-Paul Squifflet - Member Scientific Steering Committee Eurotransplant Arie Oosterlee - Director Axel Rahmel - Medical Director Jacqueline Smits - Statistician Margitta van Kasterop - Data Manager Deutsche Stiftung Organtransplantation Günter Kirste - Chairman Ulrike Wirges - Director NRW Central Trial Assistance David Kravitz - CEO Luanne Rodgers - Director Marketing & Sales Peter de Muylder - Director Perfusion Services Trial Sponsor Groningen, The Netherlands Henri Leuvenink - Coordinator Essen, NRW - Germany Bogdan Napieralski - Coordinator Leuven, Belgium Frank van Gelder - Coordinator Regional Perfusion Centres Tasks & Coordination
9. Results – Demographics Variable MP arm median (range) CS arm median (range) p-value DONOR N = 336 Donor age (yrs) 51 (16-81) - Donor type (DBD / DCD) 294 / 42 - RECIPIENT N = 336 N = 336 Age (yrs) 53 (11-79) 52 (2-79) 0.2 Pre-Tx dialysis duration (yrs) 4.5 (0.15-18) 4.4 (0.19-24) 0.6 Previous transplants 23% 21% 0.3 PRA (0-5% / 6-84% / >84%) 297 / 35 / 4 304 / 29 / 3 0.7 TRANSPLANT N = 336 N = 336 HLA mismatches (% of 0 MM) 16% 15% 0.9 Cold Ischemic Time (hrs) 15.0 (3.5-26.3) 15.0 (2.5-29.7) 0.3
10. Results – Primary Endpoint N = 672 recipients total 2-sided McNemar test Moers et al. NEJM 2009 Variable MP arm CS arm p-value DGF 20.8% (70 / 336) 26.5% (89 / 336) 0.046
11. Results – Logistic Regression (DGF) N = 672 recipients total * p ≤ 0.05 Moers et al. NEJM 2009 Variable OR (95% CI) p-value MP vs. CS* 0.62 (0.42 - 0.92) 0.02 Most recent PRA (%) 1.00 (0.99 - 1.02) 0.53 Recipient age (yr) 1.01 (0.99 - 1.03) 0.19 Donor age (yr)* 1.02 (1.00 - 1.05) 0.04 ECD vs. SCD 1.04 (0.55 – 1.97) 0.91 Cold ischemic time (hrs)* 1.07 (1.03 - 1.12) 0.002 Duration of pre-Tx dial. (yr)* 1.08 (1.01 - 1.16) 0.04 Nr. of HLA mismatches 1.12 (0.96 - 1.30) 0.16 Re-Tx vs. 1st Tx* 2.08 (1.46 - 2.95) <0.001 DCD vs. DBD* 9.68 (5.44 - 17.2) <0.001
12. Results – Logistic Regression (DGF) N = 672 recipients total * p ≤ 0.05 Moers et al. NEJM 2009 Variable OR (95% CI) p-value MP vs. CS* 0.62 (0.42 - 0.92) 0.02 Most recent PRA (%) 1.00 (0.99 - 1.02) 0.53 Recipient age (yr) 1.01 (0.99 - 1.03) 0.19 Donor age (yr)* 1.02 (1.00 - 1.05) 0.04 ECD vs. SCD 1.04 (0.55 – 1.97) 0.91 Cold ischemic time (hrs)* 1.07 (1.03 - 1.12) 0.002 Duration of pre-Tx dial. (yr)* 1.08 (1.01 - 1.16) 0.04 Nr. of HLA mismatches 1.12 (0.96 - 1.30) 0.16 Re-Tx vs. 1st Tx* 2.08 (1.46 - 2.95) <0.001 DCD vs. DBD* 9.68 (5.44 - 17.2) <0.001
13. Serum Creatinine @ day 1 - 14 AUC MP < AUC CS; p = 0.001 Moers et al. NEJM 2009
14. Results – One Year Graft Survival MP and no DGF CS and no DGF MP and DGF CS and DGF p=0.04 (logrank test) 12% Moers et al. NEJM 2009
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17. Results: Logistic regression (DGF) Jochmans et al. Ann Surg 2010 Variable Odds Ratio (95% CI) p-value MP vs. CS Cold Ischemia Time HLA mismatch Recent PRA Recipient age Donor age Re-/ first tx Length pre-tx dialysis 0.476 (0.239 - 0.949) 1.118 (1.028- 1.215) 1.073 (0.761- 1.514) 1.032 (0.992- 1.074) 1.031 (1.000- 1.062 ) 1.025 (0.997- 1.055) 1.051 (0.497- 2.225) 1.085 (0.927-1.271) 0.035 0.009 0.688 0.123 0.048 0.083 0.897 0.310
18. ECD RCT: MP vs. CS 1 y Graft Survival (N= 182) Treckmann et al. Transplant Int 2011
19. The European Multicenter Trial on Kidney Preservation on behalf of the Machine Preservation Trial Scientific Steering Committee RENAL RESISTANCE DURING MACHINE PERFUSION IS A RISK FACTOR FOR DELAYED GRAFT FUNCTION AND POORER GRAFT SURVIVAL Jochmans et al. AJT 2011
20. Association between RR and DGF at different time points Jochmans et al. AJT 2011 30 min P=0.056 10 min P=0.042 1 h P=0.175 4 h P=0.025 END P=0.021 2 h P=0. 021 Perfusion time (hrs) End-MP
21.
22. Machine Preservation Trial MP vs. CS in Kidney Transplantation in collaboration with Eurotransplant The European Multicenter Trial on Kidney Preservation The Value of Machine Perfusion Perfusate Biomarkers GST and H-FABP for Predicting Outcome after Kidney Transplantation
25. Machine Preservation Trial MP vs. CS in Kidney Transplantation in collaboration with Eurotransplant The European Multicenter Trial on Kidney Preservation Cost Effectiveness of Hypothermic Machine Perfusion versus Static Cold Storage Rutger J. Ploeg, MD PhD on behalf of the Machine Preservation Trial Scientific Steering Committee
26. Economic Evaluation – ICER Costs MP – Costs CS Effect MP – Effect CS MP better but more expensive MP better and less expensive CS better and less expensive CS better but more expensive + + - -
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28. Average costs in 1st year post-Tx MP CS Dialysis post-Tx (HD/CAPD) € 2,773 € 4,354 Organ preservation € 842 € 167 Early dysfunction (DGF/PNF) € 147 € 218 Hospital readmission € 2,062 € 2,264 Total costs per recipient € 5,824 € 7,003 Total costs N=336 / arm € 1,956,864 € 2,353,008 Savings due to MP in 1st year: € 396,144 Economic Evaluation – Results
33. Thanks to all perfusionists and participating centers ! Austria Landeskrankenhaus Graz Universitätsklinik für Chirurgie Innsbruck Allgemeines Krankenhaus der Stadt Linz Allgemeines Krankenhaus Wien Belgium Universitair Ziekenhuis Antwerpen Universitair Ziekenhuis Brussel Hôpital Erasme Bruxelles Cliniques Universitaires St. Luc Bruxelles Universitair Ziekenhuis Gent Universitaire Ziekenhuizen Leuven Centre Hospitalier Universitaire Liège Luxemburg Centre Hospitalier de Luxembourg The Netherlands Academisch Medisch Centrum Amsterdam Universitair Medisch Centrum Groningen Leids Universitair Medisch Centrum Academisch Ziekenhuis Maastricht UMC St. Radboud Nijmegen Erasmus Medisch Centrum Rotterdam Sophia Kinderziekenhuis Rotterdam Universitair Medisch Centrum Utrecht Wilhelmina Kinderziekenhuis Utrecht Slovenia University Medical Center Ljubljana Germany Universitätsklinikum Aachen Zentralklinikum Augsburg Charité Berlin - Campus Benjamin Franklin Universitätsklinikum Charité Berlin Knappschaftskrankenhaus Bochum Universitätsklinik Bonn Zentralkrankenhaus Bremen Universitätsklinikum Carl Gustav Carus Dresden Universitätsklinikum Düsseldorf Universitätskrankenhaus Erlangen-Nürnberg Universitätsklinikum Essen Klinikum der JW Goethe Universität Frankfurt Klinikum der AL Universität Freiburg Universitätsklinikum Halle Universitätskrankenhaus Eppendorf Hamburg Nephrologisches Zentrum Niedersachsen Medizinische Hochschule Hannover Klinikum der Universität Heidelberg Universitätsklinik des Saarlandes Homburg/Saar Medizinische Fakultät/Klinikum Jena Westpfalz-Klinikum Kaiserslautern Universitätsklinikum Schleswig-Holstein Kiel Universitäts Kinderklinik Köln Medizinische Universitätsklinik Köln Städtische Krankenanstalten Köln Universitätskrankenhaus Leipzig Universitätsklinikum Schleswig-Holstein Lübeck Klinikum der Joh. Gutenberg Universität Mainz Klinikum der Stadt Mannheim Klinikum Lahnberge Marburg/Lahn Klinikum Rechts der Isar München Klinikum Grosshadern München Westfälische WU Klinikum Münster Medizinische Fakultät Rostock Katharinenhospital Stuttgart Chirurgische Universitätsklinik Tübingen Universitätskrankenhaus Ulm Klinikum der Bayerischen J-M-U Würzburg Perfusionists Alexandra de Rotte Agnes de Boer Anton Hosman Anton Romeijn Bas Lier Christiaan Roosendaal Edwin Dierselhuis Eva Kingma Elsbeth Witte Gysbert de Vries Hanneke Jansen Hilde Oosterhuis Ibrahim Abou Habaga Joanne Sierink Leo Boneschansker Jan Willem Buikema Janna Munster Judith Wind Lotte van Hessem Laura van Nunspeet Leonie van den Heuvel Lieske Wierenga Merel Lambregts Madeleine Stakelbeek Marije Mellema Marjon Wiegman Melvin Kilsdonk Merel Hellemons Miranda Bijvoet Nienke Luiting Pieter-Jan Vlaar Jeannette Bronkhorst Rinske Grond Robert Jan Sprong Susan Schipperijn Thijs Stege Lam Trang Willemein Jager Wouter Stomp Joost Sprakel Elsbeth de Vries Jenneke Hamminga Nirvana Kornmann Bert Theunis Jonathan Vercruysse Tom Rosseel Melanie Wandelt Daniel Lochmann Britta Ganske Anja Gallinat Ines Thies Janina Siebe Stephanie Lehnick Tobias Schwert Michael Schlusen Michael Drescher Dietmar Reimer Frank Heisterkamp
Editor's Notes
Any difference between IF versus DGf versus PNF? PNF curve not on top of DGf curve as we would have expected! Cave only 6 PNF cases!!! ( 1 PNF Case cata not downloaded) Remember that for this Trial; we have only used kidneys which had already been accepted for transplantation based on donor characteristics, no matter what preservation method. This might be different for more extended criteria kidneys for which evolution on MP might be taken into account during the decision making proces. 2 reported cases to safety commitee: have been tranbsplanted : 1 PNF, 1 ??? Contralateral also perfused and OK: have been excluded from trial !!!
The incremental cost-effectiveness was expressed as the ratio of the difference in costs of both treatments over the difference in effects of both treatments, in this case the difference in graft survival after 1 year
This slide shows the most important unit costs used. Costs of hemodialysis were based on data from the NECOSAD study as reported by Merkus and De Wit. For peritoneal dialysis tariffs were used. Costs of complications were based on expert opinions regarding procedures performed. In case of DGF costs of a renogram, a renal ultrasound and a renal biopsy were added. In case of primary non-function, costs of graft removal were also included. For costs of hospital admission, Dutch standard prices were used.
Here you see the effects of imputation of costs of dialysis. Of the 23 subjects with PNF, 15 had missing data regarding dialysis. These caused average costs of 792 Euro in the MP arm and 1839 Euro in the CS arm. Of the subjects with graft failure other than PNF, 16 had missing data, leading to costs of approximately 100 Euro for MP and 1500 for CS. After addition of actual and imputed costs of dialysis, there is a big difference of about 1800 Euro in favour of MP. As a result, addition of the other unchanged cost items of preservation and graft failure management (ultrasound, biopsy etc) leaves a cost difference of 1250 Euro in favour of MP. Due to the fact that data regarding readmission were missing in a number of cases, the overall total cannot be calculated for all cases. For this reason, the last three numbers in both columns do not add up. The readmissions appeared to be missing especially in cases with PNF, causing the cost difference to diminish. However, the result is still a cost difference of almost 500 Euro.
Here you see the effects of imputation of costs of dialysis. Of the 23 subjects with PNF, 15 had missing data regarding dialysis. These caused average costs of 792 Euro in the MP arm and 1839 Euro in the CS arm. Of the subjects with graft failure other than PNF, 16 had missing data, leading to costs of approximately 100 Euro for MP and 1500 for CS. After addition of actual and imputed costs of dialysis, there is a big difference of about 1800 Euro in favour of MP. As a result, addition of the other unchanged cost items of preservation and graft failure management (ultrasound, biopsy etc) leaves a cost difference of 1250 Euro in favour of MP. Due to the fact that data regarding readmission were missing in a number of cases, the overall total cannot be calculated for all cases. For this reason, the last three numbers in both columns do not add up. The readmissions appeared to be missing especially in cases with PNF, causing the cost difference to diminish. However, the result is still a cost difference of almost 500 Euro.