Pediatric risk to orthotopic heart transplant (PRO) score: Insights from United Network for Organ Sharing (UNOS) waitlist mortality findings.

BACKGROUND: Pediatric heart transplant candidates on the waitlist have the highest mortality rate among all solid organ transplants. A risk score incorporating a candidate's individual risk factors may better predict mortality on the waitlist and optimize organ allocation to the sickest of those awaiting transplant. METHODS: Using the United Network for Organ Sharing (UNOS) database, we evaluated a total of 5542 patients aged 0-18 years old on the waitlist for a single, first time, heart transplant from January 2010 to June 2019. We performed a univariate analysis on two-thirds (N = 3705) of these patients to derive the factors most associated with waitlist mortality or delisting secondary to deterioration within 1 year. Those with a p <0.2 underwent a multivariate analysis and the resulting factors were used to build a prediction model using the Fine-Grey model analysis. This predictive scoring model was then validated on the remaining one-third of the patients (N = 1852). RESULTS: The Pediatric Risk to OHT (PRO) scoring model utilizes the following unique patient variables: blood type, diagnosis of congenital heart disease, weight, presence of ventilator support, presence of inotropic support, extracorporeal membrane oxygenation (ecmo) status, creatinine level, and region. A higher score indicates an increased risk of mortality. The PRO score had a predictive strength of 0.762 as measured by area under the ROC curve at 1 year. CONCLUSION: The PRO score is an improved predictive model with the potential to better assess mortality for patients awaiting heart transplant.

Community Intervention for Syrian Refugees in Baltimore City: The Lay Health Educator Program at a Local Mosque.

This study focused on a partnership with a mosque in Baltimore, MD, and its impact on the local Syrian refugee population through a peer-to-peer healthcare training program. We implemented the Lay Health Educator Program over a 6-week period in an effort to teach members of the mosque about healthcare-related topics that they could then disseminate to the Syrian refugee population that attends the mosque. Physicians and nurses instructed community members on health, healthcare resources, and healthcare information during 2-h long sessions once a week. A total of 18 community members took part in the program, and their participation highlighted that the most significant health issues for the Syrian refugees are "access to healthcare," "mental health," and insight into certain noncommunicable disease. Finally, the community program graduates implemented several health-related campaigns over 2 years in an effort to disseminate information taught to them. In doing so, they significantly impacted the ability of the refugees to assimilate to the US healthcare system.