Evaluating the Quality and Readability of Online Resources on Unspecified Kidney Donation.

BACKGROUND: Unspecified kidney donation (UKD) refers to transplantation from donors unrelated and unknown to the recipient. UKD has contributed to the expansion of the live donor pool in several countries. The United Kingdom Transplant Community has set maximizing UKDs as a priority. The Internet raises awareness and potentially influences the decision-making regarding UKD. This is the first study assessing the quality and readability of online material on UKD. MATERIALS AND METHODS: Google was searched for the terms "kidney donation" and one of "unspecified," "altruistic," "non-directed," "anonymous," or "good Samaritan," as well as "giving or donating a kidney to a stranger." Two independent assessors reviewed the top 100 websites. Quality was assessed using the Journal of the American Medical Association criteria, the DISCERN instrument and Health On the Net Code certification. Readability was assessed using the Flesch Reading Ease (FRE), Flesch-Kincaid Grade (FKG), and Simple Measure of Gobbledygook (SMOG) scores. RESULTS: Only 6% of websites displayed HONcode certification. The mean (± SD) JAMA and DISCERN scores of 1.96 (± 1.00) and 32.34 (± 11.19) indicate poor quality. The mean (± SD) FRE, FKG, and SMOG scores of 52.92 (± 13.62), 10.60 (± 2.72), and 9.64 (± 2.22) reveal poor readability. The difference in JAMA and DISCERN scores according to website classification was significant (P < .001, P = .014) with websites from medical, nonprofit, and governmental organizations scoring amongst the lowest, while comprising most search results (61%). CONCLUSIONS: Transplant centers and medical organizations should prioritize improving their online resources to lower the risk of individuals pursuing UKD based on unrealistic expectations or being discouraged unjustly.

Kidney transplantation and patients who decline SARS-CoV-2 vaccination: an ethical framework.

As SARS-CoV-2 vaccines have started to be rolled out, a key question facing transplant units has been whether listing for transplantation should be contingent on recipients having received a vaccine. We aimed to provide an ethical framework when considering potential transplant candidates who decline vaccination. We convened a working group comprising transplant professionals, lay members and patients and undertook a literature review and consensus process. This group's work was also informed by discussions in two hospital clinical ethics committees. We have reviewed arguments for and against mandating vaccination prior to listing for kidney transplantation and considered some practical difficulties which may be associated with a policy of mandated vaccination. Rather than requiring that all patients must receive the SARS-CoV-2 vaccine prior to transplant listing, we recommend considering vaccination status as one of a number of SARS-CoV-2-related risk factors in relation to transplant listing. Transplant units should engage in individualised risk-benefit discussions with patients, avoid the language of mandated treatments and strongly encourage uptake of the vaccine in all patient groups, using tailor-made educational initiatives.

Endovascular arteriovenous fistulas- are they the answer we haven't been looking for?

INTRODUCTION: Surgically created arteriovenous fistulas are the accepted gold standard for the establishment of hemodialysis access in patients requiring dialysis. However, primary and maturation failures may limit their usage. Recent advances in endovascular technology have resulted in the creation of devices for endovascular arteriovenous fistula formation. These devices may offer an additional or alternative approach to fistula formation in patients with end-stage kidney disease. AREAS COVERED: This review describes the limitations of surgical arteriovenous fistulas and the endovascular devices currently available. The review covers initial trial data and subsequent studies examining their use. EXPERT OPINION: Early results achieved with endovascular fistula formation are encouraging. Current limitations of this technology include anatomic suitability and a high rate of re-interventions required to establish maturity. Greater uptake of the technology will also require a review of long-term outcomes in larger patient cohorts.

Electrosurgical devices: are we closer to finding the ideal appliance? A critical review of current evidence for the use of electrosurgical devices in general surgery.

Over the last decade, the use of electrosurgical devices has become commonplace across all surgical specialities. The current market is large enough to warrant a comparative review of each device. This has even more impetus given the budgetary constraints of NHS organisations. This review aims to compare the benefits and drawbacks of the most popular electrosurgical devices, whilst conducting a critical review of the literature. Structured searches using databases Medline and EMBASE were conducted. The search was restricted to English language papers only. Due to the abundance of literature, this review will focus on common general surgical procedures alone. Despite a plethora of available devices, individual preference still dictates use. Conventional diathermy may always have its place, but may see a decline in use if costs improve. Newer devices have shown comparable precision and added advantages.

Outpatient parenteral antibiotic therapy in a renal transplant population: A single-center experience.

Outpatient parenteral antimicrobial therapy (OPAT) is a well-established method in medical specialties. Its use in renal transplant recipients has not been thoroughly explored. No guidelines within this patient subset exist. This study describes OPAT outcomes within a UK teaching hospital renal transplant population. Renal function, mapped by estimated glomerular filtration rate (eGFR), and clinical response to infection were collected retrospectively. A total of 635 antimicrobial episodes were administered to nine renal transplant patients over 12 discrete OPAT courses during the study period. Eleven of 12 OPAT courses (91.67%) produced a clinical improvement in infection. One course was terminated due to immunosuppressive-related neutropenia. No patient required admission due to failure of OPAT or adverse events. There was no significant change in graft function throughout the OPAT courses compared with baseline renal function (ANOVA, P = 0.06). One minor line infection was reported. This was treated conservatively and did not interrupt the OPAT. OPAT is safe and clinically effective in our renal transplant recipients with no significant deterioration in eGFR. The incidence of adverse events, specifically line complications, was lower in our population than those reported in the literature. Future work should develop OPAT guidelines designed for transplant recipients to outline the degree of monitoring required.

Imaging modalities for the in vivo surveillance of mesenchymal stromal cells.

Bone marrow stromal cells exist as mesenchymal stromal cells (MSCs) and have the capacity to differentiate into multiple tissue types when subjected to appropriate culture conditions. This property of MSCs creates therapeutic opportunities in regenerative medicine for the treatment of damage to neural, cardiac and musculoskeletal tissues or acute kidney injury. The prerequisite for successful cell therapy is delivery of cells to the target tissue. Assessment of therapeutic outcomes utilize traditional methods to examine cell function of MSC populations involving routine biochemical or histological analysis for cell proliferation, protein synthesis and gene expression. However, these methods do not provide sufficient spatial and temporal information. In vivo surveillance of MSC migration to the site of interest can be performed through a variety of imaging modalities such as the use of radiolabelling, fluc protein expression bioluminescence imaging and paramagnetic nanoparticle magnetic resonance imaging. This review will outline the current methods of in vivo surveillance of exogenously administered MSCs in regenerative medicine while addressing potential technological developments. Furthermore, nanoparticles and microparticles for cellular labelling have shown that migration of MSCs can be spatially and temporally monitored. In vivo surveillance therefore permits time-stratified assessment in animal models without disruption of the target organ. In vivo tracking of MSCs is non-invasive, repeatable and non-toxic. Despite the excitement that nanoparticles for tracking MSCs offer, delivery methods are difficult because of the challenges with imaging three-dimensional systems. The current advances and growth in MSC research, is likely to provide a wealth of evidence overcoming these issues.

The role of rapid thromboelastography in trauma.

Evaluation of: Hampton DA, Lee TH, Diggs BJ, McCully SP, Schreiber MA. A predictive model of early mortality in trauma patients. Am. J. Surg. 207(5), 642-647 (2014). In their prospective multi-centred observational study, Hampton et al. tested the ability of rapid thromboelastography (r-TEG) to predict mortality in trauma patients. A total of 795 patients were assessed. The authors analysed both patient demographic and physiological measures. Validation of variables that significantly related to mortality was subsequently undertaken. Ly30 (a measurement of the degree of clot lysis over 30 min) was observed to be a predictor of 24-h mortality in trauma (odds ratio 3.7 p = 0.03). This was incorporated with haemoglobin level, international normalized ratio, Glasgow Coma Score and the presence of penetrating injury to form their five-variable mortality prediction model. Hampton et al. conclude that the correlation between r-TEG measurements and trauma mortality makes it a useful tool in mortality prediction. The report highlights the importance of using this point-of-care coagulation assessment machine in mortality prediction for trauma patients.

Successful early cannulation of a superficial femoral vein transposition angioaccess in a patient without other alternatives.

Early cannulation of a native fistula is defined by Dialysis Outcomes and Practice Patterns Study and Kidney Disease Outcomes and Quality Initiative as between 2 and 12 weeks postoperatively. We present a case of a patient in whom anatomical and hematological barriers prevented early cannulation graft placement, and in whom temporary catheterization was not feasible as a result of central venous occlusion. Successful cannulation at the fifth postoperative day of a native angioaccess was performed and the reasons and challenges faced behind this choice under the circumstances were discussed.