ABSTRACT
Background: The Donation Improvement Program (DIP) is intended to increase organ donation at hospitals. The program includes education for healthcare professionals of participating hospitals about each step of donation as well as evaluation. The DIP consists of medical record review (MRR) and a Hospital Attitude Survey (HAS). The purpose of this study was to evaluate the DIP results for the last 7 years. Methods: For MRR, we analyzed 58,385 cases of mortality from 77 hospitals between 2012 and 2018. The HAS data for the degree of education experience, competence, and knowledge related to brain death (BD) and donation were analyzed from 23 DIP-participating hospitals in 2012 and 51 DIP-participating hospitals in 2015 and 2018 each. Results: The recognition rate of potential BD was 24.9%, 61.3%, and 73.2%, and donation rate was 7.5%, 11.7%, and 15.8% at 6 months before, 1?2 years after, and 4?5 years after the agreement, respectively. Hospital staff with the necessary competence or knowledge to explain BD constituted 44.0% in 2012, while this increased to 62.8% in 2018. Conclusions: The DIP could increase the recognition of BD and the organ donation rate, and positively affect the attitudes of healthcare professionals toward organ donation. Spreading the DIP to all hospitals is urgent to increase organ donation.
ABSTRACT
BACKGROUND AND OBJECTIVES: This study was performed to ascertain whether the position of the intercrestal line changes as a result of flexion of the lumbar spine. METHODS: Previously taken lumbar spine x-rays of 103 patients in the neutral and full-flexed positions were reviewed. In the lateral flexion images to compensate for the sagittal rotation of the pelvis during lumbar flexion and for the possible difference in the level between the two sides of the ilium when taking the lateral images, the intercrestal line was drawn as follows: a potential line, crossing the midpoint of the highest points of both iliums, should be perpendicular to the tangential line at the point of intersection of the potential line with the skin. The position of the intercrestal line in relation to the spinous process was determined on an imaginary line moved 1 cm toward the vertebral body from the tangential line on the 2 successive spinous processes, and the interspinous distance of L3-4 was measured on this imaginary line. RESULTS: With full-flexion of the lumbar spine, the position of the intercrestal line in relation to the spinous process [median (25th to 75th percentiles)] changed slightly from L4 (L4-L4-5) into L4-5 (L4-L4-5) (P <.001), but it remained at the same level in 58.3% of the patients (60/103). In no case was a change of more than 1 level observed. The interspinous width (mean +/- SD) of L3-4 increased from 6.5 +/- 2.4 mm to 13.2 +/- 4.4 mm (P <.001). CONCLUSION: When compared with the neutral position, the position of the intercrestal line usually does not change with full flexion of the lumbar spine, and even in cases in which change occurs, it does not move beyond the next level.
