Derivation of the uncontrolled donation after circulatory determination of death protocol for New York city.

Evidence from Europe suggests establishing out-of-hospital, uncontrolled donation after circulatory determination of death (UDCDD) protocols has potential to substantially increase organ availability. The study objective was to derive an out-of-hospital UDCDD protocol that would be acceptable to New York City (NYC) residents. Participatory action research and the SEED-SCALE process for social change guided protocol development in NYC from July 2007 to September 2010. A coalition of government officials, subject experts and communities necessary to achieve support was formed. Authorized NY State and NYC government officials and their legal representatives collaboratively investigated how the program could be implemented under current law and regulations. Community stakeholders (secular and religious organizations) were engaged in town hall style meetings. Ethnographic data (meeting minutes, field notes, quantitative surveys) were collected and posted in a collaborative internet environment. Data were analyzed using an iterative coding scheme to discern themes, theoretical constructs and a summary narrative to guide protocol development. A clinically appropriate, ethically sound UDCDD protocol for out-of-hospital settings has been derived. This program is likely to be accepted by NYC residents since the protocol was derived through partnership with government officials, subject experts and community participants.

Discrete nuclear sclerosis in young patients with myopia.

OBJECTIVE: To review a series of young patients with myopia who had a visually disabling cataract. DESIGN: A retrospective review of 12 consecutive patients who had a visually disabling cataract and who were examined at the Cornea Service of the University of Illinois at Chicago. RESULTS: The mean age of the patients was 44 years (range, 34-54 years). The mean best-corrected visual acuity of the patients was 20/50, and the ocular history of the patients included a progressive decrease in vision. Six patients experienced disabling monocular polyopia. Their presumed diagnoses ranged from keratoconus to myopic degeneration. All of the patients noted resolution of their symptoms after cataract extraction. CONCLUSIONS: These patients are a select group that tends not to follow the established associations between visually significant lens opacities, age, and myopia. Cataract extraction is therapeutic, and prompt diagnosis can obviate unnecessary testing and repeated office visits.