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SRTR uses data collected by OPTN to calculate metrics such as donation rate, organ yield, and rate of organs recovered for transplant but not transplanted. In 2020, there were 12,588 deceased donors, an increase from 11,870 in 2019; this number has been increasing since 2010. The number of deceased donor transplants increased to 33,303 in 2020, from 32,313 in 2019; this number has been increasing since 2012. The increase may be due in part to the rising number of deaths of young people amid the ongoing opioid epidemic. The number of organs transplanted included 18,410 kidneys, 962 pancreata, 8350 livers, 91 intestines, 3722 hearts, and 2463 lungs. Compared with 2019, transplants of all organs except pancreata and lung transplants increased in 2020, which is remarkable despite the pandemic caused by the SARS‐CoV2 virus. In 2020, 4870 kidneys, 294 pancreata, 861 livers, 3 intestines, 39 hearts, and 115 lungs were discarded. The number of discards was similar to that of the previous year. In 2019, 4,324 kidneys, 346 pancreata, 867 livers, 5 intestines, 31 hearts, and 148 lungs were discarded. These numbers suggest an opportunity to increase numbers of transplants by reducing discards. Despite the pandemic, there was no dramatic increase in number of discards and an increase in total number of donors and transplants.

SRTR uses data collected by OPTN to calculate metrics such as donation rate, organ yield, and rate of organs recovered for transplant but not transplanted. In 2019, there were 11,870 deceased donors, an increase from 10,721 in 2018; this number has been increasing since 2010. The number of deceased donor transplants increased to 32,313 in 2019, from 29,675 in 2018; this number has been increasing since 2012. The increase may be due in part to the rising number of deaths of young people due to the ongoing opioid epidemic. The number of organs transplanted included 17,425 kidneys, 1,018 pancreata, 8,275 livers, 81 intestines, 3,604 hearts, and 2,607 lungs. In 2019, 4,324 kidneys, 346 pancreata, 867 livers, 5 intestines, 31 hearts, and 148 lungs were discarded. These numbers suggest an opportunity to increase numbers of transplants by reducing discards.

SRTRuses data collected by OPTNto calculate metrics such as donation rate, organ yield, and rate of organs recovered for transplant but not transplanted. In 2018, there were 10,721 deceased donors, and this number has been increasing since 2010. The number of deceased donor transplants increased to 29,676 in 2018 from 28,582 in 2017, and this number has been increasing since 2012. The recent increase may be due in part to the rising number of deaths of young people due to the opioid epidemic. In 2018, 4994 organs were discarded, slightly more than 4813 in 2017. In 2018, 3755 kidneys, 278 pancreata, 707 livers, 3 intestines, 23 hearts, and 317 lungs were discarded. These numbers suggest an opportunity to increase numbers of transplants by reducing discards.

Background: The effect of influenza vaccine on the prothrombin time (PT) among patients taking warfarin is unclear, as previous studies have shown conflicting results and the clinical significance of such a purported effect is uncertain. Moreover, to our knowledge, there are no data confirming the safety of intramuscular injections in patients receiving anticoagulant therapy with regard to possible local hematoma formation. We measured the effect of influenza vaccine on the PT among patients receiving long-term warfarin sodium therapy and evaluated the safety of intramuscular injections among them. Methods: Forty-one adult patients who were receiving anticoagulant therapy were given 0.5 mL of influenza vaccine intramuscularly. Prothrombin time and arm girth were measured at baseline and on days 3, 7, and 14 after immunization. Local pain and tenderness were assessed on a five-point scale. Patients and study nurses were blinded to all prior measurements. Differences between baseline PT and that at each subsequent visit and the maximal change in arm circumference from baseline were calculated for each patient. Mean, range, and 95% confidence intervals were calculated for the entire group. Results: There was no statistically significant change in PT between baseline and days 3, 7, and 14 after vaccination, and no significant change in arm circumference was noted. There were no clinically detectable local complications after intramuscular injection and no major or minor bleeding episodes after influenza vaccination. Conclusions: Influenza vaccine has no significant effect on the PT in patients who are being treated with warfarin. influenza vaccine can be administered intramuscularly to patients who are receiving anticoagulant therapy without the risk of local bleeding complications. (Arch Intern Med. 1995;155:1529-1531)

Swine influenza infections, a disease primarily affecting hogs, is uncommon in humans and rarely causes death. Only 10 cases of United States civilians infected with the virus have been reported. This is the first report of swine influenza in pregnancy. A 32-year-old woman in her 36th week of pregnancy developed headache, fever, and muscle pain. She was admitted to the hospital for treatment of pneumonia. Antibiotic therapy was initiated, but breathing difficulties progressed to become respiratory distress. Although oxygen was administered, it did not increase oxygen in the blood. Since the fetus could be compromised by the lack of oxygen in the blood, labor was induced. A normal infant was delivered vaginally. The oxygen saturation in the blood continued to be inadequate in addition to a decline in blood pressure and heart rate. A week after admission to the hospital, the patient died. Although all the specimens cultured were initially negative, one specimen submitted two weeks prior to her death revealed swine influenza. The family reported that the patient had been exposed to swine when she attended a county fair four days before the symptoms appeared. The fair's veterinarian described an influenza-like illness among the swine. It is unclear whether pregnancy increases the risk of influenza pneumonia infections in women. It is suggested that pregnant women avoid contact with swine, particularly those having respiratory diseases. (Consumer Summary produced by Reliance Medical Information, Inc.)

A look at the uses of monitors and meters--what's happening and what will soon be happening Power monitors track power usage to verify billing and create an effective strategy for [...]

Background: Excessive anticoagulation increases the risk of hemorrhagic complications associated with oral anticoagulant therapy. Oral or parenteral phytonadione is used to reverse excessive anticoagulation. Intravenous (IV) phytonadione, while effective, is associated with a small risk of serious anaphylactic reactions. Subcutaneous (SC) administration is safer, but there is little information on its relative efficacy in small doses. Methods: Twenty-two patients with asymptomatic prolongation of prothrombin time were prospectively randomized and treated with 1 mg of phytonadione IV or 1 mg SC. Prothrombin time was measured at baseline and at 8 and 24 hours after phytonadione administration and expressed as international normalized ratio (INR). Results: Mean INR at baseline was 8.0 and 8.5 in the IV and SC groups, respectively (P = .70). At 8 hours, mean INR was 4.6 in the IV group and 8.0 in the SC group (P = .006), and at 24 hours, mean INR was 3.1 in the IV group and 5.0 in the SC group (P = .009). Mean decrease in INR 8 hours after administration of phytonadione was 3.4 in the IV group and 0.4 in the SC group (P = .02), and mean decrease in INR after 24 hours was 4.9 in the IV group and 3.4 in the SC group (P =. 18). Conclusions: For patients who are excessively anticoagulated with warfarin, small doses of SC phytonadione may not correct the INR as rapidly or as effectively as when administered IV. Higher doses must be considered for more rapid and complete reversal of anticoagulation by the SC route. Arch Intern Med. 1999;159:2721-2724

The proliferation of webinars and other similar web-based educational offerings attests to the interest in this instructional modality on the part of educators and learners in the public health workforce. While certain advantages of Internet-based training, including time and costs savings for learners, are evident, it is important to establish the impact of this medium on a variety of health care disciplines. To this end, a search was performed of individual studies and review articles published since 2005 that discuss the use of these methodologies by several disciplines in the domain of public health, with particular attention on randomized controlled trials and meta-analytic studies. Reports over the past decade support the belief that the health care workforce is generally satisfied with Internet-based training and that this type of training yields measurable changes in knowledge and behavior. Overall, the data strongly suggest that these techniques are better than no intervention and essentially equivalent to conventional instructional techniques. However, the specific elements that actually improve the educational value of web-based educational technologies and the evidence base for best practices in the field have yet to be identified.

In September 2003, a consortium of bioterrorism and health education experts from the University of Louisville, the University of Kentucky, the Kentucky Department for Public Health, and the Louisville Metro Health Department received funding from the Health Resources and Services Administration (HRSA) to develop a broadly based bioterrorism education program for health professionals in the Commonwealth of Kentucky and the surrounding region. This grant will fund a series of presentations tailored to the needs of professionals in medicine, dentistry, public health, nursing, behavioral medicine, allied health, pharmacy, veterinary medicine, and agriculture, providing coordinated training both on site and through distance learning technology. This article outlines the major grant-funded activities envisioned for the grant years 2003 through 2005, focusing on the use of standardized patients and computerized biosimulators, the transdisciplinary partnerships of the universities involved, and the essential collaboration provided by the state and local health departments.

The ability of pharmacists to identify potential drug interactions was studied. Simulated medication profiles were created from a list of 16 drugs. Staff pharmacists and soon-to-graduate student pharmacists at a Veterans Affairs medical center each received a set of eight 2-drug profiles, four 4-drug profiles, two 8-drug profiles, and one 16-drug profile. Each set of profiles contained a number of pairs of drugs rated by the Drug Therapy Screening System as producing an interaction of moderate or major importance. The subjects were given one hour to screen the profile for the potentially interacting pairs. The subjects detected only 66% of the interactions in the 2-drug profiles, 34% of the interactions in the 4-drug profiles, 20% of the interactions in the 8-drug profiles, and 17% of the interactions in the 16-drug profile. None of the subjects detected all interactions in the 8- or 16-drug profiles. Both true-positive and false-positive rates of identification decreased significantly as the number of drugs listed on the profile increased. This primarily reflected a reduced tendency to report the presence of drug interactions, but there was additional evidence that the accuracy of identification also declined. The number of years of pharmacy training was the only demographic characteristic highly correlated with accuracy. More years of pharmacy education seemed to improve the ability to detect drug interactions. However, none of the pharmacists or students was able to detect all potentially interacting pairs in a profile containing 8 or 16 drugs. Computerized drug interaction profiles should be used by pharmacists to ensure recognition of all potential drug interactions.

Proteins, nucleic acids, and fluorescein-conjugated antibody are shown to be identifidable in situ via the fluorescence excited by the focused electron beam of a canning electron microscope. A molecular species is identified by its characteristic fluorescence spectrum and by a characteristic alteration of the spectrum with time under the electron beam. Primary protein fluorescence is relatively rapidly destroyed by the beam, but protein photoproduct fluorescence is more rugged and will in some cases permit detection of small numbers of protein molecules. Nucleic acid fluorescence is extremely long-lived and will permit detection of small numbers of nucleic acid residues. The theoretical resolution limit for localization of a particular molecular species -- about 20 A--is determined by the known maximum distance for molecular excitation by fast electrons. Drect extapolation from an observed resolution of 900 A in the localization of nucleic acid using a low-efficiency detector leads to an experimental resolution limit of less than 60 A. Fluorescence is strongly quenched by residual water in the specimen. Similar quenching is produced by some macromolecular associations and so may serve to localize such associations.

AbstractThe cumulative risk of human immunodeficiency virus (HIV) infection over a healthcare career has rarely been estimated, but is more relevant to the description of an occupational hazard than the risk of seroconversion from a single exposure. We describe a model for assessing the individualized risk for HIV infection after multiple potential exposures over many years for surgeons and other operating room personnel, a high-risk group. For the average surgeon operating over a 30-year career on patients with an HIV seroprevalence of 0.01, the cumulative risk is estimated at 1%. The same surgeon operating on patients with a seroprevalence of 0.10 has an estimated cumulative risk of 10%. These risks may vary dramatically depending on the assumed rate of skin punctures during surgery. Healthcare workers need to be aware of the cumulative risk from multiple exposures to infectious blood and body fluids, to follow proposed suggestions for the reduction of percutaneous blood exposures and to assist in developing new technology to further reduce these risks. Failure to protect these professionals could result in the reduction of services for the approximately 1 to 1.5 million HIV-infected persons in the United States.

This paper reports a theoretical and experimental investigation of the use of an air curtain to contain the fumes in a fume cabinet. It was motivated by the susceptibility of conventional fume hoods to loss of containment in the presence of crossdrafts. An air-curtain hood should be better because of fundamental aerodynamic reasons; the experiments showed that the air curtain does enable the cabinet to contain the fumes effectively in the presence of strong crossdrafts. The presence of an operator with arms penetrating the curtain produces a small increase in the concentration of test gas measured in the breathing zone but does not destroy the integrity of the containment.

Abstract: Objective:To determine the nature, frequency and effects of internal medicine bousestaff and faculty contacts with pharmaceutical representatives (PRs). Design and setting:The authors surveyed internal medicine faculty at seven midwest teaching hospitals and housestaff from two of the teaching programs. The survey asked about type and frequency of contacts with PRs and behavior that might be related to these contacts. T-tests and logistic regression were used to estimate the relationship between reported physician contacts and behavioral changes. Participants:Two hundred forty faculty (78%) and 131 house officers (75%) responded to the survey. Results:Faculty and housestaff averaged 1.5 brief contacts per month with PRs. Housestaff averaged more than one meal/month at pharmaceutical company expense. Twenty-five percent of faculty and 32% of residents reported changing their practices at least once based on PR contact. Independent predictors of faculty change in practice were brief or extended conversations and free meals. Predictors of faculty requests for formulary addition were brief conversations and receipt of honoraria or research support. Only brief conversations independently predicted housestaff changes in practice. Conclusion:Academic housestaff and faculty have frequent PR contact; such contact is related to changes in behavior. The potential for influence of PRs in academic medical centers should be recognized, and their activities should be evaluated accordingly.

Abstract: Objective: To attempt to validate a previously reported clinical prediction rule derived to assist in distinguishing between acute bacterial meningitis and acute viral meningitis. Design: Retrospective chart review of patients treated at five hospitals between 1981 and 1990. The criterion standard for bacterial meningitis was a positive cerebrospinal fluid (CSF) or blood culture or a positive test for bacterial antigen in the CSF. For viral meningitis, the criterion standard was a positive viral culture from CSF, stool, or blood or a discharge diagnosis of viral meningitis with no other etiology evident. Setting: Two Department of Veterans Affairs (VA) hospitals, two county hospitals, and one private hospital, each affiliated with one of two medical schools. Patients: All persons aged more than 17 years who were hospitalized over a ten-year period at one of five academically affiliated hospitals for the management of acute meningitis. Measurements and main results: Sixty-two cases of bacterial meningitis and 98 cases of viral meningitis were confirmed. With all patients included, the discriminatory power of the model as measured by the area under the receiver operating characteristic curve (AUC) was 0.977 (95% CI, 0.957–0.997), compared with the AUC of 0.97 in the derivation set of the original publication. The AUCs (95% CIs) for data subsets were: Dallas cases 0.994 (0.986–1.0), Milwaukee cases 0.912 (0.834–0.990); ages 18–39 years 0.952 (0.892–1.0), ages 40–59 years 0.99 (0.951–1.0), and age >60 years 0955 (0.898–1.0). Conclusions. The authors conclude that the clinical prediction rule proved robust when applied to a geographically distinct population comprised exclusively of adults. There was sustained performance of the model when applied to cases from each city and from three age strata. Prospective validation of this prediction rule will be necessary to confirm its utility in clinical practice.

The moderately repetitive sequence Ca3 was used to fingerprint Candida albicans isolates from 32 patients hospitalized for more than 3 days, 17 recent admissions or outpatients, and 8 recently readmitted patients and 10 commensal isolates from the community in Wellington, New Zealand, plus isolates from 21 hospitalized patients, 26 outpatients or recent admissions, 4 recently readmitted patients, and 10 healthy individuals in the community in Auckland, New Zealand. In Wellington, isolates from patients hospitalized in Wellington Hospital for more than 3 days were genetically significantly less diverse than were isolates from outpatients or recent admissions or isolates from healthy individuals in the community. In addition, two clusters of genetically similar strains were isolated from hospitalized patients significantly more often than from other individuals. These observations provide evidence (albeit indirectly) for nosocomial transmission of hospital-specific C. albicans strains. In contrast, no indication of hospital-specific transmission of C. albicans was found in Auckland Hospital. Since these results were obtained under conditions in which no candidiasis outbreak occurred in either hospital, they also suggest that Ca3 fingerprinting may be a useful tool in preventive nosocomial infection control programs, allowing assessment of the extent of C. albicans transmission occurring in a hospital.

Various techniques for accessing informational resources of interest to physicians and other medical professionals currently are available on Internet, a global internetworking of computer systems. The basic strategies for sending electronic mail, transferring files, and logging on to distant computers, as well as newer and more user-friendly indexing and interface systems for accomplishing these tasks are discussed.

Venous thromboembolism is an important cause of morbidity and mortality in hospitalized patients, causing 100, 000 to 200, 000 deaths per year in the United States. Patients undergoing surgery are at the highest risk of venous thromboembolism. The magnitude of this risk in a patient depends on the surgical procedure performed and the presence of other risk factors that predispose to venous thromboembolism. The clinical diagnosis of both deep vein thrombosis and pulmonary embolism is notoriously inaccurate. Furthermore, two thirds of all fatal pulmonary emboli cause death within 30 minutes of the embolic episode, leaving little time for diagnostic work-up and effective treatment. Prophylactic treatment for prevention of venous thromboembolism is therefore important in these patients, and several effective mechanical and chemical methods for this purpose are available. The pathogenesis of deep vein thrombosis in the surgical patients, the predisposing risk factors, and the available prophylactic modalities are discussed in this article. Recommendations for the use of various approaches in different risk categories are provided.

Oral anticoagulant therapy is used extensively in the treatment of deep venous thrombosis-pulmonary embolism and prevention of systemic thromboembolism. Adoption of the International Normalized Ratio system for the laboratory monitoring of therapy has solved the problems encountered with the variable sensitivities of the available thromboplastins in North America. Although in recent years the recommended intensity of treatment has been reduced for many indications, bleeding remains the most common side effect of long-term oral anticoagulation therapy. Several drugs interact with warfarin sodium, the most commonly used oral anticoagulant drug, and potentiate its effect, thereby increasing the risk of bleeding. However, awareness of potential drug interactions and careful monitoring to maintain patients within the recommended therapeutic ranges can minimize the risk of bleeding and lead to its safe use in most patients.

AbstractObjective:To determine the duration of the immune response to plasma-derived hepatitis B vaccine among healthcare workers responding to booster doses of intradermal (ID) or intramuscular (IM) vaccine in 1986 and those with protective levels of antibody to hepatitis B surface antigen (anti-HBs) in 1986 without booster vaccine. Both groups received a primary hepatitis B vaccine series 24 to 36 months earlier.Design:Cross-sectional follow-up study two years later of an inception cohort defined in 1986.Setting:An academically affiliated metropolitan county hospital.Participants:Group 1: Hospital employees responding to booster doses of hepatitis B vaccine given ID or IM in 1986 due to low anti-HBs levels. Forty-one (82%) of 50 eligible persons were evaluated. Group 2: Persons not receiving booster vaccine in 1986 due to protective levels of anti-HBs. A random sample of 95 persons was drawn from a pool of 152 participants with protective levels in 1986. sixty-five (68%) of 95 contacted persons were restudied.Results:In 1988, 14 (64%) of 22 previous ID responders had anti-HBs levels = 10 milli-international units (mIU)/mL, compared with 17 (89%) of 19 IM responders (p= .055). The 1988 geometric mean titer of IM recipients was 66.4 ±4.5 mIU/mL and of ID recipients was 20.7 ±7.4 (p= .04). None of 65 Group 2 subjects' anti-HBs titers dropped below 10 mIU/mL by 1988.Conclusions:plasma-derived hepatitis B vaccine recipients with anti-HBs levels = 10 mIU/mL at 24 to 36 months after primary immunization are likely to maintain these levels two years later. The diminished durability of the antibody response together with the increased rate of local side effects associated with the ID injection route may limit its applicability as an alternative to using IM booster doses of hepatitis B vaccine.

The daily administration of chlorpromazine (CPZ) in doses of 8–40 mg/kg over 113 weeks to four rhesus monkeys produced dyskinesias and alterations in social behavior. General activity and social interactions were reduced by CPZ treatment but social aggression was elevated during initial drug administration. These behaviors returned to normal when treatment was discontinued. Dyskinesias appeared during CPZ treatment, and two striking ones, gravel mouth and hand gesture, persisted for 12 weeks after drug withdrawal.

The size of the ultrasonic beam and beam dispersion severely limit resolution by two-dimensional scanning systems. Resolution and tissue penetration are improved by using a highly focused, ultrasonic transducer array in conjunction with an electronic timing system for the selection of particular echo information.

To the Editor.—While the risk to immunocompetent persons for acquiring meningococcal meningitis in the United States is low, an increased risk for this potentially fatal infection is recognized in several areas of the world. Most recently, pretravel immunization has been recommended by the Centers for Disease Control for Americans traveling to (1) New Delhi1; (2) the so-called meningitis belt of sub-Saharan Africa2 (stretching from Mauretania in the west to Ethiopia in the east); (3) Saudi Arabia following the 1987 pilgrimages to Mecca and Medina3; and (4) Nepal, especially for Himalayan trekkers.4Meningococcal vaccine administered as a single 0.5-mL subcutaneous dose has been shown to have 85% to 95% clinical efficacy in preventing illness due to serogroup A, the most common cause of epidemics outside the United States.2 Vaccine reactions are usually mild and consist mainly of local erythema for 24 to 48 hours, with