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Author(s): Michael Mazzeffi [sup.1] , Srikar Jonna [sup.1] , Natalia Blanco [sup.1] , Orestes Mavrothalassitis [sup.1] , Obi Odekwu [sup.1] , Magali Fontaine [sup.1] , Peter Rock [sup.1] , Kenichi [...], Background Kidney transplant patients are frequently anemic and at risk for red blood cell (RBC) transfusion. Previous studies suggest that pre-transplant RBC transfusion may improve kidney transplant outcomes; however, RBC transfusion is also associated with infection. The purpose of our study was to characterize the relationships between intraoperative RBC transfusion, delayed graft function (DGF), postoperative surgical site infection (SSI), and sepsis. Methods Analysis was performed on a historical cohort of adult kidney transplant patients from a single medical center during a two-year period. Crude odds ratios for DGF, superficial and deep SSI, and sepsis were calculated for transfused patients and multivariate regression was used to control for potential confounders when significant relationships were identified. Results Four hundred forty-one patients had kidney transplant during the study period; 27.0% had RBC transfusion, 38.8% had DGF, 7.0% had superficial SSI, 7.9% had deep SSI, and 1.8% had sepsis. High dose RBC transfusion was associated with improved graft function, but this was negated after adjusting for confounders (OR = 0.86, 95% CI 0.26 to 2.88). There was no association between RBC transfusion and SSI. RBC transfusion was independently associated with sepsis (OR = 8.98, 95% CI 1.52 to 53.22), but the confidence interval was wide. Conclusions Intraoperative RBC transfusion during kidney transplant is not associated with improved allograft function or incisional SSI, but is associated with postoperative sepsis. RBCs should not be liberally transfused during kidney transplant surgery to improve graft outcomes.

Introduction By 2012, 14 countries in eastern and southern Africa--including the United Republic of Tanzania--had been prioritized for the scale-up of voluntary medical male circumcision. (1) The goal of the [...], Problem In the United Republic of Tanzania, the incidence of non-neonatal circumcision-related tetanus is probably underreported. Approach We analysed charts and extracted information on outcome and wound location for non-neonatal cases of tetanus admitted to the intensive care unit of Bugando Medical Centre between 2001 and 2016. Local setting Bugando Medical Centre, which is one of four teaching referral hospitals in the United Republic of Tanzania, has a 13-bed intensive care unit that manages all admitted patients with tetanus. Within the United Republic of Tanzania, formal programmes of tetanus immunization are targeted at infants or women. Relevant changes From our inpatient logs, we identified six patients with non- neonatal tetanus among male patients with a recent history of circumcision. Only one of these patients had been circumcised within a subnational programme of voluntary medical male circumcision. The other five had been circumcised outside of the programme--e.g. at small rural dispensaries or by a traditional provider with no formal medical training. The six patients were aged 11-55 years and five (83%) of them died in hospital--all of overwhelming sepsis. Lessons learnt Within the Tanzanian programme of voluntary medical male circumcision, education on wound hygiene probably helps to reduce the incidence of non-neonatal circumcision-related tetanus. The corresponding incidence among the boys and men who are circumcised beyond this subnational programme is probably higher. The training of all circumcision providers in wound care and a vaccination programme to ensure that male Tanzanians receive tetanus immunization post- infancy are recommended. Probleme En Republique-Unie deTanzanie, l'incidence du tetanos non neonatal lie a la circoncision est probablement sous-estimee. Approche Nous avons analyse des tableaux et extrait des informations concernant les suites et l'emplacement de la plaie des cas de tetanos non neonatal admis dans le service de soins intensifs du centre medical Bugando entre 2001 et 2016. Environnement local Le centre medical Bugando, l'un des quatre hopitaux centraux d'enseignement de la Republique-Unie de Tanzanie, dispose d'un service de soins intensifs dote de 13 lits qui prend en charge tous les patients admis avec le tetanos. Dans la Republique-Unie de Tanzanie, les programmes formels de vaccination contre le tetanos ciblent les nourrissons ou les femmes. Changements significatifs Nous avons releve, dans nos registres d'hospitalisation, six patients atteints de tetanos non neonatal parmi les patients masculins ayant recemment subi une circoncision. Seul un de ces patients avait ete circoncis dans le cadre d'un programme infranational de circoncision masculine medicale volontaire. Les cinq autres avaient ete circoncis en-dehors de ce programme, par exemple dans de petits dispensaires ruraux ou par un praticien traditionnel sans formation medicale formelle. Ces six patients etaient ages de 11 a 55 ans et cinq (83%) d'entre eux sont decedes a l'hopital, tous de septicemie. Lecons tirees Dans le cadre du programme tanzanien de circoncision masculine medicale volontaire, l'education a l'hygiene de la plaie contribue probablement a reduire l'incidence du tetanos non neonatal lie a la circoncision. L'incidence correspondante chez les garcons et les hommes qui sont circoncis en-dehors de ce programme infranational est probablement plus importante. La formation en matiere de soin des plaies de toutes les personnes qui pratiquent des circoncisions et la mise en place d'un programme de vaccination permettant aux Tanzaniens de beneficier de vaccins contre le tetanos apres la petite enfance sont recommandees. Problema En la Republica Unida de Tanzania, es posible que no se comunique la incidencia del tetanos relacionado con la circuncision no neonatal. Enfoque Hemos analizado graficos y extraido informacion sobre las consecuencias y la localizacion de la herida para los casos no neonatales de tetanos ingresados en la unidad de cuidados intensivos del Bugando Medical Centre entre 2001 y 2016. Marco regional El Bugando Medical Centre, uno de los cuatro hospitales de referencia en la Republica Unida de Tanzania, cuenta con una unidad de cuidados intensivos de 13 camas que se ocupa de todos los pacientes ingresados con tetanos. En la Republica Unida de Tanzania, los programas oficiales de vacunacion contra el tetanos estan orientados a infantes o mujeres. Cambios relevantes A partir de los registros de pacientes hospitalizados, se identificaron a seis pacientes con tetanos no neonatal entre los pacientes varones con un historial reciente de circuncision. Solo uno de estos pacientes habia sido circuncidado dentro de un programa subnacional para la circuncision masculina voluntarla medica. Los otros cinco habian sido circuncidados fuera del programa, por ejemplo, en pequenos dispensarlos rurales o atendidos por un proveedor tradicional sin formacion medica oficial. Los seis pacientes tenian entre 11 y 55 anos de edad y cinco (83%) de ellos murieron en el hospital, todos a causa de una sepsis Incontenible. Lecciones aprendidas Dentro del programa de Tanzania para la circuncision masculina voluntaria medica, probablemente la educacion sobre la higiene de las heridas ayude a reducir la Incidencia del tetanos relacionado con la circuncision no neonatal. Es probable que la Incidencia correspondiente entre los ninos y hombres circuncidados fuera de este programa subnacional sea mayor. Se recomienda la formacion de todos los proveedores de circuncision en el cuidado de heridas y un programa de vacunacion para asegurar que los varones de Tanzania sean vacunados contra el tetanos despues de la Infancia.

Nationwide Children's Hospital, in Columbus, Ohio, has created a large primary care network with centers placed in underserved areas around Columbus. The patients served by these primary care centers are [...]

Academic medical centers are well-known for their emphasis on teaching, research and public service; however, like most large, bureaucratic organizations, they oftentimes suffer from an inability to learn as an organization. The role of the research administrator in the academic medical center has grown over time as the profession itself has become more important in the management of the research enterprise. The field of research administration within academic medical centers has grown to encompass a wide variety of responsibilities, including making sense of complicated rules, systems and processes in the administration of sponsored research, as well as managing the burden of regulatory compliance with applicable laws, contracts, institutional policies and sponsor guidelines. Keeping abreast of the complicated and fluctuating laws, guidelines, administrative processes and systems, and means of compliance is complicated even for the experienced research professional. This problem is compounded by struggles to foster the sharing of knowledge to new employees. Using an existing assessment tool, 121 research administrators at a large, private academic medical center were surveyed to define their perception of the academic medical center as a learning community (both collectively and by department type, gender and tenure) and to identify gaps in knowledge sharing, idea development, ability to learn from mistakes and reflective thinking., Background & Objectives Now more than ever, individuals involved in research administration are faced with a multitude of challenging situations that go well beyond the basics of business administration. They [...]

The study attempts to evaluate the relative proportion, characteristics, funding and productivity of life-research conducted within US academic medical centers (AMC). The results indicate that AMCs follow an active and diverse research function and incorporate a substantial proportion of faculty into the research.

The role of primary health centers in provision of voluntary counseling and testing (VCT) in Kenya is explored. The study helped initiate a new strategy of health center-based VCT in Kenya and indicated that the government health centers in Kenya can be appropriate providers of VCT.

Objective. Although privately owned practices provide the majority of primary care for children, little is known about the organizational characteristics of these practices or how these characteristics affect the quality of care for children. The purpose of this study was to describe selected organizational characteristics and preventive service delivery features that might affect the quality of primary care for children in private practices. Methods. A cross-sectional study of 44 private pediatric and family medicine practices in 2 regions of North Carolina was performed. Preventive service performance was assessed through chart abstraction for 60 randomly selected children between 24 and 30 months of age, for evaluation of immunizations and anemia, tuberculosis, and lead screening delivery by 2 years of age. Organizational characteristics were determined through surveys of all physicians and staff members. We used descriptive statistics and scatter plots to describe variations in organizational characteristics and preventive services. Results. Overall, practices demonstrated low levels of preventive service performance, with substantial variation among practices. Only 39% of children received 3 of the 4 recommended preventive services measured (practice range: 2-88%). Few practices demonstrated evidence of a systematic approach to prevention. For example, only 12 (27%) of the 44 practices used >1 of 5 recommended preventive service delivery strategies. Furthermore, practices varied greatly with respect to many of the measured organizational characteristics, which were consistent with organizational stress in some cases. For example, turnover of clinicians and staff members was remarkably high, with practices losing an average of 27% of their clinicians every 4 years (range: 0-170%) and 39% of their office staff members every 2 years (range: 0-170%). Conclusions. Private practices caring for children in North Carolina demonstrated low overall performance for the 4 recommended preventive services examined, with large variations among practices. Few practices had evidence of comprehensive systems for prevention. There was also evidence of substantial variation in many organizational characteristics. Some organizational characteristics were at levels that might impede delivery of high-quality primary care for children. These findings suggest a growing need for research that examines the impact of organizational characteristics on the quality of care in private practices. Pediatrics 2005;115:1704-1711; private practices, preventive services, organizational management. ABBREVIATIONS. FTE, full-time equivalent; RCT, randomized, controlled trial; OSI, Office Systems Index., In a recent report on health care quality, the Institute of Medicine recommended fundamental change in the US health care system, citing remarkable variation as well as shortcomings in many [...]

Reimbursement uncertainty, federal research policy, ineffective internal decision-making, and clinical quality are concerns of the academic medical center (AMC) due to the competition from community hospitals and physicians. Details of the desirable changes made to advocate the academic medical center are discussed.

A cliche it may be, but the Colney Centre really is a state-of-the-art cancer centre. It has a collection of the most expensive, up-to-date analysis and treatment equipment and a [...]

An exciting challenge exists for psychology to establish itself in the general health care delivery system. Advances in treating physical as well as emotional disorders offer the discipline the chance to expand its traditional and formerly limited role. Convincing empirical evidence suggests that psychology can simultaneously improve health care treatment and reduce its costs. Opportunities and obstacles on the path to success in this expanded venture are examined.