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Diagnostic performance of a new ECG algorithm for reducing false positive cases in patients suspected acute coronary syndrome.

J Electrocardiol 2021 Jul 16;69:60-64. Epub 2021 Jul 16.

Department of Medicine, Nykøbing Falster Hospital, Nykøbing F, Denmark; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Cardiology, University Heart Center Hamburg, Hamburg, Germany; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.

Background: Early and correct diagnosis of ST-segment elevation myocardial infarction (STEMI) is crucial for providing timely reperfusion therapy. Patients with ischemic symptoms presenting with ST-segment elevation on the electrocardiogram (ECG) are preferably transported directly to a catheterization laboratory (Cath-lab) for primary percutaneous coronary intervention (PPCI). However, the ECG often contains confounding factors making the STEMI diagnosis challenging leading to false positive Cath-lab activation. Read More

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Fatal Clostridium septicum myonecrosis from gastric perforation: A case report.

Anaerobe 2021 Sep 24:102445. Epub 2021 Sep 24.

Northern Light AR Gould Hospital, 140 Academy Street, Presque Isle, ME, 04769, USA.

Clostridial myonecrosis is a medical and surgical emergency which requires early and aggressive intervention to reduce mortality. We report a rare case of Clostridium septicum myonecrosis that disseminated hematogenously from a gastric perforation. The patient was afebrile and hemodynamically stable upon admission. Read More

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September 2021

Impact of the COVID-19 Pandemic on Home Care Services Among Community-Dwelling Adults With Dementia.

J Am Med Dir Assoc 2021 Sep 6. Epub 2021 Sep 6.

ICES, Toronto, Ontario, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.

Objective: To examine how the COVID-19 pandemic impacted use of home care services for individuals with dementia across service types and sociodemographic strata.

Design: Population-based time series analysis.

Setting And Participants: Community-dwelling adults with dementia in Ontario, Canada, from January 2019 to September 2020. Read More

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September 2021

Prevalence of SARS-CoV-2 antibodies among nurses: A systematic review and meta-analysis.

J Clin Nurs 2021 Sep 27. Epub 2021 Sep 27.

South Western Sydney Nursing and Midwifery Research, Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia.

Aims And Objectives: This systematic review and meta-analysis reports the seroprevalence of SARS-CoV-2 antibodies among nurses.

Background: With a growing body of literature reporting the positive serology for SARS-CoV-2 antibodies among healthcare workers, it remains unclear whether staff at the point of direct patient care are more prone to developing and transmitting the virus. Given nurses make up the majority of the global health workforce, outbreaks among these workers could severely undermine a health system's capability to manage the pandemic. Read More

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September 2021

Long-term Outcomes of Transcatheter Arterial Chemoembolization Combined With Radiofrequency Ablation as an Initial Treatment for Early-Stage Hepatocellular Carcinoma.

JAMA Netw Open 2021 Sep 1;4(9):e2126992. Epub 2021 Sep 1.

Department of Radiation Oncology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.

Importance: The long-term outcomes of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) are not determined.

Objective: To report the long-term outcomes of TACE-RFA.

Design, Setting, And Participants: This cohort study analyzed long-term follow-up data from a phase 3 randomized clinical trial of adults with early HCC conducted from October 2006 to June 2009. Read More

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September 2021

Effect of Whole-Genome Sequencing on the Clinical Management of Acutely Ill Infants With Suspected Genetic Disease: A Randomized Clinical Trial.

JAMA Pediatr 2021 Sep 27. Epub 2021 Sep 27.

Department of Pediatrics, University of Tennessee Health Science Center, Memphis.

Importance: Whole-genome sequencing (WGS) shows promise as a first-line genetic test for acutely ill infants, but widespread adoption and implementation requires evidence of an effect on clinical management.

Objective: To determine the effect of WGS on clinical management in a racially and ethnically diverse and geographically distributed population of acutely ill infants in the US.

Design, Setting, And Participants: This randomized, time-delayed clinical trial enrolled participants from September 11, 2017, to April 30, 2019, with an observation period extending to July 2, 2019. Read More

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September 2021

Characterization and prediction of clinical pathways of vulnerability to psychosis through graph signal processing.

Elife 2021 Sep 27;10. Epub 2021 Sep 27.

Developmental Imaging and Psychopathology Laboratory, University of Geneva School of Medicine, Geneva, Switzerland.

Causal interactions between specific psychiatric symptoms could contribute to the heterogenous clinical trajectories observed in early psychopathology. Current diagnostic approaches merge clinical manifestations that co-occur across subjects and could significantly hinder our understanding of clinical pathways connecting individual symptoms. Network analysis techniques have emerged as alternative approaches that could help shed light on the complex dynamics of early psychopathology. Read More

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September 2021

Health Economic Implications of Remote Patient Management.

Contrib Nephrol 2019 8;197:133-142. Epub 2019 Apr 8.

Division of Nephrology, University of Virginia Health System, Charlottesville, Virginia, USA.

Remote patient management and telemedicine have great potential to improve the care of patients with end-stage kidney disease undergoing peritoneal dialysis (PD). Since PD is performed by patients and their families, typically in the home setting away from expert clinical support, remote monitoring of treatments may detect early problems, ensure compliance, and give both providers and patients a sense of reassurance that complications can be minimized and detected. These advantages may translate into improved outcomes and increased uptake of home dialysis therapies. Read More

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The emerging role of immune checkpoint inhibitors for the treatment of breast cancer.

Expert Opin Investig Drugs 2021 Sep 27. Epub 2021 Sep 27.

Department of Medicine, University of Chicago, Chicago, IL, USA.

Introduction: Breast cancer has traditionally been viewed as immunogenically 'cold', but two immune checkpoint inhibitors are now approved in combination with chemotherapy for PD-L1 positive advanced triple-negative breast cancer (TNBC), and pembrolizumab was also recently approved for early stage TNBC. As the landscape is rapidly evolving, a comprehensive review of checkpoint inhibitors in breast cancer is needed to aid clinicians in selecting appropriate candidates for therapy, and to highlight ongoing promising studies in this area and topics in need of further investigation.

Area Covered: This review summarizes the latest evidence from completed and ongoing trials of immune checkpoint inhibitors. Read More

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September 2021

Mechanistic approach to the management of cancer-related nausea and vomiting in a palliative care resource-limited setting.

Int J Palliat Nurs 2021 Sep;27(7):362-366

Palliative Care Consultant, Bethesda Health Care, Claremont, Australia.

Background: Nausea and vomiting are two interrelated distressing symptoms experienced by patients with malignancies. They are multifactorial in aetiology.

Case Presentation: A middle-aged woman diagnosed with bilateral ovarian malignancy had undergone chemotherapy and was suffering nausea and vomiting, and was responding to basic therapeutic measures. Read More

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September 2021

Accelerated loss of oogonia and impaired folliculogenesis in females with Turner syndrome start during early fetal development.

Hum Reprod 2021 Sep 26. Epub 2021 Sep 26.

Department of Growth and Reproduction, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.

Study Question: How are germ cell numbers and initiation of folliculogenesis affected in fetal Turner syndrome (TS) ovaries?

Summary Answer: Germ cell development was severely affected already in early second trimester pregnancies, including accelerated oogonia loss and impaired initiation of primordial follicle formation in TS ovaries, while the phenotype in TS mosaic ovaries was less severe.

What Is Known Already: Females with TS are characterized by premature ovarian insufficiency (POI). This phenotype is proposed to be a consequence of germ cell loss during development, but the timing and mechanisms behind this are not characterized in detail. Read More

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September 2021

Case Report: Perioperative Kounis Syndrome in an Adolescent With Congenital Glaucoma.

Front Cardiovasc Med 2021 10;8:676188. Epub 2021 Sep 10.

Department of Pediatrics, Meyer Children's Hospital, Florence, Italy.

A 12-year-old male patient suffering from congenital glaucoma developed bradycardia, left ventricular failure, and hypotension after induction of anesthesia. Electrocardiography and echocardiography revealed a complete normalization of ECG and a complete spontaneous recovery in the cardiac function 72 hours from the beginning of the clinical manifestations, while cardiac Magnetic Resonance Imaging was performed, and coronary Computed Tomography scan revealed a myocardial bridge of a tract of the left anterior descendent coronary artery. Diagnosis of Kounis syndrome (KS) was made, a relatively novel, under-recognized clinical condition, defined as the manifestation of an acute coronary syndrome accompanied by mast cell activation and platelet aggregation involving interrelated and interacting inflammatory cells in the setting of allergic, hypersensitivity, anaphylactic or anaphylactoid insults. Read More

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September 2021

Supporting Primary Care Professionals to Stay in Work During the COVID-19 Pandemic: Views on Personal Risk and Access to Testing During the First Wave of Pandemic in Europe.

Front Med (Lausanne) 2021 10;8:726319. Epub 2021 Sep 10.

Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.

Minimising primary care professionals' (PCPs) risk of SARS-CoV-2 infection is crucial to ensure their safety as well as functioning health care system. PCPs' perspectives on the support they needed in the early stages of a public health crisis can inform future preparedness. To understand PCPs' experiences of providing care during the COVID-19 pandemic, with focus on personal risk from COVID-19 and testing. Read More

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September 2021

-Related Overgrowth Spectrum From Diagnosis to Targeted Therapy: A Case of CLOVES Syndrome Treated With Alpelisib.

Front Pediatr 2021 9;9:732836. Epub 2021 Sep 9.

Medical Genetics Unit, Meyer Children's University Hospital, Florence, Italy.

-related overgrowth spectrum (PROS) is an umbrella term referring to various clinical entities, which share the same pathogenetic mechanism. These conditions are caused by somatic gain-of-function mutations in , which encodes the 110-kD catalytic α subunit of PI3K (p110α). These mutations occur as post-zygotic events and lead to a gain of function of PI3K, with consequent constitutional activation of the downstream cascades (e. Read More

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September 2021

Accidental hypothermia: characteristics, outcomes, and prognostic factors-A nationwide observational study in Japan (Hypothermia study 2018 and 2019).

Acute Med Surg 2021 Jan-Dec;8(1):e694. Epub 2021 Sep 17.

Japan Association of Acute Medicine Heatstroke and Hypothermia Surveillance Committee Tokyo Japan.

Aim: This study describes the clinical characteristics and outcomes as well as the prognostic factors of patients with accidental hypothermia (AH) using Japan's nationwide registry data.

Methods: The Hypothermia study 2018 and 2019, which included patients aged 18 years or older with a body temperature of 35°C or less, was a multicenter registry conducted at 87 and 89 institutions throughout Japan, with data collected from December 2018 to February 2019 and December 2019 to February 2020, respectively.

Results: In total, 1363 patients were enrolled in the registry, of which 1194 were analyzed in this study. Read More

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September 2021

Epidural pneumorrhachis in COVID-19: a rare clinical entity.

J Community Hosp Intern Med Perspect 2021 20;11(5):719-721. Epub 2021 Sep 20.

Department of Medicine MedStar Franklin Square Medical Center, Baltimore, MD, USA.

Pneumorrhachis is an extremely rare clinical entity, involving air entrapment within the spinal canal. We present a unique case of epidural pneumorrhachis accompanying pneumomediastinum and pneumopericardium, in the setting of COVID-19 infection in a 62-year-old woman. Diagnostic testing was remarkable for elevated inflammatory markers, along with mild transaminitis and hyponatremia. Read More

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September 2021

Level of knowledge and practice of female healthcare providers about early detection methods of breast cancer at Debre Tabor Comprehensive Specialised Hospital: a cross-sectional study.

Ecancermedicalscience 2021 19;15:1268. Epub 2021 Jul 19.

Department of Anaesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.

Background: Despite the higher mortality rate of breast cancer in low and middle-income countries, the practice of early detection methods is low and the majority of the patients presenting at an advanced stage of the disease need palliative care with low survival rates. Although healthcare providers are the key for practicing early detection methods of breast cancer for themselves and their clients, little is known about their knowledge and practice of early detection methods of breast cancer in Northcentral Ethiopia.

Methods: An institution-based cross-sectional study was conducted among female healthcare providers at Debre Tabor Comprehensive Specialised Hospital. Read More

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Emphysematous epididymo-orchitis: An unusual case report.

Ultrasound 2021 Aug 6;29(3):199-202. Epub 2020 Dec 6.

Department of Radiodiagnosis, Kalinga Institute of Medical Sciences, Bhubaneswar, India.

Introduction: Emphysematous epididymo-orchitis in the young to middle age groups without any comorbidity like diabetes or metabolic disorders is an uncommon entity.

Case Report: We present a case of a nondiabetic young patient, diagnosed with emphysematous epididymo-orchitis as a sequela to urinary tract infection.

Discussion: Clinically differentiating diagnoses of the acute scrotum may be difficult and ultrasound can be used reliably as the initial modality showing the presence of air for early diagnosis. Read More

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Korean Model for Post-acute Comprehensive rehabilitation (KOMPACT): The Study Protocol for a Pragmatic Multicenter Randomized Controlled Study on Early Supported Discharge.

Front Neurol 2021 8;12:710640. Epub 2021 Sep 8.

Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.

Early supported discharge (ESD) is a transitional care model aimed at facilitating post-acute stroke patients' discharge to home. Previous studies have demonstrated that ESD provides equivalent patient and caregiver outcomes with superior cost-effectiveness compared to conventional rehabilitation (CR). This study intends to examine the feasibility of ESD in Korea. Read More

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September 2021

A Pilot Study on Electrical Impedance Tomography During CPAP Trial in Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia: The Bright Side of Non-invasive Ventilation.

Front Physiol 2021 9;12:728243. Epub 2021 Sep 9.

Department of Anesthesia and Intensive Care, University of Foggia, Foggia, Italy.

Different severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia phenotypes were described that match with different lung compliance and level of oxygenation, thus requiring a personalized ventilator setting. The burden of so many patients and the lack of intensive care unit (ICU) beds often force physicians to choose non-invasive ventilation (NIV) as the first approach, even if no consent has still been reached to discriminate whether it is safer to choose straightforward intubation, paralysis, and protective ventilation. Under such conditions, electrical impedance tomography (EIT), a non-invasive bedside tool to monitor lung ventilation and perfusion defects, could be useful to assess the response of patients to NIV and choose rapidly the right ventilatory strategy. Read More

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September 2021

Effects of High-Fat and High-Fat/High-Sucrose Diet-Induced Obesity on PVAT Modulation of Vascular Function in Male and Female Mice.

Front Pharmacol 2021 10;12:720224. Epub 2021 Sep 10.

Department of Structural and Functional Biology, Laboratory of Vascular Biology, Institute of Biology, University of Campinas, Campinas, Brazil.

Increased adiposity in perivascular adipose tissue (PVAT) has been related to vascular dysfunction. High-fat (HF) diet-induced obesity models are often used to analyze the translational impact of obesity, but differences in sex and Western diet type complicate comparisons between studies. The role of PVAT was investigated in small mesenteric arteries (SMAs) of male and female mice fed a HF or a HF plus high-sucrose (HF + HS) diet for 3 or 5 months and compared them to age/sex-matched mice fed a chow diet. Read More

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September 2021

Invasive pulmonary aspergillosis in patients with acute respiratory syndrome by COVID-19.

Rev Esp Anestesiol Reanim 2021 Apr 20. Epub 2021 Apr 20.

Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Doctor Peset, Valencia, España; Anestesiología, Universitat de València, Valencia, España.

Patients with COVID-19 who are admitted to intensive care unit (ICU) are at high risk of developing secondary infections, including invasive fungal infections such as invasive pulmonary aspergillosis (IPA). The main purpose was to analyse the putative COVID-19 Associated Pulmonary Aspergillosis (CAPA) patients in our setting. In these patients, we performed mycological culture in bronchoalveolar lavage (BAL) for isolation of Aspergillus sp. Read More

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Risk-based surveillance of chronic wasting disease in semi-domestic reindeer.

Prev Vet Med 2021 Sep 20;196:105497. Epub 2021 Sep 20.

Centre for Ecological and Evolutionary Synthesis (CEES), Department of Biosciences, University of Oslo, P.O. Box 1066, Blindern, NO-0316, Oslo, Norway; Norwegian Institute for Nature Research (NINA), P. O. Box 5685, Sluppen, NO-7485, Trondheim, Norway.

Reindeer pastoralism is a widespread practise across Fennoscandia and Russia. An outbreak of chronic wasting disease (CWD) among wild reindeer (Rangifer tarandus) poses a severe threat to the semi-domestic reindeer herding culture. Establishing surveillance is therefore key, but current models for surveillance of CWD are designed for wild cervids and rely on samples obtained from recreational hunters. Read More

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September 2021

A Delphi study and International Consensus Recommendations: The use of bolus in the setting of postmastectomy radiation therapy for early breast cancer.

Radiother Oncol 2021 Sep 23. Epub 2021 Sep 23.

Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark.

Bolus serves as a tissue equivalent material that shifts the 95-100% isodose line towards the skin and subcutaneous tissue. The need for bolus for all breast cancer patients planned for postmastectomy radiation therapy (PMRT) has been questioned. The work was initiated by the faculty of the European SocieTy for Radiotherapy & Oncology (ESTRO) breast cancer courses and represents a multidisciplinary international breast cancer expert collaboration to optimize PMRT. Read More

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September 2021

The "Crossed Leg Sign" in the Emergency Department (or Tilli's Sign): A New Semiotic Sign for the Early Evaluation of Patients Accessing the Emergency Setting.

Ann Emerg Med 2021 Oct;78(4):573-574

Department of Emergency Medicine, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCSRome, Italy.

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October 2021

Improving interagency service integration of the Australian Nurse Family Partnership Program for First Nations women and babies: a qualitative study.

Int J Equity Health 2021 Sep 25;20(1):212. Epub 2021 Sep 25.

Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane, QLD, Australia.

Background: The Australian Nurse Family Partnership Program (ANFPP) is an evidence-based, home visiting program that offers health education, guidance, social and emotional support to first-time mothers having Aboriginal and/or Torres Strait Islander (First Nations) babies. The community-controlled sector identified the need for specialised support for first time mothers due to the inequalities in birthing and early childhood outcomes between First Nations' and other babies in Australia. The program is based on the United States' Nurse Family Partnership program which has improved long-term health outcomes and life trajectories for mothers and children. Read More

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September 2021

CABOCOL-01 trial: a single-arm phase II study assessing safety and efficacy of Cabozantinib for advanced or metastatic cervical carcinoma after platinum treatment failure.

BMC Cancer 2021 Sep 25;21(1):1054. Epub 2021 Sep 25.

Medical Oncology Department, Centre François Baclesse, F-14000, Caen, France.

Background: Cervical cancer is the tenth diagnosed cancer in the world. Early-stage and locally recurrent disease may be cured with radical surgery or chemo-radiotherapy. However, if disease persists or recurs, options are limited and the prognosis is poor. Read More

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September 2021

Early Diagnosis of Lung Cancer in the United Arab Emirates: Challenges and Strategic Recommendations.

Clin Pract 2021 Sep 15;11(3):671-678. Epub 2021 Sep 15.

Zayed Military Hospital, Abu Dhabi 111499, United Arab Emirates.

In the United Arab Emirates (UAE), lung cancer (LC) was the third leading cause of deaths due to cancer in 2017. Around 80% of the patients in the UAE are diagnosed at a late stage, rendering the treatment less effective in improving survival outcomes. Lack of awareness of disease symptomatology, deficient screening initiatives, misdiagnosis, and delayed referral to the specialist are contributing factors for delayed diagnosis. Read More

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September 2021

[Sentinel lymph node biopsy in the management of early-stage ovarian cancer: a systematic review of the literature.]

Gynecol Obstet Fertil Senol 2021 Sep 22. Epub 2021 Sep 22.

Service de Chirurgie Cancérologique Gynécologique et du Sein, APHP.Centre, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015, Paris, France. Electronic address:

The initial management of early-stage ovarian cancer consists of staging surgery including pelvic and para-aortic lymphadenectomy. The use of the sentinel lymph node (SLN) procedure in this setting may decrease the morbidity associated with this surgery. The objective of this review was to evaluate the feasibility of the SLN procedure in ovarian cancer diagnosed at an early stage by comparing the different techniques used and their accuracy. Read More

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September 2021

Impact of Extending Eligibility for Reinstatement of Waiting Time After Early Allograft Failure: A Decision Analysis.

Am J Kidney Dis 2021 Sep 17. Epub 2021 Sep 17.

Department of Emergency Medicine, Hackensack University Medical Center, Hackensack, NJ; Department of Biomedical Informatics, Columbia University Medical Center, New York, NY.

Rationale & Objective: The shortage of deceased donor kidneys identified for potential transplantation in the United States is exacerbated by a high proportion of deceased donor kidneys discarded after procurement. We estimated the impact of a policy proposal aiming to increase organ utilization by extending eligibility for waiting time reinstatement for recipients experiencing allograft failure following transplantation.

Study Design: Decision analysis informed by clinical registry data. Read More

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September 2021