Biofire pneumonia panel in lung donors: faster detection but limited pathogens.

BACKGROUND: Culture of bronchoalveolar lavage (BAL) specimens takes time to report. We tested whether a molecular diagnostic test could accelerate donor lung assessment and treatment. METHODS: We compared BioFire Film Array Pneumonia Panel (BFPP) with standard of care (SOC) tests on lung allograft samples at three time points: (1) donor BAL at organ recovery, (2) donor bronchial tissue and airway swab at implantation, and (3) first recipient BAL following lung implantation. Primary outcomes were the difference in time to result (Wilcoxon signed-ranked tests) and the agreement in results between BFPP and SOC assays (Gwet's agreement coefficient). RESULTS: We enrolled 50 subjects. In donor lung BAL specimens, BFPP detected 52 infections (14 out of 26 pathogens in the panel). Viral and bacterial BFPP results were reported 2.4 h (interquartile range, IQR 2.0-6.4) following BAL versus 4.6 h (IQR 1.9-6.0, p = 0.625) for OPO BAL viral SOC results and 66 h (IQR 47-87, p < .0001) for OPO BAL bacterial SOC results. Although there was high overall agreement of results between BAL-BFPP versus OPO BAL-SOC tests (Gwet's AC p < .001 for all), the level of agreement differed among 26 pathogens designed in BFPP and differed by types of specimens. BFPP could not detect many infections identified by SOC assays. CONCLUSIONS: BFPP decreased time to detection of lung pathogens among donated lungs, but it cannot replace SOC tests due to the limited number of pathogens in the panel.

Pediatric Orthopaedic Observerships in North America for International Surgeons: A Qualitative Study Exploring Motivations, Relevance, and Alternate Learning Platforms.

BACKGROUND: Given the growing interest among international surgeons to participate in North American clinical observerships, it is essential to incorporate international surgeons' views to further enhance the program's applicability, value, and accessibility. In this qualitative follow-up study, we explored the motivations, relevance, and opinions about alternate learning platforms among the international surgeons who had participated in a pediatric orthopaedic clinical observership in North America. METHODS: Using a semistructured interview guide, international surgeons who had participated in a North American pediatric orthopaedic observership during 2009 to 2019 were interviewed until data saturation and inductive thematic saturation were reached. Twenty-one international surgeons representing 15 different countries (1 from a low-income country, 10 from a lower middle-income country, 8 from an upper middle-income country, and 2 from a high-income country) were interviewed. RESULTS: The most commonly cited motivations for doing a clinical observership were to advance clinical training and learn specific skills. The clinical and nonclinical skills gained during the observership, such as utilizing an integrated team approach and open communication style, were helpful to most interviewees; however, several respondents highlighted the critical need to adapt and modify surgical indications, techniques, and skills to suit their local environment and limited resource availability. Although respondents were interested in exploring virtual learning models to save time and expense, several preferred a hybrid model, including access to remote learning opportunities and sharing their own clinical experiences with the North American hosts. CONCLUSIONS: Identifying the visiting surgeon's motivation for participation can allow North American hosts to align their clinical exposure more closely with the unique needs and aspirations of the international surgeons and enable a more relevant exchange of clinical and nonclinical skills. Use of a blended learning model, including in-person and virtual learning platforms, and the missed opportunity of having the international surgeons share their clinical experiences and skills with their North American counterparts should be explored further.