Renal Autotransplantation: 27-Year Experience at 2 Institutions.

PURPOSE: Renal autotransplantation is an infrequently performed procedure. It has been used to manage complex ureteral disease, vascular anomalies and chronic kidney pain. We reviewed our 27-year experience with this procedure. MATERIALS AND METHODS: This is a retrospective, observational study of 51 consecutive patients who underwent renal autotransplantation, including 29 at Oregon Health and Science University between 1986 and 2013, and 22 at Virginia Mason Medical Center between 2007 and 2012. Demographics, indications, operative details and followup data were collected. Early (30 days or less) and late (greater than 30 days) complications were graded according to the Clavien-Dindo system. Factors associated with complications and pain recurrence were evaluated using a logistic regression model. RESULTS: The 51 patients underwent a total of 54 renal autotransplants. Median followup was 21.5 months. The most common indications were loin pain hematuria syndrome/chronic kidney pain in 31.5% of cases, ureteral stricture in 20.4% and vascular anomalies in 18.5%. Autotransplantation of a solitary kidney was performed in 5 patients. Laparoscopic nephrectomy was performed in 23.5% of cases. Median operative time was 402 minutes and median length of stay was 6 days. No significant difference was found between preoperative and postoperative plasma creatinine (p = 0.74). Early, high grade complications (grade IIIa or greater) developed in 14.8% of patients and 12.9% experienced late complications of any grade. Two graft losses occurred. Longer cold ischemia time was associated with complications (p = 0.049). Of patients who underwent autotransplantation for chronic kidney pain 35% experienced recurrence and 2 underwent transplant nephrectomy. No predictors of pain recurrence were identified. CONCLUSIONS: The most common indications for renal autotransplantation were loin pain hematuria syndrome/chronic kidney pain, ureteral stricture and vascular anomalies in descending order. Kidney function was preserved postoperatively and 2 graft losses occurred. At a median followup of 13 months pain resolved in 65% of patients who underwent the procedure. Complication rates compared favorably with those of other major urological operations and cold ischemia time was the only predictor of postoperative complications.

Multiteam Systems Handling Time-Sensitive Targets: Developing Situation Awareness in Distributed and Co-located Settings.

There is an increasing interest in how to organize operations carried out by multiteam systems (MTS). Large MTS typically operate with a dedicated integration team, responsible for coordinating the operation. We report a study of a military multiteam system that prosecute time-sensitive targets. We asked whether and how the integration team's efficiency depends on its communication setting. Specifically, we studied how a co-located vs. a distributed communications setting influenced the shared situation awareness and whether the shared situation awareness again influenced the outcome of the decision processes. We found that performance fell when the integration team shifted from a co-located to a distributed setting. The fall in performance seemed to be mediated by a corresponding fall in situation awareness. Moreover, while the performance improved for each run in the co-located setting, we did not see such learning in the distributed setting. Qualitative observations revealed that misunderstandings lasted longer in a distributed configuration than in a co-located setting. We found that situation awareness at level 3 was the only level of situation awareness significant for predicting all dimensions of performance. Implications for theory, research, and practice are discussed.

Future Directions in Sports-Related Concussion Management.

This article focuses on 3 concepts that continue to be investigated in the search for the holy grail of concussion-a valid diagnostic test. Imaging advances are discussed with optimism that functional MRI and diffusion tensor imaging may be available clinically. Biomarkers and the use of genetic tests are covered. Sideline accelerometer use may help steer discussions of head trauma risk once technology exists to accurately estimate acceleration of the brain. In the meantime, strategies including allowing athletes to be substituted out of games for an evaluation and video review in elite sports can improve recognition of sports-related concussion.

Complex logistics for Trondheim facility.

Next year will see the completion of a 10-year new build and redevelopment project to create central Norway's largest regional hospital, in Trondheim, providing medical services for over 200,000 local people, and a further 450,000 inhabitants from the wider region. The new St Olavs Hospital will be Norway's first 100 per cent single-room healthcare facility, and is set to have close links with Trondheim's Norwegian University of Science and Technology. Designed to be as 'patient-centred' as possible from the outset, it incorporates a number of innovative technologies for enhancing and automating activities ranging from pill 'picking' and distribution, to logistics and waste disposal, as HEJ, and Bjørn Bakken, project manager, logistics, at hospital development company, Helsebygg Midt-Norge, explain.