Metabolic syndrome and the progression of knee osteoarthritis on MRI.

OBJECTIVE: Metabolic osteoarthritis (OA) is one of the proposed clinical phenotypes defined by the existence of metabolic syndrome (MetS). This study aimed to (1) investigate whether MetS and its components are associated with progression of knee OA magnetic resonance imaging (MRI) features, and (2) to evaluate the interaction of MetS with menopause and progression of MRI features. METHOD: 682 women from the Rotterdam Study who participated in a sub-study with knee MRI data available and 5-year follow-up were included. Tibiofemoral (TF) and patellofemoral (PF) OA features were assessed with the MRI Osteoarthritis Knee Score. MetS was quantified by the MetS severity Z-score. Generalized estimating equations were used to evaluate associations between MetS and menopausal transition and progression of MRI features. RESULTS: MetS severity at baseline was associated with progression of osteophytes in all compartments, bone marrow lesions (BMLs) in the PF compartment, and cartilage defects in the medial TF compartment. Waist circumference was associated with progression of osteophytes in all compartments and cartilage defects in the medial TF compartment. High-density lipoprotein (HDL)-cholesterol levels were associated with progression of osteophytes in the medial and lateral TF compartment and glucose levels with osteophytes in the PF and medial TF compartment. No interactions were found between MetS with menopausal transition and MRI features. CONCLUSION: Women with higher MetS severity at baseline showed progression of osteophytes, BMLs, and cartilage defects, indicating more structural knee OA progression after 5 years. Further studies are required to understand whether targeting MetS components may prevent the progression of structural knee OA in women.

Changing to an Opt Out System for Organ Donation-Reflections From England and Netherlands.

Recently England and Netherlands have changed their consent system from Opt In to Opt Out. The reflections shared in this paper give insight and may be helpful for other nation considering likewise. Strong support in England for the change in legislation led to Opt Out being introduced without requiring a vote in parliament in 2019. In Netherlands the bill passed by the smallest possible majority in 2018. Both countries implemented a public campaign to raise awareness. In England registration on the Donor Register is voluntary. Registration was required in Netherlands for all residents 18 years and older. For those not already on the register, letters were sent by the Dutch Government to ask individuals to register. If people did not respond they would be legally registered as having "no objection." After implementation of Opt Out in England 42.3% is registered Opt In, 3.6% Opt Out, and 54.1% has no registration. In contrast in Netherlands the whole population is registered with 45% Opt In, 31% Opt Out and 24% "No Objection." It is too soon to draw conclusions about the impact on the consent rate and number of resulting organ donors. However, the first signs are positive.

External validation of prediction models for time to death in potential donors after circulatory death.

Predicting time to death in controlled donation after circulatory death (cDCD) donors following withdrawal of life-sustaining treatment (WLST) is important but poses a major challenge. The aim of this study is to determine factors predicting time to circulatory death within 60 minutes after WSLT and validate previously developed prediction models. In a single-center retrospective study, we used the data of 92 potential cDCD donors. Multivariable regression analysis demonstrated that absent cough-, corneal reflex, lower morphine dosage, and midazolam use were significantly associated with death within 60 minutes (area under the curve [AUC] 0.89; 95% confidenence interval [CI] 0.87-0.91). External validation of the logistic regression models of de Groot et al (AUC 0.86; 95% CI 0.77-0.95), Wind et al (AUC 0.62; 95% CI 0.49-0.76), Davila et al (AUC 0.80; 95% CI 0.708-0.901) and the Cox regression model by Suntharalingam et al (Harrell's c-index 0.63), exhibited good discrimination and could fairly identify which patients died within 60 minutes. Previous prediction models did not incorporate the process of WLST. We believe that future studies should also include the process of WLST as an important predictor.

The Influence of End-of-Life Care on Organ Donor Potential.

Many patients with acute devastating brain injury die outside intensive care units and could go unrecognized as potential organ donors. We conducted a prospective observational study in seven hospitals in the Netherlands to define the number of unrecognized potential organ donors outside intensive care units, and to identify the effect that end-of-life care has on organ donor potential. Records of all patients who died between January 2013 and March 2014 were reviewed. Patients were included if they died within 72 h after hospital admission outside the intensive care unit due to devastating brain injury, and fulfilled the criteria for organ donation. Physicians of included patients were interviewed using a standardized questionnaire regarding logistics and medical decisions related to end-of-life care. Of the 5170 patients screened, we found 72 additional potential organ donors outside intensive care units. Initiation of end-of-life care in acute settings and lack of knowledge and experience in organ donation practices outside intensive care units can result in under-recognition of potential donors equivalent to 11-34% of the total pool of organ donors. Collaboration with the intensive care unit and adjusting the end-of-life path in these patients is required to increase the likelihood of organ donation.

Barriers to Registration in the National Donor Registry in Nations Using the Opt-In System: A Review of the Literature.

BACKGROUND: To increase the number of postmortem organ and tissue donors, donor registries (DRs) have been introduced. The aim of this review was to understand why people in nations with an Opt-in system, who are for or against donation after death, do not register in the DR. Knowing these barriers will help in developing policies to increase the registration rate in the DR. METHODS: For this review, 2 authors independently assessed the eligibility of the identified studies from 2000 to 2015 in the Pubmed- Medline database. Included were observational and interventional studies concerned with reported barriers to residents joining the national DR in Denmark, The Netherlands, and the United Kingdom. RESULTS: We included 15 relevant articles for the review. The main barriers to signing the DR in nations using the Opt-in system were: religion; medical mistrust, anxiety, and affective emotions; lack of information; concern about insufficient time to mourn, and that the funeral may be delayed and the deceased not look presentable; physical integrity; ignorance about how to register in the DR; own benefit; and social status. CONCLUSIONS: The outcome suggests that the main barriers to enrolling in the DR are based on people's doubts about their own ability to perform the registration and cope with the consequences, knowledge, outcome expectations, and concerns about what others will think of them for agreeing to donation. However, not all barriers are easily modifiable, owing to their association with affect or emotions.

Increasing Consent and Assent Rate for Organ and Tissue Donation: Communication About Donation-Telephone Advice by Psychologist.

A high percentage of family refusal is found for several outcomes in the Donor Register. Misconceptions and concerns regarding donation impede next of kin from making a well-considered decision. The donation request is the moment in which such concerns should be addressed by the requestor. The Communication about Donation-Telephone Advice by Psychologist (CaD-TAP) is a direct telephone intervention for requestors who are about to request the relatives for donation. The aim of this intervention is to improve requestors' communication skills regarding the donation request and thereby increase the consent rate for organ and/or tissue donation. The intervention started on the April 1, 2014, and lasted until December 31, 2014. To determine the effects, the consent and assent rates were compared between requestors who received the CaD-TAP intervention and those who did not. The requestors who received the CaD-TAP intervention (N = 141) had a significantly (P < .001) higher consent rate (58%) compared with the group who did not receive the intervention (N = 1563, consent rate: 34%). More tissue donor requestors received the intervention (74%) and most interventions took place outside office hours (82%). No significant difference was found in the effect of the intervention with regard to type of donation, time, or day. Furthermore, the intervention increased requestors' self-confidence in requesting for donation (P < .001), and a higher self-confidence indicated a significant association with increased consent rate. The intervention is unanimously experienced as positive and valuable by users. Based on these results the intervention is effective in increasing the consent rate for organ and tissue donation.

[More potential organ donors than actual donations in 52 intensive-care units in the Netherlands, 2001-2004]. / Orgaandonorpotentieel in 52 intensivecareafdelingen in Nederland groter dan het aantal gerealiseerde donatieprocedures, 2001-2004.

OBJECTIVE: To assess the number of potential organ donors and the main reasons why organ donation is not performed. DESIGN: Retrospective. METHOD: The number of potential heart-beating (HB) and non-heart-beating (NHB) donors was assessed by reviewing the medical records of 588o patients who died between 2001 and 2004 in 52 intensive-care units (ICUs) in 30 hospitals. The number of actual donations was also assessed. RESULTS: The potential of HB donors was 2.5 to possibly 6.6% of all ICU deaths and HB donation was performed in 1.9% of all ICU deaths. The potential of NHB donors of category III was at least 4.2% of all ICU deaths and NHB donation was performed in 1.0% of all ICU deaths. The main difficulty in the donation process was objection from family members, which was reported in 45% of all potential HB and NHB donors and in 59% of all donation requests to relatives. Of the potential HB and NHB donors 7.3% were not identified as potential donors. CONCLUSION: These results confirm that organ-donor potential is greater than the number of actual donations. Objection from family members is the main limiting factor.

Video-Based E-Learning in Communication Skills for Physicians Provides Higher Agreement to Tissue Donation.

BACKGROUND: In hospitals, physicians are rarely confronted with tissue donation. Besides correctly identifying an eligible tissue donor, the physician also must deal with the bereaved family. When the immediate family members were asked to consent for tissue donation, objection by the next of kin appears to be the main reason for the loss of potential tissue donors, if no registration is found in the donor register. Therefore, physicians' guidance of next of kin through the consent process for tissue donation is an essential part of the recruitment process and requires adequate communication about donation skills and techniques. We analyzed if physicians educated with a video-based E-learning program on "communication about donation skills" successfully contributes to a higher consent rate for tissue donation. METHODS: This retrospective study was conducted in 2014 in a Dutch teaching hospital. Two groups of physicians were compared; physicians receiving a lecture on "tissue donation" and physicians receiving additional E-learning on "communication about donation." The results were analyzed on the outcome "obtained consent" for tissue donation from next of kin. RESULTS: Analyses show that physicians receiving a lecture about organ and tissue donation extended with video-based E-learning on communication about donation obtain a significantly (P ≤ .011) higher consent rate (55.6%) for tissue donation compared with physicians who only receive a lecture (15.5%). CONCLUSIONS: A mandatory offer for physicians to follow E-learning on communication about donation must be considered. This could help the availability of tissue donors.

Frequency of fever episodes related to febrile seizure recurrence.

The aim of this study was to assess the number of fever episodes as a risk factor for febrile seizure recurrence during the first 6 months after the last previous febrile seizure. In a 6-month follow-up study of 155 children, aged 3 months to 5 y, with a first or a recurrent febrile seizure, the occurrence of fever episodes and febrile seizure recurrences was prospectively documented. Using logistic regression analysis the association between the baseline characteristics and the number of fever episodes and the outcome, a febrile seizure recurrence, was studied. In total, 260 fever episodes were registered; 29 children experienced 1 or more febrile seizure recurrence during follow-up. Two factors were associated with febrile seizure recurrence: the number of fever episodes [odds ratio (OR)= 1.8; 95% confidence interval (CI): 1.4-2.4)] and age at study entry (OR=0.6; 95% CI: 0.3-1.1). In a multivariable model, only the number of fever episodes remained significant. In conclusion, the number of fever episodes increases the risk of a febrile seizure recurrence with a factor of 1.8 per fever episode in the first 6 months after a febrile seizure.