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INTRODUCTION: There is a lack of data regarding the peri-operative and long-term outcomes of kidney transplantation in cystic fibrosis (CF) patients. Herein, we report the peri-operative and long-term outcomes of kidney transplantation in CF patients. MATERIALS AND METHODS: All CF patients who received a kidney transplant at the national kidney transplant center between 1993 and 2022 were identified. Recipients of the contralateral donor kidney were selected as a control group. Primary outcomes included 1-, 5-, and 10- year death-censored graft survival and overall survival. Secondary outcomes included peri-operative morbidity, acute graft rejection, delayed graft function (DGF), and length of stay (LOS). RESULTS: Fourteen patients received a kidney transplant over the study period. Median age at transplantation was 35 (IQR 31, 40) years. The 1-, 5-, and 10-year death-censored graft survival was 92, 74, and 74% in the CF group compared to 100, 92, and 92% in the control group (p = .44). The 1-, 5-, and 10-year overall survival in the CF group was 85, 66, and 57% compared to 100, 92, and 82% in the control group (p = .036). There was no significant difference in peri-operative outcomes including LOS (10 vs. 11 days, p = .84), ICU admission (1 vs. 0 patients, p > .99), acute rejection episodes (2 vs. 1 patients, p > .99), and DGF (1 vs. 2 patients, p = .60). CONCLUSION: CF patients have good long-term graft survival, however, overall survival was worse compared to a matched cohort. These data provide important information for transplant surgeons when considering suitable donor allografts in this unique patient population.
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Fibrosis Quística , Trasplante de Riñón , Humanos , Trasplante de Riñón/efectos adversos , Fibrosis Quística/cirugía , Rechazo de Injerto , Supervivencia de Injerto , Donantes de Tejidos , Funcionamiento Retardado del Injerto/etiología , Factores de Riesgo , Estudios RetrospectivosRESUMEN
OBJECTIVE: To assess the impact of an Outpatient Word Catheter Program (OWCP) on outcomes in women presenting with Bartholin cysts or abscesses (BC/BAs). . METHODS: This retrospective cohort study reviewed 408 women presenting with BC/BAs to our tertiary unit from 2017-2022. Analysis of medical records, with subgroup analysis of pregnant patients, and comparative analysis between pre- and post-intervention groups, was completed. Financial impact analysis using national activity-based funding pricing guidance to estimate cost was conducted. RESULTS: Pre-intervention, 65% (n = 34) of procedures were completed in theater, but after the introduction of OWCP, 61% (n = 213) of cases were treated in the day ward (χ2 = 67.43, P <0.001). Similarly, inpatient admissions reduced; 94.2% (n = 49) pre-intervention versus 26% (n = 92) post-intervention (χ2 = 92.25, P <0.001). The mean all patient admission duration decreased from 1.52 ± 0.89 days to 0.69 ± 0.59 days (P <0.001). The mean cost for those women attending in the pre-OWCP period was 4798, versus 2704 in the women who attended post-OWCP introduction (P < 0.001). CONCLUSION: After OWCP introduction, there were significant decreases in inpatient admissions, surgical procedures in theater, general anesthetic exposure, and duration of admission. Financial impact analysis revealed a significant cost reduction of ~2100 per patient. Outpatient or day-care Word catheter programs are feasible, affordable and acceptable services to provide to women presenting with BC/BAs.
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OBJECTIVE: Health-related quality of life (HRQoL) and the delivery of high-quality care are ongoing concerns when caring for pregnant women during the coronavirus disease 2019 (COVID-19) pandemic. We compared self-reported HRQoL and hospital quality of care among perinatal women with and without COVID-19. METHODS: This is a prospective cohort study of perinatal women attending a tertiary maternity unit during the pandemic. Eighteen women who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and 20 SARS-CoV-2-negative women were recruited. Participants completed the Short Form Health Survey (SF-12), Clinical Outcomes in Routine Evaluation-Outcome Measure, and Quality from the Patient's Perspective questionnaires. Mean scores were compared. RESULTS: Of the Non-COVID-19 cohort, 95% (n = 19) were Caucasian, whereas 67% (n = 12) of the COVID-19 cohort were not Caucasian (χ2 = 16.01, P < 0.001). The mean SF-12 for physical health in the COVID-19 cohort had significantly lower scores (P < 0.002). There was no difference in mental health and well-being between cohorts. The quality of care experienced was notably similar and very positive. CONCLUSION: There was a significantly greater burden on physical health among pregnant women with COVID-19. Mental health and psychological status were similar in both groups. High quality of care during a pandemic is possible to deliver in a maternity setting, irrespective of COVID-19 status.
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Atención Perinatal , Periodo Posparto/psicología , Mujeres Embarazadas/psicología , Calidad de la Atención de Salud , Calidad de Vida , Adulto , COVID-19/epidemiología , Estudios de Cohortes , Femenino , Humanos , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , SARS-CoV-2RESUMEN
Respiratory rate (RR) is routinely used to monitor patients with infectious, cardiac and respiratory diseases and is a component of early warning scores used to predict patient deterioration. However, it is often measured visually with considerable bias and inaccuracy.Objectives. Firstly, to compare distribution and accuracy of electronically measured RR (EMRR) and visually measured RR (VMRR). Secondly, to determine whether, and how far in advance, continuous electronic RR monitoring can predict oncoming hypoxic and pyrexic episodes in infectious respiratory disease.Approach.A retrospective cohort study analysing the difference between EMRR and VMRR was conducted using patient data from a large tertiary hospital. Cox proportional hazards models were used to determine whether continuous, EMRR measurements could predict oncoming hypoxic (SpO2 < 92%) and pyrexic (temperature >38 °C) episodes.Main results.Data were gathered from 34 COVID-19 patients, from which a total of 3445 observations of VMRR (independent of Hawthorne effect), peripheral oxygen saturation and temperature and 729 117 observations of EMRR were collected. VMRR had peaks in distribution at 18 and 20 breaths per minute. 70.9% of patients would have had a change of treatment during their admission based on the UK's National Early Warning System if EMRR was used in place of VMRR. An elevated EMRR was predictive of hypoxic (hazard ratio: 1.8 (1.05-3.07)) and pyrexic (hazard ratio: 9.7 (3.8-25)) episodes over the following 12 h.Significance.Continuous EMRR values are systematically different to VMRR values, and results suggest it is a better indicator of true RR as it has lower kurtosis, higher variance, a lack of peaks at expected values (18 and 20) and it measures a physiological component of breathing directly (abdominal movement). Results suggest EMRR is a strong marker of oncoming hypoxia and is highly predictive of oncoming pyrexic events in the following 12 h. In many diseases, this could provide an early window to escalate care prior to deterioration, potentially preventing morbidity and mortality.