Challenges and Opportunities of Evidence Use in Practice in Australian Children's Development Programs.

This paper explores the role of evidence and its use in a cluster of Australian community-based child development programs. The paper draws on findings from a 2016-2017 study commissioned by a not-for-profit organization to review their programs' alignment with government evidence-based program expectations. Cunningham and Duffee's (2009) evidence-based practice style typology is utilized to examine how different purposes of use drive styles of and approaches to evidence sourcing, application, and reporting. Perspectives on what constitutes evidence and how such evidence is valued, used, and reported can vary considerably between individual programs, irrespective of enforced standards and expectations. It is argued that a single-dimensional approach to program evidence-based evaluation and reporting is not appropriate and potentially damaging in contexts where community-based programs have different purposes, structures, cultures, and intentions. Given a program's particular evidence-use style, evidence-based criteria, processes, and reporting requirements should be matched accordingly.

Cadaveric renal transplantation using kidneys from donors greater than 60 years old.

Transplantation of kidneys from donors over the age of 60 yr is controversial. However, as the demand for cadaveric kidneys far exceeds the supply, exploration of the usefulness of kidneys outside the currently accepted donor pool is necessary. Between January 1987 and July 1989, 31 (5.5%) of the 558 cadaveric renal transplants performed at the University of Pittsburgh utilized organs from donors older than 60 yr. Median recipient age was 41 yr (range 24-71 yr); 4 recipients were diabetic and 6 had panel-reactive antibody levels greater than 20% at the time of transplant. All recipients were treated with cyclosporine, prednisone and azathioprine. The 1-yr allograft survival was 65% which was less than but not statistically different from the graft survival of 80% in a retrospective selected control group who received grafts from younger donors aged 11 to 50 yr. However, the 1-yr graft survival of older donor kidneys with cold ischemia time greater than 48 hours was 38%, which was significantly poorer than the 78% 1-yr graft survival seen with cold ischemia times less than 48 h (p=0.04 Breslow). The mean serum creatinine was significantly higher in the older donor kidneys at 1, 3, and 12 months post-transplant than in the control kidneys even when kidneys with greater than 48 h of cold ischemia time were excluded. In summary, transplantation of cadaver kidneys from donors older than 60 yr results in acceptable graft survival rates. These kidneys are more susceptible to cold ischemic injury and function with a higher serum creatinine than kidneys from younger donors. Expansion of the donor pool by the use of older donor kidneys in selected recipients could have an impact on alleviating the chronic national cadaver kidney shortage.