The building of an institutional liver transplant registry: opportunities and challenges.

To improve current data systems for institutional decision-making, the Adult Liver Transplant Registry was established at the Hospital Italiano de Buenos Aires, Argentina. This article describes its design and implementation and reports on the outcomes for patients transplanted since its January 2020 launch. A multidisciplinary team designed the registry by identifying key variables from a literature review while considering balance between data depth and feasibility. Rigorous quality control measures were enforced, including monthly audits and staff training. Benchmark indicators for post-transplant outcomes were established. As of November 2023, the registry included 136 transplants. Its implementation and maintenance were straightforward, with no significant difficulties encountered. Cirrhosis was the predominant indication (77%) for transplant. Only one living donor transplantation was performed. Post-transplant results generally aligned with benchmarks, but rates of biliary complications slightly exceeded the recommended thresholds. The one-year post-transplant survival rate was 87%. The successful registry implementation provides a robust framework for research, treatment management, and patient care enhancement within a liver transplant unit.

Comparison of clinical outcomes of venous thromboembolic disease between outpatient and inpatient management.

Objectives: To compare the occurrence of death, bleeding, and recurrence according to inpatient or outpatient management of venous thromboembolic disease (VTE). Materials and methods: . Retrospective cohort that included a consecutive sampling of VTE consultations between 2016 and 2019 diagnosed in the Emergency Center of a private hospital in Argentina. Results: There were 1202 cases, 908 with isolated deep vein thrombosis (DVT), 205 with isolated pulmonary embolism (PE), and 89 cases of combined DVT - PE. 66% were women, with a median age of 77 years; 72% of cases were managed on an outpatient basis (n= 862). Comorbidities associated with hospitalization were obesity (p=0.03), chronic obstructive pulmonary disease (COPD) (p=0.01), heart failure (CHF) (p=0.01), chronic renal failure (CKD) (p=0.01), and cancer (p=0.01). At 90 days, the cumulative incidence of bleeding was 2.6% in inpatient compared to 2.9% in outpatient management (p=0.81); recurrence was 0% versus 0.9% (p=0.07), and mortality was 42.9% versus 18.9%, respectively (p=0.01). The HR for 90-day mortality in hospitalized patients adjusted for confounders (sex, age, type of VTE, obesity, CKD, CHF, COPD, and cancer) was 1.99 (95% CI 1.49-2.64; p=0.01). Conclusions: In this elderly, and predominantly female Argentine population, the 90-day mortality in patients hospitalized for VTE was higher than mortality in patients with outpatient management, without differences in recurrence or major bleeding.

Curso de investigación en Atención Primaria de la Salud: experiencia sobre módulo de búsqueda bibliográfica y gestores de citas / Research course in Primary Health Care: experience with the bibliographic search module and citation managers

La Federación Argentina de Medicina Familiar y General apoyó el desarrollo, la difusión y la implementación de una propuesta educativa sobre investigación en atención primaria. Consiste en 4 módulos independientes, destinado para miembros interesados/as, con 2 encuentros virtuales teórico-prácticos, que favorecieran el intercambio de opiniones y experiencias entre colegas. El objetivo del primer módulo fue proporcionar conocimiento, brindar pautas y ofrecer herramientas para la búsqueda bibliográfica y el uso de gestores de citas. Se realizó difusión mediante sociedades y redes sociales. Se incluyó una evaluación individual, que diera cuenta de lectura complementaria y la aplicación práctica de los contenidos. Se llevó a cabo en Junio, con 39 preinscripto/as, mayoritariamente residentes. Hubo 24 participantes efectivos (61%), asistieron 17 y 20 personas respectivamente, y 11 (46%) obtuvieron el certificado de aprobación por responder la consigna en tiempo y forma. En cuanto a los/as asistentes, hubo predominio de mujeres (79%), provenientes de Asociación Metropolitana de Medicina Familiar (25%), Asociación Cordobesa de Medicina Familiar y Comunitaria (16%), Asociación Misionera de Medicina General/Familiar y del Equipo de Salud (16%), Asociación Tucumana de Medicina Familiar, General y Comunitaria (12%), y otras minorías. Expresaron satisfacción, agradecimiento y reconocimiento por la actividad, destacando la buena predisposición de organizadores y equipo docente, la utilidad práctica de la temática, la evidente planificación, y el apoyo político-económico. Esta valiosa experiencia educativa (planteada como necesidad pendiente) resultó exitosa, ya que los/as participantes demostraron un alto nivel de interés, de asistencia de diferentes provincias, y de compromiso. Los certificados emitidos otorgan créditos educativos válidos para la recertificación (AU)

The Federación Argentina de Medicina Familiar y General supported the development, dissemination and implementation of an educational proposal on research in primary care. It consists of 4 independent modules, intended for interested members, with 2 virtual theoretical-practical meetings, which favored the exchange of opinions and experiences among colleagues. The objective of the first module was to provide knowledge, guidelines and tools for bibliographic search and the use of citation managers. Dissemination was carried out through societies and social networks. An individual evaluation was included, to account for complementary reading and the practical application of the contents. It was carried out in June, with 39 pre-registered participants, mostly residents. There were 24 effective participants (61%), 17 and 20 people attended respectively, and 11 (46%) obtained the certificate of approval for answering the instructions in due time and form. As for the attendees, there was a predominance of women (79%), coming from Asociación Metropolitana de Medicina Familiar (25%), Asociación Cordobesa de Medicina Familiar y Comunitaria (16%), Asociación Misionera de Medicina General/Familiar y del Equipo de Salud (16%), Asociación Tucumana de Medicina Familiar, General y Comunitaria (12%), and other minorities. They expressed satisfaction, gratitude, and recognition for the activity, highlighting the good predisposition of the organizers and teaching team, the practical usefulness of the subject matter, the evident planning, and the political-economic support. This valuable educational experience (raised as a pending need) was successful since the participants showed a high level of interest, attendance from different provinces, and commitment. The certificates issued grant educational credits valid for recertification (AU)

Influencia de la consolidación de las tuberosidades en los resultados clínicos de la prótesis invertida para fracturas de húmero proximal / Influence of the consolidation of the tuberosities on the clinical outcomes of the reverse arthroplasty in proximal humerus fractures

Objetivo: Comparar los resultados clínicos y las complicaciones de una serie consecutiva de pacientes con fracturas de húmero proximal tratados con prótesis invertida de hombro y con consolidación anatómica de las tuberosidades o sin ella. Materiales y Métodos: Se evaluó a 113 pacientes >65 años con fractura de húmero proximal tratados con prótesis invertida de hombro. Setenta presentaron consolidación anatómica de las tuberosidades y 43, ausencia de consolidación. Se evaluó el rango de movilidad, y se utilizaron los puntajes de Constant-Murley, ASES, SANE y la escala analógica visual. Se documentaron todas las complicaciones y las reoperaciones. Resultados: El seguimiento promedio fue de 56 meses (rango 24-96) y la edad media era de 73 años (rango 65-83). La elevación activa y la rotación interna medias posoperatorias fueron de 131° (± 14) y 27° (± 5), respectivamente. La rotación externa posoperatoria media en abducción y aducción fue de 27° (± 1) y 15° (± 6), respectivamente. La escala analógica visual promedio posoperatoria fue de 1,7 (± 0,8). Los puntajes ASES, de Constant-Murley y SANE promedio fueron de 76 (± 6), 62 (± 11) y 74% (± 7), respectivamente. La elevación anterior, la rotación externa y los puntajes funcionales promedio finales ASES y de Constant-Murley fueron significativamente mejores en el grupo con consolidación de las tuberosidades. Conclusiones: En pacientes >65 años con fractura de húmero proximal tratados con prótesis invertida de hombro tanto la movilidad posoperatoria, como los puntajes funcionales fueron significativamente mejores en los pacientes con consolidación anatómica de las tuberosidades. Nivel de Evidencia: III

Objective: The objective of this study was to compare the clinical outcomes and complications of a consecutive series of patients with proximal humerus fractures (PHF) treated with reverse shoulder arthroplasty (RSA), with and without anatomical healing of the tuberosities. Materials and Methods: We evaluated 113 patients >65 years old with PHF treated with RSA. Seventy patients presented anatomical healing of the tuberosities and 43 presented absence of healing. Range of motion (ROM), Constant score, ASES score, visual analog scale (VAS) and the score of the numerical evaluation of single evaluation (SANE) were evaluated. Results: The mean follow-up was 56 months (range, 24-96 months) and the mean age was 73 years (range, 65-83 years). Mean postoperative active elevation and internal rotation were 131° (±14) and 27° (±5), respectively. The mean postoperative external rotation in abduction and adduction was 27° (±1) and 15° (±6) respectively. The mean postoperative VAS was 1.7 (±0.8). The mean ASES, Constant and SANE scores were 76 (±6), 62 (±11) and 74% (±7), respectively. Anterior elevation, external rotation, and final mean ASES and Constant functional scores were significantly better in the group with tuberosity healing than in the group without healing. Conclusions: In patients >65 years old with PHF treated with RSA, both postoperative ranges of motion and functional scores were significantly better in patients where anatomic tuberosity healing was achieved than in those where it was not achieved. Level of Evidence: III