Citations

AbstractBackgroundSignificant numbers of patients in the USA and UK die while waiting for solid organ transplant. Only 1–2% of deaths are eligible as donors with a fraction of the deceased donating organs. The form of consent to donation may affect the organs available. Forms of consent include: opt‐in, mandated choice, opt‐out, and organ conscription. Opt‐in and opt‐out are commonly practiced. A systematic review was conducted to determine the effect of opt‐in versus opt‐out consent on the deceased donation rate (DDR) and deceased transplantation rate (DTR).MethodsLiterature searches of PubMed and EMBASE between 2006 and 2016 were performed. Research studies were selected based on certain inclusion criteria which include USA, UK, and Spain; compare opt‐in versus opt‐out; primary data analysis; and reported DDR or DTR. Modeled effect on US transplant activity was conducted using public data from Organ Procurement and Transplantation Network and Centers for Disease Control WONDER from 2006 to 2015.ResultsA total of 2400 studies were screened and six studies were included. Four studies reported opt‐out consent increases DDR by 21–76% over 5–14 years. These studies compared 13–25 opt‐out countries versus 9–23 opt‐in countries. Three studies reported opt‐out consent increases DTR by 38–83% over 11–13 years. These studies compared 22–25 opt‐out versus 22–28 opt‐in countries. Modeled opt‐out activity on the USA resulted in 4753–17,201 additional transplants annually.ConclusionOpt‐out consent increases DDR and DTR and may be useful in decreasing deaths on the waiting list in the USA and other countries.Registration numberPROSPERO CRD42019098759.

Context High‐quality research into education costs can inform better decision making. Improvements to cost research can be guided by information about the research questions, methods and reporting of studies evaluating costs in health professions education (HPE). Our objective was to appraise the overall state of the field and evaluate temporal trends in the methods and reporting quality of cost evaluations in HPE research. Methods We searched the MEDLINE , CINAHL (Cumulative Index to Nursing and Allied Health Literature), EMBASE , Business Source Complete and ERIC (Education Resources Information Centre) databases on 31 July 2017. To evaluate trends over time, we sampled research reports at 5‐year intervals (2001, 2006, 2011 and 2016). All original research studies in HPE that reported a cost outcome were included. The Medical Education Research Study Quality Instrument ( MERSQI ) and the BMJ economic checklist were used to appraise methodological and reporting quality, respectively. Trends in quality over time were analysed. Results A total of 78 studies were included, of which 16 were published in 2001, 15 in 2006, 20 in 2011 and 27 in 2016. The region most commonly represented was the USA ( n = 43). The profession most commonly referred to was that of the physician ( n = 46). The mean ± standard deviation ( SD ) MERSQI score was 10.9 ± 2.6 out of 18, with no significant change over time (p = 0.55). The mean ± SD BMJ score was 13.5 ± 7.1 out of 35, with no significant change over time (p = 0.39). A total of 49 (63%) studies stated a cost‐related research question, 23 (29%) stated the type of cost evaluation used, and 31 (40%) described the method of estimating resource quantities and unit costs. A total of 16 studies compared two or more interventions and reported both cost and learning outcomes. Conclusions The absolute number of cost evaluations in HPE is increasing. However, there are shortcomings in the quality of methodology and reporting, and these are not improving over time.

Abstract Objectives Visceral Leishmaniasis (VL) can be symptomatic and asymptomatic infection. In this study we aimed at investigating the prevalence of asymptomatic infections and to study risk factors of VL in non-endemic regions in Gedaref state, Sudan. A descriptive cross-sectional study conducted during 2014. Blood samples were collected to serological and molecular analysis. Sticky traps, knockdown spray and CDC miniature light traps were used for the collection of sandflies. Results Ninety-Five participants were included; 52 from Abukishma, 15 Algadamblia Tirfa, 25 Abualnaja and 3 were from Algadamblia Aljabal. Most of the study participants were belonging to the Belala tribe (74.3%). The most frequent reported age was above 40-years old (9.5%). Females were (61.1%) and males were (38.9%). B. aeygptica was the most planted tree in/around the houses (46.3%). 73 (76.8%) of the participants bred more than two types of animals in the house. DAT test revealed 5 positive participants (5.2%). 4/5 DAT positive were past VL infection. PCR detected 35 (36.8%) positive patients. A total of 31 (32.6%) were considered asymptomatic infections based on PCR detection method. Households planted Balanites/Acacia trees or breed domestic animals were found in high percentages with VL PCR positive participants (60.1%, 91.4%).

Abstract Objectives: Prostate cancer (PC) is common cancer worldwide. Several markers have been developed to differentiate between benign prostatic hyperplasia (BPH) from PC. A descriptive retrospective hospital-based study aimed at determining the expression of Cyclin D1 in BPH and PC. the study took place at different histopathology laboratories in Khartoum state, Sudan, from December 2016 to January 2019. Formalin-fixed paraffin-embedded blocks were sectioned and fixed in 3-aminopropyltriethoxysilane coated slides incubated into primary antibody for Cyclin D1. The assessment of immunoreactivity of Cyclin D1 of each section was done using the Gleason scoring system. Results: A total of 153 males’ prostate sections included in this study, of them, 120 (78.4%) were PC, and 33 (21.6%) were BPH. Their age ranged from 45 to 88 years, mean age was 66.19 ± 8.599. 142 (92.8%) did not have a family history of PC, while 11 (7.2%) patients reported having a family history. The Gleason scoring showed a total of 81 (52.9%) patients with high-grade and 39 (25.5%) with low-grade. 118 (97.5%) patients had PC showed positive results for Cyclin D1, while BPH was 3 (2.5%). P value < 0.001. Cyclin D1 staining was associated with high-grade Gleason score and perineural invasion, P value 0.001.

Abstract Purpose: To develop a prognostic model and cytogenetic risk classification for previously treated patients with chronic lymphocytic leukemia (CLL) undergoing reduced intensity conditioning (RIC) allogeneic hematopoietic cell transplantation (HCT). Experimental Design: We performed a retrospective analysis of outcomes of 606 patients with CLL who underwent RIC allogeneic HCT between 2008 and 2014 reported to the Center for International Blood and Marrow Transplant Research. Results: On the basis of multivariable models, disease status, comorbidity index, lymphocyte count, and white blood cell count at HCT were selected for the development of prognostic model. Using the prognostic score, we stratified patients into low-, intermediate-, high-, and very-high-risk [4-year progression-free survival (PFS) 58%, 42%, 33%, and 25%, respectively, P &lt; 0.0001; 4-year overall survival (OS) 70%, 57%, 54%, and 38%, respectively, P &lt; 0.0001]. We also evaluated karyotypic abnormalities together with del(17p) and found that del(17p) or ≥5 abnormalities showed inferior PFS. Using a multivariable model, we classified cytogenetic risk into low, intermediate, and high (P &lt; 0.0001). When the prognostic score and cytogenetic risk were combined, patients with low prognostic score and low cytogenetic risk had prolonged PFS (61% at 4 years) and OS (75% at 4 years). Conclusions: In this large cohort of patients with previously treated CLL who underwent RIC HCT, we developed a robust prognostic scoring system of HCT outcomes and a novel cytogenetic-based risk stratification system. These prognostic models can be used for counseling patients, comparing data across studies, and providing a benchmark for future interventions. For future study, we will further validate these models for patients receiving targeted therapies prior to HCT.