scholarly journals Lung transplantation program for Hungarian patients

2013 ◽  
Vol 154 (22) ◽  
pp. 868-871 ◽  
Author(s):  
György Lang ◽  
Krisztina Czebe ◽  
Balázs Gieszer ◽  
Ferenc Rényi-Vámos
Keyword(s):  
Lung Transplantation ◽  
Organ Procurement ◽  
Therapeutic Option ◽  
Policy Decision ◽  
Technical Requirements ◽  
Health Policy Decision ◽  
Long Term Follow Up ◽  
End Stage ◽  
The University ◽  
Transplantation Procedures

When conservative treatment fails, lung transplantation often remains the only therapeutic option for patients with end stage parenchymal or vascular lung diseases. According to the statistics of the International Society for Heart and Lung Transplantation, in 2010 more than 3500 lung transplantations have been performed worldwide. The Department of Thoracic Surgery at the University of Vienna is considered to be one of the world’s leading lung transplantation centres; in the last year 115, since 1989 more than 1500 lung transplantation procedures under the supervision of Prof. Dr. Walter Klepetko. Similar to other Central-European countries, lung transplantation procedures of Hungarian patients have also been performed in Vienna whithin the framework of a twinning aggreement. However, many crucial tasks in the process, such indication and patient selection preoperative rehabilitation organ procurement and long term follow-up care have been stepwise taken over by the Hungarian team. Although the surgery itself is still preformed in Vienna, professional experience is already available in Hungary, since the majority of Hungarian recipients have been transplanted by hungarian surgeons who are authors of this article the professional and personal requirements of performing lung transplantations are already available in Hungary. The demand of performing lung transplantation in Hungary has been raising since 1999 and it soon reaches the extent which justifies launching of an individual national program. Providing the technical requirements is a financial an organisational issue. In order to proceed, a health policy decision has to be made. Orv. Hetil., 2013, 154, 868–871.

scholarly journals The politics of health policy knowledge transfer: the evolution of the role of British health economics academic units

2019 ◽  
Vol 15 (4) ◽  
pp. 489-507 ◽  
Author(s):  
Eleanor MacKillop ◽  
Sally Sheard
Keyword(s):  
Health Policy ◽  
Health Economics ◽  
Knowledge Transfer ◽  
Policy Decision ◽  
Policy Makers ◽  
Department Of Health ◽  
Health Policy Decision ◽  
Academic Units ◽  
The University

Economics is now central to health policy decision making, within government departments and the National Health Service. We examine how and why a health economics academic unit ‐ the Centre for Health Economics (CHE) at the University of York, England ‐ was created in 1983, funded and commissioned to provide research evidence to the British government, specifically the Department of Health and Social Security (DHSS) and its successors. Building on the knowledge transfer literature, we document the origins of this relationship and the different strategies deployed by successive governments and researchers. This paper demonstrates the value of historical methodologies such as oral history and textual analysis that highlight the limitations of existing knowledge transfer theories, by foregrounding the role of politics via the construction of individual relationships between academics and policy-makers.

Chronic Lung Allograft Dysfunction: Evolving Concepts and Therapies

2018 ◽  
Vol 39 (02) ◽  
pp. 155-171 ◽  
Author(s):  
Ariss DerHovanessian ◽  
W. Wallace ◽  
Joseph Lynch ◽  
John Belperio ◽  
S. Weigt
Keyword(s):  
Lung Transplantation ◽  
Therapeutic Option ◽  
Bronchiolitis Obliterans Syndrome ◽  
Term Survival ◽  
Chronic Lung Allograft Dysfunction ◽  
Allograft Dysfunction ◽  
Restrictive Allograft Syndrome ◽  
Technical Advances ◽  
End Stage

AbstractLung transplantation has become an established therapeutic option for a variety of end-stage lung diseases. Technical advances in graft procurement, implantation, perioperative care, immunosuppression, and posttransplant medical management have led to significant improvements in 1-year survival, but outcomes after the first year have improved minimally over the last two decades. The main limitation to better long-term survival after lung transplantation is chronic lung allograft dysfunction (CLAD). CLAD also impairs quality of life and increases the costs of medical care. Our understanding of CLAD manifestations, risk factors, and mechanisms is rapidly evolving. Recognition of different CLAD phenotypes (e.g., bronchiolitis obliterans syndrome and restrictive allograft syndrome) and the unique pathogenic mechanisms will be important for developing novel therapies. In addition to alloimmune-mediated rejection, we now recognize the importance of alloimmune-independent mechanisms of injury to the allograft. CLAD is the consequence of dysregulated repair of allograft injury. Unfortunately, currently available therapies for CLAD are usually not effective. However, the advances in knowledge, reviewed in this manuscript, should lead to novel strategies for CLAD prevention and treatment, as well as improvement in long-term outcomes after lung transplantation. We provide an overview of the evolving terminology related to CLAD, its varying clinical phenotypes and their diagnosis, natural history, pathogenesis, and potential treatments.

Selection Criteria for Lung Transplantation: Controversies and New Developments

2021 ◽  
Vol 42 (03) ◽  
pp. 329-345
Author(s):  
Hanne Beeckmans ◽  
Saskia Bos ◽  
Robin Vos
Keyword(s):  
Lung Transplantation ◽  
Selection Criteria ◽  
Therapeutic Option ◽  
Controversial Issues ◽  
Meaningful Improvement ◽  
New Developments ◽  
Transplant Candidates ◽  
End Stage ◽  
Improvement In Survival

AbstractLung transplantation is an accepted therapeutic option for end-stage lung diseases. The imbalance between limited availability and vast need of donor organs necessitates careful selection of recipient candidates, ensuring the best possible utilization of the scarce resource of organs. Nonetheless, possible lung transplant candidates who could experience a meaningful improvement in survival and quality of life should not be excluded solely based on the complexity of their case. In this review, controversial issues or difficult limitations for lung transplantation, and new developments in recipient selection criteria, are discussed, which may help broaden recipient eligibility for lung transplantation without compromising long-term outcomes.

Organ Procurement

2015 ◽  
Author(s):  
Prosanto Chaudhury ◽  
Talia B. Baker ◽  
Anton I. Skaro ◽  
Paul Alvord
Keyword(s):  
Perioperative Management ◽  
Organ Procurement ◽  
Therapeutic Option ◽  
Organ Shortage ◽  
Donor Pool ◽  
Current State ◽  
Heart Beating ◽  
Donor Evaluation ◽  
Living Donor Transplantation ◽  
End Stage

Improvements in immunosuppression, organ preservation, surgical technique, and recipient management have led to the widespread adoption of transplantation as a viable therapeutic option for end-stage organ disease. Consequently, more patients than ever are benefiting from organ transplantation. Unfortunately, the rate of organ donation has not kept pace with the increase in the number of recipients awaiting transplantation. The relative shortage of organs has necessitated an increasing reliance on creative strategies aimed at broadening or expanding the limits of the donor pool. For instance, organs now are frequently obtained from so-called extended-criteria donors (i.e., donors who are elderly or who have significant comorbid conditions) or from non-heart-beating donors. A particularly important strategy for alleviating the organ shortage has been the broader application of living donor transplantation. The authors outline the current state of organ procurement from both cadaveric and living donors, including donor evaluation, perioperative management, and the various donor procedures. This review contains 14 figures, 1 table, and 63 references.

EURRECA’s Approach for Estimating Micronutrient Requirements

2011 ◽  
Vol 81 (4) ◽  
pp. 256-263 ◽  
Author(s):  
Christophe Matthys ◽  
Pieter van ‘t Veer ◽  
Lisette de Groot ◽  
Lee Hooper ◽  
Adriënne E.J.M. Cavelaars ◽  
...  
Keyword(s):  
Reference Values ◽  
Policy Decision ◽  
Individual Variability ◽  
The Body ◽  
Decision Makers ◽  
Nutrient Requirements ◽  
Factorial Approach ◽  
Dietary Reference Values ◽  
Health Policy Decision ◽  
Quantitative Integration

In Europe, micronutrient dietary reference values have been established by (inter)national committees of experts and are used by public health policy decision-makers to monitor and assess the adequacy of diets within population groups. The approaches used to derive dietary reference values (including average requirements) vary considerably across countries, and so far no evidence-based reason has been identified for this variation. Nutrient requirements are traditionally based on the minimum amount of a nutrient needed by an individual to avoid deficiency, and is defined by the body’s physiological needs. Alternatively the requirement can be defined as the intake at which health is optimal, including the prevention of chronic diet-related diseases. Both approaches are confronted with many challenges (e. g., bioavailability, inter and intra-individual variability). EURRECA has derived a transparent approach for the quantitative integration of evidence on Intake-Status-Health associations and/or Factorial approach (including bioavailability) estimates. To facilitate the derivation of dietary reference values, EURopean micronutrient RECommendations Aligned (EURRECA) is developing a process flow chart to guide nutrient requirement-setting bodies through the process of setting dietary reference values, which aims to facilitate the scientific alignment of deriving these values.

scholarly journals Impact of public health interventions to curb SARS-CoV-2 spread assessed by an evidence-educated Delphi panel and tailored SEIR model

2021 ◽  
Author(s):  
Bernd Brüggenjürgen ◽  
Hans-Peter Stricker ◽  
Lilian Krist ◽  
Miriam Ortiz ◽  
Thomas Reinhold ◽  
...  
Keyword(s):  
Public Health ◽  
Transmission Rate ◽  
Latency Period ◽  
Policy Decision ◽  
Sensitivity Analyses ◽  
Delphi Panel ◽  
Time Step ◽  
Seir Model ◽  
Health Policy Decision ◽  
The Impact

Abstract Aim To use a Delphi-panel-based assessment of the effectiveness of different non-pharmaceutical interventions (NPI) in order to retrospectively approximate and to prospectively predict the SARS-CoV-2 pandemic progression via a SEIR model (susceptible, exposed, infectious, removed). Methods We applied an evidence-educated Delphi-panel approach to elicit the impact of NPIs on the SARS-CoV-2 transmission rate R0 in Germany. Effectiveness was defined as the product of efficacy and compliance. A discrete, deterministic SEIR model with time step of 1 day, a latency period of 1.8 days, duration of infectiousness of 5 days, and a share of the total population of 15% assumed to be protected by immunity was developed in order to estimate the impact of selected NPI measures on the course of the pandemic. The model was populated with the Delphi-panel results and varied in sensitivity analyses. Results Efficacy and compliance estimates for the three most effective NPIs were as follows: test and isolate 49% (efficacy)/78% (compliance), keeping distance 42%/74%, personal protection masks (cloth masks or other face masks) 33%/79%. Applying all NPI effectiveness estimates to the SEIR model resulted in a valid replication of reported occurrence of the German SARS-CoV-2 pandemic. A combination of four NPIs at consented compliance rates might curb the CoViD-19 pandemic. Conclusion Employing an evidence-educated Delphi-panel approach can support SARS-CoV-2 modelling. Future curbing scenarios require a combination of NPIs. A Delphi-panel-based NPI assessment and modelling might support public health policy decision making by informing sequence and number of needed public health measures.

scholarly journals Fertility and Pregnancy in End Stage Kidney Failure Patients and after Renal Transplantation: An Update

2021 ◽  
Vol 2 (2) ◽  
pp. 92-108
Author(s):  
Maurizio Salvadori ◽  
Aris Tsalouchos
Keyword(s):  
Renal Transplantation ◽  
Time Lapse ◽  
Sexual Life ◽  
End Stage Kidney Disease ◽  
Correct Evaluation ◽  
Functional Aspects ◽  
Long Term Follow Up ◽  
End Stage

Sexual life and fertility are compromised in end stage kidney disease both in men and in women. Successful renal transplantation may rapidly recover fertility in the vast majority of patients. Pregnancy modifies anatomical and functional aspects in the kidney and represents a risk of sensitization that may cause acute rejection. Independently from the risks for the graft, pregnancy in kidney transplant may cause preeclampsia, gestational diabetes, preterm delivery, and low birth weight. The nephrologist has a fundamental role in correct counseling, in a correct evaluation of the mother conditions, and in establishing a correct time lapse between transplantation and conception. Additionally, careful attention must be given to the antirejection therapy, avoiding drugs that could be dangerous to the newborn. Due to the possibility of medical complications during pregnancy, a correct follow-up should be exerted. Even if pregnancy in transplant is considered a high risk one, several data and studies document that in the majority of patients, the long-term follow-up and outcomes for the graft may be similar to that of non-pregnant women.

scholarly journals Postlaunch evidence-generation studies for medical devices in Spain: the RedETS approach to integrate real-world evidence into decision making

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Pedro Serrano-Aguilar ◽  
Iñaki Gutierrez-Ibarluzea ◽  
Pilar Díaz ◽  
Iñaki Imaz-Iglesia ◽  
Jesús González-Enríquez ◽  
...  
Keyword(s):  
Decision Making ◽  
Medical Devices ◽  
Real World ◽  
Policy Decision ◽  
Assessment Process ◽  
The European Union ◽  
Political Commitment ◽  
Real World Evidence ◽  
Health Policy Decision ◽  
Regional Health Authorities

Abstract The Monitoring Studies (MS) program, the approach developed by RedETS to generate postlaunch real-world evidence (RWE), is intended to complement and enhance the conventional health technology assessment process to support health policy decision making in Spain, besides informing other interested stakeholders, including clinicians and patients. The MS program is focused on specific uncertainties about the real effect, safety, costs, and routine use of new and insufficiently assessed relevant medical devices carefully selected to ensure the value of the additional research needed, by means of structured, controlled, participative, and transparent procedures. However, despite a clear political commitment and economic support from national and regional health authorities, several difficulties were identified along the development and implementation of the first wave of MS, delaying its execution and final reporting. Resolution of these difficulties at the regional and national levels and a greater collaborative impulse in the European Union, given the availability of an appropriate methodological framework already provided by EUnetHTA, might provide a faster and more efficient comparative RWE of improved quality and reliability at the national and international levels.

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