Defining Metrics for Short Term Success After LVAD Implant: An Analysis of the Society of Thoracic Surgeons Intermacs Registry

Purpose: While clinical trials evaluating left ventricular assist device (LVAD) technology typically use composite outcomes to assess efficacy, composite outcomes including patient reported outcomes (PROs) have not been utilized as benchmarks for LVAD implant center performance improvement initiatives or quality ranking. The objective of the study was to assess the feasibility of generating a patient composite outcome measure including PROs from a real world registry. Methods: Short term (ST, 180 days) adverse events (AEs) and mortality were tallied for Intermacs patients undergoing LVAD implant between 1/2012 and 12/2019. ST postoperative events included mortality on first device and frequencies of stroke, reoperation (device malfunction/other), right heart failure (RHF), prolonged respiratory failure, and/or dialysis on first device. Logistic regression was used to generate odds ratios for mortality for each AE. Separately, the EuroQOL visual analog scale (VAS) was assessed at baseline and 180 days in ST survivors. Results: Of 20,115 patients, 37% suffered at least one event, most commonly death, reoperation and stroke (Table, column A). Stroke, prolonged respiratory failure, and dialysis attributed the most to ST mortality (Table, column B). Of the 16725 patients alive at 180 days, 43% completed a VAS with 82.0% showing VAS improvement. Renal failure and RHF contributed most to failure to improve VAS (Figure). Conclusion: Assessment of a ST composite outcome metric after LVAD implant from a real world data source is feasible but limited by incomplete PRO reporting. ST adverse events display differential effects on mortality and PROs that can be used in development of global rank outcome scores. While reoperation is common, stroke, prolonged respiratory failure and renal failure conferred highest risks of ST deaths within Intermacs. Assessment of PROs should become a priority for LVAD centers to allow the field to generate a complete assessment of patient-centered outcomes

Challenges facing early career academic cardiologists

Early career academic cardiologists currently face unprecedented challenges that threaten a highly valued career path. A team consisting of early career professionals and senior leadership members of American College of Cardiology completed this white paper to inform the cardiovascular medicine profession regarding the plight of early career cardiologists and to suggest possible solutions. This paper includes: 1) definition of categories of early career academic cardiologists; 2) general challenges to all categories and specific challenges to each category; 3) obstacles as identified by a survey of current early career members of the American College of Cardiology; 4) major reasons for the failure of physician-scientists to receive funding from National Institute of Health/National Heart Lung and Blood Institute career development grants; 5) potential solutions; and 6) a call to action with specific recommendations

Supporting shared decision making for older people with multiple health and social care needs: a realist synthesis

Background: Health care systems are increasingly moving towards more integrated approaches. Shared decision making (SDM) is central to these models but may be complicated by the need to negotiate and communicate decisions between multiple providers, as well as patients and their family carers; particularly for older people with complex needs. The aim of this review was to provide a context relevant understanding of how interventions to facilitate SDM might work for older people with multiple health and care needs, and how they might be applied in integrated care models. Methods: Iterative, stakeholder driven, realist synthesis following RAMESES publication standards. It involved: 1) scoping literature and stakeholder interviews (n-13) to develop initial programme theory/ies, 2) systematic searches for evidence to test and develop the theories, and 3) validation of programme theory/ies with stakeholders (n=11). We searched PubMed, The Cochrane Library, Scopus, Google, Google Scholar, and undertook lateral searches. All types of evidence were included. Results: We included 88 papers; 29 focused on older people or people with complex needs. We identified four context-mechanism-outcome configurations that together provide an account of what needs to be in place for SDM to work for older people with complex needs. This includes: understanding and assessing patient and carer values and capacity to access and use care, organising systems to support and prioritise SDM, supporting and preparing patients and family carers to engage in SDM and a person-centred culture of which SDM is a part. Programmes likely to be successful in promoting SDM are those that allow older people to feel that they are respected and understood, and that engender confidence to engage in SDM. Conclusions: To embed SDM in practice requires a radical shift from a biomedical focus to a more person-centred ethos. Service providers will need support to change their professional behaviour and to better organise and deliver services. Face to face interactions, permission and space to discuss options, and continuity of patient-professional relationships are key in supporting older people with complex needs to engage in SDM. Future research needs to focus on inter-professional approaches to SDM and how families and carers are involved

Accuracy of risk models used for public reporting of heart transplant center performance.

BACKGROUND: Heart transplant programs and regulatory entities require highly accurate performance metrics to support internal quality improvement activities and national oversight of transplant programs, respectively. We assessed the accuracy of publicly reported performance measures. METHODS: We used the United Network for Organ Sharing registry to study patients who underwent heart transplantation between January 1, 2016 and June 30, 2018. We used tests of calibration to compare the observed rate of 1-year graft failure to the expected risk of 1-year graft failure, which was calculated for each recipient using the July 2019 method published by the Scientific Registry of Transplant Recipients (SRTR). The primary study outcome was the joint test of calibration, which accounts for both the total number of events predicted (calibration-in-the-large) and dispersion of risk predictions (calibration slope). RESULTS: 6,528 heart transplants were analyzed. The primary test of calibration failed (p CONCLUSIONS: Risk models employed for publicly-reported graft survival at U.S. heart transplant centers lack accuracy in general and in all subgroups tested. The use of disease-specific models may improve the accuracy of program performance metrics

Changes of land use on peatlands in Poznań region

Celem badań było ustalenie zmian w sposobie użytkowania torfowisk Wielkopolski. Badania, wykonane w 2002 r., prowadzono na 124 torfowiskach o łącznej powierzchni ok. 4000 ha. Prace realizowano za pomocą badań terenowych oraz interpretacji zdjęć lotniczych i satelitarnych, stosując programy komputerowe do prac graficznych w celu określenia obszaru zajmowanego przez poszczególne użytki. Wydzielano łąki jedno- i dwukośne, łąki niekoszone, łąki zakrzewione, ekstensywne pastwiska, szuwary trzcinowe, wody stojące, grunty orne oraz lasy i zadrzewienia. Potwierdzono znaczne zmiany w sposobie użytkowania obiektów w stosunku do stanu z lat: 1957-1969, określonego na podstawie dokumentacji geologicznej torfowisk, 1993-1998 na podstawie zdjęć lotniczych oraz 1989-1991 na podstawie zdjęć satelitarnych. Przy opracowaniu wniosków, obok omawianych badań, wykorzystano wcześniej publikowane wyniki badań własnych [Restoration ..., 2002]. Ustalono, iż na torfowiskach dużych (śr. 2 524 ha) łąki niekoszone i częściowo zakrzewione zajmują 23,3% ich powierzchni na obiektach średnich (śr. 34 ha) - 10,2% i małych (śr. 8,4 ha) - 10,7%. Udział powierzchni gruntów ornych w tych grupach torfowisk odpowiednio: 2,4, 6,7 i 18%. W dolinach rzek Cybina i Główna zmiany sposobu użytkowania są największe. Wynikają one z wyłączenia z użytkowania dużej powierzchni podmokłych łąk, pokrytych obecnie szuwarami trzcinowymi i rzadkimi zadrzewieniami, oraz z budowy dużego zbiornika retencyjnego. Wykazano małą przydatność archiwalnych zdjęć lotniczych i satelitarnych do określenia aktualnego sposobu użytkowania torfowisk.The objective of studies carried out in 2002 was to determine changes in the peatland use in Poznań region. The studies included 124 peatlands covering a total area of 4000 ha. The work was accomplished by field studies and by interpretation of aerial and satellite images using graphical computer programmes to determine particular areas. The following land use types were distinguished: meadows mown once, meadows mown twice, not mown meadows, meadows with shrubs, extensive pastures, reed rushes, stagnant waters, arable lands, forests and thickets. Significant changes in the land use were found when geological documentation of peatlands made in the years 1957-1969, aerial photographs (1993-1998) and satellite images (1989-1991) were compared. Apart from the mentioned studies, earlier publications were used (Ilnicki, 2002) when formulating conclusions . It was found that on large peatlands (mean area 2524 ha), not mown meadows and meadows partially covered by shrubs occupied 23.3 % of the total area; in medium size objects (34 ha) and in small peatlands (8.4 ha) they covered 10.2 and 10.7 %, respectively. The share of arable land increased from 2.4 to 6.7 and 18 %, respectively. In the valleys of the Cybina and Główna rivers, the changes in land use were the greatest. They resulted from abandoned land use on large areas of wet meadows, currently covered by reed rushes and thickets and from the construction of a large retention reservoir. The archival aerial and satellite photographs proved to be of little value for the determination of peatland use