The MELD score in patients awaiting liver transplant: strengths and weaknesses.

Adoption of the Model for End-stage Liver Disease (MELD) to select and prioritize patients for liver transplantation represented a turning point in organ allocation. Prioritization of transplant recipients switched from time accrued on the waiting list to the principle of "sickest first". The MELD score incorporates three simple laboratory parameters (serum creatinine and bilirubin, and INR for prothrombin time) and stratifies patients according to their disease severity in an objective and continuous ranking scale. Concordance statistics have demonstrated its high accuracy in stratifying patients according to their risk of dying in the short-term (three months). Further validations of MELD as a predictor of survival at various temporal end-points have been obtained in independent patient cohorts with a broad spectrum of chronic liver disease. The MELD-based liver graft allocation policy has led to a reduction in waitlist new registrations and mortality, shorter waiting times, and an increase in transplants, without altering overall graft and patient survival rates after transplantation. MELD limitations are related either to the inter-laboratory variability of the parameters included in the score, or to the inability of the formula to predict mortality accurately in specific settings. For some conditions, such as hepatocellular carcinoma, widely accepted MELD corrections have been devised. For others, such as persistent ascites and hyponatremia, attempts to improve MELD's predicting power are currently underway, but await definite validation

Is religious diversity good for team performance?

Yes, but when equally sized subgroups form, they may become confrontational, write Alessandro Ancarani, Ali A. Ayach, Carmela Di Mauro, Paolo Mancuso and Simone Gitt

Specific characteristics of STEMI in COVID-19 patients and their practical implications

ST-elevation myocardial infarction (STEMI) is one of the cardiac emergencies whose management has been most challenged by the COVID-19 pandemic. Patients presenting with the “lethal combo” of STEMI and concomitant SARS-CoV-2 infection have faced dramatic issues related to the need for self-isolation, systemic inflammation with multi-organ disease and difficulties to obtain timely diagnosis and treatment. The interplay between these and other factors has partly neutralized the major advances in STEMI care achieved in the last decades, significantly impairing prognosis in these patients. In the present review article, we will provide an overview on mechanisms of myocardial injury, specific clinical and angiographic characteristics and contemporary management in different settings of STEMI patients with COVID-19, alongside the inherent implications in terms of in-hospital mortality and short-term clinical outcomes

A case of a shocking rhythm

We report a case of a 40-day-old patient admitted to the neonatal and paediatric intensive care unit for severe cardiovascular failure with an initial sinus rhythm. The first diagnostic hypothesis was septic shock, thus antibiotics, fluid resuscitation, inotropic drugs and ventilatory supportwere immediately started. After achieving haemodynamic stability, a new cardiovascular failure occurred with supraventricular tachycardia (SVT), making diagnosis of cardiogenic shock. Cardiogenic shock should be considered, although it is a rare cause of shock in children. SVT may be a cause of cardiogenic shock, therefore it should be diagnosed whit the aid of a cardiorespiratory monitor, which represents a useful device in the differential diagnosis of the various types of shock

A case of pleural empyema treated with intrapleuralurokinase

Pleural empyema, a severe complication of bacterial pneumonia, is a rare entity in the neonatal period. Treatment with systemic antibiotics and tube drainage may fail because of the thick viscous fluid, bacterial products with fibrin deposition, and multiple involvement. Intrapleural fibrinolytic therapy with urokinase is an effective and non-invasive treatment option that avoids surgical intervention, although its use in neonates has not been studied extensively. In this report, we describe the case of a 39-day-old male newborn with pneumonia and pleural empyema, treated successfully with antibiotics, chest tube drainage and intrapleuralurokinase

An empirical analysis of the profitability of backshoring initiatives to Europe

Purpose: The study investigates the profitability of manufacturing firms backshoring (BS) to Europe. In particular, the article analyses the relation between BS drivers and post-relocation profitability and tests whether this relation is moderated by innovation policies that firms adopt in conjunction with BS. Design/methodology/approach: The empirical model links the post-relocation profitability to BS drivers, firms’ involvement in product innovation and/or adoption of new manufacturing technologies. Data concerning BS initiatives to Europe between 2012 and 2018 extracted from secondary sources have been matched to firms’ balance sheet data. Findings: Results show that responsiveness-driven BS is associated with higher profitability when the relocation is coupled with product innovation. A second key finding is that the adoption of new manufacturing technologies has a positive impact on post-BS profitability. Research limitations/implications: The restriction of the dataset to firms for which information on post- and pre-BS financial performance was available has led to a small sample size. Availability of longer time series of profitability data will allow estimating long-term impact, especially for innovation. Practical implications: The study provides first evidence on the impact of BS on financial performance and throws light on the relevance of innovation as a lever supporting manufacturing relocation to high-cost countries. Originality/value: The study advances empirical research on BS by offering evidence of its impact on profitability and by linking it to previous research on BS drivers. Further, the study throws light on the role of different drivers as “success factors” of BS and on how they interact with innovation efforts. The study also offers insights to business leaders who are evaluating the potential benefits on company profitability of a return to a high cost-environment and provides useful indications on the conditions under which BS pays off

Forecasting national and regional level intensive care unit bed demand during COVID-19: The case of Italy.

Given the pressure on healthcare authorities to assess whether hospital capacity allows properly responding to outbreaks such as COVID-19, there is a need for simple, data-driven methods that may provide accurate forecasts of hospital bed demand. This study applies growth models to forecast the demand for Intensive Care Unit admissions in Italy during COVID-19. We show that, with only some mild assumptions on the functional form and using short time-series, the model fits past data well and can accurately forecast demand fourteen days ahead (the mean absolute percentage error (MAPE) of the cumulative fourteen days forecasts is 7.64). The model is then applied to derive regional-level forecasts by adopting hierarchical methods that ensure the consistency between national and regional level forecasts. Predictions are compared with current hospital capacity in the different Italian regions, with the aim to evaluate the adequacy of the expansion in the number of beds implemented during the COVID-19 crisis

Stem cells for end stage liver disease: How far have we got?

End stage liver disease (ESLD) is a health problem worldwide. Liver transplantation is currently the only effective therapy, but its many drawbacks include a shortage of donors, operative damage, risk of rejection and in some cases recidivism of the pre-transplant disease. These factors account for the recent growing interest in regenerative medicine. Experiments have sought to identify an optimal source of stem cells, sufficient to generate large amounts of hepatocytes to be used in bioartificial livers or injected in vivo to repair the diseased organ. This update aims to give non-stem cell specialists an overview of the results obtained to date in this fascinating field of biomedical research

“Ordine dei Medici Chirurghi ed Odontoiatri di Bologna ” (SL).

doi:10.3748/wjg.14.4593 © 2008 The WJG Press. All rights reserved. Stem cells for end stage liver disease: How far have we got

Technology acquisition and efficiency in Dubai hospitals

The paper studies the impact of the acquisition of relevant medical technology and information technology on the efficiency of hospital wards in three public hospitals in Dubai. Efficiency scores are obtained through bootstrapped data envelopment analysis, and are then regressed on variables assessing the extent of technology acquisition using truncated regression. Results show that both the acquisition of medical technology and of information technology have a positive impact on the ward efficiency, but that the strength of this relation is moderated by several variables related to organizational and managerial factors. In particular, results point out that the relationship between efficiency and technology is positively moderated by the ability of the head of ward to manage internal conflicts, by the managerial goals, and by the tenure of the head of ward. A negative moderating impact is exerted by perceived constraints to managerial actions, such as conflicting priorities with the hospital general management