Lung transplantation in patients with cystic fibrosis and Mycobacterium abscessus infection

AbstractMycobacterium abscessus lung disease is difficult to treat and has been considered a strong relative contraindication to lung transplantation. We performed double lung transplantation in three cystic fibrosis patients with ongoing, and a fourth with recent treatment for Mycobacterium abscessus lung infection. Despite prolonged antibiotic courses and adjustment of immunosuppressive therapy the first three patients developed skin infection and abscesses. At follow-up after 1, 3, 5 and 7years respectively no patient had evidence of M abscessus infection and all had stable lung function. Lung transplantation in patients with M abscessus lung infection is feasible but may involve severe complications

Non-infectious sternal dehiscence after coronary artery bypass surgery

Funding Information: This study was funded by the University of Iceland Research Fund, Landspitali University Hospital Research Fund, and the Memorial Fund of Helga Jonsdottir & Sigurlidi Kristjansson. Publisher Copyright: © 2022, The Author(s). © 2022. The Author(s).Introduction: Non-infectious sternal dehiscence (NISD) is a known complication following coronary artery bypass grafting (CABG), with previous studies estimating an incidence of 0.4–1% of surgeries. We aimed to study the incidence of NISD together with short- and long-term outcomes in a whole-nation cohort of patients. Materials and methods: A retrospective study on consecutive CABG patients diagnosed with NISD at Landspitali from 2001 to 2020. Patients diagnosed with infectious mediastinitis (n = 20) were excluded. NISD patients were compared to patients with an intact sternum regarding patient demographics, cardiovascular risk factors, intra- and postoperative data, and estimated overall survival. The median follow-up was 9.5 years. Results: Twenty out of 2280 eligible patients (0.88%) developed NISD, and the incidence did not change over the study period (p = 0.98). The median time of diagnosis was 12 days postoperatively (range, 4–240). All patients were re-operated using a Robicsek-rewiring technique, with two cases requiring a titanium plate for fixation. Patients with NISD were older, had a higher BMI and EuroSCORE II, lower LVEF, and more often had a history of COPD, MI, and diabetes compared to those without NISD. Length of stay was extended by 15 days for NISD patients, but short and long-term survival was not statistically different between the groups. Conclusions: The incidence of NISD was low and in line with previous studies. Although the length of hospital stay was extended, both short- and long-term survival of NISD patients was not significantly different from patients with an intact sternum.Peer reviewe

Cardiovascular risk factors and peripheral vascular function in lung transplant recipients

Objective: Cardiovascular disease is a major contributor to morbidity and mortality after organ transplantation. Development of cardiovascular risk factors, like hypertension, is common after transplantation. The mechanism of post transplant hypertension is incompletely understood but vasoconstriction and endothelial dysfunction have been suggested to participate.Aims: To describe the prevalence of new-onset cardiovascular risk factors after lung transplantation, identify independent predictors and to investigate possible vascular mechanisms responsible for the development of hypertension after lung transplantation.Materials and methods: I: Lung transplant recipients (Ltx) without pre-transplant cardiovascular risk factors were included in a retrospective descriptive study. Cumulative prevalence of new-onset hypertension, hypercholesterolemia and diabetes were calculated, and independent preoperative predictors were identified. II-IV: Forearm vascular resistance (FVR) and effects on forearm blood flow of endothelial-dependent and independent vasodilators, inhibition of endothelial nitric oxide synthesis and endothelinA-receptor blockade were investigated in Ltx early (II-III) and late after transplantation (IV), and in healthy subjects by means of venous occlusion plethysmography. Plasma levels of endothelin-1 (ET-1) were determined and arterial compliance was measured by echo-tracking. Results: I: Three years after transplantation 90% of Ltx had developed at least one cardiovascular risk factor, and 40% two or more. Independent pre-transplant predictor for hypertension was; diastolic blood pressure, for hypercholesterolemia; serum-cholesterol level and for diabetes; cystic fibrosis and blood glucose level. II: Basal FVR, endothelial-independent vasodilatation and nitric oxide synthesis-inhibition induced vasoconstriction did not differ significantly between Ltx and controls. Ltx had an increased arterial stiffness. III: Ltx had an impaired vasodilatation to endothelinA-receptor blockade and increased plasma levels of ET-1. IV: Basal FVR was lower in Ltx late after transplantation while endothelial-dependent and -independent vasodilatation did not differ between the groups. There was a significant correlation between endothelin-1 levels and FVR in healthy subjects, but not in Ltx. Conclusions: Development of new-onset cardiovascular risk factors is common after lung transplantation and occurs early. No evidence of general vasoconstriction and endothelial dysfunction was detected after lung transplantation and accordingly, the results question this concept as being responsible for post-transplant hypertension. In contrast, alterations in endothelin-1 handling and endothelinA-receptor function were demonstrated in Ltx, which may have importance for the development of post-transplant hypertension

Incentive programs in co-operative enterprises : A study of change in the incentive program in a cooperative FMCG enterprise

Belöningssystem och dess utformning diskuteras både i organisationer samt forskningsvärlden. Att utforma ett fungerande belöningssystem är problematiskt och det är många faktorer att ta hänsyn till. Butiken och dess miljö är en viktig faktor i ett dagligvaruhandelsföretag för att skapa bästa upplevelsen för kunden. Butikschefen ansvarar för att skapa detta samt för att butiken ska fungera systematiskt. Men hur är ett belöningssystem utformat till butikschefer i ett dagligvaruhandelsföretag? När belöningssystem utformas finns risken att det inte leder till önskande beteenden. I dessa fall kan en förändring ske, men vad är det egentligen som motiverar förändringen? Det är detta denna rapport har tagit sikte på samt det faktum att organisationen är kooperativa påverkar ledningens beslut och således belöningssystemet. Studien kommer således att undersöka: ”Hur är ett belöningssystem utformat till butikschefer i ett svenskt kooperativt dagligvaruhandelsföretag och vad motiverar en förändring av det?”. För att undersöka detta problem har principal-agentteorin tillämpats för att belysa problematiken som kan uppstå mellan ledning och butikschefer. Kooperativa teorier öppnar till en diskussion om det faktum att organsationen är kooperativ har påverkat utformningen av belöningssystemet. Teorier kring belöningssystem utgör en del i den teoretiska referensramen för att förstå hur belöningssystem är utformade samt vad som kan motivera en förändring av dem. För att besvara problemet har en kvalitativ metod tillämpats där en fallstudie på Kf Göta har genomförts. Faktumet att organisationen är kooperativ påverkade inte belöningssystemets utformning direkt. Dock påverkades belöningssystemet indirekt på grund av den bristande medlemskontrollen och att de kooperativa värderingarna genomsyrar de dagliga besluten. Den förevarande studiens slutsats är att det inte endast finns ett optimalt belöningssystem som tillfredsställer alla organisationer utan det bör anpassas efter det beteende som ledningen vill främja. Vi har således kommit fram till att det är viktigt att belöna ett beteende som leder till ett bra resultat snarare än att bara belöna ett bra resultat.Incentive programs and its design is something that is discussed in organisations and academia. It’s problematic to design an effective incentive program and there’re many factors to consider. In a FMCG enterprise, the store and its environment is an important factor for creating the best experience for the customers. It’s the store manager's responsibility to make sure that everything in the store works in a systematic way. But how is a store manager incentive program designed in a FMCG enterprise? When incentive programs are designed, chances are that it does not lead to the behaviours that’s wanted. In these cases, a change may occur, but what actually motivates the change? This study has also reviewd if the fact that the organization is cooperative has affect the management decisions and therefore the incentive program. The study will examen "How is a incentive program designed to store managers in a Swedish cooperative FMCG enterprise and what motivates a change of it?”. To examine this problem, the principal-agent theory has been applied to illustrate the problem which can arise between management and store managers. Co-operative theories opens up to discussion about if the fact that the organisation is co-operatives has influenced the design of the incentive program. Theories about incentive programs is part of the theoretical framework for understanding how incentive programs are designed and what may motivate a change in them. To answer this problem, a qualitative method is applied and a case study on Kf Göta has been implemented. The fact that the organisation is co-operative did not affect the inceintive program design directly. However, it affected the incentive program indirectly because of the lack of member control and the co-operative values ​​permeate their daily decisions. The present study concludes that there is not only one optimal incentive program that suits all organisations, and it should be adapted to the behavior that management wants to promote. We have therefore concluded that it’s important to reward a behavior that leads to a good result rather than simply rewarding good results

The performance of EuroSCORE II in CABG patients in relation to sex, age, and surgical risk: a nationwide study in 14,118 patients

Abstract Background To determine the discriminative accuracy and calibration of EuroSCORE II in relation to age, sex, and surgical risk in a large nationwide coronary artery bypass grafting (CABG) cohort. Methods All 14,118 patients undergoing isolated CABG in Sweden during 2012–2017 were included. Individual patient data were taken from the SWEDEHEART registry. Patients were divided by age ( 8%). Discriminative accuracy was determined by the area under the receiver operating characteristic curve (AUC) and calibration by the observed/estimated (O/E) mortality ratio at 30 days. Results AUC and O/E ratio were 0.82 (95% CI 0.79–0.85) and 0.58 (0.50–0.66) overall, 0.82 (0.79–0.86) and 0.57 (0.48–0.66) in men, and 0.79 (0.73–0.85) and 0.60 (0.47–0.75) in women. Regarding age, discriminative accuracy was highest in patients aged 60–69 years (AUC: 0.86 [0.80–0.93]) but was satisfactory in all groups (AUC: 0.74–0.80). O/E ratio varied from 0.26 for patients > 60 years to 0.90 for patients > 80 years. Regarding surgical risk, AUC and O/E ratio were 0.63 (0.44–0.83) and 0.18 (0.09–0.30) in low-risk patients, 0.60 (0.55–0.66) and 0.57 (0.46–0.68) in intermediate-risk patients, and 0.78 (0.73–0.83) and 0.78 (0.64–0.92) in high-risk patients. Conclusions EuroSCORE II had good discriminative accuracy independently of sex and age, but markedly overestimated mortality risk, especially in younger patients. Accuracy and calibration were better in high-risk patients than in low-risk and intermediate-risk patients

Forty year old female with cough and chest pain

Peer reviewe

Forty year old female with cough and chest pain

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