Search Results (163)

Background: Kidney transplantation from a living donor is considered the most beneficial form of treatment for end-stage renal failure, which, in addition to providing patients with better treatment results, significantly improves their quality of life. Understanding factors that influence the willingness to donate kidneys to strangers is critical in promoting and expanding the living donor pool. When considering the decision to become an altruistic kidney donor, individuals must evaluate multiple factors, including the identity of the recipient and their own perceived level of safety. This study aimed to assess the willingness of dialysis center employees to act as living kidney donors for a stranger. Methods: We conducted a cross-sectional study from February 2023 to June 2024 among dialysis specialists across Poland. The study involved 1093 people (doctors and nurses). The study used our survey questionnaire and standardized tools. Results: Nurses (vs. physicians) and those who advocated the regulation of unspecified living kidney donation in Poland, did not believe in the risk of organ trafficking, and would donate a kidney to a husband/wife or friend and accept kidney transplantation from a husband/wife were more likely to donate a kidney to a stranger. Furthermore, respondents who accepted a loved one’s decision to donate a kidney to a stranger were significantly more willing to donate a kidney to such a person themselves. Perceived self-efficacy was positively associated with the willingness to donate a kidney to a stranger. Conclusions: Less than half of healthcare professionals supported unspecific living organ donation in Poland, and nurses were more willing to donate than physicians. The factors supporting the decision generally included knowledge about organ donation and transplantation, a lack of fear of organ trafficking, and attitudes towards donation. Full article

Patients undergoing epidermal growth factor receptor inhibitor (EGFRI) therapy frequently experience dermatologic side effects, notably papulopustular rash, which impacts 50–90% of recipients. This rash typically appears on the face, chest, and back within weeks of treatment, resembling acne but stemming from distinct pathophysiological mechanisms, causing significant discomfort and reduced quality of life. Prophylactic measures and symptom-based treatment are recommended, emphasizing patient education, topical agents, and systemic therapies for severe cases. A 41-year-old female with advanced colonic mucinous adenocarcinoma developed severe acneiform rash and pruritus during EGFRI therapy with panitumumab. Initial standard treatment with oral doxycycline was discontinued after two days due to severe gastrointestinal intolerance characterized by intense nausea and dyspepsia. With limited access to dermatological consultation, treatment with rose stem cell-derived exosomes (RSCEs) provided rapid symptom relief. Significant improvement was observed within 24 h, with complete resolution of pruritus and substantial reduction in inflammatory lesions within 72 h. RSCEs demonstrate anti-inflammatory effects through the modulation of pro-inflammatory cytokines including interleukin-6, interleukin-1β, and tumor necrosis factor-α, while promoting fibroblast proliferation and collagen synthesis enhancement. They may represent a possible alternative to corticosteroids, avoiding associated side effects such as skin atrophy, delayed wound healing, and local immunosuppression. This case underscores the potential of innovative treatments like RSCEs in managing EGFRI-induced skin complications when standard therapies are not tolerated, particularly in healthcare systems with limited dermato-oncological resources. Full article

Background: Advanced home care is becoming increasingly common for cancer patients and serves as a viable alternative to inpatient hospital care. The transition to home care is driven by both the rising costs of healthcare and evidence indicating better quality of care. This study aims to compare the costs of hospital-at-home treatment and in-hospital care for patients undergoing allo-HSCT. Methods: The cost analysis was conducted as a case–control study comparing the costs of allo-HSCT at home (HaH) to the costs of allo-HSCT for patients receiving in-hospital care (INH). The cost evaluation was conducted from the hospital’s perspective, which means that costs incurred outside the hospital setting were not included. Post-procedural costs for the first year after allo-HSCT included all readmissions and outpatient visits at Oslo University Hospital. Results: The cost for the peritransplant period could be reduced by up to 33% by treating allo-HSCT recipients at home instead of in the hospital. During the study period, 24% of the allo-HSCT recipients were treated at home, but our data from 2021 and 2022 indicate that at least a third of the patients scheduled for allo-HSCT are candidates for HaH. Conclusions: The findings demonstrate that patients in advanced home care experience significantly lower total costs compared to those receiving in-hospital treatment. Full article

Although transplantation remains the gold-standard treatment for patients with end-organ failure, lifelong adherence to immunosuppressant medication is required to prevent rejection, graft failure, and mortality. Given the increase in thoracic organ transplantation, it is crucial to better understand the associated barriers to treatment. Examining sociodemographic, transplant, healthcare access, post-transplant treatment, and patient-related psychosocial factors may help to elucidate treatment barriers that have not been previously considered in the existing literature. This single-site cross-sectional study surveyed 65 thoracic (heart and lung) transplant recipients (mean age: 62 years; 76.2% male; 72.3% White, and 21.5% Black) via phone interviews. Immunosuppressant nonadherence was found in 49.2% of participants (46.9% heart, 51.5% lung). In a four-week period, 20% of participants missed at least one dose, 40% did not take their medications on time, and 1% stopped completely. Significant correlates of nonadherence included poorer diet quality, fewer comorbidities, and maladaptive coping responses to perceived discrimination. This preliminary study highlights the importance of considering the social determinants of health—particularly post-transplant treatment and psychosocial patient-related factors—to inform post-transplant care. Addressing such variables may improve medication adherence and, subsequently, overall health outcomes. Further research with larger samples is needed to better understand the associated correlates and inform effective interventions for enhanced medication adherence. Full article

Background Socioeconomic factors significantly influence access to kidney transplantation, with socially vulnerable populations experiencing delays in receiving transplants, resulting in prolonged dialysis duration and poorer post-transplant outcomes. This study evaluates the relationship between social vulnerability and disparities in preemptive kidney transplantation using the Social Vulnerability Index (SVI), a composite measure developed by the Centers for Disease Control and Prevention (CDC). Methods Utilizing data from the Scientific Registry of Transplant Recipients (SRTR) from 2012 to 2020, we analyzed 155,424 adult kidney transplant recipients. The primary exposure was SVI, categorized into quartiles, while primary outcomes included preemptive transplant status and dialysis vintage. Multivariable regression models were adjusted for clinical covariates such as age, gender, BMI, diabetes, and peripheral vascular disease. Result Findings indicate that higher social vulnerability is significantly associated with a reduced likelihood of preemptive kidney transplantation (p < 0.0001) and an increased duration of dialysis prior to transplantation. Patients in the highest SVI quartile (0.75–1.00) were more than twice as likely to undergo dialysis before transplantation compared to those in the lowest quartile (OR = 2.21, 95% CI: 1.89–2.57). Similarly, increased SVI was strongly correlated with prolonged dialysis duration (OR = 3.43, 95% CI: 3.31–3.55, p < 0.0001). Conclusions These results highlight the impact of socioeconomic disparities on access to timely kidney transplantation. Addressing social vulnerability factors—such as poverty, education, and healthcare access—may help reduce inequities and improve transplantation outcomes. Future interventions should target high-SVI communities to facilitate earlier transplant access and reduce reliance on prolonged dialysis. Full article

The World Health Organization (WHO) cites antimicrobial resistance as among the greatest threats to human health. The multidrug-resistant pathogen Acinetobacter baumannii, recognized as a priority pathogen for healthcare and research, is responsible for a diverse array of infections including respiratory tract, soft tissue and wound, and bloodstream infections. Despite this importance, the mechanisms of its pathogenesis remain poorly understood. Conjugation represents a central mechanism for bacterial adaptation and evolution and is responsible for the spread of genes that promote pathogen survival, antibiotic resistance, virulence, and biofilm formation. Our laboratory recently characterized a large group of almost 120 Type IV Secretion System (T4SS)-encoding plasmids in Acinetobacter, distributed globally across 20 countries spanning four continents, and demonstrated that an XDR A. baumannii plasmid from this family was transmissible to another A. baumannii strain. This research investigated the potential diversity of host strains for this representative member plasmid. Using the GC1 lineage strain A. baumannii AB5075-UW harbouring the XDR plasmid p1AB5075 and a series of previously characterized clinical and environmental Acinetobacter strains, conjugative analyses demonstrated transfer of the XDR plasmid to both A. baumannii strains of more genetically divergent sequence types and to non-baumannii Acinetobacter species both inside and outside the Acinetobacter calcoaceticus–baumannii (ACB) complex. Successful recipients included diverse strains of both clinical and environmental origin within the Acinetobacter genus. Collectively, this research could provide insights into an important genetic element for future surveillance. Full article

Background: Liver transplantation has become the standard of care for patients with end-stage liver disease. Despite advances in surgical techniques, immunosuppression, and perioperative care, disparities in access and outcomes persist across demographic and socioeconomic lines. Objective: To assess trends and disparities in liver transplant admissions in the United States from 2016 to 2021, examining demographic patterns, in-hospital mortality, hospital charges, length of stay, and socioeconomic factors. Methods: Using the National Inpatient Sample (NIS) from 2016 to 2021, we identified liver transplant admissions using ICD-10 PCS codes 0FY00Z1 and 0FY00Z2. Demographic characteristics (age, sex, race, insurance status, and income quartile), clinical outcomes, and resource utilization metrics were analyzed. One-way ANOVA and Hensel’s test were used to assess variance and distribution homogeneity, with a significance threshold of p < 0.05. Results: A total of 9677 liver transplant admissions were analyzed. The mean recipient age remained stable (51–52 years), with males comprising ~62% of transplants. White patients constituted the largest group of recipients (~66–68%), followed by Hispanic (~14–17%) and Black patients (~7–10%). The proportion of transplants relative to liver failure admissions remained stable across racial groups, indicating no widening racial gap during the study period. In-hospital mortality post-transplant remained low (2.37–3.52%) and did not differ significantly by race (p = 0.23), sex (p = 0.24), or income quartile (p = 0.13). Similarly, Charlson Comorbidity Index > 5 did not predict inpatient mortality (p = 0.154). Hospital charges ranged from $578,000 to $766,000, with an average stay of ~21 days. Conclusions: Liver transplantation outcomes, including in-hospital mortality, appear consistent across demographic and socioeconomic groups once patients are admitted for transplant. However, broader disparities in access persist, necessitating further research into pre-transplant barriers and long-term outcomes. These findings support the need for equitable healthcare strategies aimed at optimizing transplant candidacy and survival across all populations. Full article

Introduction: Social workers play a critical role in healthcare settings by addressing both medical and nonmedical needs. Trained in human behavior and social environments, they are best suited to screen for social determinants of health (SDOH) and connect patients with resources paving the way for optimal health and well-being. Methods: This narrative review synthesizes the existing literature on SDOH screening practices within healthcare settings, emphasizing the role of social workers. A systematic search was conducted across multiple databases. A total of 26 studies met the inclusion criteria and were analyzed using a qualitative narrative synthesis approach. Results: This review reveals variability in SDOH screening domains, tools, and implementation strategies across healthcare settings. Facilitators and barriers to implementation were identified, including workflow integration, interprofessional collaboration, and contextual readiness. Social workers emerged as key professionals in addressing health-related social risks, leveraging their expertise in patient engagement, assessment, and system navigation. We further introduced the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to suggest the effective integration of SDOH screenings, emphasizing innovation, recipient engagement, contextual readiness, and facilitation. Conclusion: The effective integration of SDOH screenings requires structured workflows, interdisciplinary collaboration, and policy support. The review provides practice models of workflows for SDOH screenings and implications within two different healthcare settings: hospitals and outpatient clinics, offering insights into best practices and areas for future research. Strengthening the role of social workers in SDOH screenings can improve patient outcomes and promote health equity. Full article

Objectives: This study aim to determine the characteristics, roles, responsibilities, and challenges of informal caregivers for adult patients in Saudi Arabia. Methods: Adult patients who have informal caregivers were invited to participate in a cross-sectional study. The inclusion criteria were patients who were 18 years old or older and permanent Saudi residents. A self-administered online questionnaire was used to identify patients’ demographics, roles, responsibilities, and care challenges. Data collection lasted four months. Percentages, means, and standard deviations were reported in the analysis. Results: The study included 276 participants, mostly female (68.8%), with a mean age of 55.21 years (SD = 20.3). Over half were married (56.2%) and not employed (81.9%). Common chronic diseases were diabetes and hypertension, with 55.8% using up to five medications. Caregivers were mainly sons or daughters (62%) living with the patient (84.1%). The top caregiver tasks were escorting patients to appointments (63.4%), scheduling doctor appointments (60.1%), and tracking medication refills (59.4%). Common challenges included caregivers lacking time (45.3%), inconsistent care (35.9%), financial constraints (27.5%), and caregivers missing doses (27.9%). The top not encountered challenges were inappropriate medication storage (78.3%), communication barriers (74.3%), improper disposal of injections (72.5%), medication management errors (71.4%), and lack of empathy (70.3%). Conclusion: This study highlights the vital role of informal caregivers in managing chronic illnesses in Saudi Arabia. Informal caregivers face challenges such as time constraints and financial limitations. The findings emphasize the need for better support systems, including training programs and improved access to healthcare resources, to enhance care quality for patients. Full article

Background: Biologics is an exciting and growing area of medicine. Within the larger field of biologics, the use of viral vectors and virus-like particles (VLPs) is increasingly common, making it crucial to develop innovative and practical unit operations for the related purification process. Objective: Some scientists and engineers propose that membrane-based downstream virus purification (MVP) platforms would allow for more scalable and cost-effective production of these critical particles. However, the so-cial, political, and ethical implications of these advancements remain largely unex-plored. This paper aims to explore various pivotal facets of MVP technology govern-ance and regulations within the U.S. context, including (1) government policy ar-rangements related to the implementation of the technologies, (2) stakeholder atti-tudes, policy preferences, and behaviors, and (3) the fundamental factors that shape these attitudes, policy preferences, and behaviors. Methods: In doing so, we analyze publicly available federal and state government documents pertaining to biomanu-facturing, healthcare, and legislative attempts. Additionally, we will perform a stake-holder analysis on relevant industries, healthcare service providers, and recipients. Conclusions: Our goal is to outline the socio-political, ethical, and regulatory factors pertaining to the regulation and governance of these technologies. Full article

Efficient and fair allocation of donated blood depends on multiple factors, like medical urgency, donor/recipient compatibility, blood availability, geographic location, limited shelf life, etc. Due to the limited supply of blood and its critical role in healthcare, fair distribution protocols are essential. This study builds upon previous authors’ research that proposed a general mathematical model for fair blood allocation, taking as inputs the universal blood compatibility chart and the assumption of allocating equal shares of the donated blood from each blood type to recipients with respectively compatible blood types. The sum normalization technique was performed (twice, first per recipients and then per donors) for the purpose of balancing between donation needs and options. The result was an indicative blood allocation reference framework in support of the decision making in transfusion haematology. In the present paper, we tailor that general model by introducing as model variables the actual blood group frequencies of a given population. Additional customization is proposed by adding weight coefficients to the values along the framework’s main diagonal that represent ABO-identical transfusions, preferred to non-identical transfusions for minimizing the risks of hemolytic reactions. The model is further elaborated via intervalization of the estimations in the resultant blood allocation framework, thus making the model more flexible and usable. While demonstrated with Bulgarian blood group distributions from 2023, the model can be adapted to other populations and contexts. Full article

Background: Patients with liver cirrhosis are at an increased risk of mortality from coronavirus disease 2019 (COVID-19). Remdesivir, an adenosine analog, exhibits activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is thus recommended for inpatients with COVID-19. This study evaluated the effectiveness and safety of remdesivir in patients with COVID-19 and liver cirrhosis. Methods: This retrospective study was conducted using data from Taiwan’s largest healthcare system. The study cohort comprised adult patients with COVID-19 and liver cirrhosis who visited our emergency department between April 2021 and September 2022. Remdesivir’s adverse effects, including bradycardia, anemia, unstable glucose levels, and abnormal liver function test results, were recorded. Treatment outcomes were assessed in terms of hospitalization duration, mortality, intubation, and intensive care unit admission. Results: This study included 1368 patients with COVID-19 and liver cirrhosis, of whom 46 received remdesivir. Remdesivir recipients were older (66.5 vs. 62 years; p = 0.042) and had a higher rate of oxygen therapy use (56.52% vs. 32.22%; p = 0.001) than nonrecipients. Common adverse effects of remdesivir included lower heart rates (83 vs. 96 bpm; p < 0.001) and decreased hemoglobin levels (9.5 vs. 10.2 g/dL; p = 0.003) without fatal consequences. No statistically significant difference between remdesivir recipients and nonrecipients in hospitalization duration, intubation rates, or mortality rates was found. Conclusions: Remdesivir is safe for treating COVID-19 in patients with liver cirrhosis. Although remdesivir recipients exhibited trends toward improved outcomes in our study, large-scale studies are required to confirm its efficacy in this population. Full article

The sharing of DNA sequence data is essential for advancing medical technology and fostering innovation in healthcare. However, DNA sequences encode sensitive information, such as gender, physical attributes, and genetic predispositions, necessitating stringent privacy safeguards. Existing data-sharing frameworks often fail to adequately address these privacy concerns. To overcome these challenges, this study proposes a blockchain-based, privacy-preserving ecosystem for DNA sequence sharing. The system employs a decentralized architecture to manage digital identities and access permissions, ensuring robust privacy and data security. Smart contract functionalities allow users to assign granular access controls to specific DNA sequence segments, enabling selective sharing with trusted recipients. Furthermore, research institutions are required to obtain certification and classification from governmental authorities, enhancing trust and system reliability. The user-centric design prioritizes privacy, security, and autonomy, simplifying operational processes and fostering user trust. By incentivizing DNA data sharing, the proposed model aims to accelerate medical advancements while maintaining stringent privacy protections, establishing a secure and scalable ecosystem for DNA sequence sharing. Experimental results from a prototype implementation indicate that the system achieves a throughput of up to 10–20 transactions per second for identity and access operations while incurring acceptable on-chain costs (≈1.3 million gas to deploy contracts and 400–800 k gas per user registration). These performance metrics underscore the feasibility and efficiency of the proposed approach. Full article

Background: Human cytomegalovirus (CMV) remains an important pathogen, especially for immunocompromised patients such as solid organ and hematopoietic stem cell recipients. Viral genomic mutations conferring drug resistance are an important impediment to effective CMV management and frequently lead to use of alternative antiviral drugs to treat CMV disease. Methods: Results from 1459 de-identified patient samples with both UL54 and UL97 sequencing results were analyzed for ganciclovir (GCV) and maribavir (MBV) resistance mutations. Genomic sequencing was performed by the Sanger method and resistance mutations were identified by comparison to CMV reference strain AD169. Results: Ganciclovir resistance was identified in 379 of 1459 (25.98%) of the samples tested, with most resistance-conferring mutations present in viral gene UL97. A total of 121 of 1459 (8.29%) samples had MBV resistance mutations, and 84 (69.42%) of the 121 samples with MBV resistance also had GCV resistance mutations. Of the 84 samples with resistance to both MBV and GCV, 35 (41.67%) had a single UL97 mutation conferring resistance to both drugs, either C480F or F342Y. The overall prevalence of C480F was increased relative to an earlier analysis of samples from this reference laboratory. Conclusions: Although a high prevalence of CMV resistance mutations was identified, this must be taken in the context of healthcare providers submitting samples from patients with suspected CMV resistance. Most MBV-resistant samples were also resistant to GCV, suggesting that use of MBV as an alternative to GCV may benefit from genotypic resistance testing to achieve the effective control of CMV disease. Full article

Artificial intelligence (AI) has emerged as a transformative field in computational research with diverse applications in medicine, particularly in the field of liver transplantation (LT) given its ability to analyze and build upon complex and multidimensional data. This literature review investigates the application of AI in LT, focusing on its role in pre-implantation biopsy evaluation, development of recipient prognosis algorithms, imaging analysis, and decision-making support systems, with the findings revealing that AI can be applied across a variety of fields within LT, including diagnosis, organ allocation, and surgery planning. As a result, algorithms are being developed to assess steatosis in pre-implantation biopsies and predict liver graft function, with AI applications displaying great accuracy across various studies included in this review. Despite its relatively recent introduction to transplantation, AI demonstrates potential in delivering cost and time-efficient outcomes. However, these tools cannot replace the role of healthcare professionals, with their widespread adoption demanding thorough clinical testing and oversight. Full article