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Liver transplantation (LTX) using donors after controlled circulatory death (cDCD) is associated with poorer graft survival and increased incidence of nonanastomotic biliary strictures (NASs) compared to livers procured from brain-dead donors (DBD). The use of normothermic regional perfusion (NRP) during cDCD procurement may improve posttransplant outcomes and reduce the incidence of NAS. In Sweden, cDCD LTX was introduced through a national pilot protocol with mandatory NRP. This study aims to evaluate the outcome of cDCD LTX during the pilot period. Donor and recipient data were collected on all cDCD liver transplants during the pilot period between January 2020 to December 2022. Outcome on NAS, patient and graft survival, early allograft dysfunction, acute kidney injury, and comprehensive complication index was compared to a matched cohort of 28 patients transplanted with a DBD liver between 2018 and 2022. Eighteen patients were transplanted with a liver from a cDCD donor after using NRP. The mean functional warm ischemia time was 29 ± 6 minutes. The mean lactate reduction during NRP was 8.7 ± 2.4 mmol/L, and the end NRP perfusate alanine aminotransferase was 1.4 ± 1 µkat/L. When comparing recipients of cDCD liver transplant to DBD, no significant differences were observed in the incidence of NAS, patient and graft survival, comprehensive complication index, early allograft dysfunction, or acute kidney injury. Study protocol magnetic resonance cholangiopancreatography in cDCD patients showed no signs of subclinical biliary strictures. Evaluation of the Swedish national pilot of cDCD LTX with mandatory NRP shows comparable outcomes to a matched DBD cohort with 94.4% 1-year patient and graft survival and no incidence of NAS within the first year.

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What was the nature of the CPD activity and/or practice-related feedback and/or event or experience in your practice? The CPD article discussed acute pulmonary oedema, which is the build-up of excess fluid in the lungs. It is a life-threatening illness that should be treated as a medical emergency.

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Following the 2005 London bombings, a novel public health program was instituted to address the mental health needs of survivors. In this article, the authors describe the rationale for the program, characteristics of individuals assessed within the program, and preliminary outcome data. In addition to validated screening instruments and routine service usage data, standardized questionnaire outcome measures were collected. Seventy-one percent of individuals screened positive for a mental disorder. Of those receiving a more detailed clinical assessment, PTSD was the predominant diagnosis. Preliminary outcome data on 82 patients revealed large effect sizes for treatment comparable to those previously obtained in randomized controlled trials. The program succeeded in its aim of generating many more referrals of affected individuals than came through normal referral channels.

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Nebulized levalbuterol has been documented as more efficacious than albuterol in enhancing airflow in Emergency Department (ED) patients with bronchospasm. This work attempts to determine if nebulized levalbuterol yields similar improvements in peak flow measurements as those produced by albuterol in the Emergency Medical Services (EMS) arena. All adult EMS patients given a nebulized beta-agonist from January to June 2000 were included in this prospective, before-and-after, open-label study. Data collected included demographics, initial peak expiratory flow (PF), and use of home inhaled or nebulized bronchodilators before EMS arrival (PRE-TX). Outcome variable was the change in PF after a single EMS treatment with one of the study agents. Statistical analysis was performed using t-test and chi-square techniques; p was defined as 0.05. There were 298 patients enrolled; complete data for analysis were available for 196. Mean age was 68.0 years; 44.4% were male. Overall, albuterol produced a PF change of 19.7%; levalbuterol yielded a change of 20.4% (p = 0.9). In contrast to ED data, levalbuterol and albuterol produces similar changes in PF in the prehospital setting. Explanations for this finding may be linked to the pharmacokinetics of single vs. dual isomer preparations, and to the time frames of EMS care. Further efforts correlating EMS and ED data may better define the use of levalbuterol in prehospital care.

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