Guidelines For Selection Of Candidates Research Articles

Applicant Selection for Anesthesiology Residency Programs in Saudi Arabia.

Background Anesthesiology is a medical specialty that involves pre, intra, and postoperative surgical and medical procedures;it is a profession shaped by the clinician's medical knowledge and manual dexterity. To date, very few studies have addressed the selection criteria and factors associated with the applicant selection process for anesthesia residency programs in Saudi Arabia. Objectives We aimed to define the criteria, factors, and guidelines for candidate selection in anesthesia residency programs in Saudi Arabia. Methodology This was a cross-sectional study conducted using electronic questionnaires that were distributed to anesthesiology program directors in Saudi Arabia via email. The questionnaire was divided into six sections, and each section included various parameters such as demographic data, cognitive/academic activities, non-cognitive/non-academic activities, individual qualities, and red flags or negative factors of the individual. The participants rated each parameter, and the collected data were analyzed for statistical significance (p≤0.05). Results A total of 28programs were included in this survey. All 14 parameters associated with individual qualities were found to be significantly important for applicant selection (p≤0.05). Except for delayed entry into residency after graduation, all 12 parameters associated with red flags or negative characteristics of individuals were significantfor candidate selection (p≤0.05). Conclusion The results showed that academic/cognitive factors and non-academic/non-cognitive factors, along with the individual characteristics of the applicant, were given priority when selecting candidates for anesthesiology residency programs in Saudi Arabia.

Cochlear implantation outcome in straightforward cases: can we do more for adults who cannot understand speech using hearing aids alone?

Background: Many adults with moderate–profound hearing loss whose speech recognition has deteriorated and are no longer benefitting from hearing aids (HAs) could benefit from cochlear implantation (CI). Of these, only <5% are implanted. In order to inform eligible patients about expected results and ease the route to implantation, better guidelines for candidate selection are needed.Objectives: To provide reliable guidelines by determining, in a well-characterized group of implantees, the minimal expected post-CI scores for monosyllabic (MS) word recognition.Patients and methods: In total, 20 adults unilateral implantees considered (prior to implantation) straightforward CI candidates were assessed ≥20 months post-CI. Their post-CI CI-aided thresholds and MS word recognition were compared to their pre-CI scores. In addition, SSQ12 scores were evaluated post-CI.Results: Post-CI, thresholds were 40 dB or better in all participants, and 35 dB or better in 95% of them. 90% scored 60% or better on MS words in quiet. In speech noise all scored 15–60% and 50% scored 45–60%. Poorer unaided pre-CI thresholds yielded greater patient satisfaction.Conclusions: Adults with moderate–profound hearing loss, whose speech recognition has deteriorated, are no longer benefitting from HAs and fulfil defined criteria for straightforward CI, should be referred for formal CI candidacy evaluation.

Treatment Free Remission (TFR) in Chronic Myeloid Leukaemia (CML): The Tawam Hospital Experience

Introduction: CML is a chronic myeloproliferative neoplasm that is characterized by presence of Philadelphia chromosome (a translocation between chromosomes 9 and 22 leading to BCR-ABL1 fusion gene and protein). This fusion can be detected by karyotyping, FISH and polymerase chain reaction (PCR). The therapy of CML has evolved from hydroxyurea, interferon, allogeneic stem cell transplant and lately tyrosine kinase inhibitors (TKI). The target of therapy is molecular response (MR) and has also evolved from the major molecular response (MMR), defined as ≥3-log reduction in BCR/ABL1 fusion transcript using real-time quantitative PCR (RQ-PCR) to deep molecular response (DMR, ≥4-log reduction). The experience from a number of clinical trials, including STIM, TWISTER, A-STIM and KIDS, has generated interest in stopping TKIs in patients who have reached a sustained DMR. Hughes et al (Blood 2016) have published practical guidelines for selection of candidates for TFR and their subsequent management. Here we report our experience with TFR in patients with CML in DMR. Method: We searched our database for CML patients on continuous TKI therapy and monitoring. Patient not followed for more than 6 months were excluded from analysis. Molecular response was monitored in all patients at intervals defined by National Comprehensive Centre Network (NCCN) guidelines (available at www.nccn.org). Peripheral blood samples were collected in Tempus™ Blood RNA Tubes and analysed in a central Molecular Diagnostics Laboratory. Real-time quantitation of BCR-ABL1 gene transcripts was performed using the Qiagen-Ipsogen BCR-ABL1 Mbcr IS-MMR Dx® kit. The results were expressed as a percent ratio of BCR-ABL1 to ABL1 transcripts on the International Scale (IS). The assay can quantitate up to 4.96 log reductions (0.0011%IS) calculated according to the recommendations of Cross et al (Leukemia 2015). Result: We identified One hundred and seventeen CML patients on continuous TKI therapy and monitoring in our database. The median age was 36 years (range, 15-73 years). In our cohort 66/117 (56%) had achieved a DMR, while 20/117 (17%) had achieved undetectable levels of fusion transcript (≥4.5-log reduction, MR4.5). Fifteen out of the twenty (75%) with MR4.5 were candidates for TFR as they fulfilled the criteria proposed by Hughes et al (Blood 2016) of being more than 8 years on therapy with optimal response. Nine patients were counselled about TFR, monitoring and definition of progression and risk of progression. Six patients from this cohort have been initiated on TFR (Table 1). The median period of TKI therapy was 11 years. All six had undetectable levels of BCR-ABL1 transcript for more than 2 years. All were followed monthly except for the patient TW0012. Three patients have reached the six month milestone with one patient having MR 4.49 while the other 2 remain at undetectable levels. None of the patients experienced TKI withdrawal syndrome (myalgia/arthralgia) or expressed psychological anxiety for relapse. Conclusion: TFR is a very important goal especially in a young patient population. Continuous and chronic TKI therapy not only adds economic burden to the patient and healthcare system, but can also have undesirable side effects. Our limited experience outside of a clinical trial and in real world shows that willing and compliant patients and a reliable molecular laboratory will be the cornerstones of TFR as the future goal of CML. As our confidence builds with TFR, we anticipate extending it to candidates with MR4.5 when they reach 8 years or more of TKI therapy threshold. Disclosures Alam: BMS: Honoraria; Biologix: Honoraria.

Chronische respiratorische Insuffizienz: Rolle der Lungentransplantation

Lung transplantation has been established as an appropriate ultimate treatment strategy in end-stage lung disease, when all conventional therapeutic options have been exhausted. Acute and potentially reversible lung diseases (ARDS, pneumonia) and malignancy (broncho-alveolar carcinoma) are not established indications. Retrospective analyses on the natural course of the disease and new medical treatment options have led to fewer transplantations in recipients with emphysema and idiopathic pulmonary hypertension. In end-stage cystic fibrosis and patients with idiopathic pulmonary fibrosis, alternative treatment options are currently not available and lung transplantation is indicated. The available guidelines for candidate selection should be followed. Internationally, there is a trend towards a benefit-orientated allocation of organs. Recommendations for candidate selection, surgical innovations and, especially, the improved long-term follow-up have led to improved results in the last two decades. Long-term results are, however, still unsatisfactory in comparison to liver and kidney transplantations. The main obstacles to long-term survival and causes of death are chronic allograft dysfunction (bronchiolitis obliterans syndrome, BOS) and infections. In the future, the pathogenesis and treatment options for these two entities should be clarified. A further essential task is to increase the donor pool in the future because the current waiting list mortality is approximately 20 %.

Candidate Selection, Overall Results, and Choosing the Right Operation

Lung transplantation offers potential improvement in survival and improved quality of life in patients with end-stage lung disease. International guidelines for candidate selection have been agreed upon to aid physicians and providers in selecting appropriate candidates for lung transplantation. In recent years the U.S. lung allocation score (LAS) has been developed and implemented in an attempt to both maximize utility of scarce donor organs and provide benefit to those in need of lung transplantation. This has helped in the process of offering transplantation to those with the greatest need and best chance of survival. Appropriate lung transplantation candidates should have life-threatening lung disease but remain otherwise healthy, because significant comorbidities may increase the risk of poor outcomes after transplantation limiting long-term survival. Improved outcomes are seen through early referrals to a specialized center and vigilant evaluation to select the most appropriate candidates for lung transplantation.

Rechanneling of total anomalous pulmonary venous connection with or without vertical vein ligation: Results and guidelines for candidate selection

This study investigated whether postoperative low cardiac output and mortality in obstructed total anomalous pulmonary venous connection could be reduced by selective vertical vein patency. Fifty-eight patients undergoing rechanneling of total anomalous pulmonary venous connection between 1997 and 2006 were studied. The vertical vein was left patent in 27 patients (group I) and ligated in 31 (group II). Mean ages were 1.49 +/- 1.63 and 4.37 +/- 3.38 months for groups I and II, respectively. Operative mortalities were 29.1% and 7.4% for ligated and unligated groups, respectively (relative risk 1.75, 1.16-2.64, P = .036). Age younger than 1 month, obstructive total anomalous pulmonary venous connection, hypoplastic pulmonary veins, pulmonary hypertensive crisis, low cardiac output, and vertical vein ligation were significant risk factors for death according to logistic regression analysis. Patients with obstructed total anomalous pulmonary venous connection undergoing vertical vein ligation demonstrated predominant right ventricular dysfunction (relative risk 2.93, 1.28-6.73, P = .011), pulmonary hypertensive crisis (relative risk 2.90, 1.25-6.75, P = .013), and 3.28 times the risk of death (95% confidence interval 1.08-9.99, P = .032) relative to the unligated group. In a subset of patients with obstructed total anomalous pulmonary venous connection, an unligated vertical vein reduces pulmonary arterial pressure, decreases perioperative pulmonary hypertensive crises, provides a temporary pop-off valve during pulmonary hypertensive crisis, and improves survival by providing superior hemodynamics. The high mortality in the ligated group suggests that patients with obstructed total anomalous pulmonary venous connection with postbypass moderate pulmonary hypertension possibly should not undergo vertical vein ligation. We propose routine use of an adjustable ligature around the vertical vein in all patients with more than moderate post-bypass pulmonary hypertension, allowing gradual tightening in increments without multiple reoperations.