Lobar lung transplantation from deceased donors: A systematic review

AIM To systematically review reports on deceased-donor-lobar lung transplantation(dd LLTx) and uniformly describe sizematching using the donor-to-recipient predicted-total lung-capacity(pT LC) ratio. METHODS We set out to systematically review reports on ddL LTx and uniformly describe size matching using the donorto-recipient pT LC ratio and to summarize reported oneyear survival data of ddL LTx and conventional-LTx. We searched in Pub Med, CINAHL via EBSCO, Cochrane Database of Systematic Reviews via Wiley(CDSR),Database of Abstracts of Reviews of Effects via Wiley(DARE), Cochrane Central Register of Controlled Trials via Wiley(CENTRAL), Scopus(which includes EMBASE abstracts), and Web of Science for original reports on ddL LTx. RESULTS Nine observational cohort studies reporting on 301 ddL LTx met our inclusion criteria for systematic review of size matching, and eight for describing one-year-survival. The dd LLTx-group was often characterized by high acuity;however there was heterogeneity in transplant indications and pre-operative characteristics between studies. Data to calculate the pT LC ratio was available for 242 ddL LTx(80%). The mean pT LCratio before lobar resection was1.25 ± 0.3 and the transplanted pT LCratio after lobar resection was 0.76 ± 0.2. One-year survival in the ddL LTxgroup ranged from 50%-100%, compared to 72%-88%in the conventional-LTx group. In the largest study ddL LTx(n = 138) was associated with a lower one-year-survival compared to conventional-LTx(n = 539)(65.1% vs84.1%, P < 0.001). CONCLUSION Further investigations of optimal donor-to-recipient size matching parameters for ddL LTx could improve outcomes of this important surgical option.

Medical Curriculum at KU Leuven-University of Leuven, Belgium

In this paper we reflect on the evolution of medical education, with the medical curriculum at the University of Leuven as a concrete example. Formally, the Leuven curriculum follows a bachelor's and master's structure that leads to the degree of Medical Doctor after which further advanced training is required to become a practising physician. The Leuven curriculum takes the CanMEDS model as its educational framework. Embedding the CanMEDs roles within the curriculum is achieved using four learning pathways(Knowledge and Fundamentals of Medicine; Scientific Training; The Physician in Society; Skills and Communication) that run across the bachelor's and master's programmes. A stepwise approach is adopted whereby students progressively acquire the required competences to translate medical knowledge into evidence-based clinical practice. The learning process initially takes place in a simple and controlled environment, e.g. lectures or demonstrations with(simulated) patients. As the programme progresses, learning and assessment occur in ever more authentic medical situations,e.g. during the clerkships. In the future it will be important to capture new developments in e.g. education technology, health care organisation and patient involvement, and incorporate them into the medical curriculum. In this way we may fulfil our ambition to train medical doctors that are ready to participate in the 21^(st) century health care system and take their responsibility towards both the individual patient and public health care.