Chronic kidney disease affects over 10% of the global population, often leading to end-stage renal disease (ESRD) and necessitating kidney transplantation. With kidney transplantation as the preferred treatment for ESRD, the efficiency of transplantation systems becomes crucial in meeting the increasing demand. A comprehensive comparative analysis was conducted, examining key variables influencing discard rates and outcomes in both countries. These variables include transplantation processes, waitlist criteria, donor-recipient matching, and distinct components of their transplantation systems. The findings suggest that the French transplantation system exhibits greater efficiency compared to the United States, with comparable transplantation outcomes. Key factors influencing this difference include the opt-out organ donation policy, prioritization strategies, and overall health indicators. These findings provide helpful insight into the potential efficiency gains from the French system, which can provide useful direction for such future research.

Objective: To compare intra-operative and post-operative outcomes of total abdominal hysterectomy, total vaginal hysterectomy, total laparoscopic hysterectomy, and total robotic hysterectomy for benign conditions, as well as to conduct a cost approximation of each. Methods: Retrospective chart review of all hysterectomies by two surgeons between January 2017 and January 2019. For each patient, the following metrics were recorded and analyzed: age, BMI, medical history, abdominal/pelvic surgical history, surgical indication, route of hysterectomy, intra-operative complications, total operative time, time to discharge, estimated blood loss, post-operative complications, pain status, return to activities of daily living, and return to employment. Results: A total of 521 patients who underwent total abdominal hysterectomy (n=40), total vaginal hysterectomy (n=55), total laparoscopic hysterectomy (n=131), and total robotic hysterectomy (n=292) were analyzed. There were no significant differences among the groups in age, BMI, or surgical history. The total vaginal hysterectomy category included the highest percentage of pre-existing medical history (p=0.043, p=0.011). Of the four categories, total robotic and total laparoscopic hysterectomies involved shorter operative times (p=0.026, p=0.044), shorter inpatient stays (p= <0.001), fewer intra-operative complications (p= <0.001), decreased pain status (p= <0.001), and quicker return to both employment (p=0.039, 0.044) and activities of daily living (p=0.002). Total robotic hysterectomy showed less estimated blood loss (p= <0.001) and fewer post-operative complications (p=0.022, p=0.046) when compared to laparoscopic hysterectomy. Robotic hysterectomy was noted to have the highest OR-specific costs and total encounter costs. Conclusions: The two minimally invasive routes to hysterectomy, robotic and laparoscopic, appear to both be comparable in terms of intra-operative and post-operative outcomes, and are associated with improved outcomes when compared to abdominal and vaginal routes to hysterectomy. However, due to the high cost of robotic surgery, it may not be the most cost-effective approach.

The Ryan House Family Survey is used to assess family satisfaction of the respite services used. Over the last two years, the number of responses has been less than desired. This project used stakeholder interviews and peer reviewed literature to create a recommendation of how to effectively gather the most relevant information. The survey is currently ten questions and averages three minutes to take. It asks families to rate their satisfaction with different aspects of their stay. Some of these are scheduling, coordination of medical orders, and the intake process. The results of this evaluation will allow the staff at Ryan House to be assured in the care that they are providing, make improvements where needed, and give the organization data to use on a public platform.