Differences in the strength of endorsement for distributively fair and unfair leaders in interpersonal and intergroup situations were measured. Fair leaders were expected to receive stronger endorsements than unfair leaders in interpersonal situations. This difference, however, was expected to attenuate, if not reverse in intergroup situations when the unfairness favoured the ingroup. An attenuation effect obtained in Experiment 1 (N=49) using ad hoc groups in a laboratory setting. Attenuation and reversal effects obtained, respectively, in Experiments 2 (N=314) and 3 (N=213) using preexisting groups (students and New Zealanders, respectively) in a scenario setting. Fairness ratings followed patterns similar to leadership endorsements in Experiments 2 and 3. Finally, Experiment 3 showed a reversal in participants' private attitudes toward an issue about which the leader expressed an opinion. These data extend previous research on leadership endorsement and are consistent with predictions derived from Social Identity Theory (Tajfel & Turner, 1986).

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BackgroundSimulation-based-mastery-learning (SBML) is an effective method to train nephrology fellows to competently insert temporary, non-tunneled hemodialysis catheters (NTHCs). Previous studies of SBML for NTHC-insertion have been conducted at a local level.ObjectivesDetermine if SBML for NTHC-insertion can be effective when provided at a national continuing medical education (CME) meeting. Describe the correlation of demographic factors, prior experience with NTHC-insertion and procedural self-confidence with simulated performance of the procedure.DesignPre-test – post-test study.Setting2014 Canadian Society of Nephrology annual meeting.ParticipantsNephrology fellows, internal medicine residents and medical students.MeasurementsParticipants were surveyed regarding demographics, prior NTHC-insertion experience, procedural self-confidence and attitudes regarding the training they received. NTHC-insertion skills were assessed using a 28-item checklist.MethodsParticipants underwent a pre-test of their NTHC-insertion skills at the internal jugular site using a realistic patient simulator and ultrasound machine. Participants then had a training session that included a didactic presentation and 2 hours of deliberate practice using the simulator. On the following day, trainees completed a post-test of their NTHC-insertion skills. All participants were required to meet or exceed a minimum passing score (MPS) previously set at 79%. Trainees who did not reach the MPS were required to perform more deliberate practice until the MPS was achieved.ResultsTwenty-two individuals participated in SBML training. None met or exceeded the MPS at baseline with a median checklist score of 20 (IQR, 7.25 to 21). Seventeen of 22 participants (77%) completed post-testing and improved their scores to a median of 27 (IQR, 26 to 28; p < 0.001). All met or exceeded the MPS on their first attempt. There were no significant correlations between demographics, prior experience or procedural self-confidence with pre-test performance.LimitationsSmall sample-size and self-selection of participants. Costs could limit the long-term feasibility of providing this type of training at a CME conference.ConclusionsDespite most participants reporting having previously inserted NTHCs in clinical practice, none met the MPS at baseline; this suggests their prior training may have been inadequate.

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Background: Kidney transplant immunosuppressive medications are known to impair glucose metabolism, causing worsened glycemic control in patients with pre-transplant diabetes mellitus (PrTDM) and new onset of diabetes after transplant (NODAT). Objectives: To determine the incidence, risk factors, and outcomes of both PrTDM and NODAT patients. Design: This is a single-center retrospective observational cohort study. Setting: The Ottawa Hospital, Ontario, Canada. Participant: A total of 132 adult (>18 years) kidney transplant patients from 2013 to 2015 were retrospectively followed 3 years post-transplant. Measurements: Patient characteristics, transplant information, pre- and post-transplant HbA1C and random glucose, follow-up appointments, complications, and readmissions. Methods: We looked at the prevalence of poor glycemic control (HbA1c >8.5%) in the PrTDM group before and after transplant and compared the prevalence, follow-up appointments, and rate of complications and readmission rates in both the PrTDM and NODAT groups. We determined the risk factors of developing poor glycemic control in PrTDM patients and NODAT. Student t-test was used to compare means, chi-squared test was used to compare percentages, and univariate analysis to determine risk factors was performed by logistical regression. Results: A total of 42 patients (31.8%) had PrTDM and 12 patients (13.3%) developed NODAT. Poor glycemic control (HbA1c >8.5%) was more prevalent in the PrTDM (76.4%) patients compared to those with NODAT (16.7%; P < .01). PrTDM patients were more likely to receive follow-up with an endocrinologist ( P < .01) and diabetes nurse ( P < .01) compared to those with NODAT. There were no differences in the complication and readmission rates for PrTDM and NODAT patients. Receiving a transplant from a deceased donor was associated with having poor glycemic control, odds ratio (OR) = 3.34, confidence interval (CI = 1.08, 10.4), P = .04. Both patient age, OR = 1.07, CI (1.02, 1.3), P < .01, and peritoneal dialysis prior to transplant, OR = 4.57, CI (1.28, 16.3), P = .02, were associated with NODAT. Limitations: Our study was limited by our small sample size. We also could not account for any diabetes screening performed outside of our center or follow-up appointments with family physicians or community endocrinologists. Conclusion: Poor glycemic control is common in the kidney transplant population. Glycemic targets for patients with PrTDM are not being met in our center and our study highlights the gap in the literature focusing on the prevalence and outcomes of poor glycemic control in these patients. Closer follow-up and attention may be needed for those who are at risk for worse glycemic control, which include older patients, those who received a deceased donor kidney, and/or prior peritoneal dialysis.

Introduction: Kidney transplantation is considered the optimal form of renal replacement therapy. However, in the Netherlands, about sixty percent of patients on dialysis are not actively considered for transplantation, which is difficult to explain based on basic medical variables only. Indeed, various (non-) medical barriers to optimal access to transplantation have been mentioned in literature. Remarkably, no systematic inventory exists on these multiple (non-)medical barriers and the different perspectives on these barriers by these multiple stakeholders' perspectives. Hence, the present qualitative study presents the various (non-)medical barriers to optimal access to transplantation from different perspectives of multiple stakeholders. Method: Stakeholders involved in renal care are interviewed in two different phases about attitudes (phase 1) and integrative perspective of the different stakeholders (phase 2) regarding barriers to optimal access to transplantation. The topic list for the interviews contains six themes: psychological, policy, medical, ethical, social, and economic. The interview method followed grounded theory principles. Results: A total of 117 participants were involved: patients (21), donors (10), social workers (25), nephrologists (22), surgeons (5), nurses (6), policy officers (24) and representatives of insurance companies (4). The following major barriers are typical for the six themes: 1.psychological: fear for transplantation relates to delay kidney transplantation; 2.policy-based: health care providers experience a lack of or unclarity regarding treatment guidelines; 3.medical: no consensus on criteria for acceptance for transplantation, e.g. age, BMI, comorbidity; 4.ethical: lack or insufficient use of programs/interventions that could help patients reach equal access to transplantation; 5.social: lack of an effective social network or lack of skills to activate social support system; 6.economic: differences in purchasing agreements and following reimbursements for dialysis and transplantation could provide an economic incentive for choosing one or the other therapy. Conclusion: According to participants, access to transplantation rely heavily on a well-informed and acting patients, donors and health professionals. Despite the existence of national clinical guidelines, participants report ambiguity about their existence. Decision making by patients and donors is hampered by a lack of information about the different options, fears and difficulty to the complex decision-making process with multiple stakeholders. Financial incentives can influence access as they are not always aimed at encouraging early referral to kidney transplantation. Stakeholders state that access to kidney transplantation could be improved when these issues would be addressed. Next to the results of phase 1, the results of phase 2 (integrative perspective of stakeholders) will be presented.

Background: Nirmatrelvir/ritonavir has been shown to reduce the risk of COVID-19 related complications in patients at high risk for severe COVID-19. However, clinical experience of nirmatrelvir/ritonavir in the transplant recipient population is scattered due to the complex management of drug-drug interactions with calcineurin inhibitors. We describe the clinical experience with nirmatrelvir/ritonavir at The Ottawa Hospital kidney transplant program. Methods: Patients who received nirmatrelvir/ritonavir between April and June 2022 were included and followed up 30 days after completion of treatment. Tacrolimus was withheld for 24 hours and resumed 72 hours after the last dose of nirmatrelvir/ritonavir (on Day 8) based on drug level the day before. The first 30 patients had their dose adjusted according to drug levels performed twice in the first week and as needed thereafter. Subsequently, a simplified algorithm with less frequent calcineurin inhibitor level monitoring was implemented. Outcomes including tacrolimus level changes, serum creatinine and acute kidney injury (AKI, defined as serum creatinine increase by 30%) and clinical outcomes were described globally and compared between algorithms. Results: Fifty-one patients received nirmatrelvir/ritonavir. Tacrolimus levels drawn at the first timepoint, 7 days after withholding of calcineurin inhibitor and 2 days after discontinuing nirmatrelvir/ritonavir were within the therapeutic target in 17/44 (39%), subtherapeutic in 21/44(48%) and supratherapeutic in 6/44 (14%). Two weeks after, 55% were within the therapeutic range, 23% were below, and 23% were above it. The standard and simplified algorithms provided similar tacrolimus level (median 5.2 ug/L [4.0, 6.2] versus 4.8 ug/L [4.3, 5.7] p=0.70). There were no acute rejections or other complications. Conclusions: Withholding tacrolimus starting the day before initiation of nirmatrelvir/ritonavir with resumption 3 days after completion of therapy resulted in a low incidence of supratherapeutic levels but a short period of subtherapeutic levels for many patients. AKI was infrequent. The data are limited by the small sample size and short follow-up.