Background: We conducted this scoping review to (1) comprehensively compile the published literature on interprofessional education focused on climate change and health, (2) assess the quality and outcomes of the existing curriculum interventions, and (3) highlight potential areas for further growth. By evaluating published curricular interventions, our goal was to highlight effective and validated developments that could be utilized by health professional educators seeking to include topics on climate change in the curriculum. Methods: We searched Ovid MEDLINE databases (MEDLINE, In-Process, In-Data-Review and Other Non-Indexed Citations, and Epub Ahead of Print), Embase, Clarivate Web of Science, and EBSCOhost Education Abstracts from inception through March 2023. Resulting articles were screened for relevance, and data were extracted from the included studies. The Medical Education Research Study Quality Instrument (MERSQI) was used to assess the quality of each included study. Findings: We screened 688 unique articles, and 6 met inclusion criteria. Publications dated from 2013 to 2023. Three studies included students or healthcare professionals from at least three health profession education programs. The mean MERSQI score was 8·17 (SD = 1·34; range 6–10). Curricular interventions varied by study, and topics included effects of climate change on human health, effect of climate change on extreme weather events and infectious disease exposures, and role of health professionals in climate change communication. Studies did not utilize a two-group comparison design. Most studies used an assessment tool with content validity evidence, but no study provided evidence of validity for internal structure or relationships to other variables. Studies reported that curricular interventions improved outcomes related to both climate change and interprofessional education. Interpretation: Despite the growing call for health professional education focused on climate change and health, there remains a gap in the interprofessional curricular interventions that have been assessed.

Lung transplant recipients are at increased risk of Mycobacterium abscessus complex (MABC) acquisition and invasive infection. We analyzed risk factors and outcomes of early post–lung transplant MABC acquisition. We conducted a retrospective matched case–control study of patients who underwent lung transplant from 1/1/2012 to 12/31/2021 at a single large tertiary care facility. Cases had de novo MABC isolation within 90 days post-transplant. Controls had no positive MABC cultures and were matched 3:1 with cases based on age and transplant date. Recipient demographics and pre-/peri-operative characteristics were analyzed, and a regression model was used to determine independent risk factors for MABC acquisition. We also assessed 1-year post-transplant outcomes, including mortality. Among 1145 lung transplants, we identified 79 cases and 237 matched controls. Post-transplant mechanical ventilation for >48 hours was independently associated with MABC acquisition (adjusted odds ratio, 2.46; 95% CI, 1.29–4.72; P = .007). Compared with controls, cases required more days of hospitalization after the MABC index date (28 vs 12 days; P = .01) and had decreased 1-year post-transplant survival (78% vs 89%; log-rank P = .02). One-year mortality appeared highest for cases who acquired M. abscessus subsp. abscessus (31% mortality) or had extrapulmonary infections (43% mortality). In this large case–control study, prolonged post-transplant ventilator duration was associated with early post–lung transplant MABC acquisition, which in turn was associated with increased hospital-days and mortality. Further studies are needed to determine the best strategies for MABC prevention, surveillance, and management.

Lung transplant recipients are at increased risk of MABC acquisition. The objective of this study was to analyze risk factors and outcomes of early post-transplant MABC acquisition. We conducted a single center retrospective case-control study of patients who underwent lung transplant from 1/1/2012 – 12/31/2021. Cases were patients with de novo MABC acquisition within 90 days post-transplant. Controls had no positive MABC cultures and were matched 1:3 with cases based on age and transplant date. Recipient demographics, pre-/peri-operative characteristics, and outcomes for 1-year post-transplant were analyzed. Conditional logistic regression was used to determine independent risk factors for MABC acquisition. The reference model included all variables with a P value ≤ 0.2 in univariate analysis after accounting for collinearity and epidemiologic plausibility. Confounding variables and variables with an adjusted P value ≤ 0.05 were included in the final model. 79 cases and 237 controls were identified out of 1,145 lung transplants. The median time to MABC isolation was 33 days (IQR 11 – 59) after transplant. The first positive culture was pulmonary for 70 (89%) cases; 59 (75%) cases were treated with antibiotics targeting MABC. Univariate analysis found cases were more likely than controls to have CMV mismatch (D+/R-), bilateral transplant, higher end-match allocation score, increased ventilator time pre- and post-transplant, and days in the hospital before MABC index date (Table 1). IPF diagnosis and receipt of azithromycin were protective. Multivariable analysis showed only post-transplant ventilation for ≥ 2 days was independently associated with MABC (Table 2). Compared to controls, cases required more days of hospitalization after the MABC index date (28 vs. 12 days; p=0.01) and had decreased 1-year post-transplant survival (78% vs. 89%; p=0.02) (Figure 1). When stratified by subspecies, 1-year survival was 69% for M. abscessus and 89% for M. massiliense (p=0.10). Lung transplant recipient characteristics Conditional logistic regression model constructed via backward elimination to determine independent predictors and confounders of MABC acquisition Kaplan-Meier survival curve comparing cases and controls for 1-year after transplant In this large case-control study, post-transplant ventilator duration was associated with MABC acquisition, which in turn was associated with increased hospital days and mortality. Further studies are needed to determine the best strategies for MABC prevention and surveillance. Arthur W. Baker, MD, MPH, Insmed: Grant/Research Support|Medincell: Advisor/Consultant