bluuebunny/crossref_metadata_2025 huggingface dataset:
Ethical Considerations in Live Liver Donation to Children
Authors: Ventura Kara Ann
Published: July 2017

Transplant professionals are often faced with ethical situations in practice. In the field of pediatric transplantation, these ethical dilemmas can be even more profound than in adults. Transplant professionals must have a firm foundation of professional and personal ethical principles in order to handle ethical situations they encounter. This paper provides an ethical review of issues that arise during live liver donation from a parent to a child.
Methadone Maintenance Therapy in Liver Transplantation
Authors: Jiao Modi , Greanya Erica D. , Haque Mazhar , Yoshida Eric M. , Soos John G.
Published: July 2017

Cirrhosis due to chronic infection with hepatitis C virus remains by far the most common reason for liver transplantation in North America. Currently, parenteral use of street drugs is the most common means of acquiring hepatitis C. Methadone maintenance therapy is an accepted form of treatment for chronic opiate (eg, heroin) addiction and, not surprisingly, a significant proportion of methadone-treated patients have chronic hepatitis C. The feasibility of liver transplant candidacy in hepatitis patients who require methadone maintenance therapy is controversial, and some transplant centers require patients to withdraw from such therapy in order for the transplant process to move forward. Thus stable patients with end-stage cirrhosis who are receiving methadone maintenance are left in a most difficult situation: discontinue methadone and accept the side effects of withdrawal with the risk of recidivism to use of street opiates, an absolute contraindication for transplantation, or continue methadone therapy and risk exclusion from the transplant process. The issue of methadone replacement therapy in end-stage cirrhosis and the posttransplant literature on the subject are explored in this paper.
Impact of a Chronic Kidney Disease Clinic on Preemptive Kidney Transplantation and Transplant Wait Times
Authors: Khosla Neenoo , Gordon Elisa , Nishi Laura , Ghossein Cybele
Published: July 2017

Background

Despite the known benefits of preemptive kidney transplantation, its rate of use remains low.

Objective

To determine whether focused, comprehensive education provided at a clinic for patients with chronic kidney disease would improve the rate of preemptive transplantation and transplant wait times.

Methods

A retrospective cohort study design was used. The rate of preemptive transplantation and transplant wait times were compared between patients with end-stage renal disease who had been followed in a chronic kidney disease clinic for more than 3 months and patients with end-stage kidney disease who had not been followed for chronic kidney disease care during the same period.

Results

More African Americans than others had initiated dialysis without having had previous care for chronic kidney disease. The rate of preemptive transplantation was 24% for patients followed in the clinic. For those patients without living donor options, mean transplant referral time was significantly different between patients followed at the clinic and patients who were not: 234 (SD, 392) days before dialysis was started versus 161 (SD, 525) days after dialysis was started ( P= .01).

Conclusion

A chronic kidney disease clinic can influence rates of preemptive kidney transplantation and transplantation referral times.
Significant Alterations in Reported Clinical Practice Associated with Increased Oversight of Organ Transplant Center Performance
Authors: Schold Jesse D. , Arrington Charlotte J. , Levine Greg
Published: July 2017

In the past several years, emphasis on quality metrics in the field of organ transplantation has increased significantly, largely because of the new conditions of participation issued by the Centers for Medicare and Medicaid Services. These regulations directly associate patients' outcomes and measured performance of centers with the distribution of public funding to institutions. Moreover, insurers and marketing ventures have used publicly available outcomes data from transplant centers for business decision making and advertisement purposes. We gave a 10-question survey to attendees of the Transplant Management Forum at the 2009 meeting of the United Network for Organ Sharing to ascertain how centers have responded to the increased oversight of performance. Of 63 responses, 55% indicated a low or near low performance rating at their center in the past 3 years. Respondents from low-performing centers were significantly more likely to indicate increased selection criteria for candidates (81% vs 38%, P= .001) and donors (77% vs 31%, P< .001) as well as alterations in clinical protocols (84% vs 52%, P=.007). Among respondents indicating lost insurance contracts (31%), these differences were also highly significant. Based on respondents' perceptions, outcomes of performance evaluations are associated with significant changes in clinical practice at transplant centers. The transplant community and policy makers should practice vigilance that performance evaluations and regulatory oversight do not inadvertently lead to diminished access to care among viable candidates or decreased transplant volume.
Circumocular Exanthema Associated with Chronic Rejection after Kidney Transplantation
Authors: Morishita Yoshiyuki , Umino Tetsuo , Kobayashi Takahisa , Miyata Yukio , Kusano Eiji
Published: July 2017

A 43-year-old man had severe circumocular exanthema associated with chronic rejection 10 years after receiving a kidney transplant to treat end-stage renal failure. After the renal allograft was extracted, the exanthema diminished rapidly without any treatment. Donor-reactive immune cells seem to have cross-reacted with unknown pathogens on the skin and contributed to inflammation.
The Impact of a Change in Tacrolimus Monitoring Immunoassay Techniques on Clinical Decision Making
Authors: Cavanaugh Teresa M. , Parrish Nicholas , Neff Guy , Rudich Steven , Martin-Boone Jill
Published: July 2017

Context

Tacrolimus is an immunosuppressant that undergoes therapeutic drug monitoring. The laboratory at our institution changed its immunoassay techniques from the fluorescence polarization immunoassay to the cloned enzyme donation immunoassay.

Objective

To evaluate the relationship between the 2 assays and to determine the impact of the change on clinical decision making.

Design

A retrospective study of patients admitted to the hospital during the assay transition period. Tacrolimus values for the 2 assays were collected for 4 weeks and compared.

Setting

An academic health center.

Patients

Liver transplant patients hospitalized from February 18, 2008, to March 18, 2008.

Main Outcome Measure

The primary outcome was the agreement between the results of the 2 immunoassays. Secondary outcome was agreement of clinical decision making with established patient-specific therapeutic ranges or with a 30% difference in absolute values between the assays.

Results

Seventy-nine pairs of tacrolimus concentrations were collected from 21 liver transplant patients. The mean (SD) tacrolimus concentrations were 7.36 (4.21) μg/L for the fluorescence polarization immunoassay and 9.00 (5.30) μg/L for the cloned enzyme donation immunoassay ( P= .03). A clinically different decision would have been made if the fluorescence polarization immunoassay value had not been reported 51% of the time. A Bland-Altman plot indicated no relationship between the assay results.

Conclusion

A change in tacrolimus monitoring assay would have resulted in different clinical decisions 51% of the time. Awareness of changes in assay technology must be heightened to enhance clinical decision making and prevent potential impact on morbidity among liver transplant patients.
Barriers to Implementing Protocols for Kidney Paired Donation and Desensitization: Survey of US Transplant Programs
Authors: Clark Emma , Hanto Ruthanne , Rodrigue James R.
Published: July 2017

Context

Special types of kidney transplant exist for patients who have willing but incompatible donors. Two types of transplants that circumvent donor-recipient incompatibility are “kidney paired donation” and “desensitization.” Lack of access to these protocols limits living donations and shortens the life span of patients with willing but incompatible donors.

Objective

To understand potential barriers to implementing kidney paired donation and desensitization, as well as attitudes toward nondirected donation and compatible type O donation, which would maximize the number of kidney paired donation transplants performed via chains.

Design

We created a 56-question Web-based survey to elicit information from US transplant program directors about 24 potential barriers to implementing these protocols.

Participants

Of 166 programs contacted, 96 responded, including 88 complete and 8 partial responses. After pediatric-only programs and multiple responses from the same program were removed, 84 total (78 complete) remained.

Main Outcome Measures

Respondents were asked to designate each barrier as “major,” “minor,” or “not a barrier.”

Results

Availability of dedicated nurse coordinators and the United Network for Organ Sharing's variance request process (although kidney paired donation does not actually require a variance) were significant barriers to kidney paired donation. Most respondents (54%, 42/78) would prefer to participate in a regional rather than a national protocol for kidney paired donation. Risk of complications was the most significant barrier to desensitization. University affiliation, region, and training (nephrologist vs surgeon) had little effect on perception of barriers. Most (92%, 71/78) would evaluate nondirected donations; 53% (41/78) would encourage compatible type O donors to enter kidney paired donation.
Central Venous Oxygen Saturation Monitoring: Role in Adult Donor Care?
Authors: Powner David J. , Doshi Pratik B.
Published: July 2017

Monitoring oxygen saturation of blood drawn from a catheter placed within the superior vena cava (ScvO2) has recently been promoted as a substitute for evaluating oxygen saturation of mixed venous blood drawn from the pulmonary artery (Sv̄O2). The Sv̄O2 reflects the balance between oxygen delivery and oxygen consumption throughout the body and, among critically ill patients, may be helpful for assessing resuscitation, cardiac function, or oxygen homeostasis end points. Use of ScvO2 instead has been promoted because of its easier access and recent use during resuscitation of patients with severe infections. Although data from healthy subjects and critically ill patients are available, no study has been done among organ donors to evaluate customary values for either ScvO2 or Sv̄O2 or how well the values correspond. After loss of oxygen consumption in the brain following brain death, the customary values for these variables may be different from values in other groups of patients. Therefore, until donor-specific normative values for these important parameters are identified, we do not recommend that ScvO2 be used to evaluate the balance between donor oxygen consumption and delivery or as a variable to guide treatment.
Exploring the Information Needs of Adolescents and Their Parents Throughout the Kidney Transplant Continuum
Authors: Korus Moira , Stinson Jennifer N. , Pool Rita , Williams Angela , Kagan Susan
Published: July 2017

Context

Adolescents are at higher risk for organ loss than are all other age groups, but no studies have been conducted to examine the specific information needs of adolescents. A better understanding of adolescents' information needs is essential for developing programs tailored to their unique requirements.

Objective

To explore information needs of adolescents who have undergone kidney transplantation in order to inform development of an education program.

Design

A qualitative descriptive design was used. Focus groups (n = 2) were conducted by using a semistructured interview guide. Transcribed data were organized into categories that reflected emerging themes by using simple content analysis.

Participants and Setting

A convenience sample of 8 adolescents (50% female) who varied in age, donor type, and time since transplantation were recruited from a large Canadian tertiary care pediatric center.

Results

Adolescents articulated that the process of undergoing kidney transplant was very stressful and affected all aspects of their lives. In particular, adolescents identified 4 main stressors: changes in body image, wanting to be normal, pain, and breakdown in communication processes. The 2 strategies that assisted adolescents in coping with these stressors were (1) gaining knowledge about the transplantation process and (2) experiencing understanding through social support. They wanted information provided to them gradually throughout the transplant experience with choices given as to how they receive the information.

Conclusion

Adolescents were united in their call for information, self-management strategies, and meaningful social support to better manage their kidney transplant and prepare for transition to adult health care.
A Family-Centered Educational Program to Promote Independence in Pediatric Heart Transplant Recipients
Authors: Lawrence Kathy S. , Stilley Carol S. , Pollock John A. , Webber Steven A. , Quivers Eric S.
Published: July 2017

Context

Characteristic adolescent risk-taking behavior, including nonadherence with prescribed medications, can be life-threatening for transplant recipients. Suggestions for managing nonadherence in teen recipients include providing them and their parents with adequate information about medications, talking with and listening to pediatric recipients about problems with the comprehensive regimen, and encouraging age-appropriate responsibility for maintaining health.

Objective

The clinical goal of this project was to develop a structured age-appropriate educational program to prepare pediatric transplant recipients and their families for the patient's life as a responsible, independent individual. Our primary research goal was to assess patients' and parents' knowledge about critical aspects of heart transplantation and the treatment regimen with brief questionnaires before and after they received the educational materials from their primary nurse coordinator.

Design, Setting, Participants

This descriptive pre-post test study was done to assess the effectiveness of an innovative family-centered educational program among 20 pediatric heart transplant recipients and their parents at Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center.

Main Outcome Measure, Results

Percentage change in children's scores on questionnaires given before and after the educational intervention ranged from $8% to 300% (mean, 64.1%). Percentage change in scores from before to after for parents ranged from $19% to 53.8% (mean, 7.2%).
Ethics at the End of Life in Transplant Recipients
Authors: Stecher Jo
Published: July 2017

The field of transplantation is intended to try to save or improve people's lives. In some situations though, the length of a person's life is not as vital as the quality of that life. As a member of a transplant team, one must recognize the differences between quality and quantity and apply the ethical principles of autonomy, justice, nonmaleficence, and beneficence. When a lung transplant recipient became ill with posttransplant lymphoproliferative disease 10 months after her surgery, these ethical principles came to the foreground. This dynamic, vibrant woman, recently engaged, faced her own mortality with grace. There is a time for everything. When death is a long time coming, many people are referred to hospice care and the death is viewed as a blessing. This situation rarely occurs in the transplant field. Many people, whether professionals or laypersons, have a difficult time letting go. Our team and this very special woman all knew when it was time. Creating a warm and open environment in the intensive care unit helped her through the rhythms of transition in dying.
“It Has its Ups and Downs”: Adolescents' Quality of Life after Heart Transplantation
Authors: Green Angela , Meaux Julie , Huett Amy , Ainley Kathy
Published: July 2017

Context

Heart transplantation is not curative and results in a high-morbidity chronic illness. Despite this, little research has focused on adolescents' quality of life after heart transplant. Such research is critically needed because of the complex developmental changes experienced by adolescents and the need for transition to self-management during this vulnerable period.

Objective

To examine adolescents' perceptions of their quality of life and factors affecting it.

Design

Focused ethnography.

Setting and Participants

Fourteen adolescents (mean age, 17 years) who had received a heart transplant at least 6 months earlier were recruited from a large children's hospital. The ethnically diverse sample (7 black, 5 white, 1 Asian, and 1 Hispanic) included 8 females and 6 males.

Data Collection and Analysis

The adolescents participated in audio-taped qualitative interviews, which were transcribed verbatim and entered into Ethnograph to assist with data management. Thematic analysis was used to identify recurrent themes.

Results

Participants described life after transplant by saying, “It has its ups and downs.” Major themes included these: (1) I am normal and I am not normal, (2) I am grateful and I am resentful, and (3) I am managing and I am not managing. The themes reflect the dichotomous nature of the adolescents' experiences and provide insight into the complex needs of adolescents after heart transplant.
Ventilator Autotriggering: A Caution in Brain Death Diagnosis
Authors: Dodd-Sullivan Rebecca , Quirin Jamie , Newhart John
Published: July 2017

The Uniform Determination of Death Act and the American Academy of Neurology's Guidelines for Determination of Death define procedures for diagnosis of brain death before organ procurement for transplantation, including clinical assessment and apnea test. Autotriggering of mechanical ventilators can occur in both brain dead and living patients. A case is reported in which procurement was delayed because ventilator self-cycling was confused for brainstem-mediated respiratory effort. Background knowledge to effectively troubleshoot ventilator self-cycling is offered so that unnecessary delays in brain death testing can be avoided.
Donation after Cardiac Death for Lung Transplant: A Case Study
Authors: Kirschbaum Cyndy , Peeples Crystal
Published: July 2017

In late 2009, Gift of Life Michigan facilitated a donation after cardiac death lung recovery resulting in the first set of donation after cardiac death lungs to be utilized by a Michigan transplant center. Although placing lungs obtained via donation after cardiac death is more difficult because of a multitude of factors, the transplant coordinators, in conjunction with the transplant center, overcame several obstacles in order to transplant the lungs with good outcomes so far. Lung donation after cardiac death is becoming a more acceptable method of decreasing the length of the transplant waiting list as more data are becoming available.
Transplant Cost-Report Tracking at Henry Ford Transplant Institute and other Centers Nationwide
Authors: Beach-Langlois Marianne , Yankasky Pamela
Published: July 2017

Context

The lack of uniformity in the reporting of direct and indirect costs by organ acquisition cost centers, diagnosis-related groups, and in physician reimbursement often results in Medicare overpayment and findings of unjustified charges in audits conducted by the Office of the Inspector General. Although it is true that organ transplantation costs vary widely, uniform cost-report accounting is needed.

Objective

Henry Ford Transplant Institute has developed systematic auditing protocols that result in acceptable compliance with Medicare. The differences between those protocols and the methods used elsewhere are illustrated by the results of a national survey of transplant centers.

Design

The survey addresses 10 crucial questions, drawn from the cost-reporting model used at Henry Ford Transplant Institute.

Setting

Surveys were distributed via the United Network for Organ Sharing list-serv, with replies from 43 centers.

Patients or Other Participants

The participants were transplant administrators.

Results

Several important practices that are audited by the Office of the Inspector General were not followed by a number of reporting institutions. About 30% did not account for pretransplant charges, 15% did not track pretransplant services, 40% do not use an external consultant, and the frequency of physician time studies varied. On the other hand, the vast majority of institutions perform frequent time studies and manually review pretransplant charges. These results suggest that most centers use accounting methods similar to those used at Henry Ford Transplant Institute, which will significantly improve recognition of pretransplantation costs.
Using Crisis Theory to Explain the Quality of Life of Organ Transplant Patients
Authors: Denny Bianca , Kienhuis Mandy
Published: July 2017

Objectives

To evaluate the literature on the stress, coping, and quality of life of organ transplant candidates and recipients, and to place previous research within a theoretical context.

Data Sources

CINAHL database, Proquest database, Google Scholar; references from articles were also reviewed to identify additional data.

Study Selection

Qualitative and quantitative research studies and meta-analyses pertinent to the stress, coping, and quality of life of transplant candidates and recipients were selected.

Results

Stressors associated with the transplantation process, coping strategies of transplant patients, and quality of life or transplant patients have been well researched for many years. Patients typically use problem-focused coping strategies in response to various stressors. Transplant recipients typically report a higher quality of life than do transplant candidates; however, posttransplant quality of life does not typically equal the quality of life of healthy nonpatients.

Conclusions

The relationship between stress, coping, and quality of life of transplant patients has not yet been systematically investigated from a theoretical perspective. Recommendations for further research are provided.
Is Model for End-Stage Liver Disease Score Associated with Quality of Life after Liver Transplantation?
Authors: Rodrigue James R. , Nelson David R. , Reed Alan I. , Hanto Douglas W. , Curry Michael P.
Published: July 2017

Context

The Model for End-Stage Liver Disease (MELD) is used to predict short-term mortality of patients on the liver transplant waiting list and to allocate deceased donor livers for transplantation.

Objective

To examine the relationship between MELD score before transplant and quality of life and other functional status indicators after transplant.

Design, Setting, and Patients

Two-hundred sixty-five adults from 2 transplant programs completed quality-of-life measures 1 year after transplantation. A subcohort (n = 115) also completed quality-of-life assessments before transplant. Clinical parameters at the time of transplantation were collected from their medical records.

Main Outcome Measures

Short Form-36 Health Survey, version 2; Transplant Symptom Frequency Questionnaire.

Results

Patients with MELD scores greater than 25 at transplantation had significantly higher scores on the Short Form-36 general health ( P = .004) and physical component summary ( P = .02) than did patients with MELD scores of 25 or less. However, scores on the Transplant Symptom Frequency Questionnaire did not vary significantly by MELD score. Child-Turcotte-Pugh (CTP) score, a measure of disease severity, was significantly associated with total symptom frequency after transplant ( P = .03) but was not correlated with any domains on the Short Form-36. In the subcohort of 115 patients, a MELD score greater than 25 at the time of transplantation was associated with greater improvement in physical functioning (11.3 vs 4.8, P = .02), role functioning-physical (10.7 vs 4.7, P = .04), general health (11.9 vs 5.5, P = .03), vitality (10.4 vs 5.2, P = .02), and physical component summary (12.3 vs 5.4, P = .01) relative to patients with MELD scores of 15 to 25.

Conclusions

The relationship between disease severity before transplant and quality of life after transplant is different depending on the index of disease severity used (MELD vs CTP) and whether the assessment of quality of life is general or specific to transplant-related symptoms.
Infections in Patients with Chronic Renal Failure and Kidney Transplant Recipients in Brazil
Authors: Bedendo João , Giarola Luciana Borges , Moreira Rafael Renato Brondani , Rossi Robson Marcelo , Borelli Sueli Donizete
Published: July 2017

Patients with chronic renal failure who are undergoing dialysis and kidney transplant recipients are susceptible to infection for several reasons. In this study, the profile of infections in patients with chronic renal failure and kidney transplant recipients treated at a hospital in northern Paraná, Brazil, from 2007 to 2009 was examined. The study involved 187 patients: 59 kidney transplant recipients and 128 patients undergoing dialysis. The frequency of infection was 25% (32/128) in dialysis patients and 8% (5/59) in transplant recipients ( P = .008). Staphylococcus aureus was the most prevalent infectious agent, cultured from 27% (13/48) of samples, followed by Escherichia coli at 17% (8/48). All isolates of S aureus were sensitive to vancomycin and resistant to penicillin, and 43% were resistant to oxacillin. Most S aureus samples (43%) were isolated from cultures of blood samples. As for the E coli, 75% were resistant to cephalothin and 38% were resistant to sulfamethoxazole/trimethoprim. Most isolates of E coli (62%) were cultured from specimens of patients with suspected urinary tract infection.
Use of Nurse Practitioners in Pediatric Kidney Transplant: A Model for Providing Comprehensive Care to Children and Families
Authors: Brennan Jessica , McEnhill Marilyn
Published: July 2017

It is well documented that kidney transplantation is the treatment of choice for children with end-stage renal disease. Pediatric kidney transplant patients are a complex population because of their need for lifelong immunosuppression, potential for delayed growth and development, and increased risk of heart disease and cancer. Although many large pediatric kidney transplant programs use nurse practitioners, the role of the nurse practitioner is still emerging in relation to the transplant coordinator role. This article describes the practice of pediatric nurse practitioners caring for children who require a kidney transplant and why nurse practitioners are ideal for providing comprehensive care to this population. Transplant programs are regulated by the United Network for Organ Sharing and the Centers for Medicare and Medicaid Services. Both organizations require transplant programs to designate a transplant coordinator with the primary responsibility of coordinating clinical aspects of transplant care. Incorporating transplant coordinator activities into the role of the pediatric nurse practitioner is discussed as a model for providing care throughout the process of kidney transplantation. Transplant pediatric nurse practitioners are in a unique position to expand the care for pediatric kidney transplant patients by assuming the role of clinician, educator, administrator, and coordinator.
Development of the Center for Living Donation: Incorporating the Role of the Nurse Practitioner as Director
Authors: Rudow Dianne LaPointe
Published: July 2017

For decades, live organ donors have been cared for within the transplant program by the same team that cared for the recipient without any standardization, practice guidelines, or evidence-based evaluation. In an effort to improve the care of living donors, regulations and guidelines to dictate care and follow-up have been instituted. Practices still vary from center to center, and the quality of care that live donors receive also varies. A “Living Donor Center” focused solely on the care of actual and potential donors before and after donation is one way to provide the infrastructure to comply with regulatory mandates and deliver high-quality care to this specialized population of patients. A Center for Living Donation was developed within a Transplantation Institute to address the short- and long-term needs of live donors and confine all donor care to a team of experts led by a doctorally prepared nurse practitioner as the director. A transplant nurse practitioner is uniquely poised to assume such a role because of such competencies as clinical and professional leadership, ability to act as a change agent, communication skills, and ability to lead a multidisciplinary team.
Interventions Used by Health Care Professionals to Enhance Medication Adherence in Transplant Patients: A Survey of Current Clinical Practice
Authors: Berben Lut , Dobbels Fabienne , Kugler Christiane , Russell Cynthia L. , De Geest Sabina
Published: July 2017

Context

Although medication nonadherence is associated with severe complications including graft rejection and loss, its prevalence remains high among organ transplant recipients. Still, little information exists on clinical use of interventions to improve medication adherence.

Objective

To identify transplant health care professionals' methods of assessing medication adherence, classify the used interventions, and measure those interventions' perceived effectiveness.

Design, Setting and Participants

A 46-item questionnaire on adherence assessment and interventions was distributed at the 2010 International Transplant Nurses Society symposium in Germany. Data were analyzed by using descriptive statistics.

Results

Of 141 distributed questionnaires, 94 (67%) were returned. Respondents with no direct patient contact (9%, n = 8) were excluded. The most frequently used assessment strategy was patient self-reporting (60%, n = 52). On average, participants reported using 47% of the educational/cognitive, 44% of the counseling/behavioral, and 42% of the psychological/affective interventions listed. Training patients to self-administer medications and providing printed adherence information were the most frequently used interventions (79% each, n = 68), followed by providing printed medication instructions (69%, n = 59). Most respondents (90%, n = 77) reported combining interventions. The intervention perceived as most effective was medication self-administration training.

Conclusion

Although available alternatives are demonstrably more effective for enhancing medication adherence, this sample relied more on educational interventions.
Improving Transplant Discharge Education Using a Structured Teaching Approach
Authors: Frank-Bader Margaret , Beltran Karen , Dojlidko Dorothy
Published: July 2017

Context

Nonadherence to posttransplant regimens is common in transplant patients and has the potential for devastating consequences, including acute rejection, graft loss, decreased quality of life, and even death. Comprehensive education of patients and families that improves their understanding of posttransplant regimens and selfcare techniques can increase adherence and improve outcomes. Transplant recipients have to learn a vast amount of complex information in a short period as they recover from major surgery and cope with the emotional stress of transplantation. It is not surprising that many patients report that they do not feel ready for discharge.

Objective

To describe the development, implementation, and outcomes of a comprehensive interdisciplinary patient education program.

Design

A quality improvement project.

Setting

A solid organ transplant unit of a large academic medical center.

Participants

In-hospital transplant patients and their families and the interdisciplinary team.

Interventions

A comprehensive discharge education program that integrated written materials, patient and clinical pathways, and discharge instructions.

Main Outcome Measure

Improved patient satisfaction with readiness for discharge and medication teaching.

Results

A postimplementation patient discharge survey using a 5-point Likert scale showed an increase in patients' understanding of medication dosage (3.6 to 4.6) and side effects (3.6 to 4.7), and satisfaction with the discharge teaching process (3.4 to 5.0).
Curing and Drying Technologies for Coating and Laminating
Authors: Troyer Tom
Published: July 2017

Figure 9 is a summary of these basic processes. Many of these processes can be combined in any number of ways to create methods of manufacturing that are most advantageous to your product and business. Any process should be built on a combination of the best chemistry, energy transfer method, type of energy, material handling, and oven construction. These new processes should be tried and perfected on a trial basis before constructing a full equipment line. Some processes may best be achieved by putting multiple coaters, laminators, ovens, and other associated equipment in line. Most equipment manufacturers have test laboratory capabilities available so the equipment and chemistry can be developed together. It is also most essential to take into consideration any materials that will be emitted from the drying or curing process and their impact on employee safety and environmental regulations. Many times these problems can be avoided by a change in the chemistry.
A Study of Tearing in Coated Cotton Fabrics
Authors: Abbott Norman J. , Lannefeld Theodore E. , Barish Leo , Bpysson R.J.
Published: July 2017

Thirty-one experimental fabrics were woven and coated with a PVC plastisol. The design of these fabrics was varied in a systematic way to permit evaluation of the influence of a variety of constructional variables. The coating was applied using knife-over- blanket technique. Measurements made before and after coating in cluded an end and pick count, coating weight and thickness, break ing strength and elongation, tearing strength, and flexural rigidity. Application of the coating increased the breaking strengths of almost all constructions slightly. All fabrics were stiffened by the application of coating, the extent of the change not being affected to any marked degree by the construction of the fabric. Tearing strengths were all reduced by coating, the amount of reduction depending upon the weave, but not particularly by the constructional variables. Plain weaves lost about 25% of their tearing strength on the average, twills about 60%, and baskets at least 70%. In spite of this, the basket weaves had the highest tearing strengths in the coated state.
The Bending Behaviour of Some Coated Fabrics from −40°C to + 140°C
Authors: Swallow J. E. , Webb M.
Published: July 2017

The bending lengths of 25 fabrics, coated with several types of rubber, were found to follow Arrhenius-type relationships from —40°C. to + 140°C. Each fabric had its own activation energy of bending which, for single-ply fabrics, was related to the thickness of the fabric and the thickness of the coating. Differences in behaviour associated with the nature of the coating were more readily distinguishable at low temperatures.
Fracture Toughness Variations of Injection Molded Long Fiber Reinforced Thermoplastics
Authors: Gonzalez Fernando , Chassapis Constantin
Published: July 2017

The fracture toughness, defined as K c , of injection molded long fiber reinforced polypropylene with 50% E-glass and its variations is investigated. Rectangular plaques of different thicknesses at various sets of processing conditions have been fabricated. In order to assess the spatial variation of the fracture toughness, specimens aligned in the direction of the injection molding flow and perpendicular to it, have been obtained and tested at pre-selected locations. The morphology of the samples consisting of flow induced through-thickness layers was also evaluated experimentally and related to the fracture toughness, thus showing the effect of the part morphology on such mechanical property.
Effect of Environmental Pre-Conditioning on Bond of FRP Reinforcement to Concrete
Authors: Al-Dulaijan Salah U. , Al-Zahrani Mesfer M. , Nanni Antonio , Boothby Thomas E. , Boothby Thomas E.
Published: July 2017

To determine how environment affects the bond behavior of FRP reinforcement for concrete, FRP rods were subjected to accelerated environmental pre-conditioning and several mechanical tests. Specially-made smooth and lugged FRP rods consisting of glass/vinylester, carbon/vinylester, and carbon/epoxy composites were evaluated. The primary means of comparison of the pre-conditioned materials was the direct pull-out test, although pertinent properties of rods such as short-beam apparent shear strength and longitudinal modulus of elasticity were also evaluated. The results reveal that pre-conditioning of FRP rods prior to casting degrades the FRP material itself, but does not necessarily degrade the bond behavior. In particular, the smooth rods, which had low bond strength to begin with, had little change in bond strength. On the other hand, the lugged rods, which were made susceptible to the environment by the machining of lugs, had significantly reduced bond strength due to degradation of the resin or the fiber/resin interface. Of the three types of aqueous environments evaluated, high temperature combined with an alkaline solution is the most aggressive to the FRP materials evaluated. Certain experiments highlighted the importance of the resin rich surface on environmental resistance.
The Hydraulic Permeability of Dual Porosity Fibrous Media
Authors: Markicevic B. , Papathanasiou T. D.
Published: July 2017

We present a computational analysis of viscous flow through arrays of fiber bundles using the Boundary Element Method (BEM) implemented on a multi-processor computer. Up to 700 individual fibers are included in each simulation. These are simple but not trivial models for fibrous preforms used in composites manufacturing-dual porosity systems characterized by different inter- and intra-tow porosities. The way these porosities affect the hydraulic permeability of a preform is currently unknown and is elucidated through our simulations. Numerical results are compared to analytical models. Through a large number of simulations we construct a master curve for the permeability of arrays of fiber bundles for various packing arrangements.
Acquisition of Complex Assembly Skills through the Use of Systematic Training Procedures: Involving Profoundly Retarded Adults
Authors: Spooner Fred , Hendrickson Bob
Published: July 2017

Work Activity Centers in the United States have been very prone to let their clientele attempt to learn basic industrial tasks in group settings without the use of a controlled training procedure. The usual effects have been: (a) excessively long periods of skill acquisition, (b) high variability in production techniques, (c) substantial fluctuations in product quality, and (d) preferential opportunities for those whose learning ability was least severely impaired. This report is concerned with the acquisition of skills to perform a complex industrial task by seven profoundly retarded adults using a systematic training procedure. The task consisted of inserting six different colored game pawns into a poly-bag and placing the loaded bag in a finish bin. The method described was adopted after an extended period of observation during which substantial numbers of clients were found to be unable to acquire the requisite skills through any of the various non-systematized methods of presentation. The training procedure employed three phases. The first was based on a backward chaining format and took place in a designated training area with only the trainer and a single trainee present. The second phase was based on a total task presentation in the same setting; and the third continued the total task format in the production area of the Center. Each of the five individuals who completed the training has reached the established criterion for all three phases.
Teacher Modeling and Student Imitation: An Instructional Procedure and Teacher Competency
Authors: York Robert , Williams Wes , Brown Pansy
Published: July 2017

This paper discusses the advantages of using modeling as an instructional procedure to teach severely handicapped students to imitate. A discussion of the process of teaching severely handicapped students to imitate is also included. The writers also propose that modeling as an instructional procedure for teaching non-imitative students to imitate be considered a crucial instructional competency for teachers of severely handicapped students.
Screening Severely Handicapped Children: The Developmental Activities Screening Inventory
Authors: DuBose Rebecca F.
Published: July 2017

The Developmental Activities Screening Inventory (DASI) is introduced as a viable means for determining the developmental level of children functioning between the ages of 6 and 60 months. The nonverbal test includes adaptations for visually impaired children. Thus, it is useful in screening normally functioning and severely handicapped children for the purpose of planning further assessment and interim educational goals. The inclusion of procedures for teaching the skills included facilitates immediate follow-through in the classroom.
From Promise to Reality
Authors: Haring Norris G.
Published: July 2017

This article was the welcoming address given by president Haring at the Third Annual Conference of The American Association for the Education of the Severely/Profoundly Handicapped, on October 13, 1976, in Kansas City, Missouri.
Behavioral Training Strategies in Sheltered Workshops for the Severely Developmentally Disabled
Authors: Wehman Paul , Renzaglia Adelle , Schutz Richard
Published: July 2017

This paper is a behavioral analysis of learning and behavior problems which may be expected of severely developmentally disabled persons in vocational settings. The behavioral analysis includes three major sections: (1) a categorization and description of primary problems encountered by a severely handicapped population, (2) a logically arranged hierarchy of behavioral procedures which can be used to treat different types of problems, and (3) a general set of management strategies. It is recommended that the hierarchy of behavioral procedures be empirically validated.
Employing Negative Reinforcement to Establish and Transfer Control of a Severely Retarded and Aggressive Nineteen Year Old Girl
Authors: Mithaug Dennis E. , Hanawalt David A.
Published: July 2017

Negative reinforcement in the form of experimenter-administered finger pressure on the inside upper bicept area of the subject's right arm was employed to increase task-initiated responding on a prevocational task, collating a booklet. Termination of the finger pressure was contingent upon the subject's touching the cover to open the booklet and begin to collate. When compared with two other conditions, tapping on the subject's hand to prompt her to begin work and repeating a verbal cue while ignoring aggressive responses, the finger pressure procedure not only increased response rates but also resulted in a decrease and elimination of self-biting and hitting the experimenter. When a teacher aide applied the procedure on the same task but at a different time in the day, the subject's response rates similarly increased and her self-biting and hitting remained at low levels.
A Direction for the Future: AAESPH's Role in S-3 Materials Accession Process
Authors: Elder Jean K. , Pellow Mary L. , Jipson-Greenstein Janice
Published: July 2017

Information is provided on NIMIS and on AAESPH's role in S–3's Materials Accession Process, which was developed to increase the involvement of professionals in the field in establishing the NIMIS data base. While the original data base was generated from published sources, the MAP attempts to include teachers and therapists in locating materials for entry. The process of coordinating and disseminating information among professionals is discussed. It is the intent of S-3 that the experiences gained from the MAP involvement with AAESPH will lead to similar relationships with other professional organizations.
Nonverbal Communication and the Severely Handicapped: Some Considerations
Authors: Hopper Christine , Helmick Richard
Published: July 2017

Educational issues related to training severly handicapped individuals in nonspeech communications are discussed in light of empirical evidence found in the research literature. Suggestions for future research studies in the area of manual communication procedures are proposed.
Developing Social Responses in Two Profoundly Retarded Children
Authors: Burney James D. , Russell Barbara , Shores Richard E.
Published: July 2017

The effect of training upon the development of social interaction responses in two profoundly retarded children was investigated. Both children showed marked gains in the trained responses, with one child also demonstrating limited generalization of the responses to a new setting. Response generalization to a child not involved in training occurred to a limited extent.
An Examination of the Direct and Generalized Effects of a Play-Training and Overcorrection Procedure upon the Self-Stimulatory Behavior of a Profoundly Retarded Boy
Authors: Kissel Robert C. , Whitman Thomas L.
Published: July 2017

This study was designed to answer a question posed by Epstein, Doke, Sajwaj, Sorell, and Rimmer (1974) concerning whether an overcorrection technique administered to one inappropriate behavior will also suppress other untreated inappropriate responses. In addition, it examined another often-overlooked question, that is, whether the effects of treatment generalize over situations. The effects of a positive reinforcement and a hand overcorrection training package upon the play and self-stimulatory responses of a 14 year old profoundly retarded boy were examined In three different types of play situations. The design allowed both stimulus and response generalization effects to be assessed. Results indicated that the training procedures increased play behavior and decreased three different self-stimulatory responses. Although there was some evidence that both situational and response generalization effects occurred, these effects were not sufficient to preclude the need for further treatment.
The Modification of Self-Stimulatory Verbalizations in an Autistic Child through the Use of an Overcorrection Procedure
Authors: Newman Rebecca , Whorton Debra , Simpson Richard
Published: July 2017

The present study evaluated the effects of an overcorrection procedure on the self-stimulatory verbalizations of an 8-year old severely disturbed child. The procedure was applied in a public school setting. Data from the study indicate that this approach can be effectively used to decelerate self-stimulatory verbalizations In applied settings and that the procedure does not have a detrimental influence on the development of more appropriate language.
Community Transition: A Behavioral Approach with the Severely/Profoundly Retarded and Their Families
Authors: Bates Paul
Published: July 2017

This article reports the methods, procedures, content, and outcomes of a federally funded Title I program to alter the role of the institutional social caseworker and to develop smoother transition from the institution to the community. On the basis of a questionnaire to parents of institutionalized children, programs of parent-training workshops and home intervention assistance were developed, with encouraging results.
Instructional Problem-Solving in Programming for the Severely Handicapped
Authors: Knapczyk Dennis R. , Dever Richard B.
Published: July 2017

This paper presents a teaching-learning paradigm designed to help teachers make specific decisions about instructional strategies. It can be used both In teacher-training programs and by inservice teachers. The paradigm describes parameters of teacher behavior and the sequence in which instructional tasks occur.