bluuebunny/crossref_metadata_2025 huggingface dataset:
Pharmacologic Treatment of Schizophrenia: A Review
Authors: Tugrul Karen C.
Published: January 2017

Standard antipsychotic agents, such as haloperidol and chlorpromazine, continue to be the mainstay of pharmacologic treatment for schizophrenia. However, standard antipsychotics, although effective for the positive symptoms of schizophrenia, have little or no effect on the negative symptoms of this disease. Standard antipsychotics also are associated with the development of potentially disabling side effects, such as extrapyramidal symptoms and tardive dyskinesia. Newer agents, such as clozapine and risperidone, are effective for both positive and negative symptoms. They also are less likely to cause extrapyramidal symptoms.
Defining Professional Practice: The Evolution of the RANA Model
Authors: Bultema Janice K. , Getzfrid Mary Kay , Slade Maureen
Published: January 2017

Nurse leaders are reengineering delivery systems to respond to the changing health care environment and new health care values of quality, service, and reduced costs. By restructuring models of care and nursing positions, organizations are creating an improved environment of care for patients and the community. The authors describe the development and implementation of a patient-centered care model They also discuss the evolution of a unit-based leadership position with 24-hour accountability, responsibility, and authority for the patient and significant other's care and outcomes throughout the course of hospitalization. Implementation of this model and new position has been successful and the development and implementation processes have applicability to other patient populations and care settings.
Beyond Compliance: Evaluating Antipsychotic Efficacy
Authors: Littrell Kimberly H.
Published: January 2017

Over the past 40 years, clinicians have refined the pharmacologic treatment of patients with schizophrenia. Within the past several years, the introduction of two new antipsychotic medications, clozapine and risperidone, has considerably improved the quality of life of patients with schizophrenia. The availability of these newer antipsychotic drugs raises several questions: how wel patients will comply with these medications, how to accurately assess efficacy, and how to switch from one antipsychotic agent to another. Each of these issues is addressed in this article.
Uncovering Clinical Knowledge in Expert Psychiatric Nursing Practice
Authors: McElroy Ellen C.
Published: January 2017

BACKGROUND: Psychiatric nursing has been referred to as a specialty area of nursing that is fading away because of the failure of its members to develop a theoretical base for practice. Benner (1984) maintained there is knowledge embedded in expert practice that can be usedfor theory development.

OBJECTIVES: The purpose of this interpretive study was to uncover clinical knowledge embedded in the paradigm cases of expert psychiatric nurses.

STUDY DESIGN: Heideggerian bermeneutics was the method that guided the study. Analysis of data was based on the seven-stage process described in Diekelmann, Allen, and Tanner (1989).

RESULTS: Three relational themes, Uncovering Dangerousness in Psychiatric Nursing Practice, Acknowledging and Marking the Boundaries, and Reflection on Practice, emergedfrom the data. The major finding of the study was the constitutive pattern, the Primacy of the Nurse-Patient Relationship in Psychiatric Nursing Practice.

CONCLUSIONS: Embedded in the paradigm cases in this study were descriptions of theoretical knowledge being refined and extended through reflection on practice experience. Clinical knowledge consistent with competencies in all seven of Benner's nursing domains also was present in the paradigm cases.
Therapeutic Efficacy of Olanzapine
Authors: Littrell Kimberly H. , Littrell Steven H.
Published: January 2017

The evaluation of efficacy of antipsychotic medications is a complex process. For more than 40 years conventional antipsychotic agents have formed the cornerstone of treatment for patients with schizophrenia. During this period the markerfor therapeutic effectiveness has focused almost exclusively on the control of psychotic symptoms. Now with the introduction of atypical antipsychotic agents it seems possible to achieve control of symptoms in multiple domains. Clinical trials of the new antipsychotic, olanzapine (Zyprexa), demonstrated control of both positive and negative symptoms of schizophrenia and comorbid depressive symptoms. Olanzapine appeared to be significantly better than haloperidol in maintaining symptom remission and preventing relapse. Recently approved by the Food and Drug Administration as a first-line agent for the treatment of psychosis, olanzapine has demonstrated enhanced efficacy for use in both acute and maintenance treatment modalities. This article reports results from a 6-week open label trial of the drug. Significant improvements were found, Findings are limited by small sample size. However, the early positive results encourage both further testing and challenge nurses to expand their skills in assisting patients and their families with the recovery process.
Choosing an Antipsychotic in the reatment of Schizophrenia: Conversions to Olanzapine
Authors: Littrell Kimberly H. , Littrell Steven H.
Published: January 2017

The recent introduction of olanzapine (Zyprexa) has provided anotherfirst-line antipsychotic treatment option in the pharmacologic treatment ofpsycbiatric patients. Unlike clozapine which is restricted to use with refractory schizophrenia, olanzapine is labeledfor themanagement of manifestations of psychotic disorders This implies a much larger potential treatment population besides schizophrenia, and nurses should consider its use beyond patients with treatment-resistant schizophrenia Matters of therapeutic dosing, titration, and maintenance dosing are remarkably simple with this compound With the current availability of olanzapine, nurses will need to befamiliar with the issues surrounding conversion from other antipsycbotic agents to this new agent.
The Johnson Behavioral Systems Model as a Framework for Patient Outcome Evaluation
Authors: Poster Elizabeth C. , Dee Vivien , Randell Brooke P.
Published: January 2017

BACKGROUD: Although there is a great deal of interest in the outcome of the nursing care of psychSitcpatients, there is little empirical research about the effectiveness of nursing care.

METHODS: This study evaluated the medical record documentation by nurses as an important database (N=380patients). The predicted patient outcome instrument developed by the authors was used to collect the data related to patient demographics, acuity, nursing diagnosis, short-and long-term goals, and nursing interventions. The Johnson Behavioral System Model was the nursing conceptualframework used.

FINDINGS: Overall, 80% of the predicted patient outcomes were achieved by the time of discharge, with increased length of stay being a factor in increasing the likelihood of achievement ofgoals. A positive link wasfound between achievement of outcomes at time of discharge and nursing interventions. A nursing theoreticalframework made it possible to prescribe nursing care as a distinctionfrom medical care.

CONCLUSION: This study showed the importance of the nursing database in the medical records and the effectiveness of nursing interventions on predicted patient outcomes achieved by the time of discharge.
Intervening with Teen Mothers: A Case Study
Authors: Hart Ann L. , Fishel Anne H.
Published: January 2017

This article deals with how an informed network of linked services directed by one case manager was able to achieve successful steps toward interrupting the vicious cycle of adolescent pregnancy. It is the story of how a community of caregivers worked together to prevent duplication of services in an era in which erosion of services is occurring. A case study is presented illustrating the value of a one-to-one relationship between a professional caregiver and a teen. Efforts coordinated at various levels in the community provided services, support, and direction to the welfare of this adolescent mother and her child.
Bridging the Gap Between Psychiatric Hospitalization and Community Care: Cost and Quality Outcomes
Authors: Chiverton Patricia , Tortoretti Donna , La Forest Marylee , Walker Patricia Hinton
Published: January 2017

BACKGROUND: Current changes in the health care system require the development of interventions that reduce length of stay and provide alternatives to hospitalization while maintaining quality and consumer satisfaction

OBJECTIVES: The objectives were to (a) investigate differences in quality indicators for patients receiving case management services; (b) measure satisfaction of patients enrolled in the case management intervention; and (c) reduce costs related to high utilization of services as a result of recidivism and rehospitalization.

STUDY DESIGN: Inpatients were randomly assigned to either an intervention (n = 121) or control group (n = 122). The intervention group received transitional case management services; the control group received traditional care.

RESULTS: No differences were found between the two groups on the Beck Depression Inventory or the Mini-Mental Status Examination. Ninety-six percent of the patients and 95% of their caregivers were very pleased with the case management intervention Fewer patients in the intervention group (9 vs. 16 in the control group) were readmitted to the hospital over the course of the project. Similarly, only 1 patient in the intervention group versus 18 patients in the control group used the emergency department. Even considering the cost of providing case management services, an overall savings of $175,375 occurredfor the intervention group.

CONCLUSIONS: Transitional case management services maintained quality and reduced costs with a high level of consumer satisfaction.
Schizophrenia and Comorbid Substance Abuse
Authors: Littrell Kimberly H. , Littrell Steven H.
Published: January 2017

Research suggests that nearly half of all patients with schizophrenia concurrently abuse substances. However, despite the prevalence of substance abuse among persons with schizophrenia, the effective treatment of these comorbid conditions has eluded mental health professionals for decades. Apart from the obvious problems associated with schizophrenia and alcohol or drug abuse, schizophrenic persons who abuse substances also experience increased rates of depression, suicide, homelessness, unemployment, and illegal activity. These diverse problems necessitate interventions that address the special needs of this population. Research indicates that the use of atypical antipsychotic agents with persons who have a dual diagnosis may prove to be efficacious with treatment, overall This article reviews the current literature pertaining to the potential expanded therapeutic benefits of enhanced efficacy of atypical antipsychotic medication in association with decreased substance Assoc [1999].
Group Therapy for Survivors of Childhood Sexual Abuse Who Are Severely and Persistently Mentally Ill
Authors: Kriedler Maryhelen C. , Einsporn Richard L. , Zupancic Melissa K. , Masterson Colleen
Published: January 2017

BACKGROUND: Few researchers have investigated the effectiveness of long-term group psychotherapy with women who have a core issue of childhood sexual abuse, particularly those who are designated as being severely and persistently mentally ill (SPMI). Women so labeled are usually treated within a biological framework. Medications and supportive care are often the preferred therapies, denying the necessity of dealing with past traumatic issues.

OBJECTIVES: The objective of this pilot study was to determine the outcome of long-term; time-limited group therapy with women designated as SPMI. The study addressed rate of improvement in symptomatology and self-esteem scores in women who are SPMI and those not designated SPMI.a

STUDY DESIGN: A quasi-experimental design was used. The sample (N = 72) consisted of women older than 18 years who were sexually abused as children. The experimental group was made up of women labeled SPMI (n = 13), and the control group was composed of those who had not been designated SPMI (n = 59). The intervention consisted of 50 weeks of group therapy using a family systems modeL The instruments, which included the Beck Depression Inventory, the Symptom Check List-90-Revised and the Rosenberg Self-Esteem Scale, were administered at sessions I and 50.

RESULTS: Results indicated that women labeled SPMI had lower self-esteem and higher symptomatology scores before receiving the group therapy, but both groups achieved comparable improvement in scores at the end of 50 weeks of group therapy.

CONCLUSION: The results indicated that women labeled as SPMI could benefit from group therapy that addressed the core issue of childhood sexual trauma.
Understanding the Process of Grieving and Loss: A Critical Social Thinking Perspective
Authors: Bateman Anne L.
Published: January 2017

Critical social thinking is an effective approach to exploring the process of grieving and loss from an individual's lived experience and challenges the nurse to look beyond the obvious to potential oppressive forces, such as the social; political, or economic circumstances affecting the individual The critical thinking perspective includesfour basic concepts: identifying assumptions; checking the accuracy and validity of these assumptions; considering alternative perspectives; and taking informed actions. The process of grieving and loss is influenced by factors beyond the obvious issues identified by the nursing process. This article explores some of the dimensions of grieving and loss as they relate to the conceptual framework of critical social thinking and the nursing process.
Langerhans Cell Histiocytosis
Authors: Park Ligaya , Schiltz Clayton , Korman Neil
Published: January 2017

Background:

The cutaneous presentation of Langerhans cell histiocytosis (LCH) is very rare and can be highly variable among individuals, which can often lead to a delay in diagnosis.

Objective:

To discuss a case report and literature review of important clinical indicators, histology, diagnosis, evaluation, and treatment guidelines.

Methods:

Case report and literature review.

Results:

Skin biopsies positive for CD1a and/or langerin are diagnostic for LCH. A thorough review of systems, baseline laboratory tests, and imaging studies can determine the extent of LCH. Treatment of cutaneous disease is largely based on case report and small case studies, but baseline treatment should generally begin with oral or topical steroids. When patients have more severe disease that requires a systemic approach, the efficacy of therapy should be assessed 6 weeks into therapy, with subsequent treatment intensification in patients with limited response.

Conclusion:

Owing to the rarity of this condition, there are no specific guidelines for treatment of LCH, but guidelines put forth by the Histiocyte Society assist in categorization and basic treatment approaches for patients with systemic disease.
Applying Research to Health Care Policy and Practice: Medical and Managerial Views on Effectiveness and the Role of Research
Authors: Rosen Rebecca
Published: January 2017

Objectives:

This study explores the way in which doctors and managers think about the effectiveness of health care interventions and how this shapes the evidence they use to support decision-making.

Methods:

Case studies of the introduction of three new medical technologies in nine National Health Service (NHS) hospitals and health authorities.

Results:

Effectiveness research provides essential evidence on clinical and cost-effectiveness and is used primarily by clinicians and public health doctors for this purpose. However, research fails to provide the ‘evidence’ required by managerial decision-makers, whose objectives relate as much to the effect of a technology on organisational performance as on patient health and well-being. The evidence used to inform technology adoption decisions reflects the professional role and objectives of different decision-makers.

Conclusions:

The assumed relationship between ‘research’ and ‘evidence’ for the purpose of promoting effective health care does not take account of the wide range of objectives pursued by different health care decision-makers and the varied sources of ‘evidence’ they use to support their decisions.
Legitimate Decision Making: The Achilles' Heel of Solidaristic Health Care Systems
Authors: Mays Nicholas
Published: January 2017

The future sustainability of ‘solidaristic’ or universal publicly financed health systems is frequently said to be threatened by lack of resources as rising demand collides with the growing reluctance of the better-off to pay for services mainly used by others. Competitive health care arrangements are also regarded as threatening solidarity. By contrast, I argue that the main threat to the sustainability of such systems lies in the inability of so-called ‘advanced’ societies to develop institutions that are capable of acceptably reconciling inevitably scarce resources with individual and collective desires to have all the health care we want. Many ‘advanced’ societies lack, or fail to incorporate into their health systems, the range of intermediate institutions that could potentially help in more effectively reconciling individual wants with collectively determined levels of resources.
Choosing an Appropriate Unit of Analysis in Trials of Interventions That Attempt to Influence Practice
Authors: Wood John , Freemantle Nick , Wood John , Freemantle Nick
Published: January 2017

The choice of an appropriate unit of analysis in evaluations in health policy is problematic and errors are frequently made which may undermine study conclusions. This paper describes the structure of randomized trials, issues concerning randomization and replication, and the factors that should be considered when deciding upon the appropriateness of a unit of analysis.
An Evaluation of the Use of Interactive Television in an Acute Psychiatric Service
Authors: McLaren Paul , Ball Chris J , SummerfieldM A B , Watson J P , Lipsedge M
Published: January 2017

This study reports the results of the use of a low-cost videoconferencing system (LCVC) for communication in an acute psychiatric service. Qualitative research methodology was used to examine the use of the LCVC in interactions between psychiatrists, patients and nursing staff, including information on refusals. One hundred and five clinical interactions were studied over four months. The LCVC proved technically reliable and compatible with the performance of a wide range of clinical tasks. However, the results suggest the need for better understanding of the nature and origins of the attitudes that users bring to the use of such communications technology. A framework is presented for the classification of user responses in terms of preexisting attitudes of the users, technological limitations of the system and the mental state of the users. The study demonstrated the potential for interactive television to support many of the communication tasks necessary in a dispersed psychiatric service and for telepsychiatry to become a major method of service provision.
Experimental Teleradiology. Novel Telematics Services Using Image Processing, Hypermedia and Remote Cooperation to Improve Image-Based Medical Decision Making
Authors: Bellon E , Van Cleynenbreugel J , Delaere D , Houtput W , Smet M , Marchal G , Suetens P
Published: January 2017

We illustrate the possible impact of information technology on digital radiology using two pilot projects. The first aimed to improve the transfer of radiological information and the interaction between radiologist and referring physician, using hypermedia documents and hypermedia electronic mail. During a 12-month evaluation period, approximately 100 hypermedia reports were generated and distributed to hepatologists and neurosurgeons. The second project aimed to improve planning of orthopaedic surgery, using an image processing service for three-dimensional visualization and a conferencing system to support active cooperation. Over two months, 12 routine cases were reconstructed in three dimensions and conferencing was carried out between surgeons and radiologists in hospitals 15 km apart. Initial results were encouraging. Telematics may be valuable in reconciling the growing need for multidisciplinary cooperation with the growing geographical and organizational separation of different experts. We conclude that to benefit from information technology, the focus should not be on a direct translation of traditional working methods, but rather on possibilities that were not available in the film-based environment.
Three Generations of Telecare of the Elderly
Authors: Doughty Kevin , Cameron Keith , Garner Paul
Published: January 2017

The increasing number of elderly and infirm people living alone in their own homes is creating the need for new personal emergency response systems based on public telephone and cable networks. While existing systems enable clients to summon help in the event of illness, future services are likely to make use of evolving technologies to provide automatic sensing of emergencies and to predict long-term deterioration in health, using activity profiles. The characteristics and requirements of these second-generation systems are discussed and predictions are made about the innovative services and facilities that may be available in third-generation systems, when broadband communication is available to the home.
Demand for Plastic Surgical Operations after Primary Breast Cancer Surgery
Authors: Meretoja T. , Suominen E.
Published: January 2017

Background and Aims:

The aim of this study is to evaluate the demand for plastic operations after primary breast cancer surgery. In addition, this study aims to increase knowledge on factors affecting the wish of women for breast reconstruction.

Material and Methods:

A questionnaire was sent to some 111 patients who had undergone either mastectomy or breast conserving surgery. The response rate was 76 %. The questionnaire consisted of 20 structured questions. The data was analysed statistically using the t test and the chi-square test.

Results:

28 % of the mastectomized patients wanted a breast reconstruction. Factors found to affect the patient's wish for reconstruction were age ( p < 0.001) and whether the patient had received radio- ( p < 0.05) or chemotherapy ( p < 0.05). A difference was found between the mastectomy group and the breast conserving surgery group as to satisfaction in the general ( p < 0.05) and the cosmetic ( p < 0.05) outcome of the surgery, as well as patient's expectations regarding the outcome ( p < 0.01).

Conclusions:

Rather fewer mastectomized patients wanted a reconstruction. The proportion, however, grew significantly larger in the younger age groups. This study also shows that receiving radio- or chemotherapy seems to predict a woman's choice against a reconstruction. Patients who receive radio- or chemotherapy may consider their illness more severe and life-threatening than those not receiving such treatments.
Comparison of Digital and Conventional Radiostereometric Image Analysis in an Ankle Phantom Model
Authors: Mäkinen T. J. , Mattila K. T. , Määttänen H. , Aro H. T.
Published: January 2017

Background and Aims:

Radiostereometric analysis (RSA) allows accurate three-dimensional measurements of micromotion in skeletal structures. The current RSA techniques are based on the analysis of scanned plain films. This study was undertaken to compare digital filmless RSA technique to conventional scanning technique using a phantom model of the ankle mortise.

Material and Methods:

In the first experiment, the relative displacement of the markers inserted to the fibula in relation to the markers inserted to the tibia was studied by means of double examinations and the precision of DICOM images were compared to scanned images of printed radiographs. In the second experiment, the film pair of double examination was re-imported or re-scanned and self-compared in order to show merely the error related to the image processing.

Results:

The precision of RSA using scanned images of printed radiographs was compatible to DICOM images. However, the mean error of rigid body fitting (ME) values were significantly lower in use of DICOM images compared with scanned radiographs, indicating less deformation of rigid body segments in filmless analysis.

Conclusions:

Precision of the RSA method was improved under the completely filmless environment. Therefore, this technique can be recommended for clinical studies of radiostereometric analysis.
Should Abdominal Aortic Aneurysm Be Managed Differently in Women?
Authors: Lederle F. A.
Published: January 2017

Although abdominal aortic aneurysm (AAA) is 4 to 6 times more common in men than in women, more than a third of all AAA deaths occur in women. In several reports from the UK Small Aneurysm Trial group, the rupture rate for women was 3–4 times that seen in men. A joint council of several vascular societies responded to these observations with the recommendation that AAA should be repaired earlier in women, at 4.5 cm to 5.0 cm rather than the 5.5 cm established in randomized trials for men. However, this recommendation does not appear to reflect a full consideration of the evidence. For example, population-based studies have reported mortality following AAA repair to be 40–60% higher in women than in men. Also, in the UK Small Aneurysm Trial itself, there was no trend toward a benefit from early repair in women. The totality of evidence available at present provides no good reason to alter for women the 5.5 cm threshold for elective repair established for men by the small AAA trials.
The Clinical Importance of Monitoring Intra Abdominal Pressure after Ruptured Abdominal Aortic Aneurysm Repair
Authors: Björck M. , Wanhainen A. , Djavani K. , Acosta S.
Published: January 2017

Aim:

The aim of this paper was to review the literature on the clinical importance of monitoring intra-abdominal pressure (IAP) after ruptured abdominal aortic aneurysm (rAAA) repair.

Method:

The literature was searched for abdominal compartment syndrome (ACS) or intra-abdominal pressure and aortic aneurysm. Original articles were studied. Personal experiences were reported.

Results:

The consensus documents of the World society on the abdominal compartment syndrome ( wsacs.org ), with their definitions and guidelines, constitute an important step forward for the possibilities to study this clinical entity. Few papers were published describing the problem specifically in the patient population operated on for ruptured abdominal aortic aneurysm (rAAA). The incidence was approximately 5% when the patients were not monitored with IAP, and above 10% when IAP was monitored. The incidence seems to be similar irrespective if open or endovascular repair is performed, though comparative prospective studies were not published. Patients with intra-abdominal hypertension (IAH) or ACS have higher mortality and more complications. If IAH is recognized early conservative treatment may be effective to prevent development of ACS. After ACS has developed, surgical decompression is usually required. A proposed algorithm on how to act on different levels of IAH is presented.

Conclusions:

IAH/ACS is an important complication after operation on patients with rAAA. Monitoring IAP may be associated with improved outcomes.
How to Design the Optimal Stent Graft — What Have We Learnt?
Authors: Brunkwall J.
Published: January 2017

It is now more than 20 years since the first report of stent graft insertion in the human arterial system was published. The first “homemade” devices proved that the technique was possible but could not show any durability. Using these devices, it was possible to get a good seal but not a good anchorage. Not even the first generation of commercially available stent grafts proved to be durable. First after gaining knowledge about the forces acting on the stent graft, it was realized that attachment was important for the durability and the hooks and barbs or a longitudinal stability are needed to minimise the risk for distal migration. Not much of a difference in the overall performance is noticed between the ePTFE graft or the polyester graft or when comparing stainless steel stents with those made out of nitinol. The systems are made much more flexible and hydrophilic leading to a better performance and a greater chance of percutaneous approach. The optimal stent graft is not out on the market yet, but hopefully will come with further development.
Interaction between Marrow-Derived Human Mesenchymal Stem Cells and Peripheral Blood Mononuclear Cells in Endothelial Cell Differentiation
Authors: Joensuu K. , Paatero I. , Alm J. J. , Elenius K. , Aro H. T. , Heino T. J. , Hentunen T. A.
Published: January 2017

Background and Aims:

In adult connective tissues, mesenchymal stem cells (MSCs) play a key role in normal tissue turnover and repair. MSCs can participate in these processes not only through proliferation and differentiation but also through paracrine/autocrine functions. These characteristics make MSCs the optimal target in the development of cell-based therapies. This study describes a novel interaction between human MSC and blood mononuclear cells (MNCs), resulting in formation of blood vessel-like structures.

Materials and Methods:

Human marrow-derived MSCs and peripheral blood MNCs were co-cultured in monolayer cultures as well as in bovine collagen sponge up to 20 days. No exogenously supplied growth factors were applied. Morphological changes and formations of three dimensional structures were detected by light microscopy. The process was further studied for the expression of different endothelial cell markers. The expression of PECAM-1 and endoglin was studied by immunohistochemistry and the expression of vascular endothelial growth factor receptors 1 and 2 using quantitative real time PCR.

Results:

In co-cultures of human MSCs and MNCs, the previously nonadherent cells attached and started to elongate and formed tube-like structures within one week. At day 10, elongated PECAM-1 and endoglin expressing cells were detected in co-cultures. At day 20, PECAM-1 and endoglin-positive vessel-like structures were observed. VEGFR1 was up-regulated in co-cultures after 10 days, and expression levels increased with time. No PECAM-1, endoglin or VEGFR1 expressing cells were discovered in MSC-cultures without MNCs at any time point.

Conclusions:

This study demonstrates induction of endothelial differentiation in co-cultures of human MSCs and MNCs, indicating a mechanism by which local application of MSCs could induce angiogenesis in vivo.
The contextualist function: US newspaper journalists value social responsibility
Authors: McIntyre Karen , Dahmen Nicole Smith , Abdenour Jesse
Published: January 2017

A survey ( N = 1318) evaluated US newspaper journalists’ attitudes toward c ontextual reporting – stories that go beyond the immediacy of the news and contribute to societal well-being. Results indicated that journalists highly value professional roles associated with contextual reporting. Responses revealed new journalistic role functions, including the ‘Contextualist’, who placed high value on being socially responsible and accurately portraying the world. Analyses showed that younger journalists and female journalists highly valued three genres of contextual reporting: constructive journalism, solutions journalism, and restorative narrative. Additionally, a journalist’s belief in activist values such as setting the political agenda and pointing to possible solutions predicted more favorable views of all three forms of contextual journalism, while belief in an adversarial attitude predicted less favorable views of restorative narrative.
Allogeneic Cell Therapy for the Treatment of Liver Disease
Authors: Ludlow John W. , Bruce Andrew T. , Kulik Michael J. , Meheux Sonya O. , McCoy Darell W. , Asfeldt Thomas M.
Published: January 2017

The scarcity of human organs available for transplantation is clearly evident. Efforts to maximize the use of available organs and to increase the number of donors have increased the number of transplantations performed, but at a rate that remains far behind the rate of growth of the waiting list. Thus, the likelihood of a patient with severe liver disease receiving a liver replacement is decreasing. In order to offer treatment to most patients with liver disease, alternatives to whole-organ replacement must be found. Cell-based treatments, in which suspensions of liver cells are injected into patients with liver failure and reconstitute the patient's liver functions, may be that alternative. Here, we report on a regulatory-compliant process for the production of a cryopreserved cell therapy product that yields viable, metabolically active hepatocytes that can be infused directly into patients with the goal of reconstituting liver function.
Kidney and Liver Living Donors: A Comparison of Experiences
Authors: Rudow Dianne LaPointe , Charlton Marian , Sanchez Carla , Chang Sara , Serur David , Brown Robert S.
Published: January 2017

Background

Living donor kidney transplantation is considered a safe and effective means to treat end-stage renal disease, and has now exceeded the number of deceased donor kidney transplantations performed annually. Living donor liver transplantation is more controversial and has received criticism in the medical and lay community. Studies focus on recipient outcomes and medical safety. The impact of the donation on donors is not well understood.

Objective

To compare experiences from both kidney and liver living donors, including their motivation, perceived risks, and postoperative experience.

Methods

Questionnaires about the donation experience were mailed to 70 patients who underwent laparoscopic donor nephrectomy and 85 patients who underwent hepatectomy at a large academic medical center. Results of kidney and liver donors were compared.

Results

No differences were found in mean age, marital status, ethnicity, relationship to the recipient, and employment status of the 2 groups. Women were more prevalent in both groups. The most common motivating factor in both kidney and liver donors was “because it was family,” 81% and 82%, respectively. Kidney donors describe the decision to donate as easy compared to the liver donors ( P=.049). In neither group did donors feel pressure to donate or have family conflicts regarding their decision to donate. Both groups felt they were well informed of the risks. Neither group described unexpected problems, and neither group regretted their decision to donate and would do it again if asked.

Conclusion

Donors in both groups reported favorable outcomes. A greater concern for risk of death, bleeding, altered appearance, and infection existed among liver donors compared to kidney donors. The actual outcomes were better than the perceived risks.
A Review of Thyroid Hormone Administration during Adult Donor Care
Authors: Powner David J. , Hernandez Michael
Published: January 2017

Serum concentrations of thyroid hormones tetraiodothyronine and triiodothyronine commonly are low after head injury and brain death. Thyroid hormone replacement therapy, however, is a controversial part of donor management. This article reviews publications in which thyroid hormone administration was evaluated in human donors. A classification of the “quality” of study methods used in those publications is presented as part of the data review. No publications support the routine administration of thyroid hormone for all donors. “Rescue” replacement in support of cardiac inotropic function is supported by some studies, but the experimental design of those investigations is not optimal. Thyroid hormone replacement and its dosing should be decided by organ procurement organizations as part of treatment protocols.
Variables during Care of Adult Donors That Can Influence Outcomes of Kidney Transplantation
Authors: Powner David J.
Published: January 2017

Publications that relate characteristics of donors to renal function of recipients are reviewed. Most publications report retrospective observations that relate outcomes to donor variables that cannot be altered during donor care. Factors that can be altered in adult donors in an effort to improve recipients' outcomes include urine output and creatinine level. Increasing urine output to more than 100 mL/h, at least during the hour before explantation, and returning the creatinine level to match its serum concentration when the patient was admitted can improve outcomes. Ways of accomplishing those goals during donor care are discussed, with emphasis on support of renal blood flow.
Preoperative Predictors for Postoperative Problems in Heart Transplantation: Psychiatric and Psychosocial Considerations
Authors: Rivard Andrew L. , Hellmich Christina , Sampson Barbara , Bianco Richard W. , Crow Scott J. , Miller Leslie W.
Published: January 2017

The psychiatric and psychosocial evaluation of the heart transplant candidate can identify particular predictors for postoperative problems. These factors, as identified during the comprehensive evaluation phase, provide an assessment of the candidate in context of the proposed transplantation protocol. Previous issues with compliance, substance abuse, and psychosis are clear indictors of postoperative problems. The prolonged waiting list time provides an additional period to evaluate and provide support to patients having a terminal disease who need a heart transplant, and are undergoing prolonged hospitalization. Following transplantation, the patient is faced with additional challenges of a new self-image, multiple concerns, anxiety, and depression. Ultimately, the success of the heart transplantation remains dependent upon the recipient's ability to cope psychologically and comply with the medication regimen. The limited resource of donor hearts and the high emotional and financial cost of heart transplantation lead to an exhaustive effort to select those patients who will benefit from the improved physical health the heart transplant confers.
The Institutional Review Board and Protecting Human Subjects: 10 Frequently Asked Questions
Authors: Zink Sheldon , Kimberly Laura , Wertlieb Stacey
Published: January 2017

It is essential that anyone involved in research involving human subjects be familiar with the purpose and role of institutional review boards. Institutional review boards are designed, first and foremost, to protect human research subjects by overseeing the implementation of federal regulations regarding protection of human subjects. The federal government requires institutional review board approval for any human subject research that receives federal funding, and many scholarly journals require proof of institutional review board approval of the research before publication. In this article, the answers to 10 frequently asked questions about the role of institutional review boards highlight the important contributions made by institutional review boards to the conduct of ethically sound research. The aim is to generate a working knowledge of the institutional review board's function that can be used by every researcher contemplating working with human research subjects. This is the first in a series of 3 articles examining common issues in research ethics.
Role of the Independent Donor Advocacy Team in Ethical Decision Making
Authors: Rudow Dianne LaPointe , Brown Robert S.
Published: January 2017

Adult living donor liver transplantation has developed as a direct result of the critical shortage of deceased donors. Recent regulations passed by New York State require transplant programs to appoint an Independent Donor Advocacy Team to evaluate, educate, and consent to all potential living liver donors. Ethical issues surround the composition of the team, who appoints them, and the role the team plays in the process. Critics of living liver donation have questioned issues surrounding motivation and the ability of donors to provide true informed consent during a time of family crisis. This article will address issues surrounding the controversies and discuss how using the team can effectively evaluate and educate potential living liver donors and improve practice to ensure safety of living donors.
Treating Tobacco Use and Dependence in Kidney Transplant Recipients: Development and Implementation of a Program
Authors: Ehlers Shawna L. , Rodrigue James R. , Patton Pamela R. , Lloyd-Turner Joni , Kaplan Bruce , Howard Richard J.
Published: January 2017

Tobacco use adversely affects transplant outcomes such as graft survival, patient survival, and other conditions that alter transplant patient longevity. Especially concerning is tobacco's relationship to cardiovascular disease, the number 1 cause of death in kidney transplant recipients. Many authors conclude that tobacco interventions ought to be provided to patients and sometimes lament that there are no tobacco dependence interventions designed for kidney transplant recipients. European Best Practice Guidelines for Renal Transplantation also support tobacco dependence interventions. The purpose of this article is to describe one institution's experience in implementing the clinical practice guideline for treating tobacco use and dependence within a kidney and pancreas transplant program.
Family Experiences of Tissue Donation in Australia
Authors: Wilson Penelope , Sexton Wendy , Singh Andrea , Smith Melissa , Durham Stephanie , Cowie Anne , Fritschi Lin
Published: January 2017

Context

Although research exists examining the experiences of organ donor families, little is known about the specific needs of tissue donor families. Understanding family experiences in tissue donation is important to improve the process and potentially increase the number of families who consent to tissue donation.

Objective

To examine the experiences of recent tissue donor families and to identify potential areas for improvement of the donation process.

Design

Cross-sectional survey by mailed questionnaire.

Setting and Participants

Participants were families who had been approached by DonateWest, the coordinating organization in Western Australia, and had agreed to tissue donation.

Main Outcome Measures

Quantitative and qualitative analysis of data with regards to satisfaction with the approach method, reasons for consent, and appropriateness of support services.

Results

Seventy-seven of 140 mailed questionnaires were returned. Almost all respondents expressed satisfaction with the approach to donate, and this did not differ with the mode of approach, that is, by phone or in person. The most common reason for agreeing to donation was that it was known to be the donor's wish. The majority of respondents felt they had sufficient time and information to decide to donate, and almost all were happy with their decision and thought they had received adequate support during and after the process.
Attitudes toward Death Criteria and Organ Donation among Healthcare Personnel and the General Public
Authors: DuBois James M. , Anderson Emily E.
Published: January 2017

Objective

To examine attitudes toward death criteria and their relation to attitudes and behaviors regarding organ donation.

Data Sources

This article reviews empirical studies on the attitudes of healthcare personnel and the general public regarding death criteria and organ donation.

Study Selection and Data Extraction

The review was restricted to studies that had as a primary focus attitudes toward 1 or more of the following 3 specific criteria for determining death: (1) brain death, the irreversible loss of all functions of the entire brain; (2) higher brain death, the loss of cerebral cortex function alone; and (3) the circulatory-respiratory criteria commonly used in donation after cardiac death.

Data Synthesis

Studies consistently show that the general public and some medical personnel are inadequately familiar with the legal and medical status of brain death; attitudes toward the dead donor rule are strong predictors of willingness to donate organs using controversial criteria; concerns about donation after cardiac death surround the withdrawal of life support more than the actual death criteria used; and concerns about death criteria correlate with less favorable attitudes toward organ donation.

Conclusions

Both general and ethical education may serve to guide policy and facilitate family member requests and informed consent dialogues. Furthermore, helping families to understand and accept not only medical and legal criteria for determining death, but also ethical criteria for withdrawing life support may help them be more comfortable with their decisions.
The Usefulness of the New “Double-Catheter Technique” in the Treatment of Parent Artery Incorporated Wide-Necked Aneurysm with Guglielmi Detachable Coils
Authors: Shin Yong Sam , Kim Dong-Ik , Lee Seung Ik , Chung Jin Il , Yoon Pyeong Ho , Lee Kyu Chang
Published: January 2017

We describe a technique used to treat a wide-necked aneurysm in which the neck is incorporated with the parent artery. The patient was a 54-year-old woman who had suffered a grade III subarachnoid haemorrhage. Angiogram and three-dimensional CT showed a large, wide-necked aneurysm of the basilar bifurcation area with the right posterior cerebral artery incorporated in the aneurysm sac. A microcatheter was placed in the right posterior cerebral artery (PCA). Another catheter was placed within the aneurysm lumen. When making a first frame with a GDC, we made sure that the frame of the coil did not overlap the PCA positioned microcatheter.

Then, with the microcatheter positioned at the PCA, the angiogram was done. The flow pattern and dye-disappearance time were checked. Subsequent coils were introduced, but not beyond the frame of the first coil to maintain PCA flow. This new “double-catheter technique” represents a viable option for treating wide-necked aneurysms, especially when the parent artery is incorporated in a wide-necked aneurysm and the delineation of the parent artery is impossible.
Embolisation of Small (< 3 cm) Brain Arteriovenous Malformations
Authors: Willinsky R. , Goyal M. , Terbrugge K. , Montanera W. , Wallace M.C. , Tymianski M.
Published: January 2017

The role of embolisation in the treatment of small (< 3cm) brain arteriovenous malformations (AVMs) has not been elucidated. We reviewed our experience using embolisation in the treatment of small AVMs and correlated a proposed grading system based on the angioarchitecture to the percentage obliteration achieved by embolisation.

Eighty-one small AVMs in 80 patients were embolised from 1984 to 1999. The age range was from 3 to 72 years. The AVMs were given a score from 0 to 6 based on the angioarchitecture. The assigned scores were as follows: nidus (fistula = 0, < 1 cm = 1, 1–3 cm = 2), type of feeding arteries (cortical = 0, perforator or choroidal = 1), number of feeding arteries (single = 0, multiple = 2) and number of draining veins (single = 0, multiple = 1). Angiographic results based on percentage obliteration were grouped into three categories: complete, 66–99%, and 0–65%.

The goal of embolisation was cure in 27 AVMs, pre-surgical in 23, pre-radiosurgery in 26, and elimination of an aneurysm in five. Embolisation achieved complete obliteration in 22 (27%) of the 81 AVMs. In the AVMs where the goal was cure, 19 (70%) of 27 were completely obliterated. In the AVMs with angioarchitecture scores of 0–2, 12 (86%) of 14 were cured, with scores of 3–4, 8 (34%) of 24 were cured and with scores of 5–6, 2 (4%) of 44 were cured. Embolisation resulted in transient morbidity of 5.0%, permanent morbidity of 2.5%, and mortality of 1.2%. There were no complications in AVMs with scores of 0–2.

Embolisation is an effective treatment of small AVMs when the angioarchitecture is favourable (scores 0–2). This includes pure fistulas and AVMs with a single, pial, feeding artery.