bluuebunny/crossref_metadata_2025 huggingface dataset:
Preoperative sense of coherence associated with the 10-year outcomes of lumbar spinal stenosis surgery
Authors: Sinikallio Sanna , Pakarinen Maarit , Tuomainen Iina , Airaksinen Olavi , Viinamäki Heimo , Aalto Timo J
Published: January 2017

A prospective 10-year follow-up study was conducted to determine the significance of the preoperative sense of coherence, with respect to the preoperative and 10-year clinical characteristics, among lumbar spinal stenosis patients ( N = 99). In addition, the predictive value of the preoperative sense of coherence regarding the 10-year surgery outcome was also evaluated. In a logistic regression analysis, a weak preoperative sense of coherence and low functional ability predicted the patients’ functional ability 10 years after the surgery. Moreover, those patients with weak sense of coherence before surgery showed poorer functional ability 10 years after the surgery, but not preoperatively. A weak preoperative sense of coherence seems to associate with poorer long-term outcome after surgery; therefore, various rehabilitation strategies are discussed.
Application of Fracture Mechanics to Steel Connections in Moment Frames under Seismic Loading
Authors: Joh C. , Chen W.F.
Published: January 2017

The 6.8 magnitude Northridge earthquake that shook California's San Fernando Valley on January 17 in 1994, did not cause the collapse of any steel structures but connections, confidently designed and constructed in the past with traditional code simplification and common site welding techniques, were discovered not to meet our expectations.

This paper reviews connection failures during the 1994 Northridge earthquake and the design philosophy and examines the post-Northridge earthquake experimental and analytical researches. Possible causes of the moment connections damage are categorized into three classes; welding-related factors, design-related factors, and material-related factors. For the analyses, the idealizations of the moment connection considering each factor are studied. From the idealization of the moment connection, the five-plate model is analyzed to investigate the stress concentration and stress state of the connection. The equivalent design crack models are investigated using the fracture mechanics approach.
An Experiment-Based Cumulative Damage Mechanics Model of Steel under Cyclic Loading
Authors: Shen Zuyan , Dong Bao
Published: January 2017

Based on the stress-strain hysteretic curves obtained from the tests on steel under cyclic loading, a cumulative damage mechanics model using plastic strain as a basic variable is proposed in the paper, in which the effects of damage on the modulus of elasticity and the yielding stress of steel are taken into consideration. The material parameters of the model are determined according to the experimental hysteretic curves. Comparison of the theoretical hysteretic curves and repeated tensile stress-strain curves obtained from the suggested cumulative damage mechanics model with those from the tests shows that the model suggested in this paper agrees very well with the tested results.
Flexural and Shear Failure Analysis of Reinforced Concrete Slabs and Flat Plates
Authors: Guan Hong , Loo Yew-Chaye
Published: January 2017

A nonlinear layered finite element procedure is presented for flexural and shear failure analysis of reinforced concrete slabs and flat plates. A degenerated shell element employing a layered discretization scheme is adopted. This provides a simple and effective means of accounting for the nonlinear behaviour of concrete and steel reinforcement over the thickness of the slab or flat plate. The procedure is capable of determining the load-deflection response, the ultimate load capacity and crack patterns of concrete slab structures, as well as computing the punching shear strength at slab-column connections of concrete flat plates. To verify the accuracy and reliability of the proposed method of analysis, comparative studies are carried out on a collection of reinforced concrete slabs, single slab-column connections and multi-column flat plates which were tested by other researchers. In general, good correlations are obtained with the published test results.
Insolvency and Environmental Principles: A Case Study in a Conflict of Public Interests
Authors: Keay Andrew , de Prez Paula
Published: January 2017

Although the American courts are well versed in the increasingly frequent collision of environmental law and insolvency law, in English law the conflict between the provisions of the Environmental Protection Act 1990 and the Insolvency Act 1986 has only recently produced a trilogy of decisions. The inconsistent resolutions provided by the judgments in these cases offer little in the way of guidance to the Environment Agency and other interested parties. In this article the authors examine the shortcomings presented by resolutions which prioritise either insolvency or environmental law principles and argue that the public interest is likely to be better served by an attempt at compromise.
Just Say ‘I Don't Know’: A Recommendation for WTO Panels Dealing with Environmental Regulations
Authors: Oesterle Dale Arthur
Published: January 2017

Signatory states of the World Trade Organisation (WTO) have agreed to make good faith efforts to reduce trade tariffs and other trade barriers. A member may depart from these obligations under specified conditions, two of which may exempt member countries' national environmental protection legislation. In four high-profile cases, the WTO dispute resolution panels and appellate bodies have held the exemptions not to apply to US environmental legislation on dolphins, clean gasoline and sea turtles. The article describes the decisions; discusses the quandary of the dispute resolution panels in separating legitimate environmental legislation from legislation that fronts for domestic industry protectionism; and notes that the panels are attempting, without success, to develop a case law on the relevant abstract language in the General Agreement on Tariffs and Trade (GATT). The article urges the panels to refrain from using national courts as a model for their decisions, forcing a yes or no decision on the validity of the national legislation. Rather the panels should, on appropriate occasions, simply refuse to decide at all, forcing further Member State negotiation.
A Sustainability Analysis of the Common Transport Policy
Authors: Humphreys Matthew
Published: January 2017

This article reviews the sustainability of the Common Transport Policy by reference to accessibility, equity and environmental protection. It starts by considering those concepts underpinning the policy, and then goes on to consider the detail of land transport legislation. That the policy generally lacks a clear purpose is one of its most striking problems. Even those principles that do guide it, relating to profitable business and public service, mobility and accessibility, and the overarching protection of free movement, are not coherently recognised, let alone balanced sustainably. This lack of balance and purpose is reflected in the legislation constituting the policy, legislation that often attempts to do much in the combat of pollution or the promotion of road-transport alternatives to achieve a sustainable system. The review of the sustainability of the legislation shows that the revolution of thought implied by the sustainable development concept is not undertaken and that the Union is some way from achieving a sustainable transport policy.
Liability in the Law of Nuisance for Isolated Escapes from Land
Authors: McManus Francis
Published: January 2017

It is customary for the courts perfunctorily to categorise isolated escapes from one's land, where the escapes therefrom impact on the land of another, either in terms of the rule in Rylands v Fletcher, or, in terms of the law of negligence, without the courts according much discussion as to whether such escapes may be accommodated within the fold of the law of nuisance which has normally been employed to obtain redress for injury or inconvenience occasioned over a period of time. This article examines whether isolated escapes (an expression which includes escapes both of people as well as of things) from land can legitimately fall under the rubric of nuisance, and, if so, whether indeed, the law of nuisance should accommodate such escapes.
Planning, Environment and Development a Comparison of Planning Law in Malaysia and England
Authors: Harding Andrew
Published: January 2017

A comparison of planning law in Malaysia and England reveals that despite some similarities in principle, there remain a number of serious difficulties with Malaysian law. These include a lack of universal application, a lack of policy guidance, and a lack of public participation in both the formulation of development plans and in development control. There are also weaknesses in the application of environmental impact assessment in the planning process. This article examines the two systems from a comparative standpoint. It is concluded that Malaysian law has not developed sufficiently in this field, a problem which is linked to deficiencies in the rule of law, lack of adequate local finance, and a narrow view of the role of lawyers in the planning process.
The education of minorities in Bulgaria and Romania: Analyzing the formation and articulation of preferences
Authors: Kyriazi Anna
Published: January 2017

This paper investigates explanations in variation in the education-related preferences of comparable minorities in Bulgaria and Romania (i.e., Turks and Hungarians, respectively) as articulated by political, institutional, and civil society actors claiming to speak on their behalf. The study, which is based on original data extracted from 32 in-depth interviews, begins with a classification of the preferences that the interviewees articulated and the diverse arguments on which these were grounded. Subsequently, I turn to the potential explanations of the observed variation by examining a number of themes that emerged during the discussions and that also correspond to the factors usually considered in the literature on ethnic politics. These include the constraining effect of majority public opinion, the minorities' political representation, and notions related to the opportunities of exit and voice. I argue that actors' preferences adapt to the prevailing circumstances through an incremental process: before higher order preferences can be met or even conceived all the lower steps along the way have to be accounted for.
The making and unmaking of ethnic boundaries in the public sphere: The case of Norway
Authors: Midtbøen Arnfinn H
Published: January 2017

This article employs theories of ethnic boundary-making to explore when and under what conditions ethnicity and religious background shape minorities' experiences when participating in the public sphere in Norway. Drawing on in-depth interviews with elite individuals with various ethnic and religious minority backgrounds, the analysis calls into question interpretations made in other studies, which tend to imply an all-encompassing significance of race, ethnicity or religion. Although the analysis support previous findings in that negative comments and harassment do occur, the interviews demonstrate a variety of experiences and positions and that several individuals are able to strategically cross existing ethnic boundaries. Overall, the findings suggest that important changes are occurring in Norway's mediated public sphere. The question is whether these changes point to broader, societal processes of boundary-blurring or rather are opportunities offered to exceptional individuals while the existing hierarchy of ethnic categories stays intact.
What prevents people with chronic obstructive pulmonary disease from attending pulmonary rehabilitation? A systematic review
Authors: Keating Andrew , Lee Annemarie , Holland Anne E
Published: January 2017

Pulmonary rehabilitation is an essential component of care for people with chronic obstructive pulmonary disease (COPD) and is supported by strong scientific evidence. Despite this, many people with COPD do not complete their program or choose not to attend at all. The aim of this study was to determine the factors associated with uptake and completion of pulmonary rehabilitation for people with COPD. Seven electronic databases were searched for qualitative or quantitative studies that documented factors associated with uptake and completion of pulmonary rehabilitation in people with COPD. Two reviewers independently extracted data, which was synthesized to provide overall themes. Travel and transport were consistently identified as barriers to both uptake and completion. A lack of perceived benefit of pulmonary rehabilitation also influenced both uptake and completion. The only demographic features that consistently predicted non-completion were being a current smoker (pooled odds ratio 0.17, 95% confidence interval 0.10 to 0.32) and depression. The limited data available regarding barriers to uptake indicated that disruption to usual routine, influence of the referring doctor and program timing were important. In conclusion poor access to transport and lack of perceived benefit affect uptake of pulmonary rehabilitation. Current smokers and patients who are depressed are at increased risk of non-completion. Enhancing attendance in pulmonary rehabilitation will require more attention to transportation, support for those at risk of non-completion and greater involvement of patients in informed decisions about their care.
Posttransplant Diabetes Mellitus in Liver Transplant Recipients
Authors: Driscoll Carolyn J. , Cashion Ann K. , Hathaway Donna K. , Thompson Carol , Conley Yvette , Gaber Osama , Vera Santiago , Shokouh-Amiri Hosein
Published: January 2017

Context

Approximately 20% of liver transplant recipients develop posttransplant diabetes mellitus. Hepatitis C, a leading indication for liver transplantation, has been identified as a risk factor for posttransplant diabetes mellitus and is an observation that is not well described.

Objective

To evaluate the incidence of posttransplant diabetes mellitus and risk factors associated with this condition.

Design

A retrospective chart review.

Setting

A large urban transplant center.

Patients

One hundred fifteen liver transplant recipients who received a transplant between January 1, 1998, and August 31, 2001.

Results

The rate of posttransplant diabetes mellitus, calculated at 3-month intervals in the first year after liver transplantation, ranged from 19.4% to 24.6%, which is similar to the averages reported in most published studies. The cumulative rate of posttransplant diabetes mellitus, which includes all patients who developed this condition during the time studied, was 31.3%. Clinical and demographic factors, including immunosuppression regimens, were similar between patients with and without posttransplant diabetes mellitus. Two risk factors for posttransplant diabetes mellitus were identified: hepatitis C, which was the leading indication for transplantation in this group (54.8%), and cytomegalovirus infection during the first year after transplantation. Other clinical and demographic variables, such as gender, age, ethnicity, rejection episodes, body mass index, and immunosuppression, were not identified as risk factors for posttransplant diabetes mellitus in liver transplant recipients.
Conversion from Mycophenolate Mofetil to Enteric-Coated Mycophenolate Sodium in Patients with Gastrointestinal Side Effects: Case Studies
Authors: Boswell Anita , Rigg Keith , Shehata Magdi
Published: January 2017

Background

The potential benefit of the current mycophenolic acid, mycophenolate mofetil, has not yet been fully achieved in clinical transplantation because of its gastrointestinal side effects. Dose splitting, dose reduction, and drug discontinuation are strategies that are used to manage gastrointestinal symptoms. However, recently reported registry data suggest these alterations result in inadequate graft protection, leading to increased late acute rejection rates and decreased long-term graft survival.

Objective

To investigate the potential use of the new enteric-coated formulation of mycophenolic acid therapy, mycophenolate sodium, and its suggested improved side effects profile.

Participants

Five patients who previously had or were currently experiencing gastrointestinal side effects while taking mycophenolate mofetil were selected at random. These patients were initially switched to an equimolar dose of enteric-coated mycophenolate sodium. An increase in mycophenolate sodium doses was attempted according to symptoms. Changes in kidney function and gastrointestinal symptom scores were recorded before and after conversion.

Results

No episodes of acute rejection were observed in any patients during or after conversion. All patients experienced an overall improvement in gastrointestinal symptom scores following conversion, and an increase in mycophenolate sodium dose was achieved in 1 patient.
Donation after Cardiac Death Has a Minimal Impact on Thoracic Organ Recovery
Authors: Olson Leslie , Cravero Lynn , Kisthard Jim , Ward Scott , Marks William
Published: January 2017

Background

Our organ procurement organization recently developed an aggressive donation after cardiac death program. Thoracic organs are rarely recovered from Non—Heart-beating donors. Therefore, there is concern that donation after cardiac death may affect the recovery of thoracic organs from donors not allowed to progress to brain death.

Objective

To evaluate the potential impact of donation after cardiac death on the recovery of thoracic organs.

Methods

On the assumption that prolongation of care on all cases would result in a diagnosis of brain death. By retrospective chart review, all donations after cardiac death were evaluated for thoracic organ potential using the same standards that were used to evaluate brain-dead donors.

Results

During the study period there were 34 of 44 (77%) Non—Heart-beating donors qualified to donate abdominal organs only. Ten of 44 Non—Heart-beating donors (24%) qualified to potentially donate thoracic organs; the families of 4 of 10 of these donors insisted on the immediate withdrawal of life support, leaving only 6 donors with thoracic organ potential. All 6 of these donors qualified as potential heart donors and 3 as potential lung donors.

Conclusions

A total of 97 organs were recovered and successfully transplanted from 44 Non—Heart-beating donors. If all the donors who qualified to donate thoracic organs progressed to brain death and if their thoracic organs were transplantable, then 6 additional hearts and 3 pairs of lungs may have been recovered. These data demonstrate that an aggressive donation after cardiac death program contributes significantly to the organ donor pool, with a minimal impact on potential thoracic organ recovery.
Information Sharing: Its Impact on Donor and Nondonor Families' Experiences in the Hospital
Authors: Long Tracy , Sque Magi , Payne Sheila
Published: January 2017

Objective

To illustrate the methods used to convey complicated information regarding the critical injury, and death diagnosed by means of brainstem testing, to the next of kin of potential organ donors.

Design

3-year, prospective, longitudinal study.

Participants and Setting

Forty-three family members who chose to donate their deceased relatives' organs were recruited via 4 transplant coordinating centers, and 3 family members who chose not to donate were recruited via 1 intensive care unit.

Method

Face-to-face qualitative interviews were carried out with 46 family members of 43 individuals who died between June and December 2000. Family members who agreed to donation were interviewed during and after their next of kin's admission to hospital and 3 to 5 months, 13 to 15 months, and 18 to 26 months after bereavement. Three participants who chose not to donate were interviewed on 1 occasion only. Interviews were audio-recorded, and the transcribed reports were analyzed using a comparative, thematic approach focusing on the detection of similarities and differences between cases.

Results

Participants who were offered verbal information supported by complementary methods of communication had (1) a greater understanding of the critical injury sustained by their next of kin, and (2) fewer questions over time regarding brainstem testing.

Conclusion

Better methods of communicating complicated information are needed, as the sheer load of information shared makes demands of next of kin at a time when they are cognitively and emotionally poorly equipped to respond.
Advanced Practice Organ Procurement Techniques: Insertion of Central Venous Catheters
Authors: Powner David J. , Griffin Laura J.
Published: January 2017

Placement of central venous catheters by organ procurement coordinators to assist in obtaining blood samples or for measuring intravascular pressure is appropriate. Preparation for this role should include appropriate didactic instruction and supervised clinical experience. The organ procurement organization must ensure that such training occurs and must support a continuing quality assurance program for such providers. Policies and procedures must be provided to guide practitioners in site selection, timing of implementation, and titration of measurements obtained. Also, resources must be readily available to treat any complications. This discussion reviews methods for insertion of venous catheters placed in the femoral, internal jugular, or subclavian veins.
Patient-Reported Outcomes for Open versus Laparoscopic Living Donor Nephrectomy
Authors: Rodrigue James R. , Cross Natalie J. , Newman Robert C. , Widows Michelle R. , Guenther Robert T. , Kaplan Bruce , Morgan Michelle A. , Howard Richard J.
Published: January 2017

Background

Rates of living kidney donation have increased dramatically in recent years, in large part because of improved surgical techniques such as laparoscopic nephrectomy.

Objective

To compare patient-reported outcomes of laparoscopic nephrectomy versus open donor nephrectomy in 84 adult live kidney donors.

Outcome Measures

Outcomes included perceptions of pain and surgical scarring, number of surgical/medical complications, hospital length of stay, physical health problems related to donation, return to work, financial impact, health-related quality of life, and satisfaction with the donation experience.

Results and Conclusion

The 2 groups did not differ significantly in pain perceptions, number of surgical/medical complications, physical health problems, financial impact, health-related quality of life, or overall satisfaction. However, laparoscopic nephrectomy donors had significantly fewer hospital days and faster return to work time than open donor nephrectomy donors. The majority of donors report excellent health-related quality of life and no complications in the months following surgery. In addition, it appears that laparoscopic nephrectomy, in comparison to open donor nephrectomy, may reduce barriers to living kidney donation by reducing hospital length of stay and time away from work. Being able to return to work much sooner after surgery may significantly reduce the indirect costs (ie, lost wages) associated with living donation.
Is it Ethical to Prioritize Patients for Organ Allocation According to Their Values about Organ Donation?
Authors: Bramstedt Katrina A.
Published: January 2017

Because the supply of deceased donor organs fails to meet demand, patients needing a transplant frequently have lengthy waits or die while waiting. In an effort to reduce waiting times, the concept of “preferred status” has emerged. In the United States, preferred status has taken the form of a community of individuals called LifeSharers. Using directed donation, this group aims to facilitate priority organ allocation to its members—people who have agreed to be organ donors. Such preferred status programs increase societal awareness about organ donation and transplantation, but they are not without ethical controversy, as some term them “clubs.” In the case of LifeSharers, the potential to increase the pool of deceased donor organs is a worthy goal that would benefit the community of patients awaiting transplantation, not just LifeSharers members.
The ON TRAC Model for Transitional Care of Adolescents
Authors: Paone Mary C. , Wigle Margaret , Saewyc Elizabeth
Published: January 2017

This article describes the framework and clinical pathway for ON TRAC (Taking Responsibility for Adolescent/Adult Care), a model of transition care for adolescents with chronic health conditions, as applied to pediatric transplant transition. This model was developed in 1998 at Children's and Women's Health Centre of British Columbia; it provides a multidisciplinary approach to developmentally appropriate transition planning and skill building. The model is youth focused and family centered, and includes stages of transition care on the basis of the developmental stages and capabilities of adolescents. Important considerations for healthcare providers, specific tools for use in clinical settings, and case studies illustrate the use of the ON TRAC model in a pediatric transplant clinic. The ultimate goal of transition in the ON TRAC model is for all adolescents to reach their attainable levels of independence, self-sufficiency, and self-worth while transferring safely and securely into adult healthcare services and adulthood.
Smoothing Things over: The Transition from Pediatric to Adult Care for Kidney Transplant Recipients
Authors: Remorino Rowena , Taylor Judy
Published: January 2017

Background

Transition is a planned movement of adolescents with chronic physical and medical conditions from child-centered to adult-oriented healthcare systems as opposed to a purely administrative event.

Objective

To evaluate the transition of pediatric kidney transplant recipients to the adult service at Guy's Hospital between 2000 and 2001 as compared with best practice from the literature, and to establish client satisfaction with the process.

Design

Data were collected by means of a retrospective review of case notes, clinician interview, and a patient satisfaction questionnaire, and analyzed by a single reviewer.

Main Outcome Measures

Sixteen cases were analyzed with respect to their progress over the period of 1 year before and 1 year after transfer by looking at markers of adherence; a clinician's subjective assessment of overall graft stability before, during, and after transfer; and whether subjects chose to attend the transitional clinic.

Results

There was no qualitative difference in adherence or control among the patients who experienced the transitional clinic and those who did not. Patients who were considered stable and adherent before transition were not necessarily the same following transfer and vice versa. Patients who experienced the transitional clinic were not more satisfied as a group, although 9 of 11 thought their transition was “OK” or better.

Conclusion

This is an extremely challenging area of pediatric nephrology; all patients need a high level of support. Services cannot be targeted to high-risk groups.
There to Here: Young Adult Patients' Perceptions of the Process of Transition from Pediatric to Adult Transplant Care
Authors: McCurdy Corinne , DiCenso Alba , Boblin Sheryl , Ludwin David , Bryant-Lukosius Denise , Bosompra Kwadwo
Published: January 2017

Background

An increased understanding of the transition process from pediatric to adult transplant care may inform strategies for facilitating the transfer of patients and ultimately improve outcomes of care.

Objective

To explore the transition process from pediatric to adult transplant care from the perspective of young adults.

Study Design

Using a qualitative case study approach, data were collected from transplant recipients through organ-specific focus groups, from transplant coordinators and nurse practitioners through interviews, and from electronic documents. Data were analyzed using an editorial format.

Results

The analysis identified 5 elements of transition: There to Here, Getting Ready, Frame of Mind, Making It Easier, and Giving Back. In addition, threaded throughout the elements were the themes People Are Important, Expectations of Us, and Information We Need.

Conclusions

The transition for young people from a pediatric to an adult transplant center can be difficult and often traumatic. Young adults who transfer to adult care need to be better prepared for the adult center, made aware of the differences, and introduced to team members before the transfer. Transition programs that aim to improve the transition process should be developed for these patients.
Pediatric to Adult Transition: A Personal Experience
Authors: Harden Paul N. , Nadine Philip
Published: January 2017

Transitioning from pediatric to adult transplant programs presents various challenges to the patient, his or her family, and the healthcare staff. In this personal, retrospective account of the issues associated with transitioning, a patient and a nephrologist provide insights into some of the problems they confronted.
Where Has all the Staff Gone? Strategies to Recruit and Retain Quality Staff
Authors: Hauff Helen M.
Published: January 2017

Recruiting and retaining quality staff is a national issue for all healthcare organizations, and transplant programs are also affected by this crisis. Transplant administrators are faced with increased regulatory burdens, reduced reimbursement, increased competition for uniquely qualified staff, and rising healthcare costs. These factors negatively affect transplant programs that try to ensure the infrastructure exists to provide quality care. Human resources management is a key component to transplant administration. In today's environment, administrators need to adopt long-term strategic practices to recruit and retain quality staff. Maintaining adequate staffing levels means “thinking out of the box” and looking at human resources management at all levels of skill mix including physician extenders that can perform the transplant coordinator role. Investing in the future development of staff can attract quality professionals to the field of transplantation for years to come.
Update on Pharmacoeconomics in Transplantation
Authors: Cavanaugh Teresa M. , Martin Jill E.
Published: January 2017

Purpose

To provide current information on pharmacoeconomic outcomes in transplantation for the past 6 years.

Methods

An extensive literature search was undertaken using PubMed and other authenticated Internet sources. Key words used to elicit pertinent studies were “pharmacoeconomics,” “transplantation,” “cost-effectiveness,” “cost-benefit,” “cost-minimization” and “cost-utility” analyses. Studies included in the review contain updated pharmacoeconomic data generated during the past 6 years on economic, clinical, and humanistic outcomes. These data are used to describe and analyze the cost of drug therapy used in transplantation.

Results

Background information is included in the review to provide a context from which to evaluate new study material. Data extracted from the studies include significant findings and study limitations. Data were stratified into understanding pharmacoeconomic methods and their application to transplantation, maintenance and induction therapies, and management of and costs associated with adverse events and quality-of-life issues.

Conclusions

Continued evolution of pharmacoeconomic analysis is needed so that optimal care can be provided in the most cost-effective manner. Pharmacoeconomic study, done rationally and logically, is an indispensable tool in determining optimal transplantation regimens.
Regulatory Compliance in Solid-Organ Transplantation: What You Don't Know Can Hurt Your Program
Authors: Benjey Jane , Cunanan Mary , Thomson Art
Published: January 2017

The risk of noncompliance with rules and regulations in solid-organ transplantation is significant and may lead to probation, suspension, or program closure. Transplant program leadership is responsible for ensuring that programs and centers are in compliance with regulations and data reporting requirements. As the Centers for Medicare and Medicaid Services prepare to implement new rules and the Joint Commission on Accreditation of Healthcare Organizations positions itself to join the certification process for transplant programs, heightened awareness and vigilance by all members of the transplant community are warranted. This article aims to inform transplant team members, particularly transplant program leaders, of the various regulatory bodies that oversee solid-organ transplantation, as well as these bodies' responsibilities and current agendas. Information is also included to help leaders continuously prepare their programs for site visits and audits by these oversight bodies.
Quality of Life and Bronchiolitis Obliterans Syndrome in Patients after Lung Transplantation
Authors: Künsebeck Hans W. , Kugler Christiane , Fischer Stefan , Simon Andre R. , Gottlieb Jens , Welte Tobias , Haverich Axel , Strueber Martin
Published: January 2017

Background

Lung transplantation has become an established and effective treatment for patients with end-stage pulmonary disease.

Objective

To investigate health-related quality of life in correlation with occurrence and degree of bronchiolitis obliterans syndrome after transplantation.

Methods

In a cross-sectional study design, 119 consecutive lung transplant recipients (63.9% bilateral and 36.1% single lung transplants) responded voluntarily to a set of standardized questionnaires (12-Item Short-Form Health Survey, Center for Epidemiologic Studies-Depression Scale, Coping With Everyday Life, Beck Anxiety Inventory, Zerssen list of complaints) that covered health-related quality of life and psychological well being. Also, we performed pulmonary function studies to clinically grade bronchiolitis obliterans syndrome in all patients.

Results

In this cohort, 41.2% of patients developed bronchiolitis obliterans syndrome at a mean interval of 5.6 years after lung transplantation. Actuarial freedom from bronchiolitis obliterans syndrome was 90.1%±2.3% at 1 year, 79.9%±3.7% at 3 years, and 59.5%±4.8% at 5 years after lung transplantation. Recipients with bronchiolitis obliterans syndrome reported significantly lower well being and quality of life than those without bronchiolitis obliterans syndrome, who scored similar to healthy volunteers. In a subanalysis, body functioning ( P<.001) and related areas of coping ( P<.001) were mostly affected by bronchiolitis obliterans syndrome.

Conclusions

Quality of life was negatively affected by the onset of bronchiolitis obliterans syndrome. However, even patients who develop bronchiolitis obliterans syndrome reported a temporary benefit from lung transplantation. In addition to optimal medical care and efforts in preventing bronchiolitis obliterans syndrome, psychological support of lung recipients seems to be essential, especially when bronchiolitis obliterans syndrome occurs.
Advanced Practice Organ Procurement Techniques: Placement of Pulmonary Artery Catheters
Authors: Griffin Laura J. , Lambert Monique , Powner David J.
Published: January 2017

Insertion of pulmonary artery catheters by organ procurement coordinators may be incorporated into donor management to optimize organ perfusion. As invasive procedures are added to coordinator roles, the organ procurement organization must include didactic instruction and supervised clinical experience as part of any training program. Policies and procedures guiding the use of the pulmonary artery catheter and the measurements obtained must be provided by the organization to guide practitioners. This article focuses on methods for insertion and basic troubleshooting of a pulmonary artery catheter.
Web Resources for Transplant Candidates, Recipients, and Donors
Authors: Possemato A. Kyle , Geller Pamela A.
Published: January 2017

Many valuable Web-based resources for transplant candidates, donors, and recipients exist; however, high-quality Web sites that are appropriate for patient use can be difficult to find. This article describes how patients can benefit from the use of transplant-specific Web sites and highlights Web resources that medical professionals can recommend to Internet-literate patients and their families. General guidelines for finding accurate and unbiased transplant-related information on the Internet are provided and 6 Web sites that offer features such as comprehensive educational information and opportunities for patient-to-patient interaction are detailed.
Participation in Occupational Performance: Reliability and Validity of the Activity Card Sort
Authors: Katz Noomi , Karpin Hanah , Lak Arit , Furman Tania , Hartman-Maeir Adina
Published: January 2017

The Activity Card Sort (ACS) is a comprehensive instrument for assessing participation in occupational performance of instrumental, social-cultural, and leisure activities. The purpose of the study was to determine the reliability and validity of the ACS within different adult and older adult groups. The study included 263 participants comprising 5 groups of 61 healthy adults, 61 healthy older adults, 40 spouses or caregivers of individuals with Alzheimer's, 45 individuals with multiple sclerosis, and 56 individuals 1 year after having a stroke. The ACS was adapted to the Israeli culture in a previous study with the author's permission. The final version that was used in this analysis included 88 picture cards of adults performing instrumental, social-cultural, and low and high physical leisure activities that the clients sort into five categories. The ACS provides a “retained activity level” score that is the percentage of activities in which a person is currently engaged divided by those with whom he or she was involved in the past. In addition, comparisons between all groups of current activity levels were analyzed. The ACS had high internal consistency (Cronbach alpha in each area) for instrumental activities of daily living (IADL) and social-cultural activities (.82, .80), and lower for low and high physical leisure activities (.66, .61). A one-way analysis of variance (ANOVA) that compared groups of participants on total retained activity level and individual activity areas showed a significant group effect on all comparisons (p<.000) that support construct validity. Post hoc Scheffe tests revealed significant differences between most groups. The same results were found for current activity level. The results support the reliability and validity of the ACS and provide a basis for its clinical use.
Dramaturgical Challenges of Parkinson's Disease
Authors: Lyons Kathleen Doyle , Tickle-Degnen Linda
Published: January 2017

Being able to engage in satisfying and effective interpersonal interactions is an important component of health. Parkinson's disease (PD) is an example of a chronic illness that can make social interactions difficult and awkward. The aim of this study was to explore the nature of the challenges people with PD face during social occupations. Following a collective case study design, two men and one woman each participated in two qualitative interviews. Dramaturgical analysis of the interview data was conducted to offer insight into why some interactions are problematic. Elements seen in the stories of problematic encounters included a dramaturgical challenge created by PD symptoms, resulting discomfort or confusion, and the adoption of an attitude or action to surmount the challenge. Using dramaturgical analysis to explore the occupational form of social interactions can develop knowledge about the facilitation of social well-being.
Using Speech Sounds to Enhance Occupational Performance in Young and Older Adults
Authors: Maitra K.K. , Curry D. , Gamble C. , Martin M. , Phelps J. , Santisteban M.E. , Slattery E. , Thomas J. , Telage K.M.
Published: January 2017

Functional independence in daily life depends largely on performing daily occupations smoothly and efficiently. Thus, intervention is needed as the quality of daily occupational performance declines with age in older adults. Recent experimental studies indicate an interactive relationship between speech and upper extremity motor control. These studies led to the suggestion that speech sounds or vocalization might be used to enhance motor performance. The present study compared the effect of vocalization on a daily motor performance in young and older adults. It included 13 young (mean 22.5 years) and 13 older adults (mean 75.5 years) with no known neurological impairments who performed the task of reaching for a cup and placing it on a shelf during four randomly chosen conditions: no vocalization, synchronized self-vocalization, external (experimenter) vocalization, and imagery vocalization. Arm and jaw movements were recorded using a search coil system. Kinematic data were analyzed using a two-way mixed design analysis of variance (ANOVA) with post hoc contrast analysis. Older adults were consistently slower than young participants for all test conditions (p<.001). Movements in both young and older adults made with either self-vocalization or external vocalization were significantly faster and smoother than movements made without vocalization or using imagery vocalization (p<.001). Vocalization effects on movement performance were significantly more pronounced in older adults than in younger participants (p<.001). The results suggest that vocalization improves motor performance of the daily living task studied, and the study design has clinical potential that may be used for facilitating task-related motor performance in older adults.
Grieving over Complications Associated with Neuro-Endovascular Treatment
Authors: Goto K. , Noda M.
Published: January 2017

Neuro-endovascular therapy is regarded as one of the greatest achievements of modern medicine because of its effectiveness and low-invasiveness in the treatment of difficult neurovascular diseases. On the other side of the coin however, occasionally complications may occur which not only have a profound neurological effect, but also have a severe effect on the vital prognosis. The nightmare of a neuro-endovascular therapist is a catastrophe resulting from a preventive treatment for an asymptomatic or minimally symptomatic patient with a potentially dangerous disease. Therefore, grave psychic distress tends to occur on both sides of the patient-doctor relationship. Once severe complications occur, we have simultaneously to take care of not only the psychic trauma of a patient and/or family but also our own psychic trauma. If treatment is not appropriate, we might invite malpractice suits or end up in occupational burnout.

In order to study the adaptive mechanisms that allow our continued survival in this new specialty of medicine, we administered a questionnaire survey to members of the Japanese Society of Neuro-endovascular Treatment. 51% of 300 respondents stated that they had been the targets of severe recriminations by patients and/or families as a result of complications. 284 respondents had multiple (2.5 on average) signs and symptoms of psychic trauma. Also 23% of respondents were unable to continue the clinical practice of neuro-endovascular therapy or resorted to conservative treatment. Only 7% of respondents had medical curriculum or residency program training on the psychological problems of complications. There is no systematic approach to education regarding physician grief in clinical practice. Many respondents tend to focus their attention solely on the details of failed interventional procedures and repeatedly “undo” actions and relive past events. However, the study showed that intellectualization of the tragic experiences without accepting and working through grief only adds to the physician's grief. The correlation was evaluated between the respondents' initial response to grieving and their change of attitude regarding their ability or willingness to performing the procedure after they had experienced devastating complications. It may be said that by facing the emotional truths of responsibility and grief, physicians can develop the ability to empathize with patients and their families. Mention is also made of the patient-doctor relationship, medical education, and the relationship with fellow physicians and medical lawsuits.
MR Quantification of Flow in Children with Vascular Malformations
Authors: Poskitt K.J. , Marotta T. , Haw C. , Cochrane D. , Steinbok P.
Published: January 2017

The evaluation of treatments such as embolization, stereotactic radiation, and even surgery would be enhanced by an objective method of measuring flow in feeding arteries or draining veins.

We developed a non-invasive method of measuring vascular flow using cardiac gated phase contrast MR angiography (MR Q flow).

The purpose of this work was to employ the same technique in a series of patients with vascular malformations of the head and neck. We selected a series of vascular malformations with simple arterial and venous architecture and significantly smaller vessel diameters than that encountered with Vein of Galen Malformations. Our aim was to determine the reproducibility of the derived flow values by using multiple velocity encoded sequences (VENC) and compare the values derived from the arterial feeders to the venous outflow data.

There are inherent technical difficulties with assessing flow through multiple arterial feeders or draining veins, so the technique is most easily applied to AVMs with simple, easily defined feeding arteries or draining veins. Nonetheless, this technique is relatively straightforward to learn, rapid, cost-effective and may provide an objective means to assess therapeutic maneuvers when applied to head and neck vascular malformations.
An Endovascular Primate Model for the Production of a Middle Cerebral Artery Ischemic Infarction
Authors: Horowitz M. , Kassam A. , Nemoto E. , Arimoto J. , Jungreis C.
Published: January 2017

An endovascular model for producing and studying middle cerebral artery acute ischemic strokes was developed to avoid the need for an open surgical approach to the middle cerebral, anterior cerebral, posterior cerebral and internal carotid arteries. Endovascular occlusion of these vessels followed by Xenon-CT cerebral blood flow study confirmed the production of a middle cerebral artery distribution infarct in two primates. The methodology, advantages and drawbacks of this model are discussed.
Imaging and Clinical Features in a Child with Loeys-Dietz Syndrome
Authors: Suarez B. , Caldera A. , Castillo M.
Published: January 2017

We describe a boy with Loeys-Dietz syndrome (LDS) a genetic and recently described condition that affects connective tissues belonging to a group of Marfan-related disorders. Since there are only a few cases reported misdiagnosis may not be uncommon. Radiological findings in our patient include pectus excavatum, aortic root dilatation, diffuse dilatation of the intracerebral vessels and a Chiari I malformation. We describe the imaging findings, clinical presentation and diagnosis criteria of this entity.
Trigeminocardiac Reflex in a Child during Pre-Onyx DMSO Injection for Juvenile Nasopharyngeal Angiofibroma Embolization
Authors: Puri A.S. , Thiex R. , Zarzour H. , Rahbar R. , Orbach D.B.
Published: January 2017

We describe the occurrence of the trigeminocardiac reflex (TCR) during DMSO pre-flushing of the microcatheter in preparation for Onyx embolization via the internal maxillary artery. TCR has not been previously associated with embolization of extradural entities. Familiarity with this clinical reflex and its proper management may help in planning neurointerventional procedures involving DMSO injection in the trigeminal territory.