bluuebunny/crossref_metadata_2025 huggingface dataset:
Critical Care Pharmacy in Donor Management
Authors: Phongsamran Paula V.
Published: July 2017

Significant systemic changes occur following neurologic insult and subsequent brain death. If left untreated, the hemodynamic instability and neuroendocrine alterations that ensue may significantly affect the quality of the donor organs, and contribute to posttransplant allograft dysfunction. A number of pharmacologic interventions are often implemented in an attempt to stabilize donor hemodynamics and optimize organ perfusion, thereby increasing the number and quality of cadaveric donor organs available for transplantation. This review provides a summary of these interventions, with an emphasis placed on hormonal resuscitation, which involves utilizing such agents as thyroxin, vasopressin, insulin, and corticosteroids.
Quality of Life after Intestinal Transplantation
Authors: Sudan Debra
Published: July 2017

As technology introduces more advanced therapies, individuals have realized that quantity or length of life may not always be the ultimate goal in treating disease. The quality of life at times is as important as length of life. In this article, we review the literature regarding quality of life after intestinal transplantation. Published data on patient survival are briefly reviewed and the available studies investigating quality of life are examined. Few studies have been performed to date, but the limitations and implications of the available studies are summarized.
Home Care Management of Intestinal Transplant Recipients
Authors: Snell Lecia , Randolph Susan
Published: July 2017

During the past 14 years, significant advances have been made in the field of intestinal transplantation. Patients' survival rates have increased, influencing referral patterns, and there has been a growing trend toward shortened hospitalizations with earlier discharge. Home care has also evolved during this same period, with development of the resources, training, and processes required for in-home management of patients with multiple complex needs. Together these trends have led to the ability to provide care and services to higher acuity patients in the outpatient and home setting after intestinal transplantation. In this article, we review the infusion management of intestinal transplant recipients before and after they go home and the rationale for the need for specialized home care services.
Factors Predictive of Signed Consent for Posthumous Organ Donation
Authors: Godin Gaston , Bélanger-Gravel Ariane , Gagné Camille , Blondeau Danielle
Published: July 2017

Context

The shortage of organs for transplantation has led public health authorities to invest significant efforts in the promotion of organ donation.

Objective

To identify factors predictive of signed consent for posthumous organ donation by using the theory of planned behavior.

Participants and Design

A random sample of 602 adults completed a questionnaire at baseline, and behavior was self-reported 15 months later.

Results

Logistic regression indicated that intention, perceived behavioral control, moral norm, and past behavior were factors predictive of consent for posthumous organ donation. Participants' perceived behavioral control, past behavior, and moral norm were also predictive of intention to sign, but attitude and perceived barriers were 2 additional determinants. Finally, anticipated regret and knowledge of persons who had made an organ donation were 2 moderators of the intention-behavior relationship.

Conclusion

Overall, the results showed that intention is an important determinant of signing the organ donor's consent sticker and also highlighted that moral consideration and perceived difficulties could be 2 potential avenues for designing interventions.
Intermittent Antegrade Cardioplegia: Isolated Heart Preservation with the Asporto Heart Preservation Device
Authors: Rivard Andrew L. , Hellmich Christina , Swingen Cory M. , Kamdar Forum D. , Cordova Erin J. , Holstad Jonathan , Baranowski Thomas J. , Bianco Richard W. , John Ranjit
Published: July 2017

Background

A major problem in procurement of donor hearts is the limited time a donor heart remains viable. After cardiectomy, ischemic hypoxia is the main cause of donor heart degradation. The global myocardial ischemia causes a cascade of oxygen radical formation that cumulates in an elevation in hydrogen ions (decrease in pH), irreversible cellular injury, and potential microvascular changes in perfusion.

Objective

To determine the changes of prolonged storage times on donor heart microvasculature and the effects of intermittent antegrade perfusion.

Materials and Methods

Using porcine hearts flushed with a Ribosol-based cardioplegic solution, we examined how storage time affects microvascular myocardial perfusion by using contrast-enhanced magnetic resonance imaging at a mean (SD) of 6.1 (0.6) hours (n=13) or 15.6 (0.6) hours (n=11) after cardiectomy. Finally, to determine if administration of cardioplegic solution affects pH and microvascular perfusion, isolated hearts (group 1, n=9) given a single antegrade dose, were compared with hearts (group 2, n=8) given intermittent antegrade cardioplegia (150 mL, every 30 min, 150 mL/min) by a heart preservation device. Khuri pH probes in left and right ventricular tissue continuously measured hydrogen ion levels, and perfusion intensity on magnetic resonance images was plotted against time.

Results

Myocardial perfusion measured via magnetic resonance imaging at 6.1 hours was significantly greater than at 15.6 hours (67% vs 30%, P=.00008). In group 1 hearts, the mean (SD) for pH at the end of 6 hours decreased to 6.2 (0.2). In group 2, hearts that received intermittent antegrade cardioplegia, pH at the end of 6 hours was higher at 6.7 (0.3) ( P=.0005). Magnetic resonance imaging showed no significant differences between the 2 groups in contrast enhancement (group 1, 62%; group 2, 40%) or in the wet/dry weight ratio.

Conclusion

Intermittent perfusion maintains a significantly higher myocardial pH than does a conventional single antegrade dose. This difference may translate into an improved quality of donor hearts procured for transplantation, allowing longer distance procurement, tissue matching, improved outcomes for transplant recipients, and ideally a decrease in transplant-related costs.
Communicating Effectively about Donation: An Educational Intervention to Increase Consent to Donation
Authors: Siminoff Laura A. , Marshall Heather M. , Dumenci Levent , Bowen Gordon , Swaminathan Aruna , Gordon Nahida
Published: July 2017

Context

Families' refusal to consent to solid organ donation is a major contributor to the organ deficit in the United States. Previous research has identified organ procurement coordinators as best able to obtain consent from families; however, few studies have examined the effects of coordinator training programs on consent rates.

Objective

To test the effects of the Communicating Effectively About Donation intervention on the rate of family consent to solid organ donation.

Design

A nonrandomized repeated measures design.

Setting and Participants

Participants included 17 hospitals, 502 donor-eligible patients and their families, and 22 coordinators from an organ procurement organization in Ohio.

Intervention

Coordinators were given in-service training on the use of effective relational and affective communication techniques through a day-long interactive workshop and simulated donation scenarios.

Main Outcome Measures

Families' final donation decision and coordinators' donation-related behaviors.

Results

Training of coordinators was associated with increases in coordinators' comfort speaking with patients' families about donation and answering donation-related questions, in the amount of time coordinators spent discussing donation with family members, and in the number of donation-related topics discussed with families. Consent rates increased from 46.3% to 55.5% after the intervention.

Conclusions

The results suggest that improving coordinators' communication skills may be a fruitful avenue for increasing the rate of family consent to donation; however, a more definitive test of the training is needed to confirm the intervention's effectiveness.
Evolution of Quality at the Organ Center of the Organ Procurement and Transplantation Network/United Network for Organ Sharing
Authors: Brown Roger S. , Belton A. Matthew , Martin Judith M. , Simmons Dee Dee , Taylor Gloria J. , Willard Ellie
Published: July 2017

One of the goals of the Organ Center of the Organ Procurement and Transplantation Network/United Network for Organ Sharing is to increase the efficiency of equitable organ allocation in the United States. Recognizing the ever-growing need for organ donors and transplants, leaders at the Organ Center increased its commitment to quality improvement initiatives through the development of a quality management team in 2001. The Organ Center began to focus on ways to capture data on processes and pinpoint areas for improvement. As the collection and analysis of data evolved, the Organ Center embraced formal quality standards, such as improvement cycles. Using these cycles, the Organ Center has seen significant improvement. One initiative involving lifesaving heart, lung, and liver placement showed success by doubling the Organ Center's organ placement rate. Another project involving the validation of donor information demonstrated that the accuracy of organ allocation can be improved by 5% on a consistent basis. As stewards for the gift of life and leaders in organ allocation, the Organ Center uses continuous quality improvement to achieve the goal of increasing the efficiency of equitable organ allocation.
Lung Donation after Cardiac Death of Recent Heart Transplant Recipient
Authors: Angel Joshua C. , Alston Sheila , Tudor Mark
Published: July 2017

In June 2008, Gift of Life Michigan was notified of a potential donor. After the initial chart review, it was determined that the patient would be a candidate for donation after cardiac death. Two things made this case interesting: (1) the patient was an organ recipient himself, having received a heart transplant just a short time before his death, and (2) even though this was a donation after cardiac death and the patient had recently received the heart transplant, the patient's lungs and the left kidney were successfully recovered and used for transplant.
Liver Transplant Recipients: Individual, Social, and Environmental Resources
Authors: Stilley Carol S. , DiMartini Andrea F. , Tarter Ralph E. , DeVera Michael , Sereika Susan , Dew Mary Amanda , King Jennifer , Flynn William B.
Published: July 2017

Context

Patient characteristics are important in the liver transplant population because of proven associations between individual and environmental factors, treatment adherence, and health outcomes in general medical and other transplant populations.

Objective

To determine generalizability of the sample to other liver transplant populations and to establish reliability of measures used to assess individual and environmental resources.

Design

Cross-sectional analysis of baseline data in a longitudinal study of adherence and health outcomes.

Participants, Setting

Ninety first-time adult liver transplant recipients at the University of Pittsburgh Medical Center completed assessments of sociodemographic, health history, psychosocial, and environmental factors shortly after surgery; adherence and health outcomes were tracked throughout the study.

Results

The medical center cohort was older, less racially diverse, and contained more living donors than the national sample. Our sample was generally comparable to the medical center cohort on pretransplant sociodemographic and clinical characteristics. Reliability/internal consistency on psychological measures was similar between our sample and most published norms. The mean scores on all coping scales in our sample were higher than normative. Our patients indicated a more negative perception of family environment and perceived relationships with their primary caregiver more positively than did the normative group.

Conclusion

The generalizability of our sample to the parent population and reliability of individual and environmental measures reported here will enable us to examine relationships and the value of patient and contextual resources for predicting treatment adherence and health outcomes among liver transplant recipients.
Developing and Maintaining Competency with Circulatory Assist Devices: How to Meet the Challenge
Authors: Savage Laura , Murphey Jennifer , Joyce Kenna
Published: July 2017

Heart failure is the only cardiovascular disease that is increasing in prevalence in developing countries. As a result, circulatory assist devices are being used more both as a bridge to heart transplantation and as destination therapy in patients with a failing heart. Nurses must become knowledgeable about these options for their patients. Developing and maintaining competency can be challenging as more devices become available. The principles of adult learners were used by one academic medical center to set up a new circulatory assist program and to maintain ongoing competency among staff working with patients who have these devices.
Understanding Bereavement, Grief, and Mourning: Implications for Donation and Transplant Professionals
Authors: Corr Charles A. , Coolican Margaret B.
Published: July 2017

This article surveys recent literature on bereavement, grief, and mourning. It offers a review of the state of the art of current understandings of those topics to assist professionals who work in the field of organ and tissue donation and transplantation. The article's goal is to provide well-developed and up-to-date education and knowledge about bereavement, grief, and mourning to supplement the natural skills and experience of donation and transplant professionals in their work with bereaved persons.
Fatigue and Sleep Quality before and after Liver Transplantation
Authors: Rodrigue James R. , Nelson David R. , Reed Alan I. , Hanto Douglas W. , Curry Michael
Published: July 2017

Context

Recent publications suggest that fatigue and sleep disturbance are problems in patients with chronic liver disease and in liver transplant recipients.

Objectives

To characterize the severity and nature of fatigue and sleep quality before and after liver transplantation, to examine the relationship between fatigue/sleep quality and quality of life, and to identify their multivariate correlates.

Design, Settings, and Participants

Cross-sectional survey administered to 110 patients before and 95 patients after liver transplantation at 2 transplant centers.

Main Outcome Measures

Fatigue and sleep quality.

Results

Most pretransplant (86%) and posttransplant (76%) patients experienced high fatigue severity. Correlates of pretransplant fatigue severity were being female (odds ratio [OR] = 0.22, P= .04), higher body mass index (OR = 1.07, P= .04), higher mood disturbance (OR=1.05, P= .02), and poor sleep quality (OR=0.26, P= .02). Correlates of posttransplant fatigue severity were use of sleep medications in the past month (OR = 0.51, P= .02) and higher mood disturbance (OR = 1.06, P = .004). Seventy-three percent of pretransplant and 77% of posttransplant patients were classified as having poor sleep quality. Higher body mass index (OR = 1.06, P= .05), sleep medications (OR=0.43, P= .03), and more mood disturbance (OR=1.04, P = .007) were predictive of poor sleep quality in pretransplant patients, whereas higher body mass index (OR=1.07, P= .04) and more anxious mood (OR=1.28, P = .03) were predictive of poor sleep quality in posttransplant patients.

Conclusion

A very high proportion of both pretransplant and posttransplant patients experience clinically severe fatigue levels. Prospective research is necessary to identify causal mechanisms of these disorders and to evaluate strategies to reduce fatigue severity and improve sleep quality.
Why Families Decline Donation: The Perspective of Organ Procurement Coordinators
Authors: Anker Ashley E. , Feeley Thomas Hugh
Published: July 2017

Context

Current knowledge regarding the barriers to organ donation relies on 3 data sources: potential donor families, hospital staff, and members of the general public. The current study complements these findings by interviewing organ procurement coordinators about their experiences during the familial consent process.

Objective

To characterize organ procurement coordinators' reports of barriers to obtaining familial consent for donation.

Design

Structured, face-to-face interviews.

Participants

One hundred and two organ procurement coordinators recruited from a national sample of 16 organ procurement organizations.

Main Outcome Measure

Interviews were content analyzed to describe coordinators' experiences with families who decline donation. Manifest coding was used to determine the frequency with which particular barriers were identified by coordinators. Coordinators' reports of barriers were compared with organizational conversion rates to determine which barriers were associated with performance as an organization.

Results

Organ procurement coordinators revealed 16 distinct barriers in 4 overlying categories: concerns regarding decedents' wishes, structural barriers to donation, unsupportive belief systems, and lack of public education. Three reported barriers could be used to differentiate between high- and low-performance organizations: (1) familial concerns over bodily disfigurement, (2) failure of families to understand brain death, and (3) families' cultural/racial background.

Conclusion

These results supplement existing reports of barriers to donation and are discussed in terms of shaping future public education efforts and request processes to improve conversion rates.
Humoral Rejection after Pediatric Heart Transplantation: A Case Report
Authors: Stendahl Gail , Berger Stuart , Ellis Tom , Gandy Kimberly , Mitchell Michael , Tweddell James , Zangwill Steven
Published: July 2017

Humoral rejection was observed 2 years after heart transplantation in a 10-year-old African American girl with sickle cell disease. Hemodynamic compromise developed, and the patient started treatment with extracorporeal membrane oxygenation within 24 hours of admission. With cellular rejection initially believed to be the cause, administration of thymoglobulin and high-dose steroids was initiated. Human leukocyte antigen antibody analysis revealed high titers of donor-specific class I and II antibodies. Aggressive treatment for antibody-mediated rejection was started with plasmapheresis and administration of intravenous immune globulin and ritux-imab. The patient displayed clinical signs of infection and was treated with antimicrobial, antiviral, and antifungal agents. Computed tomography of the chest suggested asperigillous infection. The patient underwent a left upper lobectomy. The patient recovered and has done well, now 4 years after having received the heart transplant. Antibody-mediated rejection should be considered early in heart transplant patients presenting with hemodynamic compromise and may respond to aggressive antibody and B cell–directed therapy. Vigilance for secondary infections, especially during treatment for rejection, is crucial.
Use of Telehealth Technology for Home Spirometry after Lung Transplantation: A Randomized Controlled Trial
Authors: Sengpiel Juliane , Fuehner Thomas , Kugler Christiane , Avsar Murat , Bodmann Isabelle , Boemke Annelies , Simon Andre , Welte Tobias , Gottlieb Jens
Published: July 2017

Context

Complications often occur during the early phase after lung transplantation, and rapid diagnosis is vital. Home spirometry is used to detect early changes in graft function. Bluetooth-equipped cell phones are easy to use and facilitate data transfer from home spirometry.

Objective

To explore use of home spirometry with Bluetooth data transfer in outpatient lung transplant recipients.

Design

Single-center prospective randomized controlled trial.

Intervention

Fifty-six patients were randomized either to home spirometry with data transfer via Bluetooth-equipped cell phones or to home spirometry alone before discharge after lung transplantation. In the Bluetooth group, results were transferred to a database capable of generating alarm messages.

Main Outcome Measures

Time from onset of symptoms to physician consultation during the first 6 months after lung transplantation was the primary end point.

Results

Adherence to home spirometry was 97.2% in the Bluetooth group and 95.3% in the home spirometry alone group ( P= .73). Median time to first consultation ( P = .60) and frequency of consultation ( P = .06) did not differ significantly in the 2 groups. Mean scores on the Hospital Anxiety and Depression Scale were lower in patients in the Bluetooth group (1.5; range, 0.0–4.0) than in the home spirometry alone group (4.0; range, 2.0–6.0; P = .04).

Conclusion

Home spirometry with data transfer is feasible and safe in lung transplant recipients. Compared with home spirometry alone, additional data transfer was equally effective regarding the time interval from symptom onset to consultation. Patients in the Bluetooth group reported less anxiety, which may improve emotional well-being.
Quality Improvement in the Care of Live Liver Donors: Implementation of the Designated Donor Nurse Program
Authors: Rudow Dianne LaPointe , Cabello Charlotte C. , Rivellini Denise
Published: July 2017

Publications on living donor liver transplant have focused on the medical aspects of donor selection, postoperative management, surgical procedures, and outcomes, but little attention has been given to the nursing implications for care of live liver donors during their inpatient stay. Donor advocates from various disciplines are involved during the initial education and evaluation, but most care after surgery is delivered by an inpatient medical team and bedside nursing staff who are not as familiar with the donor and concepts related to donor advocacy. In an effort to improve the overall donor experience and provide safe, high-quality care to patients undergoing elective partial hepatectomy, our academic medical center began a quality improvement project focused on improving the inpatient stay. Inpatient nursing standards and policies and procedures were developed to ensure that consistent care is delivered. However, the infrequency of living donor liver transplantation makes it nearly impossible to have all transplant program staff on a nursing unit be “experts” on donor care. Therefore, our center determined that, similar to the Independent Donor Advocacy Team, a transplant program needs live donor champions on the nursing unit to mirror the goals of the team. To that end, we developed the concept of the Designated Donor Nurse to care for and advocate for live liver donors during the inpatient stay and also to serve as a resource to their colleagues.
Attitudes toward Organ Donation and Donor Behavior: A Review of the International Literature
Authors: Wakefield Claire E. , Watts Kaaren J. , Homewood Judi , Meiser Bettina , Siminoff Laura A.
Published: July 2017

Objective

To conduct a systematic review of published research that assessed the predictors of attitudes toward deceased organ donation, willingness to donate, and donor behavior.

Data Sources

MEDLINE, PreMEDLINE, PsycInfo, and the Cumulative Index to Nursing and Allied Health Literature were searched for the period from 1988 to 2009.

Study Selection

Eligible studies included members of the general public (ie, not transplant recipients, donor families, or health professionals) and used multivariate analyses for quantitative assessment of predictors.

Data Extraction

The search identified 33 relevant studies. Owing to heterogeneity in populations and measures, results were summarized rather than subjected to meta-analysis.

Data Synthesis

Research suggests that individuals who are younger, female, have higher education levels and socioeconomic status, hold fewer religious beliefs, have high knowledge levels, know others with positive attitudes, are more altruistic, and have fewer concerns about manipulation of the body of the deceased donor are more likely to have positive attitudes toward donation and are more willing to donate their organs.

Conclusions

The review revealed the complexity of individuals' attitudes toward donation and the need for more sophisticated future studies of the interactions between the broader factors influencing donation (such as social norms and existing legislation in each country) and individual factors, such as attitudes and beliefs.
A Two-Round Delphi Study Examining Consensus of Recommended Clinical Practices for Patients with Ventricular Assist Devices as Destination Therapy
Authors: Chichetti JoAnne V.
Published: July 2017

Objective

To identify the current clinical practices of Medicare-certified facilities offering ventricular assist devices as destination therapy and to attain a consensus of recommended clinical practices across the United States for the management of adults with ventricular assist devices as destination therapy.

Method

Sixty ventricular assist device coordinators from Medicare-certified centers were invited to participate in an online, 2-round Delphi survey. The surveys asked whether recommended practices are current practices and whether respondents always/agreed or never/disagreed with performing the recommended practice guidelines. Consensus was defined as 75% agreement. The clinical areas of focus were patient selection, preoperative preparation, postoperative care, infection control, nutrition, and patient discharge preparation. Practices were extracted from the advanced practice guidelines for HeartMate destination therapy and the International Society for Heart and Lung Transplantation's 2006 guidelines for the care of heart transplant candidates.

Results

Representing 21 states across the country, the first-round survey had a response rate of 57% (n = 34). The second-round survey had a response rate of 74% (n= 17), representing 28% of the 60 centers. Consensus was obtained for 122 practices. The dimension of patient selection—diagnostic tests and screening had the highest level of consensus (16%, n = 20), and the dimension of postoperative care—intermediate/intensive care unit dimension had the lowest level of consensus (3.3%, n = 4).

Conclusion

Survey results identify a consensus of practices for the specific group of ventricular assist device coordinators who responded, but that consensus cannot be generalized to all ventricular assist device facilities. These results can, however, provide a foundation for further research leading to the development of standard-of-care practices for patients with ventricular assist devices as destination therapy.
Capnocytophagia Canimorsus Sepsis in an Asplenic Heart Transplant Candidate with a Left Ventricular Assist System
Authors: Ensor Christopher R. , Russell Stuart D. , Wittstein Ilan S. , Conte John V.
Published: July 2017

Fulminant septic shock associated with Capnocytophagia canimorsus bacteremia developed in a 54-year-old asplenic man, a heart transplantation candidate who was supported with a HeartMate II left ventricular assist system, after he experienced a dog bite. He improved after administration of broad-spectrum antibiotics, which were narrowed to ampicillin/sulbactam for a prolonged 6-week course, and subsequently recovered fully.
Religious and Ethnic Influences on Willingness to Donate Organs and Donor Behavior: An Australian Perspective
Authors: Wakefield Claire E. , Reid John , Homewood Judi
Published: July 2017

Context

Globally, the demand for donated organs outstrips supply, meaning that there are both practical and theoretical reasons for examining factors that are predictive of individuals' willingness to donate their organs upon their death.

Objectives

To determine whether individuals of different religious denominations living in Australia have different views on organ donation, whether donation attitudes differ significantly across ethnic groups, and whether factors identified in international research are predictors of willingness to donate and actual donor behavior in this population.

Participants

Data for this study were collected from students at an Australian university from a range of religious and ethnic backgrounds, and their friends and relatives (N = 509).

Intervention

Participants were administered the Organ Donation Attitude Scale, as well as additional attitudes and knowledge measures.

Main Outcome Measures

Self-reported “willingness to donate” and “donor behavior.”

Results

Our findings complemented those reported in comparable countries, with females, younger Australians, and those with high knowledge levels being more willing to donate than males, older persons, and those with low knowledge. Persons who described themselves as having stronger religious beliefs (particularly Buddhist and Islamic) held less favorable attitudes toward donation, had lower knowledge levels, and were more likely to oppose donation.

Conclusions

Although this study established that attitudes toward, knowledge about, and predictors of organ donation in Australia are similar to those reported elsewhere, donation rates remain low. Further in-depth research examining the impact of religion and culture on attitudes, beliefs, and behavior is essential when exploring strategies to improve organ donation rates in highly multicultural societies such as Australia.
Donor Families, Distinctive Secondary Losses, and “Second Death” Experiences
Authors: Corr Charles A. , Coolican Margaret B. , Moretti Lara S. , Simon Rebecca
Published: July 2017

Communication between donor families and the recipients of their loved ones' organs and tissues is a relatively new area of study. The National Kidney Foundation founded the National Donor Family Council in 1992 as a home for donor families. One of several items addressed by the Council was guidelines for communication, supporting the rights of donor families and recipients to communicate and build relationships should they choose to do so. Donation and transplant agencies play a strong role in facilitating and supporting donor families and recipients with these unique new relationships. This article offers 3 case examples of distinctive secondary losses and “second death” experiences encountered by some donor family members when the donation of tissues or organs they have authorized could not be used for transplantation, when those grafts fail or are rejected, or when the recipient dies. On that basis, the article explores the nature of these experiences and some reasons why they occur. Initial recommendations about how to address these experiences are provided. Finally, a 4-part agenda is suggested for research about (1) the nature of these distinctive secondary loss and second death experiences encountered by some donor families; (2) communications between donation and transplant professionals, on the one hand, and potential and actual donor family members, on the other hand; (3) the education, training, and support of professionals who provide bereavement support to donor family members; and (4) a review of the National Communication Guidelines.
Quality of Life in Recipients before and after Liver Transplantation in Turkey
Authors: Ordin Yaprak S. , Dicle Aklime , Wellard Sally
Published: July 2017

Context

Liver transplantation has become the treatment of choice for patients with end-stage liver disease. Most studies show a positive effect on quality of life after liver transplantation, but most studies are based on data from Western countries and little is known about quality of life in liver transplant recipients in Turkey or other developing countries.

Objective

To investigate liver transplant recipients' quality of life and factors affecting it, before and 3 months after transplantation in western Turkey.

Design

Descriptive and comparative, with data collected prospectively.

Setting

Two medical centers in Western Turkey.

Patients

Sixty-five adult recipients of a liver transplant between May 15 and December 31, 2007.

Instruments

Quality of life was measured by using the Nottingham Health Profile Turkish version, and sociodemographic and clinical data were collected from patients' records.

Results

Scores on all subscales of the Nottingham Health Profile differed significantly from before to after liver transplantation. The differences between the mean scores for quality of life before and after transplantation varied significantly with the patients' sex and disease severity.
Working Together as a Team: Adolescent Transplant Recipients and Nurse Practitioners
Authors: Lerret Stacee M. , Stendahl Gail
Published: July 2017

Nurse practitioners are a critical part of the transplant team, enhancing the quality of patient care with their knowledge and skill with respect to disease-specific populations of patients. Adolescent transplant recipients are a vulnerable population and require specific considerations. Nurse practitioners can successfully tailor care to the adolescent developmental stages in order to promote quality of life, adherence to the medical regimen, and successful transition to adult transplant centers and to minimize risk-taking behaviors. Teamwork between the patient's family and the entire transplant team is important to optimize not only the patient's health but also to ensure quality of life after transplant. Adolescents can be especially challenging after transplant, given their complex and evolving psychosocial and cognitive development. Nurse practitioners are in a unique position to be central in adolescents' successful adaptation to their medical condition. Facilitating identification and management of medication-related side effects, awareness of emotional health and quality of life, adherence to the medical regimen, and eventual transition to adult caregivers all remain critically important steps in care that are ideally suited for advance practice leadership.
Effect of Transplant Education on Nurses' Attitudes toward Organ Donation and Plans to Work with Transplant Patients
Authors: Hoy Haley , Alexander Susan , Frith Karen H.
Published: July 2017

Context

Despite the increase in rates of solid organ transplantation in the past 2 decades, nurses are inconsistently educated regarding issues of organ donation and posttransplant care.

Objective

To characterize the attitudes of registered nurses before and after a graduate-level elective on issues in transplantation.

Design

Pre-experimental, pretest and posttest interventional study

Participants

30 graduate students, who are registered nurses, who enrolled in a transplant elective at a university in the Southeastern United States

Main Outcome Measure

Investigator-designed survey tool consisting of 18 questions delivered in an electronic format.

Results

Statistically significant results were seen in nurses' attitudes toward encouraging others to become organ donors ( P = .04), preparation to discuss transplantation with others ( P< .001), advocacy to discuss transplantation among colleagues ( P = .003), confidence in working with transplant patients ( P = .005), confidence in speaking to communities about organ donation ( P = .001), and plans to encourage others to get involved in transplantation ( P = .03).

Conclusion

These results support the need for providing focused education on transplantation issues to registered nurses, particularly in the academic setting.
Interactive Textiles: New Materials in the New Millennium. Part 1
Authors: Leitch Paul , Tassinari Thomas H.
Published: July 2017

The development of Interactive Textiles (INTEXT) is a relatively new and extremely promising trend in the textile industry. An INTEXT material is one that can respond intelligently to an environmental stimulus, such as changing color when electrically charged or releasing heat at a given temperature. This article reviews current applications of INTEXT technologies and identifies possible future applications in military and civilian markets. Based upon these applications and associated benefits, it appears that INTEXT concepts will be one of the most significant advances in textiles in the coming decades.
Effectiveness of Phosphorus-Containing Flame Retardants in Textile Back-coating Formulations
Authors: Horrocks Richard , Wang Min Y. , Hall Michael E. , Pearson John S.
Published: July 2017

A series of phosphorus-containing flame retardants including some intumescents have been formulated with selected resins and applied as back-coatings to both cotton and cotton-polyester (35:65) blended fabrics. While all formulations raise the limiting oxygen index, only those based on ammonium polyphosphate and a cyclic phosphonate enable samples to pass a small-scale version of the simulated match test. BS5852: 1979, Source 1. While the back-coatings containing intumescents promoted higher levels of char formation this did not reflect in their performance to the match test.

Thermogravimetric analysis suggests that the more effective flame retardants, as exemplified by ammonium polyphosphate, are those which liquefy by melting and/or decomposition well below 300°c. It is proposed that this liquefication enables wetting of the back face of the fabric and diffusion to the front face where, as the temperature rises towards 300°c, char formation occurs before ignition can take place.
Knife Coating of Porous Substrates
Authors: Freeston W. Denney
Published: July 2017

A theoretical analysis of the knife coating of porous substrates is derived. The purpose of this analysis is to obtain a better understanding of the effects on the penetration of the coat ing material of the knife geometry, clearance between the knife and substrate, rheological properties of the coating material, coat ing speed, and porous nature of the substrate.
Cable Harness Construction for Severely Retarded Adults: A Demonstration of Training Technique
Authors: Hunter Janis D. , Bellamy G. Thomas
Published: July 2017

Three severely retarded adults were taught to construct an eleven-wire cable harness similar to those available in many sheltered workshops. Individual training was used with two trainees who required totals of 18 and 35 hours of instruction respectively before learning the task. Both the successful acquisition of this apparently difficult work task and the subsequent rates at which it was performed argue for inclusion of more severely and profoundly retarded adults in existing sheltered work programs.
Evaluation of Training Procedures Used in a Parent-Implemented Intervention Program for Down's Syndrome Infants
Authors: Hanson Marci J.
Published: July 2017

Twelve Down's syndrome infants participating in an early intervention program were taught specific gross motor and cognitive/adaptive skills. All training was conducted by the child's parents in the home with assistance from a professional parent trainer. Data presented from illustration programs indicate that parent-implemented training procedures appear functionally related to developmental gains made by infants and appear to have resulted in more accelerated development than would be expected without intervention.
A Model for Medical/Educational Assessment of Handicapped Children in Rural and Remote Areas: American Samoa
Authors: McCrea Dennis , Beck Robin , Edgar Eugene
Published: July 2017

Procedures for medical/educational assessment of severely/profoundly handicapped children in a rural area are discussed. Special attention is given to the aspects of full cooperation between the medical and educational team members. Methods for including local medical and educational personnel are discussed as well as a sample case study.
The Determination of Adequacy — Our Gethsemane? (An Essay Shared with Friends)
Authors: Burke Philip J.
Published: July 2017

The constitutional right of handicapped children to an appropriate education has been established through recent courtroom victories and the passage of Public Law 94-142 in 1975. However, the adequacy of programs for severely handicapped citizens has not been legally defined. That has become the responsibility of professional educators, who must resist the pressures to approve less than adequate programs if the promise of the recent legal victories is to be fulfilled.
Direct and Generalized Reduction of Inappropriate Behavior in a Severely Retarded Child through a Parent-Administered Behavior Modification Program
Authors: Whitman Thomas L. , Hurley Joseph D. , Johnson Moses R. , Christian James G.
Published: July 2017

The direct and generalized effects of a parent-administered, positive reinforcement and physical restraint procedure upon the inappropriate behavior of an institutionalized, severely retarded boy were examined. The boy's mother was trained to administer the training package contingent upon three of her son's responses during a play situation conducted within the institutional setting. A hybrid of multiple baseline and reversal designs was employed to assess the effects of the procedures on the child's target behaviors. Results indicate that the procedures were effective in directly increasing the child's instruction-following behavior and decreasing his noncompliance and inappropriate play responses. Moreover, a correlated reduction in the boy's untreated aggression and clothes stripping was observed. Follow-ups conducted over a 4-month period indicate that all treatment effects were maintained over time. Possible explanations for why treatment produced a generalized decrease in responding are discussed.
The Development of Procedures to Assess Prevocational Competencies of Severely Handicapped Young Adults
Authors: Mithaug Dennis E. , Hagmeier Lee D.
Published: July 2017

This paper extends and elaborates on previous discussions that indicated the need for basing prevocational training activities upon the requirements of job entry. By following the suggestion that the proper sequence for developing a prevocational program is first to analyze the requisites for entry into a job, then to assess the clients skills vis-à-vis those requisites, and finally to prescribe training objectives to reduce identified needs, this paper presents assessment data from 56 workshops, developmental centers, and activity centers in five northwestern states that specify the requirements considered important for entry into sheltered employment. The subsequent data analyses yielded a prevocational assessment Instrument (PAI) derived from the entry level requirement data, and corresponding prevocational objectives derived from the PAI. These analyses demonstrated (1) the functional relation between job requisites, needs assessments, and training objectives and (2) that this relation can be empirically verified, i.e., the data emanating from an analysis of job requisites determine the nature and scope of the assessment instrument, which, in turn, determines which training objectives are appropriate for a particular client.
Case Studies in the Management of Inappropriate Behaviors during Prevocational Training
Authors: Mithaug Dennis E.
Published: July 2017

This paper presents four case studies that demonstrate the use of different management strategies to decrease or eliminate the undesirable behaviors of clients in a prevocational training program. The presentations and discussions focus upon the simultaneous pursuit of skill training and behavior management rather than working towards these two objectives sequentially, e.g., first behavior management and then skill training. The rationale for this approach is that discouraging inappropriate behaviors should be accompanied by procedures that encourage appropriate ones. In the prevocational program, appropriate behavior was defined as correct responses to specific training tasks. The four cases include such problem behaviors as excessive out-of-seat and running behaviors, incessant and irrelevant verbal behavior, screaming and shrieking, excessive hysterial laughing, refusal to work, self-biting, self-pinching, violent tantruming, and noncompliance. The tactics that were employed to control, decrease, and/or eliminate these behaviors include shaping, differential reinforcement of other behaviors, ignoring, timeout, and negative reinforcement. In all cases, the management strategies were in effect while new skills were trained. The clients received positive reinforcers for appropriate task responses while being discouraged from responding inappropriately.
A Functional Curriculum Sequencing Model for Teaching the Severely Handicapped
Authors: Guess Doug , Horner R. Don , Utley Bonnie , Holvoet Jennifer , Maxon Debbie , Tucker Dennis , Warren Steve
Published: July 2017

This paper presents the rationale and structure for a curriculum model for educating the severely handicapped. The model combines the advantages of the two logics used up to this point in developing curricula: the developmental/cognitive logic and the remedial/behavioral logic. It provides for sequencing of skills to be taught across and within levels of difficulty and across six content domains: self-help skills, sensory-motor skills, socialization, language skills, academic skills, and vocational preparation. Some preliminary applications of the model are given.
ISAARE a Description
Authors: Melichar Joseph F.
Published: July 2017

This paper presents an overview of an information system on adaptive, assistive, and rehabilitation equipment (ISAARE). The review includes a description of the system, its use, and an example application.
Training a Severely Retarded Young Adult to Ride the City Bus to and from Work
Authors: Sowers Jo-Ann , Rusch Frank R. , Hudson Chris
Published: July 2017

In order for severely retarded adults to move from sheltered employment to competitive employment, they must be trained to perform sophisticated survival skills. One of these is independent bus riding. Modeling, verbal instructions, and feedback were utilized successfully to train a severely retarded adult to independently and safely ride a bus to and from work. The long-term time, financial, and social advantages are significant.
Developmental Characteristics of Severely and Profoundly Handicapped
Authors: Levine Samuel , Elzey Freeman F. , Fiske-Rollin Bonnie
Published: July 2017

This paper describes the population of the California Centers for the Developmentally Handicapped in terms of attribute variables and developmental variables. Attribute variables used include chronological age, sex, length of center enrollment, current living arrangement, use of medication, and frequency of seizures. Developmental variables reported include cognition, ambulation, hand control, head control, vision, audition, and expressive language. Relationships among these variables are also reported. The authors present tentative conclusions and implications for programming and personnel training.
Habituation of Visual Fixation Responses: An Assessment Tool to Measure Visual Sensory-Perceptual Cognitive Processes in Nonverbal Profoundly Handicapped Children in the Classroom
Authors: Switzky Harvey N. , Woolsey-Hill Janet , Quoss Therese
Published: July 2017

Twelve profoundly retarded nonverbal, nonambulatory children were repeatedly exposed to one of two visual stimuli-a 2 times 2 or a 12 times 12 black-and-white checkerboard target-until a set criterion of habituation was demonstrated, as measured by a decrement in visual fixation time. When the habituation criterion was reached, the children were shown alternative presentations of the same and a novel target. Results showed an increase in visual fixation to the novel target. A control condition was instituted also; so that when the habituation criterion was reached, the children were shown only presentations of the same target. Results showed no increase in visual fixation to the same targets. Together these results suggest that profoundly retarded children do show habituation and dishabituation to visual stimuli, and are actively storing and processing information about their perceptual world. The educational implications of the habituation paradigm for the special education teacher in the classroom are discussed.