bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Educational Intervention on Organ and Tissue Donation for First-Year Medical Students
Authors: Feeley Thomas Hugh , Tamburlin Judith , Vincent Donald E. 
Published: July 2017

Context Medical students and medical professionals have knowledge deficits related to organ and tissue transplantation. Objective To implement and evaluate a medical education intervention on organ and tissue donation designed for first-year medical students. Study Design Independent sample pretest and posttest design. Setting and Participants First-year medical students attending University at Buffalo School of Medicine during fall 2005 and fall 2006 terms. Intervention A 1-hour lecture on the background of organ donation, donor eligibility (eg, living vs deceased donation), policies and roles during transplantation (eg, role of physician and organ procurement organization), and the organ-matching process. After the lecture, students participated in a small-group interaction that used standardized patients who role-played 1 of 2 scenarios designed to test students' knowledge and communication about organ and tissue donation. Outcome Measures Knowledge, self-efficacy, family discussion, and enrollment into state organ and tissue registry. Results Significant increases from pretest to posttest in medical students' knowledge, self-efficacy, and family notification of donation intentions were found. The intervention was successful in increasing students' knowledge and awareness about organ and tissue donation. Future research should implement and evaluate a course-long curriculum on donation.
What Does a Diagnosis of Brain Death Mean to Family Members Approached about Organ Donation? A Review of the Literature
Authors: Long Tracy , Psychol C. , Sque Magi , Addington-Hall Julia 
Published: July 2017

Background What a diagnosis of brain stem death (the term used in the United Kingdom) or brain death (the term used in the United States) means to the family members of potential organ donors is an important issue to explore as biomedicine moves to expand the range of end-of-life technologies that, potentially, blur the demarcation between life and death. Objective To provide some insights into how a diagnosis of brain stem death or brain death may be perceived by family members approached about organ donation. Methods A review of the literature regarding organ donation was carried out. Results Although most publications do not focus specifically on the concept of brain death, those that do so made a valuable contribution, offering potential theoretical frameworks to aid our understanding of what the diagnosis of death by brain-based criteria means to family members of potential organ donors. The diagnosis of brain death is intricately linked to the issue of organ donation and may influence family members' decision making. Also, the perception that death has occurred differs from one person to another. Conclusions A sustained increase in the number of organs available for transplantation may never be achieved until the concepts of brain death, brain stem death, and now Non—Heart-beating death (1) are debated more widely within society; (2) a greater degree of consensus is reached within health care; and (3) bereaved family members approached to donate the organs of their deceased relative have a better understanding of what these diagnoses mean.
Living-Related Donors' Quest for Information before Donation
Authors: Nasr Annette Sue , Rehm Roberta S. 
Published: July 2017

Context Providing potential living-related liver donors with all the necessary information before donation can be challenging. What information donors need and are not getting during the evaluation phase has not been defined. Objective To increase understanding of the everyday life of living-related liver donors and to suggest educational strategies that could be used by transplant centers during the evaluation process. Design An interpretive ethnographic study based on a symbolic interactionism approach. All participants were interviewed; some were reinterviewed in order to better understand their experience as a donor. Setting Interviews took place in the clinic, the donor's home, the donor's workplace, and in coffee shops depending on each donor's preference. Participants A total of 13 parents who had donated the left lower lobe of their liver to their son or daughter at least 1 year ago. Main Outcome Measures Interviews were analyzed by using qualitative research methods of coding, summarizing, and discussing concepts. Results The donors viewed the donation as a life-changing event, and 11 of 13 donors described seeking further information in addition to the information given to them by the transplant center. Searching the Internet, reading research articles, and speaking to other donors were activities demonstrated by the participants.
Distress Associated with Adverse Effects of Immunosuppressive Medication in Kidney Transplant Recipients
Authors: Koller Antje , Denhaerynck Kris , Moons Philip , Steiger Jürg , Bock Andreas , De Geest Sabina 
Published: July 2017

Context For kidney transplant patients, a lifelong intake of medication is mandatory. Health care workers' prioritization of adverse effects often differs from that of their patients, although patients' experience of adverse effects of medication can trigger nonadherence. Understanding how patients experience symptoms is therefore important. Objective To present a new method to be used in research to evaluate symptom experience related to adverse effects in adult kidney transplant recipients on maintenance immunosuppressive therapy. Design Cross-sectional secondary data analysis. Patients and Setting Three hundred fifty-six adult kidney transplant recipients from 2 Swiss transplant outpatient clinics. Main Outcome Measures Symptom experience was measured with the Modified Transplant Symptom Occurrence and Symptom Distress Scale. For each item, ridit scores were calculated. A coordinate system with occurrence and distress ratings of each symptom classified symptoms into 4 quadrants: symptoms could have high occurrence/high distress, low occurrence/high distress, high occurrence/low distress, and low occurrence/low distress symptoms. Items farther from the origin represented more extreme profiles. Results The proposed method arranges symptoms clearly in sequence of their importance. In our study, fatigue and joint and back pain were the most frequent and distressing symptoms. Symptom profiles for men and women differed: for men impotence and anxiety were key whereas for women listlessness and changed appearance seemed to play important roles. Conclusions The 2-dimensional diagram of symptom profiles enables researchers and clinicians to evaluate the impact of symptoms associated with immunosuppressive medications.
Development of a Decision Aid for Adult Cystic Fibrosis Patients considering Referral for Lung Transplantation
Authors: Vandemheen Katherine L. , Aaron Shawn D. , Poirier Charles , Tullis Elizabeth , O'Connor Annette 
Published: July 2017

Context Most adults with cystic fibrosis are eventually required to make a decision about referral for lung transplantation. Objective To identify the decisional needs of these patients and to develop a decision aid to address these needs. Methods A comprehensive review of the literature, a review of Canadian transplant statistics from 2002 to 2006, and a self-assessment survey of patients who had already made a decision about referral were performed to identify the decisional needs of patients. A decision aid was then developed and evaluated by an expert panel of health care professionals and patients. Results Transplant referral patterns vary widely among Canadian cystic fibrosis clinics. Canadian patients with cystic fibrosis who were not residing in transplant centers between 2002 and 2006 were significantly less likely to undergo lung transplants ( P < .001). Decisional needs identified by patients included wanting more information on (1) relocation to the transplant center, (2) the benefits and risks of surgery, and (3) how to cope with anxiety and depression when making the decision. In response to these identified needs, a decision aid for lung transplantation was developed. A panel of health care professionals and patients reviewed the decision aid and agreed that the content was appropriate, easy to understand, and unbiased. Conclusion The decisional needs of patients with cystic fibrosis who are considering lung transplantation are not being addressed in Canadian cystic fibrosis clinics, especially in clinics outside of transplant centers. An evidence-based decision aid could serve as a useful tool to help address these needs.
Emotional Experiences of Caregivers of Patients with a Ventricular Assist Device
Authors: Kaan Annemarie , Young Quincy-Robyn , Cockell Sarah , Mackay Martha 
Published: July 2017

Context Little is known about the stresses experienced by caregivers of patients discharged home with a ventricular assist device. Objective To describe the lived experience of caregivers of patients who were discharged home with a ventricular assist device. Design The study used a phenomenological framework to conduct semistructured interviews guided by 2 psychologists using a focus group setting. Participants Interviews of 13 caregivers of 9 patients discharged to home with a ventricular assist device between March 2004 and June 2007 were recorded, transcribed, and analyzed. Results Four themes emerged during the interviews: anxiety, initially exhibited as profound shock; loss of a loved one, of their lives, of freedom and independence; burden, both the physical burden and the burden of responsibility; and finally coping through faith, acceptance, empathy, and social support. Conclusion Caregivers of patients discharged home with a ventricular assist device experienced significant pressures that changed over the duration of support with the ventricular assist device. Caregivers described their coping mechanisms in dealing with shock, loss, and burden. Understanding the fluctuating needs of caregivers will enable teams to provide interventions based on the situation. Future care guidelines should address the significant stresses placed on caregivers of recipients of a ventricular assist device.
Hypotension after Reperfusion in Liver Transplantation: Histidine-Tryptophan-Ketoglutarate versus University of Wisconsin Solution
Authors: Ghafaripour S. , Sahmeddini M. A. , Lahsaee S. M. , Khosravi M. B. , Sattari H. , Nikeghbalian S. , Shokrizadeh S. , Malekhosseine S. A. 
Published: July 2017

Background The greatest hemodynamic instability during orthotopic liver transplantation occurs at graft reperfusion. Many factors have been implicated. Purpose To compare hemodynamic changes after reperfusion in grafted livers preserved with histidine-tryptophan-ketoglutarate (HTK) solution versus grafted livers preserved with University of Wisconsin (UW) solution. Methods In this prospective study, we randomly divided 89 patients who underwent deceased donor liver transplantation into 2 groups: the UW group and the HTK group. The HTK group was further divided into 2 subgroups: flushed and not flushed before reperfusion. The patients were monitored with hemodynamic and metabolic parameters at 3 times: after the skin incision, 5 minutes before reperfusion, and 5 minutes after reperfusion. Results Hemodynamic parameters in the UW group had not changed significantly at 5 minutes before reperfusion or 5 minutes after reperfusion ( P= .45), and the incidence of hypotension after reperfusion in the UW group was 20%. In both HTK groups, the mean arterial pressure 5 minutes after reperfusion was significantly lower than at 5 minutes before reperfusion ( P = .002); the incidence of hypotension after reperfusion in the nonflushed HTK group was 83.3% and in the flushed HTK group, 65.5%. Conclusions The incidence of hypotension after reperfusion is greater if HTK solution rather than UW solution is used. Flushing of grafted livers preserved with HTK solution might eliminate some vasoactive substances found in HTK solution.
Skin Cancer Prevention Education for Kidney Transplant Recipients: A Systematic Evaluation of Internet Sites
Authors: Robinson June K. , Alam Murad , Ashourian Neda , Khan Misbah , Kundu Roopal , Laumann Anne E. , Schlosser Bethanee J. , Yoo Simon , Gordon Elisa J. 
Published: July 2017

Context Repeated patient education about skin cancer prevention is important to self-care after transplant. Objective Examine educational materials for kidney transplant recipients available on the Internet that address sun protection and skin self-examination for early detection of squamous cell carcinoma. Design Systematic review of Web sites for kidney transplant recipients endorsed by transplant physicians and dermatologists. Participants An expert panel of 8 dermatologists providing care for kidney transplant recipients and 1 research medical anthropologist. Main Outcome Measures Reading grade level, inclusion of people with skin of color, sufficient content to support effective sun protection, and description of 4 sun-protection strategies and skin self-examination. Results Of the 40 sites identified, 11 contained information about sun protection or increased risk of any type of cancer. The Web sites had a ninth-grade median reading level (range, seventh grade to college senior). Interrater reliability for the 25-item assessment tool was assessed by Fleiss' kappa (κ = 0.87). Skin cancer risk was presented as relevant to those with fair skin. Sites recommended regular use of sunscreen with sun-protection factor of 15 or greater (n=3) to reduce the risk of skin cancer (n= 4). Few sites recommended using protective clothing (n = 5), seeking shade (n=4), and avoiding deliberate tanning with indoor or outdoor light (n = 1). Five sites recommended skin self-examination Conclusion Because many patients seek self-management information from the Internet, Web sites must provide more thorough educational information about skin cancer prevention and health promotion at a lower reading grade level.
Recommendations for the Proper Use of Nonprescription Cough Suppressants and Expectorants in Solid-Organ Transplant Recipients
Authors: Gabardi Steven , Carter Danielle , Martin Spencer , Roberts Keri 
Published: July 2017

Objective To describe the pharmacology and safety of oral over-the-counter cough suppressants and expectorants and to present recommendations for the use of these agents in solid-organ transplant recipients based on the potential for adverse drug reactions or drug-disease interactions. Data Sources and Extraction Data from journal articles and other sources describing the pharmacology and safety of over-the-counter cough suppressants and expectorants, drug-drug interactions with immunosuppressive agents, and drug-disease state interactions are reviewed. Data Synthesis Potential and documented drug-drug interactions between immunosuppressive agents and over-the-counter cough medications guaifenesin, dextromethorphan, diphenhydramine, and codeine were evaluated on the basis of pharmacokinetic and pharmacodynamic principles. Interactions between these cough medications and the physiological changes in the body following transplantation also were examined. Conclusion Diphenhydramine requires additional monitoring when used to treat cough in transplant recipients owing to its anticholinergic properties and the potential for interactions with cyclosporine. Dextromethorphan can be used in most transplant recipients, although greater caution should be exercised if the patient has undergone liver transplant or has liver impairment. Guaifenesin can be used in transplant recipients but should be used with caution in patients receiving kidney or lung transplants and in patients with renal impairment. Codeine combined with guaifenesin is another option for cough and can be used in most transplant patients although those with reduced renal function should be monitored carefully for adverse events.
A Systematic Approach to Postoperative Management of Deceased Donor Kidney Transplant Patients with a Clinical Pathway
Authors: Seawright Ashley Heath , Taylor Laura 
Published: July 2017

Context Clinical pathways have been used in many acute hospital settings. Objectives To develop a systematic approach to postoperative care of adult recipients of deceased donor kidney transplants at the University of Mississippi Medical Center. Design and Setting A pilot quality improvement project that uses implementation of a clinical pathway 24 hours after surgery for adult recipients of a deceased donor kidney transplant for 7 months. Charts from the same 7 months of the preceding year were retrospectively reviewed for comparison. The project occurred on the transplant floor in an acute care hospital and did not include any patients admitted to the intensive care unit. Main Outcome Measures To demonstrate that clinical pathways can (1) promote a method for standardizing postoperative care, (2) decrease postoperative length of stay, and (3) contain costs by minimizing hospital charges related to laboratory and room fees and promote efficient medication use in adult recipients of a deceased donor kidney transplant. Results All 24 patients in the clinical pathway group met daily goals of the implemented clinical pathway. The clinical pathway group had statistically significant decreases in postoperative length of stay, use of laboratory tests, and use of intravenous medications compared with the comparison group. The 2 groups were similar in race, sex, age, and body mass index. Surgical readmissions did not differ significantly between the 2 groups.
Identifying and Addressing Barriers to African American and Non—African American Families' Discussions about Preemptive Living Related Kidney Transplantation
Authors: Boulware L. Ebony , Hill-Briggs Felicia , Kraus Edward S. , Melancon J. Keith , Senga Mikiko , Evans Kira E. , Troll Misty U. , Ephraim Patti , Jaar Bernard G. , Myers Donna I. , McGuire Raquel , Falcone Brenda , Bonhage Bobbie , Powe Neil R. 
Published: July 2017

Context Ethnic/racial minority and nonminority families' perceived barriers to discussing preemptive living related kidney transplantation (LRKT) and their views on the potential value of health care professionals trained to address barriers are unknown. Objective, Setting, and Participants To collect pilot data for evaluating perceived barriers to preemptive LRKT and to inform the development of a culturally sensitive intervention to improve families' consideration of LRKT. In 4 structured group interviews of African American and non—African American patients (2 groups) with progressing chronic kidney disease and their family members (2 groups), participants' perceived barriers to initiating LRKT discussions and their views regarding the value of social workers to support discussions were explored. Results Patients' barriers included concerns about their (1) ability to initiate discussions, (2) discussions being misinterpreted as donation requests, (3) potential burdening of family members, (4) uncertainty about when to initiate discussions, and (5) inducing guilt or coercing family members. Family members' barriers included (1) feeling overwhelmed by patients' illness, (2) patients' denial about their illness, (3) caregiver stress, and (4) uncertainty about their own health or the health of other family members who might donate or need a kidney in the future. Participants reported that social workers could facilitate difficult or awkward discussions and help families understand the LRKT process, address financial concerns, and cope emotionally. Themes were similar between African Americans and non—African Americans. Conclusions Families identified several barriers to discussing preemptive LRKT that could be addressed by social workers. Further research must be done to determine whether social workers need to tailor interventions to address families' cultural differences.
The Role of Advanced Practice Nurses in Transplant Center Staffing
Authors: Hoy Haley , Alexander Susan , Payne Jerita , Zavala Edward 
Published: July 2017

Context Despite increased rates of solid organ transplantation and frequent use of advanced practice nurses (APNs) to manage patients, no established staffing model including APNs and their roles exists. Objective To characterize the role and integration of APNs in the staffing models of existing transplant centers. Design Descriptive research using a researcher-designed survey of transplant APN professionals. Participants 53 attendees of a national APN transplant clinical management symposium. Main Outcome Measure Investigator-designed survey tool consisting of 21 questions delivered in a paper format with 1 open-ended question about adequacy of current staffing and ideas for improvement. Results 53 responses from staff members of 21 different transplant centers were collected. In addition to APNs, members of existing transplant staffing models were identified as licensed practical nurses, registered nurses, social workers, administrative assistants, and data managers. The primary responsibilities of APNs were both inpatient and outpatient, before and after transplant, and consisted primarily of collecting patients' medical histories, doing physical examinations, handling clinic visits, and education. Licensed practical and registered nurses handled pretransplant referral management and phone triage duties. Social workers, administrative assistants, and data managers were responsible for social support, medical record management, and regulatory documentation, respectively. Most respondents (57%) found current staffing to be inadequate in their centers and suggested areas for improvement. Conclusion APNs play a vital role in management of transplant patients. Transplant centers use APNs in different capacities, depending on the individual needs of the institution. Across institutions, support staff is crucial in the perception of adequate staffing. Additional research is needed to determine the most efficient use of APNs in transplant centers.
Polylactic Acid Polymers from Com. Applications in the Textiles Industry
Authors: Lunt James , Shafer Andrew L. 
Published: July 2017

Tables 10 and 11 summarize the key takeaways. Looking at the world of “Technical Textiles” (Table 12) it is clear that this unique spectrum of properties will allow PLA polymers to participate in a wider range of markets. In particular, in this segment, the unique combination of outstanding resistance to sunlight, resiliency, and elastic recovery offers potential for use in tents, patio umbrellas, and awnings. In addition, automotive applications requiring high moisture wicking and UV stability, such as seating will benefit from these materials. The high loft and resiliency offers promise in sleeping bags and other applications requiring good insulation properties. A brief glimpse of a new polymer platform has been provided. These materials provide a rare example of a competitive polymer whose primary building block comes from a natural renewable carbohydrate source. One billion pounds of PLA is equivalent to 0.5% of the annual US corn crop. Only 75% of the available acreage is presently used and corn is the cheapest source of dextrose; therefore, monomer supply is more than adequate to meet the foreseeable future. The minimal impact on corn utilization and existing uses leads to no negative impact for either society, or disposal. In addition, because potentially any carbohydrate feedstock can be used, this technology offers the future potential to use other natural feedstocks, such as wheat, sugar beets, rice and ultimately biomass. The unique properties of these polymers have attracted considerable attention across the spectrum of plastics' applications. In particular, polylactic acid polymers show significant promise to the textiles and non-wovens industry.