bluuebunny/crossref_metadata_2025_split huggingface dataset:
Approaching a Consensus: Psychosocial Support Services for Solid Organ Transplantation Programs
Authors: Skotzko Christine E. , Stowe Judith A. , Wright Carol , Kendall Kay , Dew Mary Amanda 
Published: July 2017

Background— Solid organ transplantation has become an accepted treatment for individuals with end-stage organ dysfunction. Criteria are being developed in the United States to determine medical eligibility for transplant candidates and competencies for transplant centers and physicians. To date, similar criteria for psychosocial services have not been developed. Design and Setting— We queried participants in a specialty psychosocial transplant meeting to determine their views of which psychosocial services are essential to the comprehensive care of transplant patients in the United States. Results— There was broad based multidisciplinary support for proactive pretransplant screening to discern individual psychosocial needs; focused pretransplant interventions to improve candidacy and future compliance; and posttransplant programs that address psychosocial, rehabilitation, and financial issues. Conclusion— Among psychosocial providers of solid organ transplantation services, there is support for expanding routine screening and support services to individuals who are candidates for and undergo solid organ transplantation.
Promoting Organ Donation among High School Students: An Educational Intervention
Authors: Anantachoti Puree , Gross Cynthia R. , Gunderson Susan 
Published: July 2017

Objective— To evaluate the impact of a high school education program to promote organ donation awareness. The primary outcomes were intention to discuss organ donation with family or friends and actual discussion behavior. Design— Longitudinal, observational study. Methods— 665 high school students filled out evaluations at the beginning and at the end of a 1-hour education program. One month later, the students were asked to report whether they had discussed donation. Results— After the program, knowledge and attitude scores and the proportion of students who intended to discuss donation increased ( P < .05). At 1-month follow-up, 48% of students reported actual discussion. Intention has a strong, positive relationship with discussion behavior (odds ratio, 8.27; 95% CI, 3.18–21.51). Ethnicity, sex, and attitude of the students were also predictors of donation discussion behavior. Conclusions— This program appears to be effective in prompting discussion of organ donation among high school students.
Substance abuse in Heart Transplant Recipients: A 10-Year Follow-up Study
Authors: Hanrahan Josephine S. , Eberly Carole , Mohanty Pramod K. 
Published: July 2017

Context— Active substance abuse is widely accepted as a contraindication for heart transplantation because of the theory that relapse would occur after transplantation and result in compromise of graft function, lowering long-term survival. Listing “recovering” substance abusers for heart transplantation has been controversial. Objective— To determine if substance abuse plays an unfavorable role in the outcome of heart transplantation. Methods— The medical records of all patients at our center who received a heart transplant more than 10 years ago were retrospectively reviewed for history of substance abuse. Results— From a pool of 189 transplant recipients, 47 patients had a definite history of substance abuse (group 1) and were considered in recovery, whereas 142 patients were clearly without any history of substance abuse (group 2). Group 1 had a significantly greater percentage of patients with a pretransplantation diagnosis of idiopathic cardiomyopathy ( P=.003), a higher occurrence of heart-related cause of death ( P=.017), and a significant prevalence of noncompliance ( P=.0001) and death because of noncompliance ( P=.0004). In contrast, group 2 surprisingly had a significantly higher incidence of death related to infection ( P=.0062), which is unexplained. Despite higher incidence of noncompliance in group 1, there was no significant difference in the overall survival rate between the 2 groups. Conclusion— These results suggest that patients with a history of substance abuse can undergo successful heart transplantation with acceptable long-term survival, though they are at greater risk for substance abuse relapse and resulting noncompliance with the treatment regimen. The extent to which relapse of substance abuse and its consequences affect the cost of posttransplantation care remains to be determined.
Tissue Donation: What Does it Mean to Families?
Authors: Beard Jane , Ireland Lynette , Davis Nicola , Barr Jenny 
Published: July 2017

Context Previous research has described families' responses and experiences with the donation process; however, little attention has been paid to families linked to tissue banks that have no affiliation with hospitals or organ procurement agencies. Objective To assess the impact of approaches made to families who consented to tissue donation with the Donor Tissue Bank of Victoria, Australia, and to examine how this information could be used to improve the existing service. Design An evaluation questionnaire was developed and consisted of 15 questions. The questionnaire was part of a structured follow-up service and was given only to 339 families who consented to donation. Setting and Participants Families who are approached about tissue donation are contacted within 24 hours of their family member's death. They are coping with the sudden unexpected death of a family member and have little knowledge of tissue donation or the donor tissue bank. Main Outcome Measures Fifty-eight percent of participants completed the questionnaire. The data were quantitatively and qualitatively examined. Results The skills and procedures utilized by the transplant coordinators are affirmed by the results, and respondents appear to find contact with the donor tissue bank positive at a terrible time in their lives. Approaches to families must be made sensitively and sufficient information must be given to enable decision making.
Evaluating the Reliability and Validity of the Questionnaire for Lung Transplant Patients
Authors: Dabbs Annette De Vito , Hoffman Leslie A. , Dauber James H. , Zullo Thomas , Iacono Aldo T. 
Published: July 2017

Context The Questionnaire for Lung Transplant Patients was designed for clinical use by the pulmonary transplant team in the routine evaluation of lung transplant recipients. Using the self-administered questionnaire, recipients check symptoms that they have had since their last evaluation and rate their shortness of breath, cough, and activity tolerance. Objective To determine whether the questionnaire meets reliability and validity standards for empirical measurement. Methods Demographics and disease-severity characteristics were examined in a cross-sectional survey of 37 recipients. Test-retest and intraclass correlation methods were used to estimate stability, and the Cronbach α was used to estimate internal consistency. Criterion validity was examined by using The Modified Symptom Frequency/Symptom Distress Scale, Functional Performance Inventory, and visual analog scales for cough and shortness of breath as criterion measures. Construct validity was examined to assess the predicted negative correlation between symptoms and functional performance. Results The questionnaire and its subscales were internally consistent (Cronbach α = 0.82, 0.76, 0.80, and 0.96), and the questionnaire was stable ( r = 0.70) and reliable (intraclass correlations = 0.80 and 0.90). Significant correlations were found between the questionnaire and all criterion measures ( r = 0.50–0.93). Significant correlations in the predicted negative direction were found between the respiratory subscale and functional performance ( r = −0.51) and between cough ( r = −0.51) and shortness of breath ( r = −0.68) ratings and functional performance. Conclusions The Questionnaire for Lung Transplant Patients is reliable and valid, and it provides scientifically sound information for clinical and empirical evaluation of symptoms and their effects on activity tolerance after lung transplantation.
Donor Action Program in the Emilia-Romagna Region of Italy
Authors: Pugliese Maria Rosa , Esposti Daniela Degli , Dormi Ada , Venturoli Nicola , Gaito Paolo Mazzetti , Sestigiani Elena , Monti Marzia , Ghirardini Angelo , Costa Alessandro Nanni , Ridolfi Lorenza 
Published: July 2017

Context The high demand for organs for transplantation necessitates enhancement of organ procurement activity worldwide. Objective To detect critical areas in the organ donation process and to assess whether careful monitoring of deaths in each intensive care unit could improve rates of identification of brain death. Design Records of patients who died in intensive care units in the Emilia-Romagna region between July 1, 1998 and June 30, 2000 were reviewed through the Donor Action program. Results Of the 2469 patients who died during the period studied, 1010 (40.9%) had severe brain damage, as indicated by a score of 3 on the Glasgow coma scale. A total of 857 patients with severe brain damage who had spent more than 6 hours in the intensive care unit (34.7% of all deaths) were considered as potential donors. Signs of brain death were observed in 383 (44.7%) of the 857 patients who died. Rates of identification of brain death increased from 36% to 55% during the study period. Conclusion Considering that the characteristics of the study population had not changed, we believe that the Donor Action program was an important factor leading to the observed improvement in identification of brain death.
Family Discussion about Organ Donation among African Americans
Authors: Atkins Lamon , Davis Kimberly , Holtzman Samuel M. , Durand Roger , Decker Phillip J. 
Published: July 2017

Context Relatively little is known about family discussion concerning donation among African Americans in the United States, especially discussion predating the brain death of a family member and the donor request process. Objectives To explore the inclination of African Americans to engage in family discussion about organ donation and the characteristics of those who expressed a desire to their families to donate their organs upon death. Design Focus groups and a cross-sectional survey. Setting A large metropolitan complex in Houston, Tex, with a relatively sizeable African American population. Participants A total of 18 persons of African American background participated in 2 focus groups; 375 randomly selected African American residents were surveyed by questionnaire. Main Outcome Measure Prodonation family discussion. Results Only 10% of subjects were found to be in the “action” (having had a prodonation discussion) or “maintenance” (having had a prodonation discussion and not inclined to alter one's wishes) stages with regard to family discussion. These subjects were not found distinguished from others by age, gender, education, or frequency of religious attendance. They were, however, found differentiated from others by feelings of diffuse support for donation, knowledge of donation, having read or heard a lot about donation, and by the belief that organ donation was not against one's religion—when these variables were individually considered. Yet, when these variables were simultaneously considered in a multivariate discriminant function analysis, diffuse support for donation no longer distinguished those in the action/maintenance stage from other subjects.
Perceptions of the Donation Process from Adult-to-Adult Living Liver Donors
Authors: Winsett Rebecca P. , Russell Cynthia , Grewal Hani P. , Shokouh-Amiri M. Hosein , Gaber A. Osama 
Published: July 2017

Background Donor safety and the impact on quality of life continue to concern transplant centers as living liver transplantation increases. Methods Living liver donors participated in a focus group to discuss their perceptions of the donation process. Results The decision to donate was a personal choice made before the request by the recipient or transplant service. Spouses verified their support, but indicated that they were not included in the process. No donors felt coerced. The explanation of the procedure was thorough but excessive. Hospital care was good; however, donors admitted being unprepared for the pain and side effects of pain medications. Ongoing incisional discomfort continued beyond 6 weeks and prevented donors from feeling normal. Donors felt conflicted about competing with the “true” patient for healthcare. Conclusions Donors were positive about the need and willingness to donate. Sensitivity to the order of the disclosure process is identified.
Minimal Intervention Programs for Weight Loss in Heart Transplant Candidates: A Preliminary Examination
Authors: Park Tricia L. , Perri Michael G. , Rodrigue James R. 
Published: July 2017

Context Overweight can be a contraindication for cardiac transplantation, and empirical findings suggest that obesity may pose serious posttransplant health risks that can increase morbidity and mortality. Objective This study assessed the relative effectiveness of 2 minimal intervention programs to assist weight loss in heart transplant candidates. Design A randomized trial was employed to assess changes in body weight. Setting A large, tertiary care hospital in a Southern locale. Patients Forty-three heart transplant candidates (74% men, 79% married, 86% white), with a mean pretreatment body mass index of 32.4 (SD=4.4). Interventions Patients were randomly assigned to a bibliotherapy weight-loss program or a bibliotherapy plus telephone contact weight-loss program. Main Outcome Measures Change in body weight over 3 months and return rate of measures of program adherence (3-day food diaries and self-monitoring postcards). Results An intent-to-treat analysis showed a significant weight loss at posttreatment for the sample as a whole. Within-group analyses indicated that a significant weight change ( P<.05) in the telephone contact group (mean[SD]=-2.76[4.96] kg) but not the bibliotherapy-only group (mean[SD]=-1.02[2.97] kg). Participants in the telephone contact group returned more 3-day food diaries and self-monitoring postcards, with pounds lost significantly correlated with the number of completed self-monitoring postcards. These findings suggest that a minimal intervention program involving information plus limited professional contact may represent a viable approach to assisting overweight transplant candidates in weight management.
Future Immunosuppressive Agents in Solid-Organ Transplantation
Authors: Gabardi Steven , Cerio Jeffrey 
Published: July 2017

Objective To review the pharmacology, pharmacokinetics, efficacy, and safety of mycophenolate sodium, everolimus, and FTY720. Study Selection and Data Extraction Clinical trials and abstracts evaluating mycophenolate sodium, everolimus, and FTY720 in solid-organ transplantation were considered for evaluation. English-language studies and published abstracts were selected for inclusion. Data Synthesis Mycophenolate sodium has recently been approved by the Food and Drug Adminstration for marketing in the United States; everolimus and FTY720 are immunosuppressive agents that may soon be available in the United States. These agents have proven efficacy in reducing the incidence of acute rejection in solid-organ transplantation. Clinical trials have shown that these newer agents are relatively well tolerated. The most common adverse events associated with these agents were gastrointestinal and hematologic effects (mycophenolate sodium); hyperlipidemia, increased serum creatinine, and hematologic effects (everolimus); and gastrointestinal effects, headache, and bradycardia (FTY720). Conclusion Mycophenolate sodium has been approved in some European countries and the United States. Everolimus has been approved in some European countries and a new drug application has been submitted to the Food and Drug Administration. FTY720 is currently in phase III clinical trials and submission to the Food and Drug Administration for approval is a few years away. The approval of these agents will furnish the transplant practitioner with even more options for immunosuppression.
Nonprescription Analgesics and Their Use in Solid-Organ Transplantation: A Review
Authors: Gabardi Steven , Luu Linh 
Published: July 2017

Objective To review the pharmacology, adverse events, drug interactions, and use of the nonprescription analgesics in solid-organ transplant recipients. Study Selection and Data Extraction Studies evaluating nonprescription analgesics in solid-organ transplantation were considered for evaluation. English-language studies were selected for inclusion. Data Synthesis Nonprescription analgesics (aspirin, choline salicylate, magnesium salicylate, sodium salicylate, ibuprofen, ketoprofen, naproxen sodium, and acetaminophen) are the most commonly purchased over-the-counter agents in the United States. These agents, although generally considered safe, have been associated with a number of toxicities. The salicylates and nonsteroidal anti-inflammatory drugs have been associated with gastrointestinal damage, hematologic changes, liver and kidney dysfunction, and breathing difficulties. Acetaminophen has been shown to induce hematologic changes and liver and renal dysfunction. Conclusion A closer look at the nonprescription analgesics reveals their potential for harm when used by solid-organ transplant recipients. In this patient population, the salicylates and nonsteroidal anti-inflammatory drugs should generally be avoided if possible, because of their potential toxicities, especially renal dysfunction. Low-dose aspirin, for the prevention of cardiovascular and cardiocerebral events, appears to be safe, but patients must still be followed closely. Acetaminophen is generally considered the nonprescription analgesic and antipyretic of choice in transplant recipients because of its favorable toxicity profile. However, it is imperative that patients and transplant practitioners are aware that this agent is not without toxicities and proper monitoring is advised.
Living Kidney Donor Decision Making: State of the Science and Directions for Future Research
Authors: Nolan Marie T. , Walton-Moss Benita , Taylor Laura , Dane Kathryn 
Published: July 2017

Background The Federal government and transplantation organizations have called for further study of living donation at a time when 3 new living donor protocols are being introduced throughout the United States that promise to significantly increase the donor pool and change the face of living donation. Donation to a once incompatible and sometimes unknown recipient may now occur through the use of plasmapheresis therapy or paired and nondirected living donor protocols. Objective To describe the state of the science on living kidney donor decision making, and to provide recommendations for future research to guide donor education and care. Data Sources Automated literature search using PubMed and CINAHL scientific literature databases. Study Data Extraction Research papers on living donor decision making from 1997 to 2003. Studies available only as abstracts were excluded. Data Synthesis Studies of living kidney donor decision making and outcomes have been limited in scope, with small sample sizes and inconsistent reports of racial and ethnic characteristics of the sample. The retrospective nature of the majority of living donor studies is a significant limitation. Conclusions Future prospective studies that are diverse by sex, race, and ethnicity will contribute to our knowledge of factors that influence the decision to be a living kidney donor.
Increasing Organ Recovery from Level I Trauma Centers: The In-House Coordinator Intervention
Authors: Shafer Teresa J. , Ehrle Ronald N. , Davis Kimberly D. , Durand Roger E. , Holtzman Samuel M. , Van Buren Charles T. , Crafts Nicholas J. , Decker Phillip J. 
Published: July 2017

Purpose Daily presence of organ procurement organization staff in level I trauma centers combined with early family contact and interaction can increase donation rates. Methods A successful in-house coordinator program already in place at 2 level I trauma centers in Houston was replicated in 6 other level I trauma centers in New York City, Los Angeles, and Seattle. Organ procurement organization staff were placed inside the 8 trauma centers to provide early family support in potential donor situations and day-to-day donation system management. Comparison data were obtained on 83 level I trauma centers nationally. Data from 1999 to 2000 were compared with data from 2001 to 2002. Results Despite demographic differences, the 8 centers with in-house coordinators had higher consent rates (60% vs 53%) and conversion rates (55% vs 45%) than centers without them. Conversion of potential to actual donors was 22% higher in centers with in-house coordinators than in centers without them. Donation rates were affected by donor age, ethnicity, previous family discussion of donation, the family's initial reaction to the request (favorable, unfavorable, undecided), amount of time family spent with the in-house coordinator, presence of the in-house coordinator during explanation of brain death, whether the request was made at the same time as the brain-death explanation, and, in cases where donation was mentioned to the family before the formal request, who first mentioned donation to the family. Conclusions In-house coordinators improve the donation process by interacting with families and staff earlier and more often during potential organ donations and improving donation systems through closer relationships with hospital staff.
Financial Considerations Insurance and Coverage Issues in Intestinal Transplantation
Authors: Chaney Michael 
Published: July 2017

Objective To increase healthcare workers' knowledge of reimbursement concerns. Methods Chronological survey of transplants reimbursed at the University of Nebraska Medical Center from December 1997 to October 2003, which include accounts of 30 patients who received intestine transplants. Conclusions Gross billed hospital charges for the past 30 transplantations ranged from $112094 to $667597. Length of stay ranged from 18 to 119 days. Charges include organ procurement fees. All 30 intestine transplants were reimbursed by third-party healthcare coverage; combination of coverage; and/or patient and family payments, which resulted in adherence to financial guidelines prearranged by the hospital. Financial guidelines are usually cost plus a percentage. Thirteen transplantations occurred after April 2001, when Medicare made a national coverage decision to reimburse this form of transplantation. Since then, obtaining surgical authorization and reimbursement is easier. Most insurance companies and state public health agencies accept intestinal transplantations as a form of treatment. Researching transplant coverage before evaluation is essential to be compensated adequately. Financial guidelines will secure the fiscal success of the program. Educating patients to insurance and entitlements may reduce the out-of-pocket cost to patients. Transplant financial coordinators coordinate these efforts for the facility. The best coverage option for the patient and transplant programs is a combination of commercial healthcare coverage, secondary entitlement program, and fund-raising. With length of stay ranging up to 119 days and a lifetime of posttransplant outpatient follow-up care, it is beneficial for the facility to also have a fundraising program to assist patients.