Prog Transplant
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Bilateral living donor lobar lung transplantation is a treatment option for selected children and adults with end-stage lung disease. Careful donor evaluation, skilled intraoperative management and surgical technique, and diligent immediate postoperative care and follow-up all contribute to better outcomes. ⋯ Anatomical distinctions, such as the entire cardiac output flowing to 2 lobes instead of 5, and thoracic space issues with simultaneous mechanical ventilation and chest tube suction, contribute to these differences. Early postoperative care, including initial postoperative stabilization, ventilation, fluid management, rejection/infection surveillance and prophylaxis, and beginning rehabilitation, can be adapted to ensure successful outcomes in these patients.
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Throughout history, death and loss have given rise to social ceremonies and commemorative activities that note the death, recognize the place the person occupied in society, and assist the bereaved through the process of grief. Each culture faces death with its own definition of "appropriate" social-emotional reactions, and when death occurs, it provides the occasion for socially conditioned grief reactions and mourning practices. Historically, such practices have incorporated a set of interrelated people, the majority of whom were very knowledgeable of the customs and their purposes. ⋯ Although they may have experienced an intense loss, personally or professionally, they may not be given time off from work or have the opportunity to talk about the meaning of their loss. In our modern, compartmentalized society, social ceremonies and commemorative activities tend to be limited primarily to a small circle of the "proper" bereaved individuals. This separation has helped to create a subset of grievers whose legitimacy may not be recognized by society as a whole and whose needs are often not addressed.
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Nosocomial infections continue to escalate in response to antibiotic usage and breaches in infection control practices. Historically, naturally occurring bacteria that cause infection when present in an unfamiliar environment have been successfully treated with antibiotics. ⋯ Reservoirs of enterococci naturally occur in animals and humans, although the misuse of antibiotics in humans and animals has given rise to enterococci resistance, namely vancomycin-resistant enterococci. Once established in these reservoirs, vancomycin-resistant enterococci are easily transmitted by direct or indirect mechanisms and are proving difficult to control in hospitals, other healthcare settings, and in the community.
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The organ procurement coordinator commonly must correct and maintain the arterial blood pressure during donor care. This article reviews considerations in the accurate measurement of the blood pressure, causes of hypertension and hypotension, and desirable standards to use in order to provide adequate organ perfusion. Recommendations are presented for treatment of hypotension in a titrated response of intravenous fluids, inotropic support, and vasopressor infusion to maintain the mean arterial pressure above 65 mm Hg. Collaborative interaction between the coordinator and physician consultant remains important throughout management of blood pressure changes during donor care.
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Previous research has identified specific fears and concerns among the general public about organ and tissue donation. However, little to none of that research has dealt with fears and concerns at the time of the donation discussion. ⋯ Subsequently, the fears and concerns were classified in 4 groups: often heard and easy to deal with, often heard and hard to deal with, seldom heard and easy to deal with, seldom heard and hard to deal with. The results can be used to stimulate further research on family fears and concerns, to train and retrain coordinators to address those concerns in the donation discussion, and to improve existing strategies for increasing organ and tissue donation.