Prog Transplant
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This study analyzed the utility of the Surgical Apgar Scoring (SAS) system in predicting morbidity in kidney transplantation. Recipient comorbidities were evaluated for any effect on the SAS and then globally assessed for any relationship with intensive care unit (ICU) admission, need for dialysis, creatinine at discharge, length of stay, incremental, and total cost of transplantation. The hypothesis for this study is that a low SAS will be a statistically significant predictor of postoperative morbidity and associated costs. ⋯ The findings of this study suggest that a history of stroke in the recipient may lend to a lower SAS and that a low SAS is associated with ICU admission following transplant, leading to higher hospital costs.
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In the United States, organ donation after circulatory death (DCD) determination is increasing among those who are removed from life-sustaining therapy but is rare when death is unexpected. We created a program for uncontrolled DCD (uDCD). ⋯ It is feasible to create a process to rapidly intervene in the ED for uDCD. However, no organ transplants resulted. The utility and sustainability of an uDCD program in this particular setting are questionable.
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Comparative Study
Outcomes of living kidney donors with rheumatoid arthritis.
Patients with rheumatoid arthritis are more likely to have reduced kidney function develop over time. The aim of this study was to assess the clinical and safety outcomes of living kidney donors with rheumatoid arthritis. ⋯ Healthy kidney donors with rheumatoid arthritis have good outcomes, with no increased risk of decline in renal function, end-stage renal disease, or death.
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Context-Burnout is a response to chronic strain within the workplace and is common across nursing professions. Little has been published about burnout in organ transplant nurses. Objective-To report the prevalence of the 3 main components of burnout (emotional exhaustion, depersonalization, and reduced personal accomplishment) in organ transplant nurses and to examine factors that contribute to the development of burnout in transplant nurses. ⋯ Greater frequency and discomfort with difficult patient interactions were significant predictors of depersonalization. Younger age, lower decisional authority, and greater discomfort with difficult patient interactions were predictors of low personal accomplishment. Conclusions-The study provides strong evidence of the presence of burnout in transplant nurses and opportunities for focused and potentially very effective interventions aimed at reducing burnout.
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Of the 119 310 people on the national transplant waiting list, 97 280 people are waiting for kidneys. There simply are not enough organs to meet the demand. Recognizing that 64% of the people waiting for kidney transplants are at least 50 years old, this organ procurement organization embarked on a study to evaluate the potential of increasing the number of viable kidneys available for transplant by pursuing expanded criteria donors as donation after circulatory death (ECD/DCD) candidates. ⋯ The overall discard rate including all donors in all classifications during the study period was 13.1% (122 discards from 928 kidneys) compared with 12.6% (111 discards from 880 kidneys) when the study set was excluded. Although ECD/DCD donors still had the highest discard rates of all the groups, the 0.5% increase in the overall discard rate due to pursuing ECD/DCD kidneys was considered insignificant when compared with the benefit of the 30 additional kidneys transplanted. Including potential ECD/DCD patients in the donor pool increases the number of viable kidneys available for transplant without significantly increasing the overall kidney discard rates.