Magister Scientiae Dentium - MSc(Dent) / Between September 1992 and August 1995, all patients with haematological malignancies who were treated as in-patients in the Haematology Unit at Groote Schuur Hospital received a twice weekly, oral and perioral examination. Sixty patients were monitored while following the traditional hospital oral care protocol (chlorhexidine, hydrogen peroxide, sodium bicarbonate, thymol glycol, benzocaine mouthrinse and nystatin). The mouth care protocol was then changed (protocol A = chlorhexidine, benzocaine lozenges, amphotericin B lozenges) and patients monitored until the sample size matched that of the hospital mouth care regimen (n = 60). A further 60 patients were then monitored using a third protocol (protocol B = benzydamine hydrochloride, chlorhexidine, benzocaine lozenges, amphotericin B lozenges). A statistically significant reduction in oral complications was found upon introduction and maintenance of protocols A and B. The findings of this study suggest that improved oral care and a structured oral care routine reduces the number of oral complications associated with chemo- and radiotherapy. / Medical Research council

Background: Gram-negative bloodstream infections (BSI) are common complications after kidney transplantation. In this cohort study, we evaluated the long-term effect of Gram-negative BSI on allograft survival in kidney transplant recipients. Methods: Among a cohort of 1820 kidney recipients who were prospectively followed at the Mayo Clinic (Rochester, MN) from January 1, 1996, to December 31, 2007, we identified 120 patients with initial episodes of Gram-negative BSI before allograft failure. Multivariable Cox proportional hazard regression was used to examine the association between Gram-negative BSI, as a time-dependent covariate, and allograft and patient survival. Results: The median age of kidney recipients was 51 years (interquartile range, 39-61 years) and 58% were men. Among patients with Gram-negative BSI, 75% had a urinary tract source of infection and Escherichia coli was the most common microorganism (50%). Gram-negative BSI after transplantation was independently associated with allograft loss due to allograft failure or death (hazard ratio [HR], 2.52; 95% confidence intervals [CI], 1.83-3.47; P<0.001), allograft failure with death-censored (HR, 3.17; 95% CI, 2.11-4.76; P<0.001) and all-cause mortality (HR, 2.25; 95% CI, 1.55-3.26; P<0.001). Conclusions: Prevention and proper management of urinary tract infections in kidney recipients is essential to reduce the risk of more serious complications, including Gram-negative BSI, that are associated with reduced allograft and patient survival.

Splenectomy has been reported to have a beneficial effect in treating Acute antibody-mediated rejection (ABMR). This reason for this often rapid and profound beneficial effect is not readily apparent from what is known about normal splenic immunoarchitecture. While the spleen is rich in mature B cells, it has not been noted to be a repository for direct antibody-secreting cells. We present a case of a Native American female who received a renal transplant and developed a severe episode of ABMR. The patient was initially refractory to both plasmapheresis and IVIG. The patient underwent an emergent splenectomy with almost immediate improvement in her renal function and a rapid drop in her DR51 antibodies. Immunohistochemical stains of the spleen demonstrated abundant clusters of CD138+ plasma cells (>10% CD138 cells as opposed to 1% CD138 cells as seen in traumatic controls). Though this is a single case, these findings offer a rationale for the rapid ameliorative effect of splenectomy in cases of antibody rejection. It is possible that the spleen during times of excessive antigenic stress may rapidly turn over B cells to active antibody-secreting cells or serve as a reservoir for these cells produced at other sites. © 2010 The American Society of Transplantation and the American Society of Transplant Surgeons.

No description available.

Study Objective: Drug-related problems (DRPs) are associated with increased rates of infection, rejection, and graft loss in kidney transplant recipients. This study aimed to develop a model to predict which patients are at highest risk of DRPs to streamline pharmacists’ workflow in a chronic kidney transplant clinic. Design: Prospective observational study. Setting: Chronic kidney transplant clinic at a large, tertiary care, academic hospital. Patients: Two hundred thirty-seven adults seen in the kidney transplant clinic between September 16, 2015, and November 30, 2015, who were at least 90 days posttransplantation at the time of their clinic visit. Measurements and Main Results: Prospective data detailing DRPs and a survey assessing baseline characteristics and patient-related outcomes were used to generate a predictive model to identify patients at risk of having six or more DRPs; the cutoff of six DRPs provided a threshold for identifying a subset of high-risk patients on whom the transplant pharmacists could focus their efforts. DRPs were categorized as nonadherence, overdosing or underdosing, duplication of therapy, preventable adverse drug reaction, missing medication, erroneous medication, conflicting provider information, undermonitoring or lack of monitoring, and wrong medication received. In total, 865 unique DRPs were identified, and the most common were erroneous medication, missing medication, and nonadherence, accounting for 38%, 21%, and 16% of the DRPs, respectively. A nine-variable model with a sensitivity of 62.5% and specificity of 66.7% (area under the receiver operating characteristic curve of 0.720) was developed to identify patients at risk of having six or more DRPs. The model included the following variables: age, Medicaid for prescription insurance, current employment status, medication affordability, difficulty or lack of difficulty obtaining medications from the pharmacy, negative impact of medications on quality of life, medication nonadherence, poor rating of current health status, and moderate or poor medication understanding. Conclusion: These results demonstrated that a straightforward, 5-minute survey completed by renal transplant recipients prior to their clinic visit may be capable of effectively determining those at risk of having six or more DRPs, potentially allowing use as a screening tool for transplant pharmacists’ workflow prioritization. External validation is needed before this tool can be used in the outpatient setting.

Background: Organ transplantation is an established form of treatment applied worldwide, which saves many lives. There is however, an imbalance between supply and demand for organs, which means that the patients on the waiting list for organs often have to stay there for a long time. In worst case, they die before a suitable organ is found. Patients waiting for vital organs are therefore in a very exposed situation and this causes many feelings. Aim: The aim of the study was to describe patients´ experiences while waiting for vital organs. Method: A literature based study analysing twelve qualitative studies, that based onpatient interviews describe the patients' experiences while waiting for vital organs. Results: The result showed that patients felt bound, both physically and mentally. They experienced anxiety and stress during the long wait for an organ but had also hope forrecovery and wished to be able to return to a normal life. Information and support were an important part of getting through the wait. Two themes appeared during the analysis; To hope and to understand, the mixed emotions and To be bound and to be in need. Conclusion: All patients' experiences were individual, although there are many similarities in how they experienced waiting for vital organs, especially regarding emotions. Hope was a prerequisite for patients while waiting for a vital organ, as it servesas a driving force to hold out during their uncertain life situation.

Bakgrund: Allt fler lever idag med ett transplanterat hjärta. En hjärttransplantation kan vara en omställning både kroppsligt och känslomässigt. I väntan på ett nytt hjärta är det vanligt att patienten upplever stor rädsla och oro inför framtiden. De känslor patienten erfar innan hjärttransplantationen kan höra ihop med hur patienten erfar situationen efteråt, här kan sjuksköterskans roll vara betydelsefull. Syfte: Syftet med studien var att belysa patienters känslor och upplevelser efter hjärttransplantation.  Metod: En litteraturstudie innehållande kvalitativa och kvantitativa artiklar analyserades och sammanställdes. Resultatet: Resultatet bestod av tre Huvudkategorier: Komplexa känslor, Upplevelser av stöd och Det nya livet. Patienterna upplevde en tacksamhet gentemot donatorn. Flera av de hjärttransplanterade kände rädsla, oro och skuld. Vissa av patienterna upplevde en period av nedstämdhet efter hjärttransplantationen. Upplevelsen av stöd var betydelsefullt. Det nya livet bestod av olika känslor och upplevelser kring den nya situationen och en kamp med självidentiteten. Slutsats: Litteraturstudiens resultat visade på att det är en omfattande process för patienten att genomgå en hjärttransplantation, både fysiskt och psykiskt. Patienterna genomgår många komplexa känslor som kan liknas vid en berg- och dalbana där önskan och hopp blandas med sorg, nedstämdhet och rädsla. Det är grundläggande att sjuksköterskan har kunskap och förståelse för patientens livsvärld för att kunna stödja patienten i den situationen.

Background: Organ transplantation is seen as a treatment to save lives. There are great differences in the transplantation process between different countries. Patients have previously described the process of organ transplantation as restrictive and emotionally draining with an overhanging fear of death before transplant. Aim: The aim of this study was to describe patients’ experiences of waiting for organ transplantation.  Method: This literature-based study was conducted with analysis of qualitative research to gain knowledge about the patients’ experiences. Analysis of the eleven articles was performed by using Friberg’s five-step method. Results: Two main themes and six subthemes emerged from the analysis. The main themes The need for support and information highlighted the patients need for support and adequate information from both family and health care professionals. This was seen as a way to handle the uncertainty that the waiting time could bring. The other main theme The time on the waiting list described that waiting for an organ transplantation could bring restrictions to their daily life. Patients described the time on the waiting list as uncertain and many thoughts about the donor arose. Also, hope about their future was prominent throughout the time on the waiting list. At times this hope could turn to despair. Conclusion: Waiting for an organ transplantation is a multifaceted experience. Support from family was considered crucial and therefore should be included when possible. Nurses are responsible for giving enough and appropriate information and support to the patients during their wait.

No description available.

When it comes to inclusion of social support as a criterion for kidney transplantation, there is lack of standardization and understanding of what it truly means to staff, clinicians, even patients and their families. Despite the variability in what “social support” means to many kidney transplant teams and centers, studies (mostly through survey studies) have shown that inadequate social support serves as an exclusion for patients awaiting kidney transplantation. With inadequate social support serving as an exclusion criterion and without it being properly addressed, inequities currently present in the kidney transplant considerations may be perpetuated. This thesis aims to tangibly define this social support criterion within an urban setting – North Philadelphia. Through REDCap survey administration to practitioners and support staff that handle candidacy for kidney transplantation, we will get a sense of how social support defined by wealth, marriage relationship and parental relationship affect views on the ethics of kidney transplant considerations. Discussions will also be applied to pediatric settings. This thesis will be a commentary on whether the current transplant system fulfills the standards of urban bioethics principles. This will present a framework for social support referrals to be implemented as a necessary resource if a patient on the transplant list presents with inadequate social support. I will argue support of the urban bioethical principles of social justice and solidarity for the purpose of helping healthcare systems, government and insurance understand that such resources should be funded by them to support candidates who truly need it. / Urban Bioethics