The Effect of Educational Initiatives on the Attitude and Knowledge of Health Care Professionals Regarding Organ Donation and Transplantation: An Integrative Literature Review.

BACKGROUND: This integrative literature review synthesizes evidence on the effect of educational initiatives (EI) on the attitude and knowledge of health care professionals regarding organ donation and transplantation (ODT), and the EI effect considering the risks of the ODT process related to the professionals' attitudes and knowledge. METHODS: This search included 8 databases, with search terms across 4 groups: ODT activities, health professionals, attitude/knowledge, and EI. We applied the PICO framework to select articles: Population - health care professionals; Intervention - any EI; Comparison - pre/post or intervention/control designs; and Outcomes - indicators of attitudes or knowledge toward ODT. After the appraisal of 2,221 citations, 21 studies were included in this review. RESULTS: The EI varied to a great extent in terms of format (seminars, workshops, video lectures; online or in-person training), duration (from 15 minutes to 3 months), and the number of participants (from 12 to 1011). The effects reported were positive, increasing professionals' knowledge and attitude regarding the ODT process for all EI formats. Most articles (14; 67%) presented positive results with statistical significance for all indicators analyzed, and the remaining studies (7; 35%) reported statistical significance for some of the indicators analyzed. All EIs focused on donation or post-transplantation activities, lacking studies on the transplantation stage. CONCLUSIONS: Results suggest that different types of EIs may positively affect the attitude and knowledge of health care professionals regarding the ODT process. This study provides an up-to-date overview of the main themes examined in this literature, highlighting critical knowledge gaps and methodological flaws.

Brazilian Health Care Professionals` Attitudes and Knowledge Regarding Organ Donation and Transplantation: A Systematic Review.

PURPOSE: This systematic literature review synthesizes evidence on Brazilian health care professionals' attitudes and knowledge regarding organ donation transplantation. METHOD: This search included 5 databases-EBSCO, PubMed, Web of Science, Scopus, and Virtual Health Library. Search terms were conceptualized into 4 groups-organ transplantation/donation, health care professionals, attitude/knowledge, and Brazil. The eligibility criteria included academic articles that applied quantitative methods to examine the attitudes and/or knowledge of health care professionals toward organ donation-transplantation (ODT). After a critical appraisal of the citations initially retrieved, 13 studies were included in this review. RESULTS: Although most studies pointed to an overall positive attitude of participants toward ODT, insufficient knowledge level among participants was also observed in most studies, especially knowledge gaps regarding aspects such as legal requirements and the functioning of the ODT processes in Brazil. In convergence with the broader ODT literature, education was highlighted as a central point in ODT processes. CONCLUSION: The results reveal the scarcity of studies on the subject in Brazil and indicate an opportunity for educational efforts to improve the knowledge of health care professionals regarding the ODT process. This study enriches the academic literature and encourages new investigations on the issue, especially in the North and Northeast of Brazil.

Risk Analysis of the Organ Donation-Transplantation Process in Brazil.

BACKGROUND: Organ transplantation has been for years one of the best treatment options for several medical conditions, and, all over the world, thousands of people need an organ transplant. However, the process through which an organ goes from a brain-dead patient to a new recipient is a complex and delicate one. RESEARCH QUESTIONS: This study aims at identifying and assessing the main risks, their impact, and their relevance on the organ donation-transplantation (ODT) process in Brazil. DESIGN: To identify and to assess the risks of the process, we interviewed coordinators at the 10 State Transplantation Centers in Brazil, which is responsible for over 90% of donations that occurred in Brazil in 2019. We applied the Failure Mode and Effect Analysis method to calculate the risks in terms of severity, occurrence, and detection. The scores obtained from each risk were used to elaborate a ranking comparing the impact of 1 risk in relation to the others. MAIN FINDINGS: The interviewees identified 30 risks throughout the ODT process in Brazil. Most of them are related to insufficient human and material resources, lack of staff training and commitment, and poor infrastructure or logistical aspects. CONCLUSIONS: This study complements findings from previous studies and add new risks, based on the Brazilian state coordinators' point of view. It highlights the most critical weaknesses of the process and serves as a basis for future studies to delve deeper into each of those risks.

Hospital accreditation impact on healthcare quality dimensions: a systematic review.

PURPOSE: To systematically review the impact of hospital accreditation on healthcare quality indicators, as classified into seven healthcare quality dimensions. DATA SOURCE: We searched eight databases in June 2020: EBSCO, PubMed, Web of Science, Emerald, ProQuest, Science Direct, Scopus and Virtual Health Library. Search terms were conceptualized into three groups: hospitals, accreditation and terms relating to healthcare quality. The eligibility criteria included academic articles that applied quantitative methods to examine the impact of hospital accreditation on healthcare quality indicators. STUDY SELECTION: We applied the PICO framework to select the articles according to the following criteria: Population-all types of hospitals; Intervention-hospital accreditation; Comparison-quantitative method applied to compare accredited vs. nonaccredited hospitals, or hospitals before vs. after accreditation; Outcomes-regarding the seven healthcare quality dimensions. After a critical appraisal of the 943 citations initially retrieved, 36 studies were included in this review. RESULTS OF DATA SYNTHESIS: Overall results suggest that accreditation may have a positive impact on efficiency, safety, effectiveness, timeliness and patient-centeredness. In turn, only one study analyzes the impact on access, and no study has investigated the impact on equity dimension yet. CONCLUSION: Mainly due to the methodological shortcomings, the positive impact of accreditation on healthcare dimensions should be interpreted with caution. This study provides an up-to-date overview of the main themes examined in the literature, highlighting critical knowledge-gaps and methodological flaws. The findings may provide value to healthcare stakeholders in terms of improving their ability to assess the relevance of accreditation processes.

Inflammatory mediators generated at the site of inoculation of Loxosceles gaucho spider venom.

Patients bitten by Loxosceles spiders generally manifest marked local inflammatory reaction and dermonecrosis. This report evaluated edema formation, leukocyte infiltration and release of inflammatory mediators at the injection site of Loxosceles gaucho venom. BALB/c mice were i.d. injected with venom and thereafter paws were disrupted and homogenized to obtain differential counts of migrated cells, as well to assay the levels of cytokines, chemokines and lipid mediators. Increased footpad thickness was detected as soon as 30 min after venom injection, and 24h later was similar to that of the control group. Loxosceles venom mildly augmented the recruitment of leukocytes to the footpad in comparison with PBS-injected mice. Moreover, it stimulated the release of IL-6, MCP-1 and KC at 2 and 24h after venom injection. In addition, higher levels of PGE(2) were detected 30 min after venom injection in comparison with control group. However, the venom failed to increase levels of IL-1 beta, TNF-alpha, TXB(2) and LTB(4). Our results demonstrate that L. gaucho venom evokes an early complex inflammatory reaction, stimulating the secretion of pro-inflammatory cytokines and lipid mediators (PGE(2)), and recruiting leukocytes to the footpad which contribute to the local reaction induced by L. gaucho venom.

Inflammatory mediators generated at the site of inoculation of Loxosceles gaucho spider venom

Patients bitten by Loxosceles spiders generally manifest marked local inflammatory reaction and dermonecrosis. This report evaluated edema formation, leukocyte infiltration and release of inflammatory mediators at the injection site of Loxosceles gaucho venom. BALB/c mice were i.d. injected with venom and thereafter paws were disrupted and homogenizedto obtain differential counts of migrated cells, as well to assay the levels of cytokines, chemokines and lipid mediators. Increased footpad thickness was detected as soon as30 min after venom injection, and 24 h later was similar to that of the control group. Loxosceles venom mildly augmented the recruitment of leukocytes to the footpad in comparison with PBS-injected mice. Moreover, it stimulated the release of IL-6, MCP-1 and KC at 2 and 24 h after venom injection. In addition, higher levels of PGE2 were detected30 min after venom injection in comparison with control group. However, the venom failed to increase levels of IL-1b, TNF-a, TXB2 and LTB4. Our results demonstrate that L. gaucho venom evokes an early complex inflammatory reaction, stimulating the secretionof pro-inflammatory cytokines and lipid mediators (PGE2), and recruiting leukocytes to the $footpad which contribute to the local reaction induced by L. gaucho venom.

Helminth products as a potential therapeutic strategy for inflammatory diseases.

Helminths secrete several molecules that can modulate the immune responses, favoring their evasion and perpetuate their survival in the host. These molecules interfere with antigen presentation, cell proliferation and activation, antibody production, cause cell death, and stimulate regulatory responses. Here, we focus on some helminth products and address their immunomodulatory effects in the host immune system and, also, we describe some anti-inflammatory properties of an Ascaris suum-derived immunomodulatory molecule, named PAS-1. This protein is a 200-kDa molecule isolated by affinity chromatography using MAIP-1 (monoclonal antibody which recognizes PAS-1), coupled to Sepharose 4B. It suppresses the inflammatory responses in murine models of delayed-type hypersensitivity, lung allergic inflammation and LPS-induced inflammation into air pouches. PAS-1 also stimulates the secretion of regulatory cytokines such as IL-10 and TGF-beta and primes IFN-gamma-secreting CD8+ and IL-10/ TGF-beta-secreting CD4+CD25+ cell clones that avoid the lung inflammation. Thus, this protein is a potent immunomodulatory component that may be used for therapeutic interventions in inflammatory diseases.

PAS-1, a protein affinity purified from Ascaris suum worms, maintains the ability to modulate the immune response to a bystander antigen.

Helminth infections and parasite components have potent immunomodulatory effects on a host's immune system. In the present study, we investigated the effect of PAS-1, a protein component of Ascaris suum adult worms recognized by a monoclonal antibody (MAIP-1), on humoral and cell-mediated responses to a bystander antigen (ovalbumin [OVA]). MAIP-1 recognized only one of the three polypeptide chains of PAS-1, but neutralized the suppressive effect of the whole worm extract on OVA-specific antibody production. PAS-1 inhibited antibody production against a T-cell-dependent, but not a T-cell-independent, antigen in a dose-dependent way. IgM, IgG1, IgG2b, and also IgE and anaphylactic IgG1 levels were downregulated. In addition, PAS-1 inhibited OVA-specific delayed type hypersensitivity reactions in the footpad of mice, showing a potent immunosuppressive activity on both Th1 and Th2 responses that seems to be mediated by the induction of large amounts of IL-10 and IL-4. Indeed, PAS-1-specific spleen cells secreted sevenfold more IL-10 and threefold more IL-4 than OVA-specific cells in response to in vitro restimulation with the respective antigens. In conclusion, we showed that PAS-1, a single protein component from A. suum, maintains all its immunosuppressive properties.