A Cost-Effectiveness Analysis of Organ Preservation Methods for Deceased Donor Kidneys at High Risk for Delayed Graft Function in Brazil.

The clinical benefit of machine perfusion (MP) was recently assessed in a 1-year Brazilian multicenter prospective randomized trial, that showed that the use of MP was associated with a reduced incidence of delayed graft function (DGF) compared to static cold storage (SCS) in kidney transplant recipients (45% vs 61%). The objective of the present analysis is to consider the cost-effectiveness of MP relative to SCS based on clinical data from this Brazilian cohort. A decision tree model was constructed to simulate a population of 1000 kidney transplant recipients based on data derived from this Brazilian multicenter clinical trial. The model accounts for different health state utilities to estimate the cost-effectiveness of deceased donor kidney transplantation in Brazil comparing 2 kidney preservation methods: MP and SCS. The model accounts for 3 possible graft outcomes at 1 year post-transplantation: success (an immediate functioning kidney), failure (primary nonfunction requiring a return to dialysis), or DGF 1 year post-transplant. MP provided 612 total quality-adjusted life years (QALYs) (0.61 QALYs per patient) as compared to SCS (553 total QALYs, 0.55 QALYs per patient). MP was cost effective relative to SCS (US$22,117/QALY, R$70,606/QALY). The use of MP also resulted in more functioning grafts than SCS (821 vs 787), leading to a cost per functioning graft of US$38,033 (R$121,417). In conclusion, this analysis indicates that, despite the initial added cost associated with MP, the use of MP results in more functioning grafts (821 vs 787) and higher patient quality of life relative to SCS in Brazil.

Biochemical markers in myocardial injury.

Biochemical markers are substances that are detected in body fluids or tissues that may signify a disease or other abnormality. Biochemical markers have been used to help in the diagnosis of acute myocardial infarction since the 1950s. The major problem with these markers is that they lack specificity for cardiac muscle as they are also elevated in many disease states and after minor muscle damage.

Anatomy and physiology of the esophagus.

Modern diagnosis and treatment of esophageal disease is a result of progress in assessing the anatomy and physiology of the esophagus, as well as refinements in anesthetic and surgical techniques. Esophageal carcinoma spreads rapidly and metastasizes easily. The tendency for early spread and the absence of symptoms result in late diagnosis that reduces treatment options and cure rates. Lifestyle (i.e., use of alcohol and tobacco), nutritional deficiencies, ingestion of nitrosamines, and mutagen-inducing fungi are blamed for cancer of the esophagus. Other pathologic conditions (e.g., achalasia, Barrett's epithelium, gastric reflux, hiatal hernia) are potential contributors to the development of carcinoma. Nurses are in key positions to identify the existence of factors contributing to premalignant or malignant lesions and to educate patients and make the appropriate referrals.

Quantification of left ventricular diastolic wall motion by Doppler tissue imaging in healthy cats and cats with cardiomyopathy.

OBJECTIVE: To assess Doppler tissue imaging (DTI) for evaluating left ventricular diastolic wall motion in healthy cats and cats with cardiomyopathy. ANIMALS: 20 healthy cats, 9 cats with hypertrophic cardiomyopathy (HCM), and 9 cats with unclassified cardiomyopathy (UCM). PROCEDURE: A pulsed wave DTI sample gate was positioned at a subendocardial region of the left ventricular free wall in the short axis view and at the lateral mitral annulus in the apical 4-chamber view. Indices of diastolic wall motion were measured, including peak diastolic velocity (PDV), mean rate of acceleration and deceleration of the maximal diastolic waveform (MDWaccel and MDWdecel, respectively), and isovolumetric relaxation time (IVRT). RESULTS: The PDV of cats with HCM and 6 of 9 cats with UCM was significantly decreased, compared with that of healthy cats. In the 3 cats with UCM that had a PDV that was not different from healthy cats, MDWaccel and MDWdecel were greater, and IVRT was shorter than those of healthy cats. The IVRT in cats with HCM was longer than that of other cats. CONCLUSIONS AND CLINICAL RELEVANCE: Indices of diastolic function in cats with HCM, and in many cats with UCM, differed from those of healthy cats and were similar to those reported in humans with HCM and restrictive cardiomyopathy, respectively. However, the hemodynamic abnormality was not the same for all cats with UCM; some cats with an enlarged left atrium and a normal left ventricle (ie, UCM) had abnormal left ventricular wall motion consistent with restrictive cardiomyopathy while others did not.

Vascular hemodynamics.

The vascular system is a complex network transporting blood to and from all parts of the body. It distributes oxygenated and nutrient-rich blood to body tissue via arteries, arterioles, metarterioles, and capillaries. Venules and veins carry deoxygenated blood, cellular wastes, and carbon dioxide to the heart and lungs to be oxygenated or removed. The lymphatic system removes fluid left at the venous end of the capillaries and returns it to the circulatory system by way of the lymphatic ducts. Understanding the vascular system is basic to providing quality nursing care.

Cardiac anatomy and physiology: a review.

This article reviews the normal anatomy and physiology of the heart. Understanding the normal anatomic and physiologic relationships described in this article will help perioperative nurses care for patients who are undergoing cardiac procedures. Such knowledge also assists nurses in educating patients about cardiac procedures and about activities that can prevent, reverse, or improve cardiac illness.

Surgical treatment of pheochromocytomas.

Pheochromocytomas are tumors that develop from chromaffin tissue of the embryonic sympathoadrenal system. These tumors may occur anywhere chromaffin tissue exists but most often develop in the adrenal medulla. Less than 50% of patients are diagnosed with pheochromocytomas while alive, and most of these tumors are found on autopsy. The classic signs and symptoms of pheochromocytomas are headache, perspiration, palpitations, pallor, and paroxysmal hypertension. Elevated levels of vanillylmandelic acid and metanephrines in patients' 24-hour urine collections are the most reliable diagnostic indicators of pheochromocytomas. Most patients with pheochromocytomas can be cured if diagnoses and surgical resections of tumors occur before irreversible cardiovascular disease and end-organ damage from hypertension develop.

Acceptability of interventions for pediatric pain management.

Examined the effects of pain symptom severity and patient diagnostic status on pediatric staffs' acceptability ratings of 6 interventions used to treat pediatric pain. Results indicated that (a) extinction was significantly less acceptable than all other behavioral and pharmacologic interventions, (b) self-management was more acceptable than all other interventions with the exception of contingency management, (c) accelerative procedures and self-management interventions were preferred to pharmacologic treatment, (d) patient diagnostic status and pain symptom severity failed to significantly influence treatment ratings, (e) self-management was the only intervention differentially rated as a function of pain symptom severity, and (f) pharmacologic treatment was differentially rated as a function of patient diagnostic status.

Moral judgment in delinquents and nondelinquents: recognition versus production measures.

Juvenile delinquents' (n = 60) and nondelinquents' (n = 73) stages of moral development were compared using both recognition and production measures. Juvenile delinquents were found to score significantly lower than nondelinquents on a production measure of moral judgment (the Sociomoral Reflection Measure). A recognition measure (the Sociomoral Reflection Objective Measure), however, did not discriminate between the two groups in an analysis controlled for significant covariates of age, socioeconomic status, and IQ. The possibility that delinquents are delayed in the production but not recognition of mature moral reasoning is considered. The possibility is also considered, however, that excessive error variance associated with recognition measures of moral reasoning when administered to juvenile delinquents is responsible for the inability of such measures to discriminate between delinquents and nondelinquents.