Graft preservation in heart transplantation: current approaches.

Heart transplantation (HTx) represents the current best surgical treatment for patients affected by end-stage heart failure. However, with the improvement of medical and interventional therapies, the population of HTx candidates is increasingly old and at high-risk for mortality and complications. Moreover, the use of "extended donor criteria" to deal with the shortage of donors could increase the risk of worse outcomes after HTx. In this setting, the strategy of donor organ preservation could significantly affect HTx results. The most widely used technique for donor organ preservation is static cold storage in ice. New techniques that are clinically being used for donor heart preservation include static controlled hypothermia and machine perfusion (MP) systems. Controlled hypothermia allows for a monitored cold storage between 4°C and 8°C. This simple technique seems to better preserve the donor heart when compared to ice, probably avoiding tissue injury due to sub-zero °C temperatures. MP platforms are divided in normothermic and hypothermic, and continuously perfuse the donor heart, reducing ischemic time, a well-known independent risk factor for mortality after HTx. Also, normothermic MP permits to evaluate marginal donor grafts, and could represent a safe and effective technique to expand the available donor pool. However, despite the increasing number of donor hearts preserved with these new approaches, whether these techniques could be considered superior to traditional CS still represents a matter of debate. The aim of this review is to summarize and critically assess the available clinical data on donor heart preservation strategies employed for HTx.

Knowledge, practice and faith on Total Quality Management principles among workers in the Health Care System: evidence from an Italian investigation.

BACKGROUND: The implementation of Total Quality Management (TQM) principles in the sanitary field, in order to be effective, requires a radical change in management practice as well as the organizational culture and its philosophy. The need to monitor such a transformation emerges too. OBJECTIVES: This study surveys how well TQM principles are known and understood by health care professionals from the employees' point of view and the factors affecting it. RESEARCH DESIGN AND SUBJECTS: The Health Care System in Trieste was surveyed. MEASURES: The Total Quality Test was used, a novel and quick instrument aimed at routine assessment of the penetration and interiorization of TQM principles within the health care structure. RESULTS: Direct exposure to public, job role and time spent working within the same structure have been proved related to the penetration of TQM principles, whereas previous formative intervention did not prove to be associated with the penetration of TQM principles. CONCLUSIONS: The implementation of a quick and simple instrument to monitor the TQM implementation highlighted several critical areas for intervention.

Burnout syndrome in the helping professions.

Burnout can be defined as a long-term reaction to occupational stress which involves, particularly, the helping professions. The main aim of this study was the assessment of burnout in a sample of professional and voluntary health care workers and comparison of the two samples on scores from the Maslach Burnout Inventory. Analysis suggests a significant difference in mean scores for Emotional Exhaustion of volunteers vs professional workers. Some evidence has supported the hypothesis of a fourth dimension, called Behavioral Exhaustion, in the burnout syndrome.