The coordinator attrition problem in the United States: myth or reality?

Excessive attrition among organ procurement coordinators has been suspected problem for many years. In 1994 the United Network for Organ Sharing undertook a procurement coordinator attrition study. Initially, focus groups were conducted in conjunction with the 1994 North American Transplant Coordinators Organization's annual meeting. In 1996, 69 executive directors from organ procurement organizations were surveyed on the subject of procurement coordinator attrition. Thirty-five executive directors responded, resulting in a 51% response rate. The UNOS procurement coordinator attrition study explored actual attrition rates, relationships of certain demographic factors to attrition rates, economic impact of attrition on the organizations, and various job tenure issues. The period under study was January 1, 1990 through December 31, 1993. Results did not demonstrate an industry-wide attrition problem. Additionally, the study revealed no enduring attrition problem in any single organization, and some organizations were found to have no attrition during the entire study period.

Filter assay technique and quench-flow experiments: examples of receptor-mediated transmembrane ion-exchange measured with membrane vesicles.

Modifications to a quench-flow apparatus are described which allow a rapid, in-line filter assay with immediate washing, in conditions to give minimum background. A design for an effluent spout is presented, which decelerates the liquid by a large factor, prevents splashes, limits the area of the filter exposed to the sample and allows an immediate wash over a larger area. A design for a filter assay funnel for general use is also presented. These devices feature minimal contact of the funnels with the filter disc. Examples are given in which in-line filtration was used to follow transmembrane ion flux in membrane vesicle preparations. In measurements of transmembrane flux with membrane vesicles and radioisotope the filter assay background can be resolved into three components. These are, (1) the uptake of radioactivity by the filter, (2) the radioactivity inside the vesicles not taking part in the specific measurement and (3) the occlusion of radioactivity in aggregated membrane particles on the filter. These different components depend on the conditions in different ways. Techniques for minimizing the background in filter assays are discussed. The importance of rapid filtration and immediate washing is demonstrated. The examples given illustrate that the function of the acetylcholine receptor from E. electricus is not affected by diisopropylfluorophosphate in the conditions used, and that added GABA is not removed from solution in a brain membrane preparation by the GABA uptake mechanisms in the short times of the experiments.

gamma-Aminobutyric acid-activated chloride channels in rats selectively bred for differential acute sensitivity to alcohol.

Effects of various sedative hypnotic agents on GABA-mediated chloride flux were evaluated in whole brain membrane vesicles (microsacs) prepared from rats selectively bred for high (HAS) and low sensitivity (LAS) to an acute hypnotic dose of alcohol. The HAS rats were more sensitive to the effects of pentobarbital, phenobarbital, flunitrazepam, and ethanol on GABA-mediated chloride flux compared with the LAS rats. No differences between the lines in GABA-stimulated chloride flux were observed. Modulation of 1-[3H]-phenyl-4-butyl-2,6,7-trioxabicyclo(2.2.2)octane ([3H]-TBOB) and [3H]-diazepam binding also was measured. The lines did not differ in inhibition of [3H]-TBOB binding by pentobarbital, phenobarbital, muscimol or picrotoxin. Although the lines displayed almost identical KD and Bmax for [3H]-diazepam binding, the GABA agonist, muscimol, was a more potent stimulator of [3H]-diazepam binding in membranes prepared from HAS rats than from LAS rats. These findings are discussed in light of previous work using other selected lines.

Oral pulse prednisone therapy in the treatment of HBsAg negative chronic active hepatitis.

A young woman with hepatitis B surface antigen negative chronic active hepatitis and hypergammaglobulinemia was treated successfully with oral pulse steroid therapy consisting of prednisone, 90 mg/day, given in repeated 3--5-day courses at 3--4-wk intervals. This approach, which is hypothetically founded on the ability of steroids to cause prolonged inhibition of immunoglobulin G synthesis and proposed mechanisms of hepatocellular damage in chronic active hepatitis, permitted complete clinical, chemical, and histologic remission without morbidity. Oral pulse prednisone therapy deserves further study as a possible adjunct or alternative to existing methods of managing hepatitis B surface antigen negative chronic active hepatitis associated with hypergammaglobulinemia.

An initial experience with post-data processing in hepatic sonography.

Sonographic image manipulation became a possibility with the advent of digital equipment. Depending on the manufacturer, this manipulation may be called pre-data processing, post-data processing, or both. It involves changing the normal assigned gray scale curve to accentuate defined decibel ranges. Sixty consecutive patients were examined who had technically adequate hepatic sonograms using the normal linear gray scale range and post-data processing (PDP). Sonograms were considered normal in 32 patients, while 28 were believed abnormal. In 10 of the 28 abnormal scans, hepatic metastases were better visualized with post-data processing (one false-positive). These were patients in whom there was a minimal echogenic difference between the surrounding normal liver and the lesion. However, in no case was a lesion seen after post-data processing that was not recognizable on the linear gray scale scan. In the other 18 abnormal scans (one false-positive study), the echogenic difference between the lesion and the liver was large enough that PDP was not helpful. The possible pitfalls in the use of PDP, such as poor technique, are discussed and demonstrated. Improvement in hepatic sonographic sensitivity will require more fundamental improvement of equipment than provided by post-data processing.

Computed tomography of colon carcinoma.

A review was made of 80 computed tomographic (CT) examinations of the abdomen and/or pelvis in patients with known carcinoma of the colon. These studies were obtained for evaluation of the initial extent of disease, delineation of the progression of disease, determination of the response to therapy, or location of possible recurrence. The sites of metastases are reported. The results support the routine use of CT in patients with colon carcinoma.

Topical lidocaine in preendoscopic medication.

A double blind study of 111 consecutive elective upper gastrointestinal endoscopies performed with a flexible fiberoptic esophagogastroduodenoscope was made to determine the efficacy of topical pharyngeal anesthesia with lidocaine as an adjunct to intramuscular meperidine, intramuscular atropine, and intravenous diazepam. Patients who received lidocaine rated the over-all endoscopy and passage of the endoscope significantly easier than did those receiving placebo. The endoscopist found that patients who received lidocaine tolerated endoscopy significantly better, although gagging was not affected.