What Is the Effect of Organ Donation Authorization Rates When Utilizing a Standardized Effective Request Process?

To determine if implementation of a standardized effective request process (ERP) can increase organ donation authorization rates. DESIGN: A retrospective, observational study was performed using data acquired from the Midwest Transplant Network. chi-square test was used to analyze categorical data, with p value of less than 0.05 deemed significant. SETTING: The Midwest Transplant Network located in Westwood, KS from January 1, 2013 to June 30, 2017. PATIENTS: A total of 1,391 consecutive patients were identified as potential donors based on medical evaluation of the patient's neurologic status, organ function, and established age criteria. INTERVENTIONS: An ERP was used when discussing donation with 733 patients (53%), compared with no ERP usage with 658 patients (47%). MEASUREMENTS AND MAIN RESULTS: A significant increase (30%) in donation rates was observed when an ERP was used. A comparative decrease in donation rates was observed whenever a breakdown in any of the four identified steps occurred. LIMITATIONS: The data analyzed was gathered retrospectively. Due to the retrospective nature of our study, there is no way to determine delay in authorization times versus no delay. Although most population data information about the authorized donors was known, this information was limited in patients who declined. CONCLUSIONS: With proper preparation and planning, the implementation of a standardized ERP may improve organ donation rates and increase the number of life-saving organs for transplant.

A 360° Rotational Positioning Protocol of Organ Donors May Increase Lungs Available for Transplantation.

OBJECTIVES: To evaluate the improvement in lung donation and immediate lung function after the implementation of a 360° rotational positioning protocol within an organ procurement organization in the Midwest. DESIGN: Retrospective observational study. SETTING: The Midwest Transplant Network from 2005 to 2017. Rotational positioning of donors began in 2008. SUBJECTS: Potential deceased lung donors. INTERVENTIONS: A 360° rotational protocol. Presence of immediate lung function in recipients, change in PaO2:FIO2 ratio during donor management, initial and final PaO2:FIO2 ratio, and proportion of lungs donated were measured. Outcomes were compared between rotated and nonrotated donors. MEASUREMENTS AND MAIN RESULTS: A total of 693 donors were analyzed. The proportion of lung donations increased by 10%. The difference between initial PaO2:FIO2 ratio and final PaO2:FIO2 ratio was significantly different between rotated and nonrotated donors (36 ± 116 vs 104 ± 148; p < 0.001). Lungs transplanted from rotated donors had better immediate function than those from nonrotated donors (99.5% vs 68%; p < 0.001). CONCLUSIONS: There was a statistically significant increase in lung donations after implementing rotational positioning of deceased donors. Rotational positioning significantly increased the average difference in PaO2:FIO2 ratios. There was also superior lung function in the rotated group. The authors recommend that organ procurement organizations consider adopting a rotational positioning protocol for donors to increase the lungs available for transplantation.

International cultural immersion: en vivo reflections in cultural competence.

A baccalaureate nursing program developed and implemented an international cultural immersion course in Guatemala to explore the impact of cultural immersion on student nurses' cultural competence. This qualitative descriptive study generated data through in-depth interviews and en vivo reflective journals. The three themes: Navigating daily life, Broadening the lens, and Making a difference, revealed an expanded context and worldview of culture. International service learning seemed to pervade all aspects of the students' experience. Exercises in participant-observation and reflective writing could enhance student self-awareness and their ability to benefit from a cultural immersion course.

Alterations in growth hormone secretory dynamics in adolescent girls with anorexia nervosa and effects on bone metabolism.

Anorexia nervosa (AN) is a disorder that is increasing in frequency in adolescents, and the age of onset is often in the prepubertal years, potentially affecting the development of peak bone mass and linear growth. The GH-IGF-I axis plays an important role in bone formation, and alterations in GH secretory patterns have been described in adult women with AN. However, GH secretory dynamics in adolescents with AN have not been described, and the effects of alterations in GH secretory patterns and GH concentration on bone metabolism in AN are not known. We examined patterns of GH secretion by deconvolutional analysis, and GH concentration by Cluster analysis, in adolescent girls with AN (n = 22) and controls (n = 20) of comparable bone age and pubertal stage. We also examined the roles of cortisol, leptin, and estradiol in the regulation of GH secretion and concentration, and the relationship of GH secretory patterns and concentration to bone metabolism. Basal GH secretion and secretory pulse number in adolescent girls with AN were increased compared with control values (P = 0.03 and 0.007, respectively), and increased disorderliness of GH secretion (approximate entropy) was found in AN (P = 0.004). Mean and nadir GH concentrations and total area under the concentration curve were increased (P = 0.03, 0.002, and 0.03, respectively), and IGF-I levels were decreased (P = 0.0002) in girls with AN compared with healthy adolescent girls. IGF-I levels correlated negatively with nadir GH concentrations (r = -0.35; P = 0.02). Serum cortisol levels were higher in girls with AN than in controls (P < 0.0001) and correlated inversely with IGF-I (r = -0.58; P = 0.0001) and weakly with GH concentration (area under the concentration curve; r = -0.43; P = 0.05). A strong inverse relationship between markers of nutritional status (body mass index, fat mass, and leptin) and basal and pulsatile GH secretion, and mean and nadir GH concentrations was observed. GH concentration predicted levels of all markers of bone formation and a marker of bone resorption (N-telopeptide) in healthy controls, but not in AN. We demonstrate increases in basal GH secretion, number of secretory bursts, and GH concentration in adolescents with AN compared with controls, accompanied by low IGF-I levels. These data are consistent with the hypothesis that an acquired GH resistance occurs in this undernourished group. We also demonstrate that GH secretion and concentration are nutritionally regulated, and that the effects of nutrition exceed the effects of cortisol on GH concentration. Acquired GH resistance may play a role in the osteopenia and decreased peak bone mass frequently associated with AN.