A Protocol to Assess Feasibility, Acceptability, and Usability of Mobile Technology for Symptom Management in Pediatric Transplant Patients.

BACKGROUND: Pediatric blood and marrow transplant (PBMT) patients experience significant symptom distress, and the use of mobile health (mHealth) technologies may enhance symptom management by providing patient-generated health data to foster personalized health strategies. OBJECTIVES: The aim of this study was to present a study protocol to explore feasibility, acceptability, and usability of integrating mHealth technologies to collect and monitor symptom data for PBMT patients. METHODS: An exploratory mixed-methods design is employed for 20 PBMT patients to monitor symptoms using real-time data from two mHealth devices: (a) a self-developed mHealth application and (b) a wearable tracking device. Patient-Reported Outcomes Measurement Information System surveys for fatigue, pain, and sleep disturbance are obtained monthly. Interviews are conducted to obtain further feasibility and usability data. RESULTS: The study began in October 2017; data collection should be completed in 2018. Feasibility and usability results to monitor and record symptom-related data daily via mobile devices will be reported. Patient-Reported Outcomes Measurement Information System surveys and interviews will further explore patients' symptoms and experiences with the mobile devices. DISCUSSION: This study will be among the first to explore the feasibility, acceptability, and usability of integrating multiple mHealth technologies to obtain patient-generated symptom data for the PBMT population. Results will enhance our understanding of how these data present, interact, and cluster together throughout the posttransplant period for these children and lead to symptom management strategies. Results will focus on a high-risk population that potentially stands to benefit from the use of mobile technologies.

Perfil biológico y social de la población trasplantada en el hospital Garrahan por hepatitis fulminante y su relación con la evolución postrasplante / Biological and social profile of patients who underwent liver transplantation because of acute liver failure at the Garrahan Hospital

El objetivo de este estudio fue describir el perfil biológico y social del paciente pediátrico con trasplante hepático por insuficiencia hepática aguda (IHA) y la evolución postrasplante. Material y Método: trabajo retrospectivo, descriptivo y observacional, se revisaron la base de datos de 142 pacientes trasplantados por IHA desde 1992 al 2008. Se describieron los datos demográficos y sociales, indicaciones de trasplante, tipo de injerto utilizado, compatibilidad del grupo ABO, evolución pos trasplante (resultados primarios), complicaciones del trasplante y sobrevida. Resultados: El 51% de los casos de IHA fue asociado a la hepatitis infecciosa por virus A (HAV) y el 41% correspondió a las IHA indeterminadas. El 85% de la población trasplantada (120 casos) recibió un donante de tipo cadavérico (DC) y la compatibilidad de grupo ABO fue del 85%. Las complicaciones más frecuentes fueron: biliares 33 casos, infecciones bacterianas 20 casos y vasculares 13 casos. El rechazo agudo estuvo presente en 72 casos mientras que el rechazo crónico se diagnosticó en 7 casos. La sobrevida de la IHA al año del postrasplante fue del 80% y a los 5 y 10 años fue del 77%. La conciencia de enfermedad reflejada en el cumplimiento de las consignas médicos sociales estuvo presente en un 86,25%. El 70% de los padres de los niños trasplantados eran biológicos y el 52% de la población provino del área centro (Buenos Aires, Córdoba, Entre Ríos, y Santa Fe). La cobertura estuvo a cargo del estado en el 45% de la muestra (AU)

The aim of this study was to describe the social and biological profile of pediatric patients who undergo liver transplantation because of acute liver failure (ALF) and post-transplant outcome. Material and Methods: A retrospective, descriptive, and observational study was conducted. The database of 142 patients who underwent liver transplantation because of ALF between 1992 and 2008 was reviewed. Demographic and social features, indication for transplantation, type of graft used, ABO group compatibility, post-transplant outcome (primary results), complications of the transplantation and survival were evaluated. Results: ALF was associated with infectious hepatitis A (HAV) in 51% of the cases and with indeterminate ALF in 41%. Overall, 85% of the transplanted patients (120 cases) received a deceased donor (DD) organ and ABO group compatibility was 85%. Most common complications were: biliary in 33 cases, bacterial infections in 20 cases, and vascular in 13 cases. Acute rejection was observed in 72 cases while chronic rejection was diagnosed in seven cases. Oneyear post-transplant survival after ALF was 80%, while 5- and 10-year survival was 77%. Disease awareness expressed in compliance with medical and social indications was observed in 86%. Seventy percent of the parents of transplanted children were there biological parents and 52% of the population came from the central area of the country (Buenos Aires, Córdoba, Entre Ríos, y Santa Fe). Forty-five percent of the sample had public health care coverage (AU)

Complicaciones osteomusculares en el trasplante cardíaco / Musculoskeletal complications in heart transplant

Objetivo. Conocer la incidencia, etiología y tratamiento de las complicaciones osteomusculares más frecuentes que pueden surgir en los pacientes en la fase pre y postrasplante cardíaco. Estrategia de búsqueda. Se realiza búsqueda bibliográfica de los trabajos relevantes en las bases de datos: PubMed, PEDro, Cochrane, Tripdatabase. Las palabras clave para la búsqueda han sido: trasplante cardíaco, complicaciones, osteomuscular, osteoporosis, densidad mineral ósea, osteonecrosis, efectos secundarios, inmunosupresores. Selección de artículos. Se consideran los artículos escritos en castellano e inglés relativos a pacientes adultos. Síntesis de resultados y conclusiones Las complicaciones osteomusculares que más morbilidad ocasionan a los pacientes con trasplante cardíaco son la osteoporosis, fracturas vertebrales, osteonecrosis y complicaciones de los fármacos inmunosupresores. Se revisa la bibliografía actual sobre el diagnóstico y tratamiento de estas patologías en los pacientes con trasplante cardíaco (AU)

Aim. To know the incidence, etiology ant treatment of the most frequent osteomuscular complications in pre and post- transplant phase patients. Search strategy. A bibliographic search was performed in the following databases: PubMed, PEDro, Cochrane, Tripdatabase. Keywords used for the search were: Heart, cardiac, transplant, complications, osteoporosis, osteomuscular, bone mineral density, osteonecrosis, side effects, immunosupressants. Study selection. All articles found in Spanish or English regarding adult patients were considered. Results summary and conclusions. Musculoskeletal complications resulting in the most morbidity heart transplant patients are: osteoporosis, vertebral fractures, osteonecrosis and immunosuppressant-induced complications. The current bibliography on the diagnosis and treatment of these conditions in heart transplant patients has been reviewed (AU)

Benefits of home-based endurance training in lung transplant recipients.

BACKGROUND: To investigate the effect of home-based exercise training on exercise tolerance, muscle function and quality of life in lung transplant recipients (LTR). METHODS: Twelve LTR and 7 age-matched healthy subjects underwent exercise training (ET, 12-wk, 3×/wk, 40 min). Peak aerobic capacity VO2peak, endurance time (T(end)), minute ventilation (VE) quadriceps strength, percentage of type I fiber (%Ifb), fiber diameters and chronic respiratory questionnaire were assessed before and after ET. A positive response to ET was defined as an improvement in T(end) at least comparable to the mean change observed in healthy subjects. RESULTS: Training significantly improved T(end) (+12 ± 11 min), isowatt during exercise (-5.5 ± 2.6L/min), muscle strength (+4.6 ± 2.6 kg) and dyspnea score (+0.6 ± 0.9) in LTR (p < 0.05), leading to recovery of T(end) and muscle strength up to healthy subjects' values. In responders (n = 6), VO2peak, %Ifb and fatigue score were improved after training (p < 0.05). Non-responders had lower %Ifb and greater delay between surgery and the beginning of the study than responders (56 [21-106] vs. 8 [2-59] months respectively, p = 0.03). CONCLUSIONS: Home-based ET was effective to improve exercise tolerance, muscle strength and quality of life in LTR but more successful in patients with moderate muscle dysfunction and in the first years after transplantation. Multicenter and controlled-studies are needed to confirm the benefits and optimal modalities of home training in LTR.

Técnica actual del trasplante de pelo de unidades foliculares / Follicular Unit Hair Transplantation: Current Technique

Desde que en 1959 Norman Orentreich describiera el fenómeno de dominancia donante en la alopecia androgenética, abriendo así el camino a los trasplantes capilares, el campo del trasplante de pelo ha estado en permanente evolución. Con los avances surgidos en estos últimos 15 años, principalmente con la disección microscópica de los injertos en unidades foliculares, se ha conseguido desterrar la idea de que el trasplante es una técnica agresiva que produce un resultado artificial. Gracias al uso exclusivo de unidades foliculares como el único elemento de trasplante, el trasplante de pelo se ha convertido en una técnica con resultados naturales, indetectables y reproducibles, muy diferentes a los alcanzados con las técnicas anteriores. Por todo ello, hoy día no existe excusa para dejar de ofrecer la posibilidad del trasplante a aquellos pacientes con alopecia androgenética, tanto hombres como mujeres, que sean buenos candidatos al mismo. En este artículo de revisión describimos de forma general el procedimiento actual del trasplante de pelo con unidades foliculares (AU)

Since 1959, when Norman Orentreich described the phenomenon of donor dominance in androgenic alopecia and opened the way to hair transplantation, the field of hair replacement surgery has been evolving continuously. Advances in the last 15 years, particularly the microscopic dissection of donor strips into follicular units, have eradicated the idea that follicular transplantation is an aggressive procedure that produces an artificial result. Hair transplantation procedures involving the transplant of only follicular units can now achieve natural, undetectable, and reproducible results, very different from the outcomes achieved with earlier techniques. Consequently, there is no excuse today for not offering hair transplantation to patients with androgenic alopecia, both male and female, who are good candidates for this technique. This review provides a general overview of the current procedure for follicular unit hair transplantation (AU)

Health technology assessment of a homecare device for telemonitoring and telerehabilitation for patients after hand transplantation.

Hand rehabilitation requires continuous and frequent monitoring of the functionality in order to assess therapy and/or refine it. In order to contain costs for the rehabilitation program, a telehomecare rehabilitation system is suitable. The purpose of this paper was to describe the setup and configuration of a homecare device for telemonitoring/telerehabilitation of patients who underwent hand transplant. The telehomecare device allows the assessment of dynamics and kinematics of hand function by integrating dedicated software in two components. The first was a commercial glove, the HumanGlove by Humanware (Pisa, Italy). The second was a set of instruments for the measurement of digit force using an Instrumented Keyboard and an Instrumented Mouse-Like device. The software integrating the devices is composed of two modular components. The first is to drive the devices; the second is for the data-analysis and display. The methodology was validated at the Istituto Superiore di Sanit (the Italian National Institute of Health) in the framework of an Italian National Project, funded by the Ministry of Health.

Aloenxerto de pele: um novo substituto dérmico? / Skin allograft: is it a new dermal substitute?

Introdução: a utilização de aloderme processada e armazenada em glicerol como substituto dérmico tem sido aventada na literatura, propiciando um avanço no tratamento de pacientes com grandes defeitos cutâneos. Objetivo: avaliar, através de comprovação histológica, a evolução clínica do aloenxerto de pele como substituto dérmico. Métodos: relatar um caso de avulsão completa de couro cabeludo tratado com aloenxertia de pele do Banco de Pele da Santa Casa de Porto Alegre e posterior autoenxertia. Foi realizada análise histológica do aloenxerto após 21 dias do alotransplante e acompanhamento clínico. Resultados: a paciente evoluiu com melhora do defeito e integração do aloenxerto. A análise histológica evidenciou integração com neovascularização da aloderme, sem sinais de rejeição dérmica.Houveepidermólisenaaloepiderme. A Aloderme permitiu bom substrato para autoenxertia, que em 6 meses teve pouca retração cicatricial e aceitável resultado estético. Discussão: o aloenxerto de pele parece ser um novo método de substituir-se derme, promovendo leito de boa qualidade para autoenxertia, funcionando, possivelmente, como um scaffold para regeneração dérmica. Conclusão: centímetros A análise histológica, após três semanas do aloenxerto, demonstrou integração com neovascularização, sem rejeição, possibilitando a autoenxertia sobre o aloderme. O autoenxerto evoluiu com pouca retração cicatricial e aceitável qualidade estética e funcional.

Background: the use of allografts processed and stored in glycerol as dermal substitute has been researched, propitiating an advance in the treatment of patients with great cutaneous defects. Objective: to evaluate, through histological evidence, the clinical evolution of alloderm of skin as dermal substitute. Methods: to tell a case of traumatic pulled away scalp hair treated with allograft with skin from the Santa Casa de Porto Alegre Skin Bank and posterior autograft. The allograft was histologically analyzed in 21 days, and the patient was clinical accompaniment for 6 months. Result: the patient evolves with improvement of the defect and integration of allograft. The histological analysis evidenced integration with neovascularization of alloderm, without signals of dermic rejection. It had epidermosis in aloepidermis with rejection. The Alloderm allowed good substratum for autograft, that in 6 months had little scar retraction and acceptable aesthetic result. Discussion: Allograft of skin seems to be a new method to dermal substitute, promoting a stream bed of good quality for autograft, functioning, possibly, as one scaffold for dermal regeneration. Conclusion: the histological analysis demonstrated to integration with neovascularization, without rejection, making possible the autograft on alloderm. Autograft evolved with little cicatricial retraction and acceptable aesthetic and functional quality.

Surgical approach to complicated intestinal failure for benign disease in adult patients: transplantation or surgical rehabilitation?

Surgical approaches to complicated benign intestinal failure are gaining acceptance, especially in the pediatric population. Less international experience has been obtained in adult patients, who are usually treated with total parenteral nutrition (TPN). An intestinal rehabilitation program was started in our institution with comprehensive medical rehabilitation, surgical bowel rescue, and transplantation. Among 38 adult patients referred by our gastroenterologists for bowel rehabilitation and surgically treated in our institution, 92.2% received TPN on admission. After careful evaluation, 71% underwent transplantation. Five patients died, but 18 recipients were completely weaned off TPN at follow-up. Eleven patients underwent surgical resection of the affected bowel and a subsequent program of intestinal rehabilitation: they were all alive and weaned off TPN at discharge. At a 2-year mean follow-up, deaths occurred only in the transplant population. Therefore, intestinal surgical rescue, if successful, is optimal in adult patients.

Trasplantes seguimiento del paciente trasplantado: recomendaciones desde Atención Primaria / Follow up on post-transplant patients. Recommendations from Primary Health Care

El avance obtenido en el trasplante de órganos sólidos, constituye uno de los éxitos médicos más relevantes de la década pasada. El aumento de la supervivencia a largo plazo, supone la aparición de una gran variedad de complicaciones médicoquirúrgicas, la mayoría relacionadas directa o indirectamente con la utilización continua de drogas inmunosupresoras, que se ha implicado como el factor determinante en estos pacientes para presentar mayor susceptibilidad a padecer infecciones, procesos malignos, hipertensión arterial, hiperuricemia-gota, etc.La mayoría de las enfermedades que presentan estos pacientes son similares a las del resto de la población, y pueden ser asumidas por el médico de familia; debemos por tanto conocer y saber manejar las principales complicaciones, y las actividades preventivas que debemos realizar para mejorar su supervivecia (AU)

A social worker's role on a transplant team.

Transplant team social workers are essential components of the team because of their knowledge and intervention skills in assisting patients. Sensitivity to the needs of the transplant patient is a catalyst for the development of creative intervention strategies.

Employing transplant recipients: a pilot study.

This pilot study aimed to give some indication of the reasons why many transplant recipients seem to have difficulty finding employment. Twenty-one transplant recipients and 17 employers completed a questionnaire covering a variety of health and employment-related topics. The transplant procedures the recipients had undergone included heart, heart/lung, heart/liver, and heart/kidney. The employers represented a selection of large and small companies drawn from the Standard Occupation Classification. The responses indicated that the employers' knowledge of transplantation varied according to size of the company, the nature of its work and which department had completed the questionnaire (occupational health or personnel). The views of recipients on employment prospects varied, with some claiming they had not attempted to find employment as they were happy with their new health and 'just enjoyed living', while others considered employment an important factor in the quality of their lives. Key indicators for future research efforts have been identified.

Twenty years of renal transplantation in children.

Two-hundred three children 1 to 16 years of age received kidney transplants during a 20-year period, 100 from living donors and 103 from cadaver donors. The overall survival rate was 79%. Actuarial patient and kidney survival rates at 15 years were 79% and 52%, respectively, for recipients of living donor kidneys and 57% and 19%, respectively, for recipients of cadaver donor kidneys. One of two children who received transplants in 1964 was alive 20 1/2 years later. Twenty-nine children had kidneys that had functioned more than 10 years; their mean serum creatinine concentration was 1.7 mg/dL and 24 were fully rehabilitated. Eighteen were more than 2 SD below the mean height of normal children, however. Comparison of survival rates during successive 5-year intervals showed significant improvement in patient survival during the 20-year period and smaller improvements in kidney survival after 1979. Patient survival after living donor transplants during the last 10 years was 100%, and kidney survival during the last 5 years was 92%. Improvement was attributed to the effect of experience, as well as to changes in immunosuppressive therapy in 1972 and the introduction of donor-specific transfusions in 1978.

Rehabilitation after dialysis and kidney transplantation

La rehabilitación después del transplante en pacientes con enfermedad renal terminal es estudiada en 106 sujetos que recibieron 117 transplantes. Cincuenta y tres porciento de nuestros pacientes estaban empleados antes del transplante. Después del transplante, no existió ningún aumento en el empleo de los pacientes. En general, los pacientes que recibieron transplantes, se sintieron mejor y estuvieron físicamente más activos que los pacientes en diálisis. Unicamente 19% de los pacientes en diálisis se sintieron que llevaban una vida normal, cuando 40% tuvieron la misma sensación después del transplante. A pesar de la mejoría obtenida después del transplante, todavía 31% los pacientes no fueron sexualmente funcionales