Withdrawn: Simulated Donor Family Encounters at Organ Transplantation Coordinators In-service Training Course: Process and Impact Evaluation.

OBJECTIVE: The study was aimed at introducing the modified version of the organ transplantation coordinator course including simulated donor family encounters (SDFEs), communication skills, and evaluating the participants' opinions, achievement levels, and how they implemented what they learned in the course in their work settings. METHODS: The course was modified using the ADDIE (analysis, design, development, implementation, and evaluation) model and was evaluated in three steps: The participants' views were obtained using the course overall evaluation form and communication skills evaluation form, their success was assessed with the post-test and SDFEs evaluation form, and the effects of what they learned during the course on their work settings were assessed through phone interviews. At this step, the participants were asked to write letters about the targets they intended to achieve in their work settings. The letters were analyzed with the content analysis method, and a questionnaire consisting of 105 targets was developed. A year later the participants were telephoned and asked to what extent they achieved their targets. RESULTS: The participants' satisfaction from the whole course was high (x: 8.65 ± 1.06). In the communication skills evaluation form, the participants stated that they would mainly use their communication and empathy skills during donor family encounters. The participants' mean post-test score was high (x: 96.0 ± 3.8). During the SDFEs, 70% of the respondents' performance was considered sufficient. Telephone interviews conducted with the questionnaire revealed that 77.6% of the targets were fulfilled. CONCLUSION: It can be said that the course affected the participants in terms of implementing their knowledge and communication skills related to family encounters.

Simulated Donor Family Encounters at Organ Transplantation Coordinators In-Service Training Course: Process and Impact Evaluation.

OBJECTIVE: This study introduced the modified version of the Organ Transplantation Coordinator course including simulated donor family encounters (SDFEs) and communication skills. It also evaluated participants' opinions and achievement levels, and how they implemented what they learned in the course in their work settings. METHODS: The course used the modified Analysis, Design, Development, Implementation, and Evaluation model and was evaluated in 3 steps. The participants' views were obtained using the course overall evaluation form and communication skills evaluation form, their success was assessed with the posttest and SDFEs evaluation form, and the effects of what they learned during the course on their work settings were assessed through telephone interviews. At this step, the participants were asked to write letters about the targets they intended to achieve in their work settings. The letters were analyzed with the content analysis method, and a questionnaire consisting of 105 targets was developed. A year later the participants were telephoned and asked to what extent they achieved their targets. RESULTS: The participants' satisfaction from the whole course was high (x: 8.65 ± 1.06). In the communication skills evaluation form, the participants stated that they would mainly utilize their communication and empathy skills during donor family encounters. The participants' mean posttest score was high (x: 96.0 ± 3.8). During the SDFEs, 70% of the respondents' performance was considered sufficient. Telephone interviews conducted with the questionnaire revealed that 77.6% of the targets were fulfilled. CONCLUSIONS: It can be said that the course affected the participants in terms of implementing their knowledge and communication skills related to family encounters.

The effect of maternal betamethasone administration on Doppler flow velocity parameters of the fetal branch pulmonary artery.

To investigate the effects of antenatal betamethasone on fetal pulmonary blood flow velocity waveforms. The study comprised 28 women with singleton pregnancies at high risk for preterm delivery. They were treated with two doses of 12 mg betamethasone intramuscularly 24 h apart to enhance lung maturity. Flow velocity waveforms were recorded with Doppler ultrasound from the middle segment of pulmonary artery (PA). Compared with the pretreatment mean value, a significant decrease in the pulmonary artery pulsatility (PI) and the resistance indexes (RI) was noted at 24 h and 48 h after the administration of first dose of betamethasone (p = 0.022 and p = 0.018 for PI and p = 0.001 and p = 0.004 for RI, respectively). After 7 days, the pulmonary artery velocity waveforms returned to the types of waveform observed before treatment (p = 0.216 for PI and p = 0.249 for RI). Maternal antenatal betamethasone resulted in a significant transient decrease in the pulsatility and the resistance indexes in the pulmonary artery. These findings indicate a direct effect of betamethasone on fetal pulmonary circulation.

A preterm infant with prolonged respiratory problems due to Ritscher-Schinzel syndrome.

Ritscher-Schinzel also known as cranio-cerebello-cardiac (3C) syndrome is a very rare clinical entity. The striking features of this syndrome are cerebellar, cardiac and craniofacial abnormalities. Life threatening features of this syndrome are generally associated with cardiac abnormalities. We here present prolonged respiratory problems due to pulmonary hypertension in a preterm baby with Ritscher-Schinzel syndrome.

Partial trisomy 8p (8p11.2-->pTER) and deletion of 13q (13q32-->qTER): case report.

We report a female infant with partial trisomy 8p (8p11.2-->pter) and deletion of 13q (13q32-->qter). She was born with mild hypotonia, intrauterine growth retardation, microcephaly, micrognathia, large low set ears, pectus excavatum, anteriorly placed anus, and bilateral clinodactyly. Echocardiography showed left ventricular hypertrophy, bicuspid aortic valve, dilatation of the aorta and pulmonary artery, and prolapse of atrio-venticular valve leaflets. Cytogenetic investigation of her sister and her father showed that the altered region resulted from a balanced translocation between the part of the long arm of chromosome 13 and short arm of chromosome 8. In partial trisomy 8p, the clinical picture of the patients comprises hypotonia, structural brain abnormalities, facial anomalies including a large mouth with a thin upper lip, a high arched palate, a broad nasal bridge, an abnormal maxilla or mandible, malformed, low set ears, and orthopedic anomalies. Although patients with proximal deletions of 13q that do not extend into band q32 have mild to moderate mental and growth delays with variable minor anomalies, patients with more distal deletions including at least part of band q32 usually have major malformations such as retinoblastoma, mental-motor growth retardation, malformation of brain and heart, anal atresia, and anomalies of the face and limbs. To our knowledge partial trisomy 8p and partial monosomy of 13q have not been reported previously in the same person.

The convention and the consequences of the 8th European Donor Day in Istanbul, Turkey.

The 8th European Donor Day took place in Istanbul, Turkey, on October 14, 2006. It was jointly sponsored by the Council of Europe and the Local Health Care Directorate of Istanbul. International problems of transplantation and organ donation were discussed in the public arena by professionals in five round tables. As a result, the importance of working together internationally to promote organ donation was strongly emphasized, and the immediate positive consequences of this kind of collaboration in Istanbul were discussed.

In-vitro and in-vivo evaluation of a matrix-controlled bromocriptine mesilate-releasing vaginal ring.

The aim of this study was to evaluate the in-vitro release rates and in-vivo effectiveness of a controlled release, intravaginal dosage form of bromocriptine mesilate. The dimeticone (poly(dimethylsiloxane)) elastomer vaginal ring contained 3 mg bromocriptine mesilate and low molecular weight gelatin in a ratio of 1:3, and 10% propylene glycol. The daily release rate of the drug was designed to be 10% of the total administered dose and was confirmed with release experiments under sink conditions. The effect of the vaginal ring preparation on plasma prolactin level in the rabbit was investigated over a 10-day period. The results showed that the vaginal ring of bromocriptine mesilate significantly decreased the plasma prolactin level of the test group (P < 0.001-0.05) compared with the control and placebo groups. It was concluded that bromocriptine mesilate was effectively absorbed from rabbit vagina and that this controlled release intravaginal ring preparation of bromocriptine mesilate was effective in decreasing the plasma prolactin level in rabbits for ten days.

Preparation and evaluation of bromocryptine mesylate-polydimethylsiloxane matrices.

The aims of the present study were to characterize the compatibility of silicone polymers with bromocryptine mesylate and excipients and to investigate the in vitro release characteristics of the drug from polydimethylsiloxane matrices. Silicon elastomers, MDX-4-4210 and A-2186, were chosen as polymer materials. Compatibility studies of polymers with drug and various liquid and solid excipients such as propylene glycol, polyethylene glycol, glycerol, sorbitan monolaurat, polysorbate 20, polysorbate 80, polyvinylpyrrolidone, citric acid, lactose, sodium chloride and low-molecular-weight gelatin were carried out. After the macroscopic examination of the excipient-polymer formulations, sorbitan monolaurat, propylene glycol, lactose, sodium chloride, citric acid and low molecular weight gelatin were chosen for investigation of the effect of these materials on drug release. Cylinder-shaped drug polymer matrices were prepared for the drug release studies. The best release profile was obtained with the formulation containing MDX-4-4210, 10% of propylene glycol and a kneading mixture of drug: low-molecular-weight gelatine in a ratio of 1:3.

Quantitation of Doppler color flow jet areas for mitral regurgitation in children: angiographic correlation.

Eighteen patients with chronic isolated rheumatic mitral regurgitation aged between 7 and 19 years (mean age +/-SD, 12.69+/-3.47 years) were analyzed with color Doppler imaging. Sixteen patients were performed cardiac catheterization within 24 h. Jets were classified as eccentric and central. Regurgitant jet area and its ratio to left atrial area and body surface area were measured by Doppler color flow imaging. Regurgitant volume and regurgitant fractions were calculated with angiography. There was a good correlation between regurgitant jet area and angiographic grade of mitral regurgitation (P<0.01). The correlation between regurgitant jet area/left atrial area ratios and angiographic grade of mitral regurgitation was limited (P<0.01). There was excellent correlation between regurgitant jet area/body surface area and angiographic regurgitant fraction (r = 0.85; P<0.001). There was also a good correlation between regurgitant jet area and regurgitant fraction (r = 0.82; P<0.001). However, the relation of regurgitant jet area/left atrial area to regurgitant fraction was weak (r = 0.72; P<0.01). In conclusion, the measurement of regurgitant fraction and its ratios to left atrial area and body surface area by color Doppler flow imaging can predict the angiographic severity in children who have even eccentric regurgitant jets.

Relation of mass/volume ratio to ECG abnormalities and symptoms in children with aortic stenosis/insufficiency.

In this study, to determine whether symptoms and ECG abnormalities relate to left ventricular (LV) mass, volume, and mass/volume (M/V) ratio in children with aortic stenosis (AS) and/or insufficiency (AI), the authors examined 23 patients with echocardiography. LV volumes and mass were calculated with echocardiography. Also, the peak and mean gradients across the aortic valve and left ventricular meridional wall stress (ESWS) were determined by use of echo Doppler techniques. Fourteen patients (mean age 5.84+/-3.49 years) had AS alone. Of these, 14 had symptoms and seven had abnormal-appearing ECGs. Nine patients (mean age 6.91+/-4.35 years) had AS/AI. Of these nine, four had symptoms and two had ECG abnormalities. The authors observed that the incidences of symptoms and ECG abnormalities were higher in the patients with AS than in those with AS/AI. There was no significant correlation between symptoms and ECG abnormalities with peak gradient, mean gradient, valve area, LV mass, volume, and mass/volume ratio in patients with AS/AI. However, significant correlation was found between symptoms and ECG abnormalities and ESWS in AS/AI patients. In conclusion, ECG abnormalities and symptoms do not always indicate the severity of AS and AS/AI.

Congenital isolated apical ventricular septal defects.

The diagnosis of apical ventricular septal defects (VSDs) is difficult and the ratio of spontaneous closure is not well known. At the Ankara University Pediatric Cardiology Department, between the years 1992 and 1997, 33 patients were identified by color-flow Doppler (CFD) imaging as having a small defect at the apical portion of the ventricular septum. The age range was 1 day to 13 years. All patients were asymptomatic with normal telecardiograms and electrocardiograms. There were grade 2-3/6, pansystolic murmurs at the apex or closer to the apex in 19 patients. In 30 patients, narrow and short colored jets were seen at the apex of the heart, distal to the moderator band. The jets were wide in three patients. These defects were difficult to image and required specific angulation of the transducer. Of the 23 patients who had follow-up examinations, at 3 months to 3.5 years, there was spontaneous closure in ten (43.5%). To the authors' knowledge, this report is the largest series of isolated apical trabecular ventricular septal defects (t-VSDs). In their experience, color-flow imaging is more sensitive in detecting a small apical VSD. They conclude that although the closure of apical VSD is not the rule, the prognosis is excellent.