Psicologia e diabetes no Brasil: um mapeamento de profissionais e de suas ações / Psychology and diabetes in Brazil: the mapping of professionals and their practices / Psicología y diabetes en Brasil: un mapeo de los profesionales y sus acciones

Pouco se sabe sobre a atuação do psicólogo no Brasil junto a pessoas com Diabetes Mellitus. O objetivo desta pesquisa foi identificar os psicólogos brasileiros que trabalham com essa população e suas ações. Foram convidados a responder a um questionário online psicólogos que atuam ou atuaram junto a pessoas com diabetes. Participaram 79 psicólogos, principalmente da região Sudeste (59,5%). Todos declararam que haviam cursado pósgraduação. Na amostra, predominou o gênero feminino (89,9%), com idade entre 26 e 40 anos (46,8%). A maioria dos que atuam com diabetes declarou-se autônoma ou voluntária, e quase metade trabalhava menos do que 10 horas semanais. Entre aqueles que deixaram de trabalhar com diabetes, apenas uma minoria tinha vínculo empregatício. Além do trabalho com pessoas com diabetes, a maior parte declarou exercer outras atividades profissionais, como atendimentos clínicos em consultórios particulares, sugerindo que esta não é a atividade principal. Majoritariamente, os respondentes declararam não ter conhecimentos suficientes para o atendimento específico às pessoas com diabetes. Discute-se a qualidade da formação profissional dos psicólogos no Brasil, a necessidade de aprimoramento em relação à atuação com pessoas com diabetes e as condições de trabalho.(AU)

Little is known about the practice of psychologists in Brazil caring for people with Diabetes Mellitus. The aim of this research was to identify the Brazilian psychologists who work with this population and describe their actions. Psychologists who work or have worked with people diagnosed with diabetes were invited to answer an online questionnaire. The 79 participants lived mainly in the Southeast Region (59.5%). All of them declared to have a graduate degree, most were female (89.9%), aged 26 to 40 years (46.8%). Most of those working with diabetes declared to be autonomous or voluntary, and almost half had a workload of less than 10 hours a week. Among those who stopped working with diabetes, only a minority had a formal employment contract. In addition, most of them stated that they had other professional activities related to clinical care in private offices, suggesting that working with diabetes is not their main activity. Mostly, respondents stated that they did not have enough knowledge to care for people with diabetes. The quality of professional education of psychologists in Brazil, the need for specific improvement in labor relations and conditions were discussed.(AU)

Son escasas las informaciones del trabajo de los psicólogos en Brasil con las personas con Diabetes Mellitus. El objetivo de este estudio fue identificar los psicólogos brasileños que trabajan con esta población y describir sus acciones. Se invitó a psicólogos que trabajan o hayan trabajado con personas con diabetes a responder un cuestionario en línea. Participaron 79 psicólogos, principalmente de la región Sureste de Brasil (59,5%). Todos declararon tener posgrado. En la muestra hubo una mayor prevalencia del género femenino (89,9%), de edades de entre 26 y 40 años (46,8%). La mayoría de los que trabajan con personas con diabetes se declararon autónomos o voluntarios, y casi la mitad trabajaba menos de 10 horas a la semana. Entre los que dejaron de trabajar con las personas con diabetes, solo una minoría tenía una relación laboral. Además de trabajar con personas con diabetes, la mayoría afirmó tener otras actividades profesionales, como la atención clínica en consultorios privados, lo que sugiere que esta no es su actividad principal. La mayoría de los encuestados afirmaron que no tenían los conocimientos suficientes para atender específicamente a las personas con diabetes. Se discuten la calidad de la formación profesional de los psicólogos en Brasil, la necesidad de mejora en relación con el trabajo con personas con diabetes y las condiciones laborales.(AU)

Actitud hacia la Ley Anita en estudiantes de la Facultad de Ciencias de la Salud Universidad Nacional del Caaguazú, año 2021 / Attitude towards the Anita Law in students of the Facultad de Ciencias de la Salud Universidad Nacional of Caaguazú, year 2021

Introducción: la donación de órganos sigue siendo un problema incluso en aquellos sistemas más exitosos en la detección de donantes. Objetivo: identificar la actitud hacia la Ley Anita en estudiantes de la Facultad de ciencias de la salud Universidad Nacional del Caaguazú, año 2021. Metodología: estudio observacional, tipo descriptivo y de corte transversal. Se llevó a cabo en la Facultad de Ciencias de la Salud, de la Universidad Nacional de Caaguazú, en el periodo comprendido durante los meses de junio a agosto del año 2021. El instrumento fue un cuestionario de preguntas cerradas con opciones múltiples. Resultado: en cuanto a la actitud respecto a la donación de órganos el 81.9 % donaría sus órganos y el 95.1 % donaría sus órganos si es un familiar el que necesita del mismo, el 69.8 % afirmó donarían los órganos de sus familiares. La opinión de la familia es favorable para el 43.4 % es favorable mientras que el 52.2 % de la población manifestó que su religión condice con la donación de órganos. El 92.3 % está a favor de la ley Anita. Conclusión: la actitud favorable hacia la donación de órganos estuvo relacionada con la opinión favorable de la familia y de la religión, además de ser positiva para los que están de acuerdo con la donación de sangre. La opinión de la familia y la religión influye también en la actitud favorable hacia la donación de órganos de familiares, además de asociarse hacia la actitud favorable hacia la Ley Anita.

Introduction: organ donation continues to be a problem even in the most successful systems in donor detection. Objective: to identify the attitude towards the Anita Law in students at the College of Health Sciences, Universidad Nacional de Caaguazú, during 2021. Methodology: this was an observational, descriptive and cross-sectional study. It was carried out at the College of Health Sciences, Universidad Nacional de Caaguazú, from June to August, 2021. The instrument was a questionnaire of closed questions with multiple-choice answers. Result: regarding attitudes towards organ donation, 81.9 % would donate their organs and 95.1 % would donate their organs if a family member required so, 69.8 % said they would donate the organs of their relatives. Family opinions were favorable for 43.4 % while 52.2 % of the population stated that their religious denomination agrees with organ donation. 92.3 % support the Anita law. Conclusion: the favorable attitude towards organ donation was related to the favorable opinions of the family and religious denomination, in addition to being positive for those who agree with blooddonation. The opinion of the family and religious denomination also influences the favorable attitude towards family organ donation, in addition to being associated with a favorable attitude towards the Anita Law.

Tecnologias de cuidado capazes de subsidiar segurança no contexto dos transplantes de órgãos / Care technologies capable of subsidizing safety in the context of organ transplants / Tecnologías asistenciales capaces de subsidiar la seguridad en el contexto de los

Objetivo: Mapear tecnologias de cuidado capazes de subsidiar segurança nas etapas do processo de transplante de órgãos. Métodos: Revisão de escopo desenvolvida em cinco etapas por meio de buscas em seis bases de dados, entre outubro e novembro de 2020. Resultados: Entre as publicações selecionadas, 2020 foi o ano com superior número de estudos (25,92%), a base de dados PubMed dispôs da maior seleção de artigos (37,03%) e o país com maior número de publicações foi o Estados Unidos (51,85%). Quanto às tecnologias de cuidado identificadas, 77,77% foram leves-duras e 22,22% duras. Referente ao tipo de tecnologia, 51,85% são digitais, 22,22% máquinas/equipamentos, 14,81% modelos preditivos e outras relacionadas com protocolo e tecnologia robótica (11,11%). Conclusão: Em relação às potencialidades das tecnologias, as mesmas oportunizam monitoramento, rastreamento de dados, educação em saúde, educação permanente, comunicação rápida e efetiva viabilidade dos órgãos, bem como qualidade nas etapas dos processos de transplante e segurança. O impacto desse estudo é a visualização do panorama do desenvolvimento tecnológico em saúde no cenário dos transplantes de órgãos, evidenciando as áreas que estão sendo estudadas e os problemas nesse contexto que estão sendo resolvidos através das tecnologias em saúde. (AU)

Objective: To map care technologies capable of subsidizing safety in the stages of the organ transplantation process. Methods: Scope review developed in five stages through searches in six databases, between October and November 2020. Results: Among the selected publications, 2020 was the year with the highest number of studies (25.92%), the PubMed database had the largest selection of articles (37.03%) and the country with the largest number of publications was the United States (51.85%). As for the care technologies identified, 77.77% were light-hard and 22.22% were hard. Regarding the type of technology, 51.85% are digital, 22.22% machines / equipment, 14.81% predictive models and others related to protocol and robotic technology (11.11%). Conclusion: In relation to the potential of the technologies, they provide monitoring, data tracking, health education, permanent education, rapid and effective communication of organs, as well as quality in the stages of the transplant and safety processes. The impact of this study is the visualization of the panorama of technological development in health in the context of organ transplants, highlighting the areas that are being studied and the problems in this context that are being solved through health technologies. (AU)

Objetivo: Mapear tecnologías asistenciales capaces de subsidiar la seguridad en las etapas del proceso de trasplante de órganos. Métodos: Revisión de alcance desarrollada en cinco etapas mediante búsquedas en seis bases de datos, entre octubre y noviembre de 2020. Resultados: Entre las publicaciones seleccionadas, 2020 fue el año con mayor número de estudios (25,92%), la base de datos PubMed tuvo la mayor selección de artículos (37,03%) y el país con mayor número de publicaciones fue Estados Unidos (51,85%). En cuanto a las tecnologías asistenciales identificadas, el 77,77% fueron ligeras y duras y el 22,22% fueron duras. En cuanto al tipo de tecnología, el 51,85% son digitales, el 22,22% máquinas / equipos, el 14,81% modelos predictivos y otros relacionados con la tecnología de protocolo y robótica (11,11%). Conclusión: En relación al potencial de las tecnologías, brindan monitoreo, rastreo de datos, educación en salud, educación permanente, comunicación rápida y efectiva de órganos, así como calidad en las etapas de los procesos de trasplante y seguridad. El impacto de este estudio es la visualización del panorama del desarrollo tecnológico en salud en el contexto de los trasplantes de órganos, destacando las áreas que se están estudiando y los problemas en este contexto que se están resolviendo a través de las tecnologías sanitarias. (AU)

The current state of pediatric transplant hepatology fellowships: A survey of recent graduates.

BACKGROUND: The number of programs offering a PTH fellowship has grown rapidly over the last 10 years. This study aimed to describe the clinical, didactic, procedural, and research experiences of recent PTH fellowship graduates. In addition, we sought to understand graduates' post-fellowship professional responsibilities and their perception about the utility of the PTH fellowship. METHODS: An anonymous survey was distributed from February to October 2020 through REDCap to all recent graduates (2015-2019) of an ACGME-approved PTH fellowship program. The survey consisted of 49 questions focused on the PTH fellowship experience. Results were summarized using descriptive statistics. RESULTS: Thirty-eight of 43 graduates (88%) responded to the survey representing 12 PTH fellowship programs. The didactic experience varied; 97% received pathology lectures, 81% radiology lectures, 54% organ allocation lectures, 54% procedural lectures, 57% immunology lectures, and 43% live donation lectures. During the PTH fellowship, the majority of fellows performed >10 liver biopsies (82%) and >5 variceal bandings (58%); however, 63%, 32%, 8%, and 8% never performed paracentesis, variceal sclerotherapy, variceal banding, and liver biopsies, respectively. The majority of fellows (95%) completed a research project during PTH fellowship. Currently, 84% of graduates are employed at a transplant academic institution. All graduates recommended the fellowship. CONCLUSIONS: There is variability in the didactic, clinical, and procedural training among PTH fellowship programs. Although uniformly viewed as a beneficial fellowship year, there is an opportunity to collaborate to create a more standardized training experience.

Assessment of National Organ Donation Rates and Organ Procurement Organization Metrics.

Importance: Organ transplant is a life-saving procedure for patients with end-stage organ failure. In the US, organ procurement organizations (OPOs) are responsible for the evaluation and procurement of organs from donors who have died; however, there is controversy regarding what measures should be used to evaluate their performance. Objective: To evaluate OPO performance metrics using combined mortality and donation data and quantify the associations of population demographics with donation metrics. Design, Setting, and Participants: This national cohort study includes data from the US organ transplantation system from January 2008 through December 2017. All individuals who died within the US, as reported by the National Death index, were included. Exposures: Death, organ donation, and donation eligibility. Main Outcomes and Measures: Evaluation of the variation in donation metrics and the use of ineligible donors by OPO and demographic subgroup. Results: This study included 17 501 742 deaths and 75 769 deceased organ donors (45 040 men [59.4%]; 51 908 White individuals [68.5%]). Of these donors, 15 857 (20.9%) were not eligible, as defined by the OPOs. The median donation metrics by OPO were 0.004 (range, 0.002-0.012) donors per death, 0.89 (range, 0.68-1.30) donors per eligible death, and 0.72 (range, 0.57-0.86) eligible donors per eligible death. The OPOs in the upper quartile of the overall eligible donors per eligible death metric were in the upper quartile of annual rankings on 90 of 140 occasions (64.3%). There was little overlap in top-performing OPOs between metrics; an OPO in the upper quartile for 1 metric was also in the upper quartile for the other metrics on 37 of 570 occasions (6.5% of the time). The median donor eligibility rate, defined as the number of eligible donors per donor, was 0.79 (range, 0.61-0.95) across OPOs. Age (eg, 65 to 84 years, coefficient, -0.55 [SE, 0.03]; P < .001; vs those aged 18 to 34 years), sex (male individuals, -0.09 [SE, 0.02]; P < .001; vs female individuals), race (eg, Black individuals, 0.35 [SE, 0.02]; P < .001; vs White individuals), cause of death (eg, central nervous system tumor, 0.48 [SE, 0.08]; P < .001; vs anoxia), year (eg, 2016-2017: -0.10 [SE, 0.03]; P < .001; vs 2008-2009), and OPO were associated with the use of ineligible donors; OPO was a significant factor associated with performance in all metrics (χ256, 500.5; P < .001; coefficient range across individual OPOs, -0.15 [SE, 0.09] to 0.75 [SE, 0.09]), even after accounting for population differences. Female and non-White individuals were significantly less likely to be used as ineligible donors. Conclusions and Relevance: We demonstrate significant variability in OPO performance rankings, depending on which donation metric is used. There were significant differences in OPO performance, even after accounting for differences in potential donor populations. Our data suggest significant variation in use of ineligible donors among OPOs, a source for increased donors. The performance of OPOs should be evaluated using a range of donation metrics.

Management of nurse care in the organ and tissue donation process / Gestión de la atención de enfermería en el proceso de donación de órganos y tejidos / Gerenciamento do cuidado do enfermeiro no processo de doação de órgãos e tecidos

ABSTRACT Objective: to identify the activities developed by nurses in care management in the organ and tissue donation process. Method: this is a quantitative, retrospective, exploratory and descriptive study, carried out in two hospital institutions in southern Brazil, between June 2013 and June 2016. The sample consisted of 104 records of patients notified to the State Transplant Center. For data analysis, descriptive statistics were used. Results: at Institution A, 70.2% (73) of medical records were analyzed and at Institution B, 29.8% (31). As for activities developed by nurses, it is noteworthy that in the first, they carried out 1,299 management activities (93.7%) and in the second, 317 (53.9%). As for assistance activities, in the first, 507 (83.1%) and in the second, 217 (63.1%) activities. With regard to nursing care, care should be taken to maintain temperature, water balance and glycemic control. Conclusion: it was possible to identify that nurses develop a greater number of actions aimed at management issues in the donation process. As for assistance, there was a greater concern with maintaining the temperature.

RESUMEN Objetivo: identificar las actividades que desarrollan las enfermeras en la gestión del cuidado en el proceso de donación de órganos y tejidos. Método: estudio cuantitativo, retrospectivo, exploratorio y descriptivo, realizado en dos instituciones hospitalarias del sur del país, entre junio de 2013 y junio de 2016. La muestra estuvo conformada por 104 registros de pacientes notificados al Centro Central de Trasplantes. Para el análisis de datos se utilizó estadística descriptiva. Resultados: en la Institución A se analizó el 70,2% (73) de las historias clínicas y en la Institución B, el 29,8% (31). En cuanto a las actividades desarrolladas por las enfermeras, se destaca que en la primera realizaron 1.299 actividades gerenciales (93,7%), y en la segunda 317 (53,9%). En cuanto a las actividades asistenciales, en la primera, 507 (83,1%) y en la segunda, 217 (63,1%) actividades. Con respecto a los cuidados de enfermería, se debe tener cuidado de mantener la temperatura, el equilibrio hídrico y el control glucémico. Conclusión: se pudo identificar que la enfermera desarrolla un mayor número de acciones enfocadas a temas de gestión en el proceso de donación. En cuanto a los cuidados asistenciales, hubo una mayor preocupación por mantener la temperatura.

RESUMO Objetivo: identificar as atividades desenvolvidas pelos enfermeiros no gerenciamento do cuidado no processo de doação de órgãos e tecidos. Método: estudo quantitativo, retrospectivo, exploratório e descritivo, realizado em duas instituições hospitalares do sul do país, no período entre junho de 2013 e junho de 2016. A amostra foi composta por 104 prontuários de pacientes notificados à Central Estadual de Transplantes. Para análise dos dados se utilizou estatística descritiva. Resultados: na Instituição A foram analisados 70,2% (73) dos prontuários e na Instituição B, 29,8% (31). Quanto às atividades desenvolvidas pelos enfermeiros, destaca-se que na primeira realizaram 1.299 atividades gerenciais (93,7%) e na segunda, 317 (53,9%). Quanto às atividades assistenciais, na primeira, 507 (83,1%) e na segunda, 217 (63,1%) atividades. Com relação aos cuidados de enfermagem, destacam-se os cuidados para manutenção da temperatura, balanço hídrico e controle glicêmico. Conclusão: foi possível identificar que o enfermeiro desenvolve maior número de ações voltadas às questões de gerenciamento no processo de doação. Quanto aos cuidados assistenciais, houve uma maior preocupação com a manutenção da temperatura.

Guia de consulta rápida: Sistema Único de Saúde (SUS): Estado de Goiás / Quick consultation guide: Unified Health System (SUS): State of Goiás

A criação deste material foi pautada na Lei de introdução às normas do Direito Brasileiro, que expressa, em seus artigos 20 a 22, que a decisão judicial sobre fornecimento de medicamentos e serviços de saúde deverá trazer fundamentação sobre as suas consequências práticas, considerando os obstáculos e as dificuldades reais do gestor e as exigências das políticas públicas, não podendo fundar-se apenas em valores jurídicos abstratos. E tem como objetivo apresentar os procedimentos administrativos de acesso à assistência no SUS, bem como apontar o ente federativo responsável

The creation of this material was based on the Law of introduction to the norms of Brazilian Law, which expresses, in articles 20 to 22, that the judicial decision on the supply of medicines and health services should bring reasons on its practical consequences, considering the obstacles and real difficulties of the manager and the requirements of public policies, and cannot be based only on abstract legal values. And it aims to present the administrative procedures of access to assistance in the SUS, as well as to point out the federative entity responsible.

Construção e validação do questionário de conhecimento, atitude e prática na doação de órgãos / Construction and validation of the questionnaire of knowledge, attitude and practice in the donation of organs

Objetivo: Construir e validar um questionário para avaliação do Conhecimento, Atitude e Prática sobre o processo de Doação de órgãos e Tecidos. Método: Estudo metodológico para construção e validação do questionário a ser aplicado para os profissionais que atuam nas Comissões Intra-Hospitalares de Órgãos e Tecidos para Transplantes. Na primeira etapa, foi realizado um levantamento bibliográfico e formulação do conteúdo das questões. Na segunda, ocorreu a seleção dos juízes e validação de face e conteúdo do questionário através do cálculo de Índice de Validade de Conteúdo (IVC), com valor de corte superior a 0,79. Na terceira etapa, foi realizada a síntese das revisões dos juízes e estruturação do instrumento. Resultados: Foi elaborado um instrumento de 25 questões divididos em conhecimento, atitude e prática. Como juízes participaram nove profissionais. Todos os IVCs foram superiores a 0,889. Conclusão: O questionário foi construído e apresenta evidências de validade. (AU)

Objective: To construct and validate a questionnaire for the evaluation of Knowledge, Attitude and Practice on the process of Organ and Tissue Donation. Methodology: Methodological study for the construction and validation of the questionnaire to be applied to professionals working in the Intra-Hospital Organ and Transplant Tissue Commissions. In the first stage, a bibliographical survey and formulation of the content of the questions was carried out. In the second, the selection of the judges and validation of the face and content of the questionnaire were performed by calculating the Content Validity Index (IVC), with a cutoff value above 0.79. In the third stage, the synthesis of the judges' reviews and the structuring of the instrument were carried out. Results: An instrument of 25 questions divided into knowledge, attitude and practice was elaborated. As judges nine professionals participated. All IVCs were greater than 0.889. Conclusion: The constructed questionnaire presents evidence of validity. (AU)

Objetivo: Construir y validar un cuestionario para la evaluación del Conocimiento, Actitud y Práctica sobre el proceso de donación de órganos y tejidos. Metodologia: Estudio metodológico para la construcción y validación del cuestionario a ser aplicado para los profesionales que actúan en las Comisiones Intra-Hospitalarias de Órganos y Tejidos para trasplantes. En la primera etapa, se realizó un levantamiento bibliográfico y formulación del contenido de las cuestiones. En la segunda, ocurrió la selección de los jueces y validación de cara y contenido del cuestionario a través del cálculo del Índice de Validez de Contenido (IVC), con valor de corte superior a 0,79. En la tercera etapa, se realizó la síntesis de las revisiones de los jueces y la estructuración del instrumento. Resultados: Se elaboró un instrumento de 25 preguntas divididas en conocimiento, actitud y práctica. Como jueces participaron nueve profesionales. Todos los IVC fueron superiores a 0,889. Conclusión: El cuestionario construido y presenta evidencias de validez. (AU)

Manejo clínico-terapéutico del donante multiorgánico / Multiorgan donor clinical-therapeutic management

La mayor parte de los potenciales do-nantes de órganos proceden de las Uni-dades de Emergencias y Cuidados Inten-sivos, lugar en donde se ubican la ma-yoría de los pacientes con trastorno neu-rológico agudo y grave1.Durante el diagnóstico de muerte ence-fálica (ME) comienza el auténtico man-tenimiento del donante, ya que hay mo-mentos críticos, como la realización del test de apnea. Durante la fase previa al es-tablecimiento de ME el paciente ha sido tratado de manera agresiva con todos los métodos a nuestro alcance, muchos de ellos encaminados a preservar la perfu-sión cerebral manitol, tiopental sódico, etc., nos encontramos a menudo con po-tenciales donantes con gran inestabilidad hemodinámica e importantes alteraciones del medio interno1.El mantenimiento del donante multior-gánico constituye un desafío para el equipo de la Unidad de Cuidados In-tensivos. Este proceso implica poner en práctica el conocimiento total del manejo de disfunción multiorgánica en un paciente muerto. El tiempo de dete-rioro de los órganos juega también un rol en el tratamiento de todas las compli-caciones que se presentan en este tipo de pacientes. La adherencia a un protocolo de manejo es fundamental para lograr que un mayor número de donantes se trasladen a quirófano para la extracción de órganos viables2.

INTRODUCTION:Most of the potential organ donors come from the Emergency and Intensive Care Units, where most of the patients with acute and severe neurological disorder are located1.During the diagnosis of brain death, the authentic maintenance of the donor begins, as there are critical moments, such as the apnea test. Since during the pre-establishment phase of brain death the patient has been treated aggressi-vely with all the methods at our dis-posal, many of them aimed at preser-ving cerebral perfusion manitol, thio-pental sodium, etc., we often find our-selves with potential donors with high hemodynamic instability and significant changes in the internal environment1.The maintenance of the multiorgan donor is a challenge for the Intensive Care Unit team. This process involves putting into practice the total knowledge of the management of multi-organ dys-function in a dead patient. The time of deterioration of the organs also plays a role in the treatment of all the complica-tions that occur in this type of patients. Adherence to a management protocol is essential to ensure that a greater number of donors are transferred to the opera-ting room for the extraction of viable organs2.

Avaliação de uma coorte de transplante cardíaco por escore relacionado ao doador / Assessment of a heart transplantation cohort using a donor-related scoring system

Existem poucos sistemas de avaliação de mortalidade após transplante cardíaco (TC) que se baseiem em fatores relacionados com o doador e que sejam capazes de predizer o prognóstico. Identificar características dos doadores que têm impacto na sobrevida depois do TC pode contribuir para melhorar os resultados e a alocação de órgãos. Aplicamos um sistema de avaliação americano para predizer a mortalidade pós-TC em uma coorte brasileira. Objetivo: Avaliar um escore americano como preditor de mortalidade depois de TC em uma coorte brasileira. Métodos: Análise de uma base de dados de um centro de TC brasileiro de 2013 a 2015. Foram avaliadas quatro características dos doadores: tempo de isquemia, idade do doador, discordância racial doador/receptor e a função renal do doador. A sobrevida foi estimada pelo teste de log-rank em faixas de pontuação pré-determinadas. Resultados: Foram 110 doadores, 89% homens e 62% brancos. A principal causa de morte foi trauma (66,6%). Os doadores tinham em média 29,8 anos, 18,6 de relação Nitrogênio da ureia sanguínea / Creatinina, 175 minutos de tempo de isquemia e 42% de discordância racial com o receptor. Não houve diferença de sobrevida entre as faixas de pontuação. Conclusão: Apesar de preditor de mortalidade após transplante cardíaco em uma população americana, esse escore não foi útil para uma coorte de transplante brasileira. As diferenças, inclusive a alta taxa de miscigenação pode ser uma explicação para esses achados

here are few systems to assess mortality after heart transplantation (CT) that are based on donor-related factors and can predict prognosis. Identifying donor characteristics that impact post-CT survival can contribute to improved outcomes and organ allocation. We applied a US evaluation system to predict mortality after CT in a Brazilian cohort. Objective: To evaluate an American score as a predictor of mortality following CT in a Brazilian cohort. Method: Database analysis of a Brazilian CT center from 2013 to 2015. Four donor characteristics were evaluated: ischemia time, donor age, donor-recipient race mismatch, and donor renal function. Survival was estimated by the log-rank test in predetermined score ranges. Results: There were 110 donors, 89% male and 62% white. The main cause of death was trauma (66.6%). Donors had a mean age of 29.8 years, a mean blood urea nitrogen / creatinine ratio of 18.6, a mean ischemia time of 175 minutes, and race mismatch with the recipient of 42%. There was no difference in survival between the score ranges. Conclusion: Although it was a predictor of mortality after cardiac transplantation in an American population, this score was not useful for a Brazilian transplant cohort. Differences, including the high rate of miscegenation, may explain these findings

[THE LEGAL FRAMEWORK FOR THE RESOLUTION OF THE VARIOUS TYPES OF RELATIONSHIPS].

The objective of the article is to study the main organizational and legal problems of carrying out transplantation of organs and anatomical materials in Ukraine. To achieve this objective, the author has formulated the methodological complex, which included both general scientific methods and special methods of cognition. The application of the historical method made it possible to analyze the retrospective of legal provision of transplantation, to find out the errors (shortcomings) and to establish achievements both in theory and in the activities of medical institutions in the field of transplantation. Systemic and functional analysis allowed us to characterize transplantation as the comprehensive system and its components. By using the comparative and legal method, the author has analyzed international legal acts on the organization and conduction of transplantation in order to formulate propositions for the improvement of Ukrainian legislation. The author in the course of the research has highlighted legal problems that lie in the lack of legal regulation of mutual relations in the process of transplantation between donors, recipients and health care professionals. The author has stressed on the need to revise the principles of conducting transplantation in Ukraine, which is necessary to provide an orderly, acceptable structural basis for the procedures of the acquisition and transplantation of human cells, tissues and organs for therapeutic purposes in compliance with ethical principles. The current situation in the health care system directly indicates the fact that prohibitions and control do not save lives of people. It is necessary to stipulate by the law the possibility of realizing human rights under the condition of inadmissibility of the state's monopoly on transplantation surgeries.

Excluding patients from transplant due to social support: Results from a national survey of transplant providers.

Social support is used to determine transplant eligibility despite lack of an evidence base and vague regulatory guidance. It is unknown how many patients are disqualified from transplantation due to inadequate support, and whether providers feel confident using these subjective criteria to determine eligibility. Transplant providers (n = 551) from 202 centers estimated that, on average, 9.6% (standard deviation = 9.4) of patients evaluated in the prior year were excluded due to inadequate support. This varied significantly by United Network for Organ Sharing region (7.6%-12.2%), and by center (21.7% among top quartile). Significantly more providers used social support in listing decisions than believed it ought to be used (86.3% vs 67.6%). Nearly 25% believed that using social support in listing determinations was unfair or were unsure; 67.3% felt it disproportionately impacted patients of low socioeconomic status. Overall, 42.4% were only somewhat or not at all confident using social support to determine transplant suitability. Compared to surgical/medical transplant providers, psychosocial providers had 2.13 greater odds of supporting the criteria (P = .03). Furthermore, 69.2% supported revised guidelines for use of social support in listing decisions. Social support criteria should be reconsidered in light of the limited evidence, potential for disparities, practice variation, low provider confidence, and desire for revised guidelines.

Gendered Differences in Letters of Recommendation for Transplant Surgery Fellowship Applicants.

BACKGROUND: No published study has explored gender differences in letters of recommendation for applicants entering surgical subspecialty fellowships. METHODS: We conducted a retrospective review of letters of recommendation to a transplant surgery fellowship written for residents finishing general surgery residency programs. A dictionary of communal and agentic terms was used to explore differences of the letters based on applicant's gender as well as the academic rank and gender of the author. RESULTS: Of the 311 reviewed letters, 228 were letters of recommendation written for male applicants. Male surgeons wrote 92.4% of the letters. Male applicant letters were significantly more likely to contain agentic terms such as superb, intelligent, and exceptional (p = 0.00086). Additionally, male applicant letters were significantly more likely to contain "future leader" (p = 0.047). Letters written by full professors, division chiefs, and program directors were significantly more likely to describe female applicants using communal terms like compassionate, calm, and delightful (p = 0.0301, p = 0.036, p = 0.036, respectively). In letters written by assistant professors, female letters of recommendation had significantly more references to family (p = 0.036). CONCLUSIONS: Gendered differences exist in letters of recommendation for surgical fellowship applicants. This research may provide insight into the inherent gender bias that is revealed in letters supporting candidates entering the field.

Low energy cost for cultured pearl formation in grafted chimeric Pinctada margaritifera.

The pearl oyster is one of the rare animal models that support two distinct genomes, through the surgical graft process operated for culture pearl production. This grafted organism is assimilated to a chimera whose physiological functioning remains poorly known. The question of the energy expenditure comparison between chimera and non-chimera animals arises. To answer this question, grafted and non-grafted pearl oysters were evaluated for their energetic needs by the indirect calorimetry method. This method made it possible to measure the energy expenditure based on the respiration rate (RR) measurement, reflecting the basal metabolism. The results showed that the RR values for grafted and non-grafted pearl oysters were not significantly different (p < 0.05). The estimated cost of pearl calcification including CaCO3 and proteins synthesis was 0.237 ± 0.064 J h-1, representing 0.64% of the total energy expenditure of grafted pearl oysters. This study made it possible, for the first time, to see the energy cost of cultured pearl formation in P. margaritifera and the little impact in the energetic metabolism of the chimera organism.

Transplantation crisis at the time of economic recession in Greece.

OBJECTIVES: Aim of the study was to assess the effect of economic recession on organ donation and transplantation in Greece. METHODS: Retrospective data (2002-2016) provided by the Hellenic Transplant Organization (HTO), International Registry in Organ Donation and Transplantation, Eurotransplant, Scandiatransplant, National Health Service Blood and Transplant (NHSBT), and United Network of Organ Sharing (UNOS) databases were analyzed. HTO database was divided into the precrisis (2002-2008) and crisis (2009-2016) era. Donation and transplantation rates between the two periods were compared. Trend estimation analysis was applied on the latter period. RESULTS: Since 2009, organ donation significantly declined without significant change in the reported brain deaths. Overall solid organ transplantations decreased (319.63 ± 70.4 from 460 ± 55.25 transplants/year, P = 0.001). Kidney transplantation rates declined (139.38 ± 29.7 from 209.43 ± 20.9 transplants/year, P = 0.000), with dramatic reduction in both deceased (99 ± 27.5 from 136.43 ± 131.4 transplants/year, P = 0.030) and living donor kidney transplantations (40.38 ± 6.1 from 73 ± 12.5 transplants/year, P = 0.000). Liver, heart, and lung transplant rates were not significantly affected; however, they have been low throughout both periods. Convertion to donation has not been affected by the crisis. Time series logistic regression of the crisis period demonstrated declining trends in organ donation, total solid organ transplantation, and deceased donor kidney, liver, and lung transplantation. In 2015, Greek organ donation rates were inferior to Eurotransplant, Scandiatransplant, NHSBT, UNOS, and Italy. CONCLUSIONS: There has been a temporal correlation between the economic recession and organ donation and transplantation crisis in Greece. Irrespective of the cause, measures should be taken to reverse this in order to avert the increased morbidity and mortality on the transplant waiting list.