Asunto(s)
Prestación Integrada de Atención de Salud , Enfermedad Hepática en Estado Terminal/cirugía , Trasplante de Hígado , Donantes de Tejidos/provisión & distribución , Obtención de Tejidos y Órganos , Adulto , Anciano , Prestación Integrada de Atención de Salud/economía , Prestación Integrada de Atención de Salud/organización & administración , Enfermedad Hepática en Estado Terminal/diagnóstico , Enfermedad Hepática en Estado Terminal/economía , Enfermedad Hepática en Estado Terminal/epidemiología , Femenino , Costos de la Atención en Salud , Humanos , Cooperación Internacional , Kuwait/epidemiología , Trasplante de Hígado/economía , Donadores Vivos/provisión & distribución , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Factores de Tiempo , Obtención de Tejidos y Órganos/economía , Obtención de Tejidos y Órganos/organización & administraciónAsunto(s)
Infecciones por Coronavirus/epidemiología , Hepatitis Autoinmune/cirugía , Trasplante de Hígado , Necrosis Hepática Masiva/cirugía , Pandemias , Neumonía Viral/epidemiología , COVID-19 , Atención a la Salud , Urgencias Médicas , Femenino , Encefalopatía Hepática/etiología , Encefalopatía Hepática/cirugía , Hepatitis Autoinmune/complicaciones , Humanos , Necrosis Hepática Masiva/complicaciones , Persona de Mediana Edad , Programas Nacionales de Salud/organización & administración , Grupo de Atención al Paciente , España/epidemiología , Obtención de Tejidos y Órganos/organización & administraciónRESUMEN
PURPOSE: Randomized controlled trials investigating the efficacy and safety of fecal microbiota transplantation (FMT) for recurrent Clostridioides difficile infection (CDI) are reviewed, and practical issues for pharmacists to consider are discussed. SUMMARY: Eight randomized controlled trials evaluating the use of FMT for recurrent CDI were analyzed. The trials varied in the type of sample (fresh, frozen, lyophilized), route of administration (nasogastric tube, colonoscopy, enema, oral), and comparator agent (different type of FMT, vancomycin). Efficacy rates ranged from 43.8% to 96.2% with FMT, and safety data were relatively similar. With these favorable data, pharmacists are likely to be involved at multiple steps in the delivery of FMT to patients with recurrent CDI, including the procurement, documentation, and administration of various products and patient education. CONCLUSION: FMT is an option for recurrent CDI that is supported by findings of randomized controlled trials, although a preferred method for the delivery remains to be defined. Pharmacists can play an important role in the successful management of patients with recurrent CDI who may benefit from FMT.
Asunto(s)
Clostridioides difficile/aislamiento & purificación , Infecciones por Clostridium/terapia , Trasplante de Microbiota Fecal/métodos , Farmacéuticos/organización & administración , Infecciones por Clostridium/microbiología , Trasplante de Microbiota Fecal/efectos adversos , Humanos , Educación del Paciente como Asunto/organización & administración , Rol Profesional , Ensayos Clínicos Controlados Aleatorios como Asunto , Recurrencia , Recolección de Tejidos y Órganos/métodos , Obtención de Tejidos y Órganos/organización & administración , Resultado del TratamientoAsunto(s)
Prestación Integrada de Atención de Salud/organización & administración , Accesibilidad a los Servicios de Salud/organización & administración , Trasplante de Células Madre Hematopoyéticas , Trasplante de Órganos , Obtención de Tejidos y Órganos/organización & administración , Conducta Cooperativa , Disparidades en Atención de Salud/organización & administración , Humanos , Cooperación Internacional , Italia , Donantes de Tejidos/provisión & distribución , Listas de EsperaAsunto(s)
Conducta Cooperativa , Prestación Integrada de Atención de Salud/organización & administración , Cooperación Internacional , Trasplante de Riñón , Donadores Vivos/provisión & distribución , Obtención de Tejidos y Órganos/organización & administración , Selección de Donante , Europa (Continente) , Histocompatibilidad , Humanos , Evaluación de Programas y Proyectos de SaludAsunto(s)
Prestación Integrada de Atención de Salud/organización & administración , Trasplante de Riñón , Programas Nacionales de Salud/organización & administración , Obtención de Tejidos y Órganos/organización & administración , Supervivencia de Injerto , Humanos , Trasplante de Riñón/efectos adversos , Montenegro , Complicaciones Posoperatorias/etiología , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Considerable differences exist among the living donor Kidney Exchange Programmes (KEPs) that are in use and being built in Europe, contributing to a variation in the number of living donor transplants (Newsletter Transplant; International figures on donation and transplantation 2016). Efforts of European KEPs to exchange (best) practices and share approaches to address challenges have, however, been limited. METHODS: Experts from 23 European countries, collaborating on the European Network for Collaboration on Kidney Exchange Programmes Cooperation on Science and Technology Action, developed a questionnaire to collect detailed information on the functioning of all existing KEPs in Europe, as well as their opportunities and challenges. Following a comparative analysis, results were synthesized and interpreted by the same experts. RESULTS: The practices, opportunities and challenges reported by 17 European countries reveal that some of the 10 operating programs are mature, whereas others are in earlier stages of development. Over 1300 transplants were performed through existing KEPs up to the end of 2016, providing approximately 8% of their countries' living kidney donations in 2015. All countries report challenges to either initiating KEPs or increasing volumes. Some challenges are shared, whereas others differ because of differences in context (eg, country size, effectiveness of deceased donor program) and ethical and legal considerations (eg, regarding living donation as such, nonrelated donors, and altruistic donation). Transnational initiatives have started in Central Europe, Scandinavia, and Southern Europe. CONCLUSIONS: Exchange of best practices and shared advancement of national programs to address existing challenges, aided by transnational exchanges, may substantially improve access to the most (cost) effective treatment for the increasing number of patients suffering from kidney disease.
Asunto(s)
Benchmarking/organización & administración , Conducta Cooperativa , Prestación Integrada de Atención de Salud/organización & administración , Disparidades en Atención de Salud/organización & administración , Cooperación Internacional , Trasplante de Riñón , Donadores Vivos , Obtención de Tejidos y Órganos/organización & administración , Europa (Continente) , Humanos , Formulación de Políticas , Desarrollo de Programa , Evaluación de Programas y Proyectos de SaludAsunto(s)
Prestación Integrada de Atención de Salud/organización & administración , Cooperación Internacional , Trasplante de Órganos , Obtención de Tejidos y Órganos/organización & administración , Universidades , Asia , Conducta Cooperativa , Humanos , Intercambio Educacional Internacional , Evaluación de Programas y Proyectos de Salud , TurquíaAsunto(s)
Prestación Integrada de Atención de Salud/organización & administración , Trasplante de Órganos , Obtención de Tejidos y Órganos/organización & administración , Argentina , Prestación Integrada de Atención de Salud/legislación & jurisprudencia , Regulación Gubernamental , Política de Salud , Humanos , Trasplante de Órganos/legislación & jurisprudencia , Formulación de Políticas , Obtención de Tejidos y Órganos/legislación & jurisprudenciaRESUMEN
English summary: Hand transplantation in Sweden - preparations under way Some patients with a uni- or bilateral hand- or forearm amputation cannot use a hand prosthesis, although high-tech prostheses have been developed. A hand transplantation, particularly for those with bilateral amputations, may be an alternative solution. In a hand-transplanted patient, grip function, strength, sensibility and subsequent improved quality of life can be restored. Risks related to immunosuppression must be balanced by expected benefits, and thorough selection of patients has to be performed from both medical and psychological point of view. Therefore, a national network has been established in Sweden to achieve coordination with the needed competence.
Asunto(s)
Trasplante de Mano , Rechazo de Injerto/prevención & control , Trasplante de Mano/economía , Trasplante de Mano/métodos , Trasplante de Mano/psicología , Trasplante de Mano/rehabilitación , Humanos , Terapia de Inmunosupresión , Calidad de Vida , Suecia , Obtención de Tejidos y Órganos/legislación & jurisprudencia , Obtención de Tejidos y Órganos/organización & administración , Resultado del TratamientoAsunto(s)
Prestación Integrada de Atención de Salud , Trasplante de Órganos , Obtención de Tejidos y Órganos , Bélgica , Prestación Integrada de Atención de Salud/historia , Prestación Integrada de Atención de Salud/legislación & jurisprudencia , Prestación Integrada de Atención de Salud/organización & administración , Prestación Integrada de Atención de Salud/tendencias , Difusión de Innovaciones , Predicción , Política de Salud/historia , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Modelos Organizacionales , Trasplante de Órganos/historia , Trasplante de Órganos/legislación & jurisprudencia , Trasplante de Órganos/tendencias , Formulación de Políticas , Factores de Tiempo , Donantes de Tejidos/provisión & distribución , Obtención de Tejidos y Órganos/historia , Obtención de Tejidos y Órganos/legislación & jurisprudencia , Obtención de Tejidos y Órganos/organización & administración , Obtención de Tejidos y Órganos/tendencias , Listas de EsperaRESUMEN
The aim of this article was to analyze contractual incentives for kidney transplants in Brazil based on the principal-agent model. The approach assumes that the Brazilian Ministry of Health is the principal and the public hospitals accredited by the National Transplant System are the agent. The Ministry of Health's welfare depends on measures taken by hospitals in kidney uptake. Hospitals allocate administrative, financial, and management efforts to conduct measures in kidney donation, removal, uptake, and transplantation. Hospitals may choose the levels of effort that are consistent with the payments and incentives received in relation to transplantation costs. The solution to this type of problem lies in structuring an optimal incentives contract, which requires aligning the interests of both parties involved in the transplantation system.
Asunto(s)
Trasplante de Riñón/economía , Modelos Econométricos , Obtención de Tejidos y Órganos/economía , Obtención de Tejidos y Órganos/organización & administración , Algoritmos , Brasil , Hospitales Públicos/economía , Hospitales Públicos/organización & administración , Humanos , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/organización & administración , Recolección de Tejidos y Órganos/economíaRESUMEN
Resumo: O objetivo do artigo foi analisar os incentivos contratuais de transplantes renais no Brasil com base no modelo agente-principal. A abordagem assume que o Ministério da Saúde seja o principal e os hospitais públicos credenciados pelo Sistema Nacional de Transplantes sejam o agente. O bem- estar do Ministério da Saúde depende das ações tomadas pelos hospitais captadores desse órgão. Os hospitais alocam esforços administrativos, financeiros e gerenciais para realizar as ações de doação, remoção, captação e transplante de rim. Os hospitais podem escolher os níveis de esforços que são compatíveis com os pagamentos e incentivos recebidos referentes ao custeio de transplantes. A solução para esse tipo de problema está na estruturação de um contrato ótimo de incentivos, no qual se requer um alinhamento de interesses de ambas as partes envolvidas nesse sistema de transplantes.
Abstract: The aim of this article was to analyze contractual incentives for kidney transplants in Brazil based on the principal-agent model. The approach assumes that the Brazilian Ministry of Health is the principal and the public hospitals accredited by the National Transplant System are the agent. The Ministry of Health's welfare depends on measures taken by hospitals in kidney uptake. Hospitals allocate administrative, financial, and management efforts to conduct measures in kidney donation, removal, uptake, and transplantation. Hospitals may choose the levels of effort that are consistent with the payments and incentives received in relation to transplantation costs. The solution to this type of problem lies in structuring an optimal incentives contract, which requires aligning the interests of both parties involved in the transplantation system.
Resumen: El objetivo del artículo fue analizar los incentivos contractuales de trasplantes renales en Brasil, a partir del modelo agente-principal. Este enfoque asume que el Ministerio de Salud sea el principal y los hospitales públicos, autorizados por el Sistema Nacional de Trasplantes, sean los agentes. El bienestar del Ministerio de Salud depende de las acciones tomadas por los hospitales receptores de este órgano. Los hospitales proporcionan los esfuerzos administrativos, financieros y de gestión para realizar las acciones de donación, extirpación, recepción y trasplante de riñón. Los hospitales pueden escoger los niveles de esfuerzos que son compatibles con los pagos e incentivos recibidos, referentes al costeo de trasplantes. La solución para este tipo de problema está en la estructuración de un contrato óptimo de incentivos, en el que se requiera un alineamiento de intereses de ambas partes involucradas en este sistema de trasplantes.
Asunto(s)
Humanos , Obtención de Tejidos y Órganos/economía , Obtención de Tejidos y Órganos/organización & administración , Trasplante de Riñón/economía , Modelos Econométricos , Algoritmos , Brasil , Recolección de Tejidos y Órganos/economía , Hospitales Públicos/economía , Hospitales Públicos/organización & administración , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/organización & administraciónRESUMEN
Several challenging obstacles remain to increasing the number of organ donations from deceased patients in a hospital setting. These include medical, administrative, and ethical issues. Possible medical obstacles include the failure of early recognition of possible donors and inadequate care of potential and actual donors. To maximize the use of donated organs, proper care of the donors and expedited donor consent cannot be overemphasized. The care rendered to patients should ensure appropriate perfusion and nutrition of the organs, with meticulous follow-up until organ recovery. For example, patients involved in accidents are presumed to be healthy, but many have no available medical history on file. At the time of organ recovery, unexpected infections or malignancies can be minimized by raising the index of suspicion of the presence of serious conditions in donors, especially in donors with unknown medical history. A careful physical examination and an appropriate and aggressive laboratory investigation may disclose the cause of suspected clinical conditions in these potential donors. Individuals who work in intensive care units are the main group of health care providers directly involved in the process of organ donation. Appointing a donor coordinator in each intensive care unit could improve all aspects of organ donation. Such coordination could harmonize efforts toward the goals mentioned above and surmount the obstacles encountered during deceased-donor organ donation. Here, we describe the preliminary results of the Proactive Detection Program, a collaboration between the Saudi Center for Organ Transplantation (the national organ donation and transplant supervising center) and intensive care units of donating hospitals. With its success in Saudi Arabia, it is hoped that it will be widely adopted in other regions.
Asunto(s)
Prestación Integrada de Atención de Salud/organización & administración , Trasplante de Órganos , Donantes de Tejidos/provisión & distribución , Obtención de Tejidos y Órganos/organización & administración , Conducta Cooperativa , Prestación Integrada de Atención de Salud/métodos , Accesibilidad a los Servicios de Salud/organización & administración , Humanos , Comunicación Interdisciplinaria , Trasplante de Órganos/métodos , Grupo de Atención al Paciente/organización & administración , Desarrollo de Programa , Arabia Saudita , Obtención de Tejidos y Órganos/métodosRESUMEN
The Republic of Kazakhstan is one of the fastest developing countries in the world and has a health care system that is unique in Central Asia. Its organ transplant services are also developing rapidly. We aimed to analyze and briefly report on the current status of organ transplant in the Republic of Kazakhstan. We analyzed organ transplant activities in that country for the period 2012 to 2014. All data were collected from the official database of the National Transplant Coordinating Center of the Republic of Kazakhstan. At the end of 2014, the number of transplant centers had increased to 10, three of which could perform multiorgan transplants; during the same period, the number of deceased-donor organ-donating hospitals increased up to 37. By 2013, the transplant activity rate for all centers had reached 9.22 per million population. During the previous 3 years (2012-2014), there was a 3-fold increase in the number of living donors and an 18-fold increase in the number of kidney transplants. Between 2012 and 2014, the number of living-donor liver transplants increased from 17 to 25, and the number of deceased-donor transplants increased from 3 to 7. During the last 3 years (2012-2014), the number of heart transplants increased to 7 cases. During the last 3 years (2012-2014), Kazakhstan achieved a significant improvement in the organization of its transplant services, and a noticeable upward trend in the system continues.
Asunto(s)
Prestación Integrada de Atención de Salud/organización & administración , Trasplante de Órganos , Donantes de Tejidos/provisión & distribución , Obtención de Tejidos y Órganos/organización & administración , Conducta Cooperativa , Bases de Datos Factuales , Prestación Integrada de Atención de Salud/métodos , Países en Desarrollo , Accesibilidad a los Servicios de Salud/organización & administración , Humanos , Cooperación Internacional , Kazajstán , Trasplante de Órganos/métodos , Grupo de Atención al Paciente/organización & administración , Desarrollo de Programa , Factores de Tiempo , Obtención de Tejidos y Órganos/métodosRESUMEN
INTRODUCTION: The increase in the number of donors is the main objective of all transplantation organizations around the world. Further understanding of the factors involved in increasing donation rates is very important for planning future strategies to improve outcomes in each country. OBJECTIVE AND METHOD: With this purpose we analyzed the relationship between social and economic factors of the countries and organizational aspects of health systems and institutions dedicated to transplantation in relation to the number of actual donors per million population. We analyzed rates of deceased donors per million population of Latin America, North America, and Europe (20 countries) and correlated them with the human development index and its most important indicators. We also studied the correlation with spending on health and organizational aspects of the health system. RESULTS: On the one hand, we found that donation rates (DRs) per million population (pmp) were not statistically significantly correlated with the human development index (significant correlation 0.61 and 0.181). There is a correlation, albeit weak, between observed donation rates and gross domestic product (GDP) of each country (significance, 0.04; correlation, 0.46). On the other hand, there exists a strong correlation between the percentage of GDP spent on health and DRs pmp (significance, 0.01; correlation, 0.53). Those countries with an integrated national health system (P = .01) and a higher percentage of hospitals with intrahospital transplantation coordinators (P = .001) had higher DRs pmp. CONCLUSIONS: The best DRs are closely linked to organizational aspects of the donation system in particular and the health system in general. There is a weak correlation between observed DRs and socio-economic and development indicators of countries. These data should be taken into account in planning future strategies to increase DRs, health plan policies, and investments.
Asunto(s)
Países Desarrollados , Países en Desarrollo , Donantes de Tejidos/provisión & distribución , Obtención de Tejidos y Órganos/estadística & datos numéricos , Prestación Integrada de Atención de Salud , Europa (Continente) , Producto Interno Bruto , Política de Salud , Humanos , América Latina , América del Norte , Factores Socioeconómicos , Donantes de Tejidos/estadística & datos numéricos , Obtención de Tejidos y Órganos/organización & administraciónRESUMEN
There are no European recommendations on issues specifically related to lung transplantation (LTX) in cystic fibrosis (CF). The main goal of this paper is to provide CF care team members with clinically relevant CF-specific information on all aspects of LTX, highlighting areas of consensus and controversy throughout Europe. Bilateral lung transplantation has been shown to be an important therapeutic option for end-stage CF pulmonary disease. Transplant function and patient survival after transplantation are better than in most other indications for this procedure. Attention though has to be paid to pretransplant morbidity, time for referral, evaluation, indication, and contraindication in children and in adults. This review makes extensive use of specific evidence in the field of lung transplantation in CF patients and addresses all issues of practical importance. The requirements of pre-, peri-, and postoperative management are discussed in detail including bridging to transplant and postoperative complications, immune suppression, chronic allograft dysfunction, infection, and malignancies being the most important. Among the contributors to this guiding information are 19 members of the ECORN-CF project and other experts. The document is endorsed by the European Cystic Fibrosis Society and sponsored by the Christiane Herzog Foundation.
Asunto(s)
Fibrosis Quística/cirugía , Trasplante de Pulmón/normas , Contraindicaciones , Circulación Extracorporea/normas , Rechazo de Injerto/prevención & control , Humanos , Trasplante de Pulmón/efectos adversos , Trasplante de Pulmón/métodos , Terapia Nutricional/normas , Educación del Paciente como Asunto , Cuidados Posoperatorios/normas , Cuidados Preoperatorios/normas , Psicología , Apoyo Social , Obtención de Tejidos y Órganos/organización & administraciónRESUMEN
The use of intracytoplasmic sperm injection (ICSI) has resolved many issues in male infertility management and abolished the need in many instances for donor insemination (DI). Despite this, clinics in the UK have, for some years, struggled to maintain the necessary infrastructure to recruit adequate numbers of sperm donors to provide for the national need. A significant proportion of treatment is for single women and same sex couples. Many patients now seek treatment abroad either to avoid waiting lists, or access care to which they are excluded in the NHS. In addition, many patients now have treatment using sperm imported from abroad. A number of solutions to the UK shortage might be considered, e.g. re-evaluation of the limitation of family numbers, paying donors, gamete sharing and exchange schemes or changing sperm quality thresholds for the acceptance of donors. The development of a centrally funded national service framework is being piloted at the present time.
Asunto(s)
Espermatozoides , Obtención de Tejidos y Órganos/organización & administración , Humanos , Inseminación Artificial Heteróloga , Internacionalidad , Masculino , Motivación , Programas Nacionales de Salud , Selección de Personal , Reino UnidoRESUMEN
We describe the organization of a high-volume Brazilian kidney transplant program that performed 7,833 transplants in 12 years fulfilling government expectations without compromising the care of the patients. The annual number of kidney transplants increased from 428 in 1999 to 1,048 in 2010. In our Organ Procurement Organization (6.1 million inhabitants) brain death notifications increased from 196 to 468 in 2010 and 35% became actual donors. There are 5,011 patients on the waiting list and recipient selection is based on HLA matching. A significant proportion of the recipients is of black ethnicity and had been for long time on dialysis. Over 700 first appointments for living donation are done every year. After the transplant, the majority of patients are followed locally (200-250 appointments per day). The transplant outcome among living-donor recipients is comparable to large registries but inferior outcome have been observed among recipients of deceased donor organs, though consistent improvement has been seen in more recent years. We also discuss issues related to local regulations and solutions to improve efficiency and outcomes.
Asunto(s)
Trasplante de Riñón , Programas Nacionales de Salud , Evaluación de Procesos y Resultados en Atención de Salud , Donantes de Tejidos/provisión & distribución , Obtención de Tejidos y Órganos , Adulto , Brasil , Prestación Integrada de Atención de Salud , Femenino , Costos de la Atención en Salud , Accesibilidad a los Servicios de Salud , Hospitales Universitarios , Humanos , Reembolso de Seguro de Salud , Trasplante de Riñón/economía , Trasplante de Riñón/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/estadística & datos numéricos , Objetivos Organizacionales , Evaluación de Procesos y Resultados en Atención de Salud/estadística & datos numéricos , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Donantes de Tejidos/estadística & datos numéricos , Obtención de Tejidos y Órganos/economía , Obtención de Tejidos y Órganos/organización & administración , Obtención de Tejidos y Órganos/estadística & datos numéricos , Resultado del Tratamiento , Listas de Espera , Adulto JovenRESUMEN
A clinical case is used to explore the ethical complexities of solid organ donation and transplantation within the Hmong community in the United States. Although many cultures can present various ethical issues, the challenges of the Hmong belief system are unique and distinctly complex. Ways for the medical team to integrate with the Hmong value system to attempt to create an environment of transcultural respect and appreciation are described.