Anesthetic Considerations for the Parturient After Solid Organ Transplantation.

Over the past 40 years, the success of organ transplantation has increased such that female solid organ transplant recipients are able to conceive and carry pregnancies successfully to term. Anesthesiologists are faced with the challenge of providing anesthesia care to these high-risk obstetric patients in the peripartum period. Anesthetic considerations include the effects of the physiologic changes of pregnancy on the transplanted organ, graft function in the peripartum period, and the maternal side effects and drug interactions of immunosuppressive agents. These women are at an increased risk of comorbidities and obstetric complications. Anesthetic management should consider the important task of protecting graft function. Optimal care of a woman with a transplanted solid organ involves management by a multidisciplinary team. In this focused review article, we review the anesthetic management of pregnant patients with solid organ transplants of the kidney, liver, heart, or lung.

Childhood asthma surveillance by community coalitions.

Multiple benefits can accrue when community coalitions conduct asthma surveillance activities. Surveillance data are used to identify children with asthma, assess disease burden and needs in the community, understand the illness and risk factors, identify children with asthma who are undertreated, plan community interventions, evaluate the effect of interventions, and monitor trends. These data, which are used to inform coalition and program decisions and to evaluate asthma interventions, can also be used to strengthen state and national asthma surveillance efforts and to inform clinical practice and public health policies. Local coalition data collection represents a complementary approach to national asthma surveillance, allowing action at the local level and showing how local findings vary from national observations. The Allies Against Asthma coalitions developed several practical means to conduct childhood asthma surveillance that informed coalition efforts and facilitated innovative linkages among government officials, health care providers, community agencies, families, and academicians and/or researchers.

Coalition-based approaches for addressing environmental issues in childhood asthma.

Outdoor air pollution and the indoor environment have been shown to cause or exacerbate childhood asthma. Allies Against Asthma coalitions implemented a broad range of activities to reduce or remediate indoor exposure to asthma environmental triggers for children with asthma including education and trigger remediation, physician and other health care provider education, and policy efforts to improve air quality in homes and schools. Outdoor environmental triggers were addressed through programs to increase education and awareness and efforts to change policies related to environmental conditions. Implementation of such efforts was complicated by the lack of safe and affordable housing and the amount of time and resources necessary to address policy change. Keys to success included promoting coordination and partnerships among coalition members, implementation of consistent messages, and building a broad and unified voice for policy change.

Collaborative design and implementation of a multisite community coalition evaluation.

Evaluation designs assessing community coalitions must balance measures of how coalitions do their work and evidence that the coalitions are making a difference. The Allies cross-site evaluation attempts to determine the combined effects of the seven coalitions' work at the individual, organizational, and community levels. Principal components considered are (a) contextual factors of the coalition community, (b) coalition processes and structure, (c) planning and planning products, (d) implementation actions, (e) activities and collaborations, (f) anticipated intermediate outcomes, and (g) expected asthma related health outcomes. Measurements are quantitative and qualitative, and data generated by these methods are used as ends in themselves and as a way to confirm or inform other measures. Evaluation has been an integral part of the planning and implementation phases of the Allies coalition work, with a priority of involving all of the partners in conceiving of and deciding upon the elements of assessment.

Efforts to quit smoking by parents of children with asthma.

The objective of this project was to assess the prevalence of (1) tobacco smoke exposure at home among children with asthma and (2) efforts to quit smoking by their parents. We employed a cross sectional survey of 622 parents of children diagnosed by a doctor with asthma. Seventy-five percent of parents reported smoke-free homes. Overall, 85% of parents pledged to keep smoke-free homes, 92% in existing smoke-free homes and 64% in homes with smoke.

Pediatric asthma case management: a review of evidence and an experimental study design.

Asthma is a complex disease that involves physiological, environmental, and psychosocial factors. This paper reviews childhood asthma case management by social service professionals, lay health workers, and nurses, and it presents a new randomized controlled study using nurse case management in a local community coalition. Evidence suggests the common factor for success involves case managers spending time contacting and patiently and persistently working with the family, thus building a trusting relationship. Although case management time is an expense for a health care payer, provider, and the child and family, the positive outcomes achieved can demonstrate the benefit of these interventions to all parties involved. The described experimental study assesses the cost and effectiveness of home-based nurse case management by a community coalition for children visiting an emergency department for asthma care.