Analysis of cardiovascular risk factors for the viability of cornea donors: a case-control study.

OBJECTIVE: The main objective of the study was to evaluate the influence of arterial hypertension, diabetes, dyslipidaemia, smoking, alcoholism and COPD (chronic obstructive pulmonary disease) on the viability of the extracted tissue as well as the donor. DESIGN: Observational case-control study. SETTING: Regional hospital in Northern Spain. PARTICIPANTS: 1517 corneas were registered. INTERVENTIONS: Patients' medical history was reviewed after corneal donation and evaluation. Previous medical information (age, sex and cardiovascular risk factors (CVRFs)) and data related to the donor (type of donor), the corneal tissue and its evaluation, and the viability of the implant were collected. RESULTS: A total of 1517 corneas were registered and 81.5% of the donors presented at least one CVRF. In relation to the viability of the donor, it was observed that having suffered from COPD reduced the viability of the donor (no COPD: 93.8% vs COPD: 88%; OR=0.49; 95% CI: 0.28 to 0.84) while alcohol consumption increased it (drinker or ex-drinker: 95.8% vs non-drinker: 92.5%; OR=1.84; 95% CI: 1.01 to 3.33). Regarding tissue viability, decreased viability was observed in the presence of COPD (no COPD: 72.5% vs COPD: 64; OR=0.67; 95% CI: 0.47 to 0.96) and diabetes mellitus (no diabetes: 72.9% vs diabetes: 67.2%; OR=0.76; 95% CI: 0.58 to 0.99). As regards the viability of the implant, a total of 1039 corneas (68.9%) were suitable, observing decreased viability when suffering from COPD (no COPD: 69.8% vs COPD: 60.7%; OR=0.67; 95% CI: 0.47 to 0.94) and increased when having an active smoking habit (no habit: 65.3% vs habit: 74.1%; OR=1.52; 95% CI: 1.21 to 1.91). CONCLUSIONS: Through this study, it can be concluded that in the absence of absolute exclusion criteria for donors, the assessment of how CVRF, alcoholism and COPD may affect the donor provides details about the quality of the tissue to be obtained.

[Knowledge and attitudes toward organ donation among health professionals in a third level hospital]. / Conocimientos y actitudes ante la donación de órganos de los profesionales sanitarios de un hospital de tercer nivel.

OBJECTIVE: The Spanish model is the model adopted by many countries to increase their donation rate, being the implication of the healthcare professionals one of the keys to this success. The attitude of these before the donation is crucial for the hour of influence on the population. Organ transplantation has been established as an effective treatment that has been improving over the years. The objective was to determine the knowledge and attitudes of health professionals before the donation of organs. METHODS: Cross-sectional descriptive study. An ad hoc questionnaire was conducted and distributed among the health professionals (medical staff, nurses and nursing assistants) of a tertiary hospital during February 2015. A total of 615 potential participants were estimated in the different areas of the hospital. A total of 342 completed questionnaires were collected (55%). The statistical analysis with SPSS® Statistics for Windows. Version 20.0. A level of significance P lower than 0.05 was used in all the analyses. RESULTS: The average age of the respondents was 43.34 (SD = 10.37) years, being 86.6% women and 60% nurses. 35.5% showed good knowledge about the donation process, being higher in men (51.1% Vs 33.1%, p lower than 0.05), medical personnel (55% vs 34.3% vs 31.9%). %; p lower than 0.05) and lower in those services with a direct relationship with the donation process (36.8% vs 31.9%, p lower than 0.05). 71% of the professionals expressed their willingness to donate their organs, with special sensitivity towards donation those services in direct relation with the donation program (82.2% vs 65.9%, OR: 1.24, p lower than 0.001 ). 50% of the professionals would donate the organs of a family member; the medical group had the highest percentage (70% vs 50.7% vs 40.4%, OR: 3.8, p lower than 0.05). 74.5% knew some Spanish legal document about donation and transplants. CONCLUSIONS: Health professionals as a whole have a low level of knowledge; but a good attitude towards donation.

OBJETIVO: El modelo español es el modelo adoptado por numerosos países para aumentar su tasa de donación siendo una de las claves de este éxito la implicación de los trabajadores sanitarios. La actitud de estos ante la donación resulta crucial a la hora de influir sobre la población. El trasplante de órganos se ha establecido como un tratamiento efectivo que ha ido mejorando a lo largo de los años. El objetivo de este estudio fue determinar los conocimientos y actitudes de los profesionales sanitarios ante la donación de órganos. METODOS: Estudio descriptivo transversal. Se realizó un cuestionario ad hoc y se distribuyó entre los profesionales sanitarios (personal médico, enfermería y auxiliares de enfermería) de un hospital de tercer nivel durante febrero 2015. Se estimó un total de 615 potenciales participantes en las diferentes áreas del hospital. Se recogieron un total de 342 cuestionarios cumplimentados en su totalidad (55%). El análisis estadístico se realizó con SPSS® versión 20.0 versión Windows. Se utilizó un nivel de significación P menor de 0.05 en todos los análisis. RESULTADOS: El promedio de edad de los encuestados fue de 43,34 (DT=10,37) años, siendo el 86,6% mujeres y el 60% enfermeras. El 35,5% mostraron buenos conocimientos sobre el proceso de donación, siendo mayor en hombres (51,1% Vs 33,1%;p menor de 0,05), personal médico (55% vs 34,3% vs 31,9%;p menor de 0,05) e inferior en aquellos servicios con una relación directa con el proceso de donación (36,8% vs 31,9%;p menor de 0,05). El 71% de los profesionales manifestaron estar dispuestos a donar sus órganos, con especial sensibilidad hacia la donación aquellos servicios en relación directa con el programa de donación (82,2% vs 65,9%; OR:1,24;p menor de 0,001). El 50% de los profesionales donarían los órganos de un familiar; siendo el colectivo médico el que presentaba un porcentaje mayor (70% vs 50,7% vs 40,4%; OR:3,8; p menor de 0,05). El 74,5% conocía algún documento legal español sobre donación y trasplantes. CONCLUSIONES: Los profesionales de la salud en su conjunto tienen un bajo nivel de conocimiento, pero una buena actitud hacia la donación.

Conocimientos y actitudes ante la donación de órganos de los profesionales sanitarios de un hospital de tercer nivel / Knowledge and attitudes toward organ donation among health professionals in a third level hospital

Fundamentos. El modelo español es el modelo adoptado por numerosos países para aumentar su tasa de donación siendo una de las claves de este éxito la implicación de los trabajadores sanitarios. La actitud de estos ante la donación resulta crucial a la hora de influir sobre la población. El trasplante de órganos se ha establecido como un tratamiento efectivo que ha ido mejorando a lo largo de los años. El objetivo de este estudio fue determinar los conocimientos y actitudes de los profesionales sanitarios ante la donación de órganos. Método. Estudio descriptivo transversal. Se realizó un cuestionario ad hoc y se distribuyó entre los profesionales sanitarios (personal médico, enfermería y auxiliares de enfermería) de un hospital de tercer nivel durante febrero 2015. Se estimó un total de 615 potenciales participantes en las diferentes áreas del hospital. Se recogieron un total de 342 cuestionarios cumplimentados en su totalidad (55%). El análisis estadístico se realizó con SPSS® versión 20.0 versión Windows. Se utilizó un nivel de significación P < 0.05 en todos los análisis. Resultados. El promedio de edad de los encuestados fue de 43,34 (DT=10,37) años, siendo el 86,6% mujeres y el 60% enfermeras. El 35,5% mostraron buenos conocimientos sobre el proceso de donación, siendo mayor en hombres (51,1% Vs 33,1%;p< 0,05), personal médico (55% vs 34,3% vs 31,9%;p<0,05) e inferior en aquellos servicios con una relación directa con el proceso de donación (36,8% vs 31,9%;p<0,05). El 71% de los profesionales manifestaron estar dispuestos a donar sus órganos, con especial sensibilidad hacia la donación aquellos servicios en relación directa con el programa de donación (82,2% vs 65,9%; OR:1,24;p<0,001). El 50% de los profesionales donarían los órganos de un familiar; siendo el colectivo médico el que presentaba un porcentaje mayor (70% vs 50,7% vs 40,4%; OR:3,8; p<0,05). El 74,5% conocía algún documento legal español sobre donación y trasplantes. Conclusiones. Los profesionales de la salud en su conjunto tienen un bajo nivel de conocimiento, pero una buena actitud hacia la donación

Background. The Spanish model is the model adopted by many countries to increase their donation rate, being the implication of the healthcare professionals one of the keys to this success. The attitude of these before the donation is crucial for the hour of influence on the population. Organ transplantation has been established as an effective treatment that has been improving over the years. The objective was to determine the knowledge and attitudes of health professionals before the donation of organs. Method. Cross-sectional descriptive study. An ad hoc questionnaire was conducted and distributed among the health professionals (medical staff, nurses and nursing assistants) of a tertiary hospital during February 2015. A total of 615 potential participants were estimated in the different areas of the hospital. A total of 342 completed questionnaires were collected (55%). The statistical analysis with SPSS® Statistics for Windows. Version 20.0. A level of significance P <0.05 was used in all the analyses. Results. The average age of the respondents was 43.34 (SD = 10.37) years, being 86.6% women and 60% nurses. 35.5% showed good knowledge about the donation process, being higher in men (51.1% Vs 33.1%, p <0.05), medical personnel (55% vs 34.3% vs 31.9%). %; p <0.05) and lower in those services with a direct relationship with the donation process (36.8% vs 31.9%, p <0.05). 71% of the professionals expressed their willingness to donate their organs, with special sensitivity towards donation those services in direct relation with the donation program (82.2% vs 65.9%, OR: 1.24, p <0.001). 50% of the professionals would donate the organs of a family member; the medical group had the highest percentage (70% vs 50.7% vs 40.4%, OR: 3.8, p <0.05). 74.5% knew some Spanish legal document about donation and transplants. Conclusions. Health professionals as a whole have a low level of knowledge; but a good attitude towards donation

Technique of uniportal VATS major pulmonary resections.

The surgical approach to lung resections is evolving constantly. Since the video-assisted thoracoscopic surgery (VATS) anatomic lobectomy for lung cancer was described two decades ago, many units have successfully adopted this technique. The VATS lobectomy can be defined as the individual dissection of veins, arteries and bronchus, with a mediastinal lymphadenectomy, using a videothoracoscopic approach visualized on screen and involving 2 to 4 incisions or ports, with no rib spreading. However, the surgery can be performed by only one incision with similar outcomes. Since 2010, when the uniportal approach was introduced for major pulmonary resections, the technique has been spreading worldwide. This technique provides a direct view of the target tissue. The parallel instrumentation achieved during the single-port approach mimics the maneuvers performed during open surgery. It represents a less invasive approach than the multiport technique, and minimizes the compression of the intercostal nerve. As the surgeon's experience with the uniportal VATS lobectomy grows, more complex cases can be performed by using this approach, thus expanding the indications for single-incision thoracoscopic lobectomy.

Uniportal video-assisted thoracoscopic lymph node dissection.

Lymphadenectomy is an important part of lung cancer surgery. At the moment, video-assisted thoracoscopic (VATS) is the most common approach to remove these tumors, when it is technically possible. With our current experience in VATS in major resections we have obtained a radical videothoracoscopic mediastinal lymphadenectomy, and single-port provides us with the best anatomic instrumentation and a direct view.

Management of complications by uniportal video-assisted thoracoscopic surgery.

Since the video-assisted thoracoscopic surgery (VATS) anatomic lobectomy for lung cancer was described two decades ago, many units have successfully adopted this technique. VATS lobectomy is a safe and effective approach for the treatment not only of early stage lung cancer but also for more advanced disease. It represents a technical challenge. As the surgeon's experience grows, more complex or advanced cases are approached using the VATS approach. However, as VATS lobectomy has been applied to more advanced cases, the rate of conversion to open thoracotomy has increased, particularly early in the surgeon's learning curve, mostly due to the occurrence of complications. The best strategy for facing complications of VATS lobectomy is to prevent them from happening. Avoiding complications is subject to an appropriate preoperative workup and patient selection. Planning for a VATS resection as safely as possible involves the consideration of the patient´s characteristics and the anticipated technical aspects of the case. Awareness of the possibility of intraoperative complications of VATS lobectomy is mandatory to avoid them, and the development of management strategies is necessary to limit morbidity if they occur.