Outcomes of re-referrals of patients with alcohol-associated liver disease, who were previously declined for liver transplantation.

Since 2018, our program has utilized specific psychosocial criteria and a multidisciplinary approach to assess patients for liver transplant due to alcohol-associated liver disease (ALD), rather than the 6-month abstinence rule alone. If declined based on these criteria, specific recommendations are provided to patients and their providers regarding goals for re-referral to increase the potential for future transplant candidacy. Recommendations include engagement in treatment for alcohol use disorder, serial negative biomarker testing, and maintenance of abstinence from alcohol. In our current study, we evaluate the outcomes of patients with ALD, who were initially declined upon assessment and re-referred to our program. This is a retrospective cohort study that includes 98 patients with ALD, who were previously declined for liver transplantation and were subsequently re-referred for liver transplant assessment between May 1, 2018, and December 31, 2021. We assess the outcomes of patients who were re-referred including acceptance for transplantation following a second assessment. Of the 98 patients who were re-referred, 46 (46.9%) fulfilled the recommendations made and proceeded to further medical evaluation. Nine were eventually transplanted; others are listed and are waiting for transplant. The presence of a partner was independently associated with a higher rate of acceptance (OR 0.16, 95% CI: 0.03-0.97, p = 0.05). Most of the patients who did not proceed further (n = 52) were declined again due to ALD contraindications (n = 33, 63.4%), including ongoing drinking and lack of engagement in recommended addiction treatment. Others had medical contraindications (11.2%), clinically improved (6.1%), had adherence issues (5.1%), or lack of adequate support (2%). Patients with ALD previously declined for a liver transplant can be re-referred and successfully accepted for transplantation by fulfilling the recommendations made by the multidisciplinary team. Important factors including ongoing abstinence, engagement in addiction treatment, and social support are key for successful acceptance.

Results of Early Transplantation for Alcohol-Related Cirrhosis: Integrated Addiction Treatment With Low Rate of Relapse.

BACKGROUND & AIMS: In 2018, our team initiated a prospective pilot program to challenge the paradigm of the "6-month rule" of abstinence for patients with alcohol-related liver disease (ALD) requiring transplant. Our pilot involved an in-depth examination of patients' alcohol use, social support, and psychiatric comorbidity, as well as the provision of pre- and post-transplantation addiction treatment. METHODS: Patients with ALD were assessed for inclusion in the pilot by a multidisciplinary team. Relapse prevention therapy was provided directly to all patients deemed to meet the program's inclusion criteria. Random biomarker testing for alcohol was used pre and post transplantation. RESULTS: We received 703 referrals from May 1, 2018 to October 31, 2020. After fulfilling the program's criteria, 101 patients (14%) were listed for transplantation and 44 (6.2%) received transplants. There were no significant differences in survival rates between those receiving transplants through the pilot program compared with a control group with more than 6 months of abstinence (P = .07). Three patients returned to alcohol use during an average post-transplantation follow-up period of 339 days. In a multivariate analysis, younger age and lower Model for End-Stage Liver Disease scores at listing were associated with an increased likelihood of a return to alcohol use (P < .05); length of abstinence was not a predictor. CONCLUSIONS: Our prospective program provided direct monitoring and relapse prevention treatment for patients with ALD and with less than 6 months of abstinence and resulted in a reduction of post-transplantation return to drinking. This pilot study provides a framework for the future of more equitable transplant care.

Interés de estudiantes de la licenciatura en nutrición de universidades latinoamericanas y su formación en el campo de la nutrición comunitaria / Interest of students of the degree in nutrition of latinamerican universities and their training in the field of the community nutrition

Fundamentos: El campo profesional Nutrición Comunitaria es reconocido por su relación con una necesidad social de coadyuvar en la solución de los problemas de alimentación y nutrición, existen evidencias de su escaso desarrollo en la formación y mercado laboral, el objetivo del presente estudio fue conocer su importancia en los planes de estudio de la licenciatura en nutrición, así como el interés de los estudiantes por realizar estudios de posgrado en este campo. Métodos: Estudio transversal, la muestra se conformó de dos universidades, una pública y una privada de: Argentina, Uruguay, Paraguay, Chile, México y Perú. Se encuestó a estudiantes del primero y último año y se entrevistó al director y dos profesores de cada licenciatura. Para el análisis se utilizó Excel y SPSS. Resultados: El campo profesional de mayor interés para realizar estudios de posgrado fue Nutrición Clínica, seguido de Nutrición Comunitaria, situación semejante se presentó en la importancia de cada campo en los planes de estudio. No se encontraron diferencias a valores de P≤0.05, entre los estudiantes del primero y último año. Conclusiones: Aunque la Nutrición Comunitaria se ubicó en segundo nivel de importancia, con base en la situación epidemiológica, se considera conveniente impulsar un mayor desarrollo en la licenciatura y ofertar más oportunidades de estudios de posgrado

Background: Community Nutrition professional field is recognized by its relationby a social need to contributein the solution of food-supply and nutrition problems, there exist evidences of scanty development in the student formation and labor market area, for the aim of the present study was to know about its importance in the study plans of the nutrition degree, as well as the interest of the students to realice postgraduate studies. Methods: Transversal study, the sample was conformed of two universities of each country, a private and a public one from: Argentina, Uruguay, Paraguay, Chile, Mexico and Peru. Students were polled of firstly and last year and one interviewed the director and two teachers of every program, for the analysis we used Excel and SPSS. Results: The professional field of major interest to realize postgraduate studies was Clinic Nutrition, followed by Community Nutrition, a similar situation appeared in the importance of every field in the study plans. There was not differences to values of P≤0.05 among the students of the firstly and last year. Conclusions: Though the Community Nutrition was located in the second level of importance, with base in the epidemiological situation, it is considered suitable to stimulate a major development in the master and to offer more opportunities of postgraduate studies

Avaliação dos registros de enfermagem no balanço hídrico de pacientes em unidade de terapia intensiva / Evaluation of nursing records in the water balance of patients in intensive care unit

Objetivo: avaliar os registros de enfermagem no balanço hídrico de pacientes em unidade de terapia intensiva. Metodologia: estudo descritivo exploratório, quantitativo, realizado na unidade de terapia intensiva de um hospital privado, em Fortaleza-Ceará, com 51 pacientes. Os dados foram coletados dos prontuários dos pacientes, no período de agosto a outubro de 2012, com um roteiro estruturado, sendo expostos em tabelas e gráficos. Estudo aprovado pelo Comitê de Ética da Universidade Estadual do Ceará.Resultados: quanto às anotações no formulário do balanço hídrico, as principais vias de administração identificadas foram a via oral e a endovenosa; a diurese foi a via de eliminação predominante; 90,20%realizaram a soma correta das infusões e 94,10% das eliminações. O cálculo do balanço hídrico final foi realizado corretamente por 88,20%. Em 70,58% dos prontuários o enfermeiro realizou os registros e em 29,42%os técnicos de enfermagem; em 84,32% constava a assinatura do responsável pelas anotações. Conclusão: os profissionais dispensam cuidado nos registros do balanço hídrico, pois foram visualizadas poucas inconsistências nas anotações.

Objective: to evaluate nursing records about water balance for the patients in the intensive care unit. Methods: descriptive, exploratory, quantitative approach, performed in the intensive care unit of a private hospital, in Fortaleza-Ceará, with 51 patients. Data collected from patients' records, from August to October 2012, using structured interviews, displayed in tables and graphs. Study approved by the Ethics Committee of State University of Ceará. Results: it was found as the main routes of administration, the oral and intravenous; diuresis was the predominant elimination pathway; 90.20% performs the correct sum of the amounts related to infusions and 94.10% to eliminations. The final calculation of water balance was performed correctly by 88.20%. In 70.58% of records was the nurse who performed the records and in 29.42%the nursing technicians; 84.32% them often sign such records. Conclusion: that professionals give care duringthe records, considering that were seen a few inconsistencies in the annotations.

Portuguese immigrant women's perspectives on wife abuse: a cross-generational comparison.

This descriptive study seeks to understand what first and second generation Portuguese women believe about wife abuse and what actions they believe are appropriate for an abused wife. Eighty first generation and 54 second generation women participated. The researcher read the questionnaire items aloud in one-on-one meetings. Overall, participants defined wife abuse broadly, did not approve of wife abuse, were most likely to believe that women should seek external help, and did not hold strong patriarchal beliefs. However, a number of generational differences were found. Second generation women were more likely to label an abusive behavior as abuse, and first generation women were more likely to approve of abuse, endorse indirect or traditional options to deal with wife abuse, and hold stronger patriarchal beliefs. The study's implications for research and practice within Portuguese communities are discussed.

Portuguese-speaking women voice their opinions: using their words to teach about wife abuse.

BACKGROUND: This study examined Portuguese-speaking women's definitions of wife abuse and beliefs about appropriate responses to abuse. The goals were to determine the breadth of definitions and to examine cultural stereotyping. This information was sought in an effort to design education strategies in the Portuguese-speaking community. METHODS: One-on-one semistructured interviews were conducted with 163 Portuguese-speaking women living in Toronto, Canada. The participants' open-ended answers were first coded using Qualitative Software Research NUDIST and then narrowed and grouped. Responses were then tagged by group label to generate descriptive statistics using Statistical Package for Social Sciences. RESULTS: Participants defined wife abuse broadly with respect to kind, prevalence, and severity. Six themes for abuse emerged: physical, psychological, sexual, financial, patriarchal, and infidelity. Participants provided various responses to what women should do and actually do in response to abuse. Most participants believed that Portuguese-speaking women should leave their husbands and/or seek help for the abuse, but that they actually remain quiet about the abuse and take very little action. Their responses and explanations demonstrate that they hold stereotypes about their culture. CONCLUSIONS: The range of definitions reported by participants suggests that a continuum of wife abuse, using Portuguese-speaking women's own words, can be created to educate them about how abusive acts are linked and used to maintain control over women. The differences that emerged with respect to appropriate responses to abuse suggest that it may be important to challenge Portuguese-speaking women about the cultural stereotypes that they hold to help them see patriarchy as widespread rather than particular to their culture.