ABSTRACT
OBJECTIVES: Kidney transplant is the optimal treatment for end-stage renal disease; however, due to the imbalance between demand and supply, several strategies have been implemented to increase the donor pool. To increase the number of donors, expanded criteria donors after circulatory death have been explored as an acceptable graft source. In this study, we compared graft survival, estimated glomerular filtration rate at 3 and 5 years, and the incidence of delayed graft function between standard and expanded criteria donors after brain death and between standard and expanded criteria donors after circulatory death. MATERIALS AND METHODS: A prospective cohort study was conducted between January 1, 2015, and December 31, 2019, at Reina Sofia University Hospital. Variables related to the donor, recipient, and transplant procedure were analyzed, and univariate and multivariate logistic and Cox regression analyses were performed. RESULTS: Our study included 308 deceased donor kidneys. The kidneys from standard criteria brain dead donors had higher estimated glomerular filtration rate than the other groups (P < .03).However, no significant differences in estimated glomerular filtration rate were observed among the suboptimal groups (expanded criteria and standard criteria donors after brain death and expanded criteria donors after circulatory death). The incidence of delayed graft function was significantly higher in expanded criteria donors after circulatory death than in the other groups (odds ratio = 6.9; 95% CI, 2.22-21.71; P < .001). Nevertheless, we found no significant differences in death-censored graft loss among the groups. CONCLUSIONS: Kidney transplants from expanded criteria donors and donors after cardiac death are comparable, even when both criteria are combined. The use of expanded criteria donor kidneys after cardiac death is therefore a suitable approach to expand the donor pool, despite the higher risk of delayed graft function, as there were no significant differences in death-censored graft loss.
Subject(s)
Kidney Transplantation , Tissue and Organ Procurement , Humans , Kidney Transplantation/methods , Delayed Graft Function/etiology , Retrospective Studies , Prospective Studies , Brain Death , Risk Factors , Tissue Donors , Graft Survival , DeathABSTRACT
OBJETIVOS: Primario: Evaluar el efecto del uso de simuladores en exploración prostática y sondaje vesical sobre la carga mental de trabajo soportada y la confianza adquirida en estudiantes de medicina. Secundario: Analizar el grado de satisfacción y habilidades adquiridas por parte de los estudiantes al usar simuladores como método docente. MÉTODOS: Estudio prospectivo y aleatorizado sobre estudiantes de medicina. Hubo dos grupos de estudio: El grupo 1 (G1) recibió sólo explicación teórica y el grupo 2 (G2) explicación teórica + taller con simuladores. La valoración de la carga mental de trabajo se hizo a través del cuestionario validado NASA-TLX. El grado de confianza, de satisfacción y las habilidades adquiridas fueron también evaluadas. RESULTADOS: Veintiocho estudiantes participaron en el taller de exploración prostática. Todos obtuvieron un mayor nivel de confianza tras la explicación teórica, siendo superior en el grupo que recibió también el taller con simuladores. En el taller de cateterismo vesical donde participaron 34 estudiantes todos aumentaron su confianza tras la actividad. El G2 mostró mejores puntuaciones en el examen de habilidades adquiridas que el G1. La mayoría consideró muy positiva la incorporación de simuladores en su aprendizaje. El uso de simuladores en ambos talleres produjo menos frustración según los resultados del NASA-TLX. CONCLUSIONES: La formación de los alumnos mediante la implementación con simuladores podría lograr una mejora en el nivel de confianza, con un menor nivel de frustración al realizar estas exploraciones en el futuro y así una mejor calidad asistencial
OBJECTIVES: Primary: to assess the use of simulators in prostate digital rectal examination and bladder catheterization on mental workload and the level of confidence in medical students. Secondary: to analyze student satisfaction and skills acquired by students with simulators. METHODS: We conducted a prospective, randomized study on medical students. Participants were divided into two groups: Group 1 (G1) (only the explanation) and group 2 (G2) (explanation + simulator workshop). For workload assessment, the validated NASA-TLX questionnaire was completed. The acceptability of the activity the degree of confidence and the skills acquired were also evaluated. RESULTS: A total of 28 students participated in the practice of prostate examination. All participants reported a higher level of confidence after the theoretical explanation. 34 students participated in the bladder catheterization workshop and all of them increased their confidence after the activity. The G2 showed better scores on the acquired skills exam than the G1. Most students considered positive the incorporation of these models in their learning. According to the NASA-TLX results, less frustration is experienced with the use of simulators in both activities. CONCLUSION: The implementation of simulators in the training of students may improve their level of confidence, reducing frustration when performing these explorations in the future and improving care quality
Subject(s)
Humans , Male , Female , Young Adult , Digital Rectal Examination , Simulation Training , Urinary Catheterization , Urology/education , Workload , Clinical Competence , Job Satisfaction , Prospective StudiesABSTRACT
OBJECTIVES: Primary: to assess the use of simulators in prostate digital rectal examination and bladder catheterization on mental workload and the level of confidence in medical students. Secondary: to analyze student satisfaction and skills acquired by students with simulators. METHODS: We conducted a prospective, randomized study on medical students. Participants were divided into two groups: Group 1 (G1) (only the explanation) and group 2 (G2) (explanation + simulator workshop). For workload assessment, the validated NASA-TLX questionnaire was completed. The acceptability of the activity, the degree of confidence and the skills acquired were also evaluated. RESULTS: A total of 28 students participated in the practice of prostate examination. All participants reported a higher level of confidence after the theoretical explanation. 34 students participated in the bladder catheterization workshop and all of them increased their confidence after the activity. The G2 showed better scores on the acquired skills exam than the G1. Most students considered positive the incorporation of these models in their learning. According to the NASA-TLX results, less frustration is experienced with the use of simulators in both activities. CONCLUSIONS: The implementation of simulators in the training of students may improve their level of confidence, reducing frustration when performing these explorations in the future and improving care quality.
