The APOL1 gene and allograft survival after kidney transplantation.

Coding variants in the apolipoprotein L1 gene (APOL1) are strongly associated with nephropathy in African Americans (AAs). The effect of transplanting kidneys from AA donors with two APOL1 nephropathy risk variants is unknown. APOL1 risk variants were genotyped in 106 AA deceased organ donors and graft survival assessed in 136 resultant kidney transplants. Cox-proportional hazard models tested for association between time to graft failure and donor APOL1 genotypes. The mean follow-up was 26.4 ± 21.8 months. Twenty-two of 136 transplanted kidneys (16%) were from donors with two APOL1 nephropathy risk variants. Twenty-five grafts failed; eight (32%) had two APOL1 risk variants. A multivariate model accounting for donor APOL1 genotype, overall African ancestry, expanded criteria donation, recipient age and gender, HLA mismatch, CIT and PRA revealed that graft survival was significantly shorter in donor kidneys with two APOL1 risk variants (hazard ratio [HR] 3.84; p = 0.008) and higher HLA mismatch (HR 1.52; p = 0.03), but not for overall African ancestry excluding APOL1. Kidneys from AA deceased donors harboring two APOL1 risk variants failed more rapidly after renal transplantation than those with zero or one risk variants. If replicated, APOL1 genotyping could improve the donor selection process and maximize long-term renal allograft survival.

Measuring quality of life of patients of traumatic brain injury.

Quality of life (QOL) is recognized as an important indicator of health care and the patient's ability to cope with illness, treatment, and recuperation. Issues that need to be addressed in any proposed QOL research include a clear definition of QOL, a sound rationale for the choice of a measurement instrument, and the value of qualitative data. Measuring QOL in a patient population that has experienced traumatic brain injury (TBI) raises special concerns associated with the physical, behavioral, and cognitive limitations inherent with the specific TBI population. These pertinent issues are discussed with a focus that should be helpful for persons planning QOL projects and those reading and critiquing related literature. A study conducted by the author with patients with severe trauma injury will be used as an example of the impact of these issues on an actual project.

Evidence-based clinical practice guidelines.

Evidence-based practice is a process, encompassing research utilization, clinical expertise, and appreciation of the unique needs of patients. Clinical practice guidelines are tangible evidence of an environment that fosters evidence-based practice. Development and evaluation of guidelines need to be research-based, and the implementation needs to be styled for the particular organization.

"Slow" code: perspectives of a physician and critical care nurse.

"Slow" codes are not conducted frequently, but even their limited use is controversial from an ethical point of view. Physicians and nurses may view the rationale for a "slow" code differently. A critical care nurse and a physician were interviewed regarding their experiences with and their views about "slow" codes.

Ethical issues in organ donation and transplantation: are we helping a few at the-expense of many?

Ethical issues have always been apparent in the transplantation process and are becoming more evident as the demand for organs increases. The basic question is how just and ethical are the new policies enacted to encourage organ donation, considering that they affect the total public and benefit the small percentage of patients who require transplantation? Pros and cons of several of these policies will be discussed as will several clinical situations that raise ethical questions.

A model for collaborative nursing research.

A nursing research center based upon collaboration can provide partners, practice, and academia with essential services for conducting and disseminating research. The design and implementation of such a center is discussed. The center's activities provide advantages for both settings, especially considering the present pressure in the health care industry for increased productivity and efficiency.

Characteristics of flight nursing practice.

INTRODUCTION: The purpose of this study was to describe the roles, levels of responsibility and backgrounds of flight nurses employed in flight programs across the country and to determine if the role of the flight nurse varied as a function of crew configuration or size of program. METHODS: In 1991, a retrospective statistical questionnaire was sent to 105 programs with 50 or more flights per month. RESULTS: This survey provides national data regarding description of programs, evidence of the critical-care environment, professional profiles of flight nurses and practice differences between nurse and paramedic personnel. A difference in the practice for nurses existed in the larger programs (> or = 1,100 flights) with nurse/paramedic flight configurations. Nurses more frequently performed interventions regarding initiating and discontinuing medications (p = 0.00023)--especially paralyzing agents (p = 0.012) and blood (p = 0.0016)--and recognizing by physical exam the need for interventions to decrease intracranial pressure (p = 0.0194). In the larger programs, nurses also were more responsible for decision making regarding titration of medications (p = 0.027). CONCLUSIONS: Flight nurses practice in advanced autonomous roles, performing duties and skills consistent with critical care and emergency medicine in air medical transport.