Effectiveness of an Education Program on Donation and Transplant Aimed at Students of the Nursing Degree Course.

BACKGROUND: Health workers' awareness and knowledge of transplant medicine can improve people's sensitivity and reduce their degree of opposition to donations. The medical literature contains numerous examples of education programs aimed at university students. This work describes the experience of an education program for students of the second and third year of a nursing degree course. METHODS: From April to September 2013, an education program was set up for 80 university students. It was divided into 3 stages: group self-learning based on prearranged topics, sharing of the results, and participation in the final seminar. The effectiveness was assessed according to a pretest/posttest design. RESULTS: The first questionnaire contained 19 questions, and the second contained 27. The questions were subdivided into specific areas: subjective knowledge, objective knowledge, attitude, awareness, participation in the event, evaluation of the information material handed out, and appreciation of the tools used. There was a significant increase for items relating to knowledge, whereas awareness and attitude (already high at the start of the program) showed no changes. After the program, many students discussed the question of donation with their relatives and friends, and about 70% filled in a donor card. The students expressed a highly positive opinion of the initiative and the tools used. CONCLUSIONS: The initiative proved its validity, improving subjective and objective knowledge to a statistically significant extent and also increasing awareness and attitude. The students' evaluation was extremely positive.

Organ and tissue donation in migrants: advanced course for cross-cultural mediators.

Between 2004 and 2010 in Piedmont (Italy Northern Region) 1556 brain-death situations were reported, including 113 (7.3%) in migrants as potential organ and tissue donors. The health staff often has to face migrants, who show great cultural differences and language difficulties. The Molinette Hospital Customer Care Service, the Piedmont Regional Tissue and Organ Procurement Coordination Agency (RPC), and the Cross-Cultural Mediators Association (CMA) organized a special course for intercultural mediators, to decrease misunderstandings between the health staff and the migrants' families and to improve professional communication. In 2011, 28 cultural-linguistic mediators representing different groups of migrants in Piemonte took part in a specific course. Over a 5 month period they were informed about emotional and communicative aspects, proper to the moment of death, as well as organ donation as an intercultural field, the professional role of the mediator, the clinical and forensic aspects of brain death and donation, and the psychological aspects of organ donation. The course was organized by cultural-linguistic mediators of the CMA, the staff of the RPC and the teachers at Turin University. The list of the 21 mediators who passed the final exam was given to organ and tissue donation hospital co-ordinators in Piedmont, so that if necessary, they could obtain the cooperation of these qualified people.

Organ donation awareness project for Piedmont high school students.

FOREWORD: Law no. 91 of April 1, 1999 confirmed the principle of citizens' free choice and awareness with regards the donation of their own organs and tissue. Many studies have shown that information/communication programs aimed at secondary school students are able to significantly increase their propensity toward donation. Students who are made more aware of the topics of donation and transplantation are, in turn, a means of information for their families and acquaintances. METHODS: To be effective, communication must contain both cognitive and emotional elements. This is the principle underlying the development of an awareness-building project that involves the viewing of a play-"Two of Hearts"-telling the story of a transplant patient, followed by a brief scientific presentation aimed at clarifying the basic concepts of transplantation medicine, and then an open discussion between the students and experts. This initiative was promoted by the Piedmont Regional Tissue and Organ Procurement Coordination Agency, the Communication Office of the Piedmont Region, and the Regional Education Office for Piedmont. RESULTS: Seven meetings took place in the main town of each of the provinces that make up the Piedmont Region. These were attended by a total of 1373 students, who were each given an anonymous questionnaire. In all, 785 returned the questionnaire; of these, 95% affirmed that the contents of the meeting had been clearly presented, and 57% stated that they had spoken about it with their family and friends. The project proved be a good tool for communicating with young people and, via them, with their families; at least 2300 people were reached in this way.

Organ donation and transplantation in migrants: Piedmont reality from 2004 to 2011.

BACKGROUND: Over the last 20 years, an increasing number of people have immigrated into Italy. On January 1, 2011, there were 4,570,317 foreign residents in Italy, including 398,910 in the Piedmont region (Italian National Statistics Institute data). The Romanian community was the largest, followed by the Moroccan and Albanian ones. The numbers are even layer if we consider illegal immigrants. As a result, the number of foreign people with brain death has increased, as well as the number of foreign people needing organ transplantations. METHODS: The Piedmont Regional Coordination Agency of Tissue and Organ Procurement has analyzed our 1781 brain death situations between January 2004 and December 2011, including 126 (7%) in people not born in Italy (migrants). RESULTS: Non-refusal for donation occurred in 79 cases (62.7%). The agency also analyzed each community looking at number of brain deaths and non-refusals of donation. We utilized 61 donors, for 174 transplantations. Migrants in Italy are not only potential tissue and organ donors, but also potential tissue and organ recipients. Between 2004 and 2011, 222 patients who had not been born in Italy had been transplanted with: a liver (n = 66), a kidney (n = 130), a heart (n = 21) or a lung (n = 5).

Extracorporeal membrane oxygenation as a bridge to organ donation: a case report.

Hemodynamic instability is a frequent complication in potential organ donors. Despite maximal medical therapy, it can lead to cardiac arrest with consequent loss of organs. In this study we present the use of extracorporeal membrane oxygenation circulation (ECMO) as a bridge to organ procurement in a potential donor with hemodynamic instability. A 14-year-old girl who drowned in a pool experienced cardiorespiratory arrest with prolonged resuscitation. In the intensive care unit (ICU), she displayed hemodynamic instability requiring high doses of inotropis agents. After 60 hours for ICU admission clinical diagnosis of brain death, was established and consent for organ donation obtained. During the observation period, the hemodynamic instability worsened, requiring ECMO which was continued during transport to the operating room and during organ retrieval, totaling 3 hours. We retrieved liver, kidneys, heart valves and cornea. Liver and kidney transplantations were successfully performed in 3 recipients, all of whom displayed appropriate organ functions after 15 months. In conclusion, ECMO support of potential donors can be used to prevent cardiac arrest, preserve organs, and thus increase the number of potential donors.

Digoxin bioequivalence study: determination in human plasma by microparticle enzyme immunoassay.

OBJECTIVE: In this study a bioanalytical method for digoxin quantification was developed using Abbott AxSYM Digoxin II with fluorescence detection to assess the bioequivalence of two digoxin tablet formulations (Digox 0.25 mg tablet from Pharlab Ind. Ltd., Brazil as test formulation and Digoxin 0.25 mg tablet from Laboratório Glaxo SmithKline, Brazil as reference formulation). MATERIAL AND METHODS: 30 healthy volunteers (both sexes) received a single oral dose of digoxin in an open, randomized, two-period crossover study with a seven half-life washout interval of at least (21 days). Plasma samples were obtained over a 288-h interval after each oral administration of digoxin. The present method utilizes microenzyme particle immunoassay technology, in which the digoxin in the sample binds to anti-digoxin-coated microparticles and after separation; digoxin-alkaline phosphatase conjugate binds to the available sites remaining. Digoxin concentrations are calculated from the fluorescent products generated as a result of substrate (4-methylumbelliferyl) passage through the matrix cell. RESULTS: The method was shown to be specific and sensitive with good accuracy and precision. The geometric mean and 90% confidence intervals (CI) for the Digox/Digoxin ratio were 107.62% (96.71 - 119.80%) for AUC0-t, 97.15% (80.54 - 117.19%) for AUC0-inf, and 91.23% (83.55 - 99.62%) for Cmax. CONCLUSION: Since the 90% CI for the parameters were all within the 80 - 125% interval proposed by the US Food and Drug Administration Agency, the two formulations were considered bioequivalent in terms of rate and extent of absorption.

Comparative bioavailability study of two phenoxymethylpenicillin potassium tablet formulations in healthy volunteers.

OBJECTIVE: The aim of this study was to evaluate the performance of 2 phenoxymethylpenicillin 500,000 UI tablet formulations in healthy human volunteers. MATERIAL AND METHODS: The study was conducted using an open, randomized crossover design with a 7-day washout interval. A single dose of each formulation was administered to 26 healthy volunteers as assessed by clinical and laboratory test evaluations. The plasma samples were obtained over an 8-h interval and phenoxymethylpenicillin concentrations were quantified by a suitable and validated HPLC-UV method with detection at 220 nm. Systolic and diastolic blood pressure and pulse rate measurement were taken pre dose and at intervals up to 8 h. RESULTS: Tolerance of both products was adequate. The mean of Meracilina/Pen-Ve-Oral 500,000 UI% geometric mean was 99.89% for AUC0-t, 100.86% for AUC0-infinity and 101.11% for Cmax. The 90% confidence intervals were 94.62 - 105.46%, 95.22 - 106.83% and 98.61 - 103.87%, respectively. The mean recovery of phenoxymethylpenicillin was 94.8%, while the retention time observed for phenoxymethylpenicillin and phenytoin (internal standard) was 4 and 10 min, respectively. The limit of quantification was 0.10 mg/l. CONCLUSION: Since the 90% CI for AUC0-t, AUC0-infinity and Cmax ratios were all within the 80 - 125% interval proposed by the US FDA and accepted by ANVISA, it was concluded that the Meracilina formulation (manufactured by AchA(c) S.A.) is bioequivalent to Pen-Ve-Oral (manufactured by Eurofarma) for both the rate and the extent of bioavailability.

CVVH in postoperative care of liver transplantation.

OBJECTIVE: To evaluate CVVH (Continuous Veno-Venous Hemofiltration) as acute renal replacement treatment in postoperative care of liver transplantation. DESIGN: Retrospective study. SETTING: Intensive Care Unit, year 1995. PATIENTS: 86 OLT performed in 1995, 11 of them underwent acute renal replacement treatment. In the same period, in the ICU were admitted 237 patients, and 20 underwent acute renal replacement treatment (control group). Evaluation with SOFA (Sepsis-related Organ Failure Assessment) score. INTERVENTION: CVVH performed heparin free, pump system, polyamide or polysulphone 0.6 mq membrane hemofilter device, blood flow 150-200 ml/min, UF rate 1000-1200 ml/h, clearance 16-20 ml/min. MEASUREMENTS: Coagulation monitoring (PT as INR, PTT, fibrinogen, antithrombin III, d-dimer, platelet count) was performed 3 times a day or on variation of the clinical conditions. RESULTS: SOFA score did not differ between the two groups. Mortality was higher in the patients treated with CVVH. CVVH was performed from 16 to 18 hrs/day for 9.90 +/- 2.33 days. Three patients developed clinical bleeding before CVVH, 3 during CVVH but 1 of them underwent repeated surgical procedures. CONCLUSIONS: We cannot demonstrate that CVVH doesn't affect bleeding, but we can say that, for the complexity of the post OLT patients, CVVH can be the treatment of choice in case of renal replacement treatment.