Organizational aspects of donor procurement activity in the North Italy Transplant programme (NITp).

In Italy, organ procurement is insufficient to meet patient need. The aim of this study was to estimate the potential donor pool, quantify nonused donors, identify causes of nonretrieval, and evaluate the impact of some hospital organizational problems on organ procurement. In 1995 a questionnaire was sent to 103 intensive care units (ICUs) in 92 hospitals of the NITp area. Out of 432 potential donors identified, 239 (55.3%) were used. Causes of nonretrieval included family refusal (51.7%), clinical reasons (43.9%) and organizational problems (4.4%). In comparison with 1990 and 1993 data, a higher percentage of donors were used and the donors lost for organizational reasons had decreased significantly, while no significant differences were observed in the number of donors lost for family refusal and for clinical reasons. The marked improvement in donor procurement in NITp from 1990 to 1995 was probably as result of measures aimed at motivating ICU personnel and solving their organizational difficulties.

Nursing care planning for terminally ill cancer patients receiving home care.

Nursing home care for terminally ill cancer patients was organized according to nursing care plans that were based on diagnoses as recommended by the North American Nursing Diagnosis Association (NANDA). This study was carried out among a sample of 40 patients receiving home health care for a period of 1 to 19 weeks. More than 697 nursing diagnoses were identified in the study. The most frequently recorded nursing diagnoses were anxiety, constipation, and diminished food intake. Fifteen of the 40 patients in the study were able to complete a weekly self-report of their symptoms. The patients' own descriptions of their symptoms were then compared with their symptoms as identified by nursing staff. There was a congruence in 63% of reported instances. Although nurses' assessments were not always in agreement with the symptoms reported by the patients, agreement was more frequently found with somatic symptoms than with psychological ones. One conclusion is that nursing plans should incorporate multidimensional methods for assessing patients' real needs.

[Neuroleptic malignant syndrome. A case report]. / La sindrome maligna da neurolettici. Descrizione di un caso clinico.

A psychotic received neuroleptics and lithium salts for a few days, developing a classic clinical presentation of a neuroleptic malignant syndrome. Treatment in our ICU was started with dantrolene sodium and bromocriptine p.o., associated with artificial cooling of the body and cardiac, respiratory and metabolic measures. In this way we were able to normalize the clinical conditions of the patients. The clinical description of this case allows a general review of the literature on this "rare" syndrome, starting from the anaesthesiologist point of view.

[Experience in prophylactic peroperative cardiac electrostimulation (author's transl)]. / La nostra esperienza in tema di elettrostimolazione cardiaca provvisoria peroperatoria.

The Authors refer on about 35 cases of prophylactic peroperative cardiac electrostimulation on about 50,500 cases undergoing surgical procedures during seven years. The indications were: bifascicular block, complete left bundle branch block, primitive sinusal bradycardia, surgical correction of carotid synus syndrome, atrial fibrillation with spontaneous low ventricular rate, neurosurgical treatment of cranial trauma by suspected MAS syndrome, surgical implantation of epicardial electrodes. It is enphasized the necessity to continue with prophylactic peroperative cardiac stimulation in all these cases, except for bifascicular blocks for which one has to decide case by case according to the clinical history and ECG findings.