Undergraduate Education in Transplantation.

INTRODUCTION: Training in the transplants of organs, tissues, and cells as a therapeutic modality of multiple pathologies is essential in undergraduate education. The medical aspects typical of the theme are associated with ethical, legal, religious, and philosophical concerns, giving a holistic view of the process. We present a teaching model of the donation-transplant process with 15 years of experience. METHODS: The subject of Organ, Tissue, and Cell Transplants began its activities in 2008. It is an elective, annual subject included in the last year of the medical career. Since its inception, it has established a continuous teaching methodology with a global approach to the donation and transplantation process. RESULTS: During the last 15 years and until the moment of the presentation, 1057 students have registered for the subject, 80.6% (852) completed the requirements of approval of the course, 79.9% of the students presented for the final evaluation (681), and 96.4% (654) of the students passed the final assessment. The average final grade calculated was equal to 6.53 ± 2.9 points out of 10; 205 students (19.4%) still need to comply with the final evaluative instance. CONCLUSION: The available literature has different training modalities, but none resembles the model presented. It is concluded that, during these 15 years, the pedagogic expectations in the training of human resources have been exceeded.

Online Continuing Medical Education for the Latin American Nephrology Community.

A continuing medical education (CME) course was implemented for Latin American nephrologists in 2013. The topic was Immunopathology in native and transplanted kidneys. The course was given in Spanish and Portuguese. The activities included a distance education seven-week asynchronous online modality with multiple educational strategies. Thirty hours of study workload were estimated to complete the course. Four hundred and ninety-eight physicians coming from 18 countries registered for the course; 442 of them participated in it. Of those who participated, 51% received a certificate of completion and 29% a certificate of participation. Sixty-five percent of registrants participated in the case discussions. Eighty-six percent were very satisfied and 13% were satisfied. Lack of time to devote to the course was the main limitation expressed (62%), while Internet access or difficulties in the use of technology were considered by only 12 and 6% of participants, respectively. There was a significant increase in knowledge between before and after the course; the average grade increased from 64 to 83%. In conclusion, technology-enabled education demonstrated potential to become an instrument for Latin American nephrologists.

Saltear una o más sesiones de diálisis aumenta significativamente la tasa de mortalidad: impacto de medir la no adherencia / Skipping one or more dialysis sessions significantly increases mortality rate: measuring the impact of non-adherence

Introducción: La no adherencia a la frecuencia prescripta de sesiones de diálisis se observa en rangos del 2% al 50% de los pacientes. El objetivo de este estudio fue evaluar el impacto de medir y detectar la no adherencia a la frecuencia dialítica prescripta y determinar la importancia de un enfoque multidisciplinario con el fin de mejorar la adherencia. Métodos: Estudio de cohorte longitudinal incluyendo a 8164 pacientes en HD de clínicas de Fresenius Medical Care Argentina, prevalentes en abril 2010, con más de 90 días de tratamiento y seguimiento a 3 años. Se evaluó por encuesta: salteo de al menos una sesión de diálisis en un mes o acortamiento de por lo menos 10 minutos de una sesión de diálisis en un mes, durante los 6 meses previos a la encuesta. Se evaluaron riesgos relativos de mortalidad entre grupos. Resultados: 648 pacientes (7.93%) salteaban sesiones de diálisis: 320 (3.92%) salteaban una sesión por mes y 328 (4.01%) salteaban más de una sesión por mes. Luego de 3 años de seguimiento, 349 pacientes (53.85%) permanecían activos en hemodiálisis y 299 estaban inactivos por diferentes motivos: 206 fallecidos (31.79%), 47 transferencias o pérdidas de seguimiento (7.25%), 36 trasplantados (5.55%), 8 cambios de modalidad a DP (1.23%) y 2 recuperaciones de la función renal (0.3%). Saltear una sesión de diálisis por mes aumentó significativamente el riesgo de mortali dad comparando ambos grupos (salteadores y no salteadores): RR = 2,65 (IC 95% 2.24 - 3.14). Saltear más de una sesión de diálisis también aumentó significativamente el riesgo de mortalidad comparado con los no salteadores: RR = 2.8 (IC 95% 2.39 - 3.28). Luego de 3 años de seguimiento, un 41,66% de los salteadores al inicio habían mejorado su adherencia a través de un programa multidisciplinario de mejora de calidad. Conclusión: La mortalidad global fue mayor entre aquellos pacientes salteadores de sesiones de diálisis. Una proporción considerable de pacientes salteadores al inicio modificaron su conducta a través de la implementación de un programa multidisciplinario de mejora de calidad.

Background: Non-adherence to the prescribed dialysis sessions frequency ranges from 2% to 50% of patients. The objective of this study was to evaluate the impact of detecting and measuring the non-adherence to the prescribed dialysis frequency and to determine the importance of a multidisciplinary approach with the aim of improving adherence. Materials: longitudinal cohort study including 8,164 prevalent hemodialysis patients in April 2010, with more than 90 days of treatment, in Fresenius Medical Care Argentina units that were monitored for 3 years. The survey evaluated: interruption of at least one dialysis session in a month or reduction at least 10 minutes of a dialysis session in a month, during 6 months prior to the survey. Relative mortality risks were evaluated among groups. Results: 648 patients (7.9%) interrupted dialysis sessions: 320 (3.9%) interrupted one session per month and 328 (4.01%) interrupted more than one session per month. After 3 years monitoring, 349 patients (53.8 %) remained active in hemodialysis and 299 were inactive due to different reasons: 206 deceased (31.8 %), 47 transfers or monitoring losses (7.25 %), 36 transplanted (5.55 %), 8 changes to PD modality (1.2%) and 2 recovered their kidney function (0.3 %).Interrupting one session per month significantly increased the mortality risk comparing both groups (interrupters and non-interrupters): RR 2.65 (IC 95% 2.24 - 3.14). Interrupting more than one dialysis session also increased significantly mortality risk comparing to the non-interrupters: RR 2.8 (IC 95% 2.39 - 3.28). After 3 years monitoring, 41.6 % of interrupters at the beginning had improved their adherence through a multidisciplinary program of quality improvement. Conclusion: Global mortality was greater among patients who interrupted dialysis sessions. A considerable proportion of interrupter patients at the beginning modified their behavior through the implementation of a multidisciplinary program of quality improvement.