Should we retransplant a patient who is non-adherent? A literature review and critical reflection.

The majority of transplant centers around the world face an ethical debate whether to retransplant a young non-adherent patient. Non-adherence to lifelong immunosuppressants presents a significant risk for graft loss, yet rates remain consistently high. Despite a number of these patients presenting for retransplantation, there is little evidence to guide professionals in their decision-making. This paper aims to provide such guidance, by systematically reviewing the existing outcome data for retransplantation in patients who are known to be non-adherent to their immunosuppressants. This review searched for original papers that addressed retransplantation of a solid organ and included quantitative data on adherence or graft function. Only one original research paper was found to meet the inclusion criteria. This paper is reviewed, and details of the protocol to determine eligibility for retransplantation are summarized. The findings are discussed within the ethical context that transplant professionals work within, and the arguments for and against retransplantation are considered. The need for effective integration of adherence management into routine practice is highlighted, with an emphasis on reliable measurement of adherence throughout the patient's life. Examples of good practice are discussed, favoring prevention over cure.

Acquiring a Pet Dog Significantly Reduces Stress of Primary Carers for Children with Autism Spectrum Disorder: A Prospective Case Control Study.

This study describes the impact of pet dogs on stress of primary carers of children with Autism Spectrum Disorder (ASD). Stress levels of 38 primary carers acquiring a dog and 24 controls not acquiring a dog were sampled at: Pre-intervention (17 weeks before acquiring a dog), post-intervention (3-10 weeks after acquisition) and follow-up (25-40 weeks after acquisition), using the Parenting Stress Index. Analysis revealed significant improvements in the intervention compared to the control group for Total Stress, Parental Distress and Difficult Child. A significant number of parents in the intervention group moved from clinically high to normal levels of Parental Distress. The results highlight the potential of pet dogs to reduce stress in primary carers of children with an ASD.

Cystic fibrosis: what do patients know, and what else would they like to know?

As the survival of patients with cystic fibrosis (CF) improves, it becomes increasingly important to address such issues as employment, reproduction, and quality of life in adulthood. In this study, 22 patients and 20 parents completed a questionnaire about the natural history, treatment and genetics of cystic fibrosis. Patients and parents knew as much as each other about the natural history of cystic fibrosis. Patients under 13 knew significantly less about the genetics and treatment. All found probability questions about heredity difficult. All the patients indicated that they would like further information on the future and how they would cope, through CF literature, organized patient groups and, in adolescence, would prefer to obtain information from medical staff rather than parents. Patients had received considerable information about the disease and its treatment from parents and clinical staff, but few had discussed the day to day problems of living with cystic fibrosis. This study has identified specific areas of ignorance in patients with cystic fibrosis, areas that need addressing in view of the improved survival associated with this disease.

[Quantitative Tc 99m - DISIDA hepatobiliary scintigraphy in normal and cirrhotic alcoholic subjects]. / Centellografía hepatobiliar cuantitativa con 99m Tc DISIDA en sujetos normales y en cirróticos alcohólicos.

UNLABELLED: Quantitative hepatobiliary scintigraphy (Q.H.S.), with 99m Tc-DISIDA was performed on 15 control subjects and 32 alcoholic cirrhotic patients (A.C.). We used a dynamic planar scintigraphy (30 seg/frame, up to 45 min) technique following injection intravenously of 99m Tc-DISIDA. Time/activity curves were obtained from the right upper lobe of the liver and the: 1) slope uptake, 2) half-time (T 1/2 min) uptake, 3) excretion half-time (T1/2 min), were measured from the curve. The A.C. were divided in two groups, IIA (n = 32) and IIB (n = 6) if the excretory curve show negative slope or not respectively. RESULTS: The mean value (+/- 1 D.S. 95% coinfidence interval) of the slope uptake of the A.C. IIB (1.2 +/- 0.40) was significantly slower than a.C. IIA (2.8 +/- 0.39) and control (4.5 +/- 1.17, p = 0.0001 respectively). The difference also was significantly when the mean of A.C. IIA was compared to control (p = 0.007). The mean of T1/2 uptake of A.C.IIB (62.2 +/- 22.2) was significantly longer than A.C. IIA (28.4 +/- 4.4 p = 0.011) and control (17.9 +/- 3.87, p = 0.003). The mean T1/2 excretory of the A.C. IIA (90.0 +/- 17.8) was also significant delayed compared to the mean of normal control (35.6 +/- 7.6 p = 0.001). In the A.C. IIB the excretion plateau curve was associated with visualization of the gallbladder and bowel activity suggesting that the excretion of the IDA preferentially came from the left hepatic lobe. We conclude that alcoholic cirrhotic patients have impaired the mechanism related with the uptake/excretion transport of organic anion, and suggest that noninvasive Q.H.S. with 99m Tc-DISIDA, can be a useful clinical technique to be used for the quantification of hepatic function in cirrhotic alcoholic patients.

Numerical solution for water table rise estimation behind deep underground dam.

A comprehensive numerical approach has been developed to solve the transient groundwater level changes due to the construction of underground dams. This method assumes no flow takes place through the dam and does not require knowledge of either the dam hydraulic properties or information about downstream water table changing level or aquifer geometry beyond the dam site. It couples the solution of the general groundwater flow equation with a modified equation derived at the lower boundary nodes of the simulated domain. The robustness of this method has been tested against simulations of the full groundwater equation for different time periods of up to 50 years with different aquifer characteristics. Comparison shows good agreement between the developed model outputs and the full groundwater flow equation simulated results, under the different simulated scenarios.

Salmonella Michigan soft tissue infection in an immunocompromised child.

A rare case of soft tissue infection due to Salmonella Michigan in an immunocompromised child is reported. The same organism was isolated from a tortoise kept in the home. Immunocompromised patients are especially susceptible to reptile-associated salmonellosis and should be advised appropriately.

Do the younger siblings of learning-disabled children see them as similar or different?

Pre-school siblings' comments about, and behaviour towards, their older, learning-disabled brothers and sisters are reported. Initially, some of the very young siblings want to be similar, and attempt to imitate their brothers and sisters, particularly if he or she is also physically disabled; this may be because of the immediate visibility of physical disability, which makes it appear interesting and important to the younger child. Before they are 2 years old, children are able to recognize that their older brothers and sisters are different, and often imitate the parents' behaviour towards the older child.

The effects of experience and sexual abuse training on the attitudes of learning disability staff.

Staff employed in three day centres for people with learning disabilities were offered training in sexual abuse. Their knowledge and attitudes about sexual abuse were measured immediately before and after training. Staff were asked about their perceptions of the risks of people with learning disabilities being sexually abused, and their estimations of the probability of the perpetrator being either a member of staff, a client, a person known to the abused person or a stranger. Their responses were found to be influenced by the recent training and their prior personal experience.

Centellografía hepatobiliar cuantitativa con 99m Tc DISIDA en sujetos normales y en cirróticos alcohólicos. / [Quantitative Tc 99m - DISIDA hepatobiliary scintigraphy in normal and cirrhotic alcoholic subjects]

Quantitative hepatobiliary scintigraphy (Q.H.S.), with 99m Tc-DISIDA was performed on 15 control subjects and 32 alcoholic cirrhotic patients (A.C.). We used a dynamic planar scintigraphy (30 seg/frame, up to 45 min) technique following injection intravenously of 99m Tc-DISIDA. Time/activity curves were obtained from the right upper lobe of the liver and the: 1) slope uptake, 2) half-time (T 1/2 min) uptake, 3) excretion half-time (T1/2 min), were measured from the curve. The A.C. were divided in two groups, IIA (n = 32) and IIB (n = 6) if the excretory curve show negative slope or not respectively. RESULTS: The mean value (+/- 1 D.S. 95

coinfidence interval) of the slope uptake of the A.C. IIB (1.2 +/- 0.40) was significantly slower than a.C. IIA (2.8 +/- 0.39) and control (4.5 +/- 1.17, p = 0.0001 respectively). The difference also was significantly when the mean of A.C. IIA was compared to control (p = 0.007). The mean of T1/2 uptake of A.C.IIB (62.2 +/- 22.2) was significantly longer than A.C. IIA (28.4 +/- 4.4 p = 0.011) and control (17.9 +/- 3.87, p = 0.003). The mean T1/2 excretory of the A.C. IIA (90.0 +/- 17.8) was also significant delayed compared to the mean of normal control (35.6 +/- 7.6 p = 0.001). In the A.C. IIB the excretion plateau curve was associated with visualization of the gallbladder and bowel activity suggesting that the excretion of the IDA preferentially came from the left hepatic lobe. We conclude that alcoholic cirrhotic patients have impaired the mechanism related with the uptake/excretion transport of organic anion, and suggest that noninvasive Q.H.S. with 99m Tc-DISIDA, can be a useful clinical technique to be used for the quantification of hepatic function in cirrhotic alcoholic patients.