Reduction in Maintenance Immunosuppression in Kidney Transplant Recipients With Stable Donor-Derived Cell-Free DNA Measurements: A Case Series

Personalization of maintenance immunosuppression in kidney transplant recipients has long remained a goal in the transplant community. The recent addition of donor-derived cell-free DNA assays to detect allograft rejection and monitor allograft health may permit for reductions in maintenance immunosuppression in recipients with stable levels. Herein, we described 5 patients with stable donor-derived cell-free DNA levels who underwent reduction in maintenance immunosuppression without precipitation of clinical rejection, proteinuria, or de novo donor specific antibody formation.

Randomized comparison trial of the RIK and the Nimbus 3 mattresses

A randomized comparison trial was carried out at Queen's Hospital, Burton-on-Trent, to compare patient outcomes on the RIK mattress (KCI) and the Nimbus 3 mattress (Huntleigh Healthcare). One hundred and fifty-eight patients, who were assessed to be at particular risk of development of pressure ulcers using the Waterlow score (85 on RIK mattress, 83 on Nimbus), completed the trial. There were no statistically significant differences in baseline parameters at recruitment or pressure ulcer progress. Lack of difference can be as useful as evidence of superiority. Other factors such as nursing interventions required accessible equipment, and costs are important when making equipment choices. For a significant proportion of patients, a static (RIK) mattress can be as effective as an active (Nimbus 3) mattress for management of pressure ulcers.

Asthma, power, and the therapeutic conversation

Previous research has indicated that family therapy may be of use when a child has chronic, uncontrolled asthma. The significant power relations were considered to be those between the child and the parents. In this article, I examine the wider contextual relations that the family encounters when asthma is a problem, and suggest that these relations are unable to be understood without more thoroughly theorizing power. Because of power relations, the meanings of therapeutic encounters for families and health care professionals may not be consensual. The effect may be to hamper adequate asthma management. I suggest that when Foucault's work is examined alongside that of Hoffman, and Anderson and Goolishian, then the processes that distort these understandings are more readily understood. These ideas are illustrated with examples from a research project.