Donor kidney disease and transplant outcome for kidneys donated after cardiac death

Background

Although outcomes of kidney transplants following donation after cardiac death (DCD) and donation after brainstem death (DBD) are similar, generally only optimal younger DCD donors are considered. This study examined the impact of pre-existing donor kidney disease on the outcome of DCD transplants.

Methods

This retrospective study compared the outcome of all DCD kidney transplants performed during 1996–2006 with contemporaneous kidney transplants from DBD donors. Implantation biopsies were scored for glomerular, tubular, parenchymal and vascular disease (global histology score). There were 104 DCD and 104 DBD kidney transplants.

Results

Delayed graft function (DGF) occurred more frequently in DCD than DBD kidneys (64·4 versus 28·8 per cent; P < 0·001). Long-term graft outcome was similar. The only donor factor that influenced outcome was baseline kidney disease, which was similar in both groups, even though DCD donors were younger, with a higher predonation estimated glomerular filtration rate. The global histology score predicted DGF (odds ratio 1·85 per unit; P = 0·006) and graft failure (relative risk 1·55 per unit; P = 0·001), although there was no difference for DCD and DBD kidneys.

Conclusion

Transplant outcomes for DCD and DBD kidneys are comparable. Baseline donor kidney disease influences DGF and graft survival but the impact is no greater for DCD kidneys.

Red cell or serum folate? Results from the National Pathology Alliance benchmarking review

AIMS

The National Pathology Alliance benchmarking review has completed five years of data collection and analysis of the workload and organisation of haematology laboratories in the UK. This study analyses variation in practice in how laboratories respond to a request to determine whether or not a patient has folate deficiency.

METHODS

A three year analysis of workload data on the number of serum/plasma folate and red cell folate assays performed on an annual basis for the period 1 April 1999 to 31 March 2002.

RESULTS

Three diagnostic testing strategies were found, namely: serum/plasma folate only, red cell folate only, and both serum/plasma folate and red cell folate.

CONCLUSION

Evidence from the literature indicates that serum folate measurements provide equivalent information to red cell folate measurements when attempting to determine whether folate deficiency is present. There seems to be no basis for the routine testing of all samples for serum/plasma folate and a red cell folate.

'Psychiatric nursing was great, but I want to be a "real" nurse': is psychiatric nursing a realistic choice for nursing students?

The present paper reports the results of a quasi-experimental study that examined the relationship between exposure to the theory and practice of psychiatric nursing and the desirability of psychiatric nursing as a future career choice. A time series design was utilized to enable a comparison between pre- and post-test scores. A significant increase in the popularity of psychiatric nursing was evident in the experimental group in the post-test phase, while no significant change was detected in the control group. Despite this increase, a large number of students from the experimental group indicated their reluctance to undertake a career in psychiatric nursing without first consolidating their skills in the medical-surgical area. This situation reflects an image of nursing that is contrary to the caring philosophy it purports to embrace, but which appears to favour certain areas of nursing practice at the expense of others.

Can educational methods influence the popularity of psychiatric nursing?

The ongoing difficulty of attracting sufficient numbers of undergraduate nursing students to a career in psychiatric nursing has been acknowledged. Limited available research suggests that education can produce a more positive view of psychiatric nursing. Despite these findings, research into the impact of educational methods upon the popularity of psychiatric nursing has not been undertaken. This paper reports the findings of a quasi-experimental research project, which examined the relationship between the study of, and the popularity of, psychiatric nursing. The results propose that through undertaking the psychiatric nursing program, psychiatric nursing as a future career option became more popular. The greater significance of the results of this study than had been found in previous studies suggests that problem-based learning is an educational method capable of influencing the development of more positive attitudes.

Psychiatric nursing education: doing the impossible?

Historically, psychiatric nursing has struggled to attract sufficient numbers of graduates of comprehensive nursing programs. Limited available research suggests that psychiatric-nursing education can produce more positive attitudes towards psychiatric-nursing practice and the care of the mentally ill. This article describes the results of a research project undertaken in Victoria, Australia, to extend existing knowledge by determining the impact of education in augmenting interest in psychiatric nursing as a future career option. The results of this quasi-experimental study suggest education can significantly increase the popularity of psychiatric nursing as a profession.

A seroepidemiological study of hepatitis B amongst Fiji health care workers

Hepatitis B immunization for health care workers is common policy in many countries where they constitute a particular at risk group. A seroepidemiological study of hepatitis B virus (HBV) in Fiji health care workers was conducted to determine whether this occupational group (or subgroups thereof) were at higher risk of infection than the general Fiji population. The purpose of this study was to ascertain whether health staff should be immunized, or whether it would be more productive to focus resources on neonatal immunization. Blood samples were obtained from 2,639 health workers and the sera analysed by radio-immunoassay for hepatitis B surface antigen (HBsAg), and hepatitis B surface antibody (anti-HBs). Prevalence rates of HBV markers of infection were compared with those observed in the general population, from a previous population-based cluster sample survey. Approximately 70% of the health care staff participated in the study. Prevalence of total HBV markers was 24%. The rate of HBsAg was 5%. Sex and ethnic group specific prevalence rates varied. Male subjects, Fijians and "other" Pacific Islanders all experienced higher rates of infection. Rural/urban and age related trends were also observed. Rates of infection in health staff were lower than those reported in the general population. Previous studies have indicated that most of the transmission of hepatitis B in hyperemdemic Pacific populations occurs at birth or within the next few years. There was no consistent pattern of hepatitis B infection in different occupational groups of health care workers. Certain relatively socially homogeneous subgroups of health workers were analysed separately, and among these health workers there was evidence for increased risk of infection due to exposure to blood or used hypodermic syringes, but not due to patient contact. Until health staff assume a higher risk of infection than the general Fijian population, efforts directed at community-wide control of hepatitis B continue to be the most appropriate use of resources.