LIVER TRANSPLANTATION IN PATIENTS WITH LIFE SUPPORT: SIGNIFICANT PROGNOSTIC IMPROVEMENT ACHIEVED IN THE PAST DECADE

2008 ◽  
Vol 86 (Supplement) ◽  
pp. 675
Author(s):  
E Akpinar ◽  
E Palaois ◽  
J Montes de Oca ◽  
T Kato ◽  
S Nishida ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Life Support ◽  
The Past

scholarly journals Knowledge and perceptions of cardiopulmonary resuscitation amongst New Zealand podiatrists: a web-based survey

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Angela Brenton-Rule ◽  
Daniel Harvey ◽  
Kevin Moran ◽  
Daniel O’Brien ◽  
Jonathon Webber
Keyword(s):  
New Zealand ◽  
Cardiopulmonary Resuscitation ◽  
Life Support ◽  
Survival Rates ◽  
Sudden Cardiac Arrest ◽  
Cross Sectional Study ◽  
Trial Registration ◽  
Cross Sectional ◽  
Web Based ◽  
The Past

Abstract Background Podiatrists in New Zealand have a duty of care to assist patients in an emergency, and current cardiopulmonary resuscitation (CPR) certification is a requirement for registration. However, it is unknown how competent and confident podiatrists are in administering CPR and how they would respond in an emergency. Having a health professional who has a competent knowledge of CPR and skills in basic life support, can improve survival rates from sudden cardiac arrest. Therefore, the aim of this study was to survey New Zealand podiatrists to determine their CPR knowledge and qualifications; beliefs about the application of CPR; and perceptions of their competency in CPR. Methods This cross-sectional study used a web-based survey. Participants were New Zealand registered podiatrists with a current annual practising certificate. The 31-item survey included questions to elicit demographic information, CPR practice and attitudes, and CPR knowledge. Responses were collected between March and August 2020. Results 171 podiatrists responded to the survey. 16 % of the podiatrists (n = 28) had performed CPR in an emergency, with a 50 % success rate. Participants were predominantly female (n = 127, 74 %) and working in private practice (n = 140,82 %). Nearly half of respondents were younger than 40 years (n = 75,44 %) and had less than 10 years of clinical experience (n = 73, 43 %). Nearly all (n = 169,97 %) participants had received formal CPR training in the past two years, with 60 % (n = 105) receiving training in the past 12 months. Most respondents (n = 167,98 %) self-estimated their CPR ability as being effective, very effective, or extremely effective. Participants’ knowledge of CPR was variable, with the percentage of correct answers for CPR protocol statements ranging between 20 and 90 %. Conclusions This study provides the first insight into New Zealand podiatrists’ CPR knowledge and perceptions. Podiatrists were found to have high levels of CPR confidence but demonstrated gaps in CPR knowledge. Currently, New Zealand registered podiatrists require biennial CPR re-certification. However, resuscitation authorities in New Zealand and overseas recommend an annual update of CPR skills. Based on this study’s findings, and in line with Australia and the United Kingdom, the authors recommend a change from biennial to annual CPR re-certification for podiatrists in New Zealand. Trial registration The study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12620001144909).

It’s Time to Talk to Prehospital Providers: Feedback Disparities among Ground-Based Emergency Medical Services Providers and its Impact on Job Satisfaction

2021 ◽  
pp. 1-9
Author(s):  
Sarayna S. McGuire ◽  
Anuradha Luke ◽  
Aaron B. Klassen ◽  
Lucas A. Myers ◽  
Aidan F. Mullan ◽  
...  
Keyword(s):  
Job Satisfaction ◽  
Patient Care ◽  
Emergency Medical Services ◽  
Performance Feedback ◽  
Life Support ◽  
Clinical Care ◽  
Medical Services ◽  
The Past ◽  
Emergency Medical ◽  
Overall Job Satisfaction

Abstract Objective: Performance feedback on clinical care and patient outcomes is a cornerstone of medical education, yet it remains lacking in the prehospital environment. Research seeking to establish the quantity of feedback provided to Emergency Medical Services (EMS) has been limited and studies focused on complimentary feedback or how feedback relates to EMS job satisfaction are lacking. The objectives of this study were to measure the frequency and nature of feedback received by EMS agencies and to identify the importance of receiving feedback as it relates to EMS job satisfaction. Methods: This was an anonymous, survey-based study of twenty-nine Basic Life Support (BLS) and fifteen Advanced Life Support (ALS) agencies located in Southeastern Minnesota (USA). Descriptive statistics and Fisher exact tests were used. The study was deemed exempt by the Mayo Clinic Institutional Review Board. Results: Ninety-four responses were included from nineteen different EMS agencies, including sixty-one (64.9%) paramedics and thirty-three (35.1%) emergency medical technicians (EMTs). One-half of all respondents reported that they had not received any type of feedback in the past 30 days, while another 43.6% of respondents indicated that they had only received feedback one to three times in the same time period. Twenty (60.6%) EMTs reported receiving no feedback in the past 30 days, compared with twenty-seven (44.3%) paramedics (P = .123). Of respondents receiving feedback, 65.9% reported never or rarely receiving positive reinforcing feedback and 60.6% reported never or rarely receiving constructive criticism or feedback regarding something that did not go well with patient care or transport. The majority of respondents were dissatisfied with the quantity (86.1%) and quality (73.4%) of feedback received. An overwhelming majority (93.6%) indicated that feedback on patient care or outcomes was important in influencing their overall job satisfaction. This high importance was maintained across all demographic groups. Conclusion: Within the cohort of survey respondents, a paucity of feedback received by EMS personnel is a source of dissatisfaction for EMS providers. Feedback on patient care strongly relates to overall job satisfaction. These findings suggest system-wide opportunities for structured feedback processes, focusing upon both quality and quantity of delivered feedback, to improve both patient care and staff satisfaction.

Availability and use of medications by prehospital providers trained to manage medical complications of patients in hazardous materials incidents

2021 ◽  
Vol 16 (3) ◽  
pp. 215-223
Author(s):  
K. Moses Mhayamaguru, MD ◽  
Joshua B. Gaither, MD ◽  
Robert N. E. French, MD, MPH ◽  
Nicholas D. Christopher ◽  
Kristina E. Waters, BS, MS ◽  
...  
Keyword(s):  
United States ◽  
Calcium Gluconate ◽  
Medical Management ◽  
Life Support ◽  
Hazardous Materials ◽  
Medical Complications ◽  
Advanced Training ◽  
The Past ◽  
Frequency Of Use ◽  
Medical Emergencies

Introduction: Little is known about prehospital availability and use of medications to treat patients from hazardous materials (hazmat) medical emergencies. The aim of this study was to identify the availability and frequency of use of medications for patients in hazmat incidents by paramedics with advanced training to care for these patients.Methods: A prospectively validated survey was distributed to United States paramedics with advanced training in the medical management of patients from hazmat incidents who successfully completed a 16-hour Advanced Hazmat Life Support (AHLS) Provider Course from 1999 to 2017. The survey questioned hazmat medication availability, storage, and frequency of use. Hazmat medications were considered to have been used if administered anytime within the past 5 years. For analyses, medications were grouped into those with hazmat indications only and those with multiple indications.Results: The survey email was opened by 911 course participants and 784 of these completed the survey (86.1 percent). Of these 784 respondents, 279 (35.6 percent) reported carrying dedicated hazmat medication kits, ie, tox-boxes, and 505 (64.4 percent) did not carry tox-boxes. For those medications specifically for hazmat use, hydroxocobalamin was most commonly available, either within or not within a dedicated tox-box. Of the 784 respondents, 313 (39.9 percent) reported carrying hydroxocobalamin and 69 (8.8 percent) reported administering it within the past 5 years. For medications with multiple indications, availability and use varied: for example, of the 784 respondents, albuterol was available to 699 (89.2 percent) and used by 572 (73.0 percent), while calcium gluconate was available to 247 (31.5 percent) and used by 80 (10.2 percent) within the last 5 years.Conclusion: Paramedics with advanced training in the medical management of patients in hazmat incidents reported limited availability and use of medications to treat patients in hazmat incidents.

scholarly journals Five-Year Experience of Liver Transplant at Kerman University of Medical Sciences: Afzalipoor Hospital

2020 ◽  
Author(s):  
Masood Dehghani
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Cross Sectional Study ◽  
Outcome Data ◽  
Time Interval ◽  
Cross Sectional ◽  
The Past ◽  
Transplantation Center ◽  
Set Up ◽  
End Stage

Introduction: The only option for treatment of end stage liver diseases is liver transplantation. Afzalipour Hospital in Kerman, Iran is the third largest liver transplantation center in Iran. In this study, the outcomes of this center have been studied during the past 5 years. Methods: In this cross-sectional study, the pre and post transplantation’s clinical, demographic and outcome data of all patients who received liver transplant at Afzalipour Hospital during the past 5 years have been collected and reviewed. SPSS software ver. 16 was used to analyze the data. Results: Forty-three patients have received liver transplantation during this time interval. The 3-year survival rate of patients was 77%. The most common cause of death was primary nonfunction graft after transplantation. The most common complication was acute rejection (15%), all of which were successfully treated with corticosteroids. Conclusion:  Due to increment of cases of acute and chronic liver failure in the community and since the final treatment of these cases is liver transplantation, so there is need to develop liver transplant centers in the future. Quantitative and qualitative study of the activity of centers based liver transplant in Iran is necessary to set up successful centers.

scholarly journals Microbial biospherics: The experimental study of ecosystem function and evolution

2019 ◽  
Vol 116 (23) ◽  
pp. 11093-11098 ◽  
Author(s):  
Matthias C. Rillig ◽  
Janis Antonovics
Keyword(s):  
Ecosystem Function ◽  
Life Support ◽  
Natural World ◽  
Sensor Technology ◽  
Ecosystem Ecology ◽  
The Past ◽  
Closed Systems ◽  
Reductionist Approach ◽  
Long Term Studies

Awareness that our planet is a self-supporting biosphere with sunlight as its major source of energy for life has resulted in a long-term historical fascination with the workings of self-supporting ecological systems. However, the studies of such systems have never entered the canon of ecological or evolutionary tools and instead, have led a fringe existence connected to life support system engineering and space travel. We here introduce a framework for a renaissance in biospherics based on the study of matter-closed, energy-open ecosystems at a microbial level (microbial biospherics). Recent progress in genomics, robotics, and sensor technology makes the study of closed systems now much more tractable than in the past, and we argue that the time has come to emancipate the study of closed systems from this fringe context and bring them into a mainstream approach for studying ecosystem processes. By permitting highly replicated long-term studies, especially on predetermined and simplified systems, microbial biospheres offer the opportunity to test and develop strong hypotheses about ecosystem function and the ecological and evolutionary determinants of long-term system failure or persistence. Unlike many sciences, ecosystem ecology has never fully embraced a reductionist approach and has remained focused on the natural world in all its complexity. We argue that a reductionist approach to ecosystem ecology, using microbial biospheres, based on a combination of theory and the replicated study of much simpler self-enclosed microsystems could pay huge dividends.

Ischemic Complications after Liver Transplantation

2018 ◽  
Vol 02 (03) ◽  
pp. 244-248
Author(s):  
Martin Montenovo ◽  
Christopher Ingraham
Keyword(s):  
Liver Transplantation ◽  
Patient Survival ◽  
Vascular Complications ◽  
Biliary Tree ◽  
Biliary Complications ◽  
Surgical Anastomosis ◽  
Biliary Leak ◽  
The Past ◽  
Ischemic Complications ◽  
Transplantation Complications

AbstractDespite major advances in the field of liver transplantation over the past few decades with both increased graft and patient survival, biliary complications still occur in many patients after liver transplantation. Complications can range from a biliary leak or biloma to strictures most commonly involving the surgical anastomosis, or elsewhere in the biliary tree. Etiologies of these complications include surgical technique, rejection, complications secondary to infection, and vascular complications causing ischemia of the bile ducts. Biliary complications, particularly biliary ischemia, can cause significant morbidity to the patient, and may require multiple endoscopic, endovascular, or percutaneous therapies for successful treatment, or even retransplantation in severe cases. This review will provide an overview of common biliary complications with a focus on biliary ischemia.

Paramedic Knowledge, Attitudes, and Training in End-of-Life Care

2009 ◽  
Vol 24 (6) ◽  
pp. 529-534 ◽  
Author(s):  
Susan C. Stone ◽  
Jean Abbott ◽  
Christian D. McClung ◽  
Chris B. Colwell ◽  
Marc Eckstein ◽  
...  
Keyword(s):  
Los Angeles ◽  
End Of Life ◽  
Life Support ◽  
Clinical Skills ◽  
Chi Square ◽  
Convenience Sample ◽  
Terminal Disease ◽  
The Past ◽  
Almost All ◽  
Eol Care

AbstractIntroduction:Paramedics often are asked to care for patients at the end of life. To do this, they must communicate effectively with family and caregivers, understand their legal obligations, and know when to withhold unwanted interventions. The objectives of this study were to ascertain paramedics' attitudes toward end-of-life (EOL) situations and the frequency with which they encounter them; and to compare paramedics' preparation during training for a variety of EOL care skills.Methods:A written survey was administered to a convenience sample of paramedics in two cities: Denver, Colorado and Los Angeles, California. Questions addressed: (1) attitudes toward EOL decision-making in prehospital settings; (2) experience (number of EOL situations experienced in the past two years); (3) importance of various EOL tasks in clinical practice (pronouncing and communicating death, ending resuscitation, honoring advance directives (ADs)); and (4) self-assessed preparation for these EOL tasks. For each task, importance and preparation were measured using a four-point Likert scale. Proportions were compared using McNemar chi-square statistics to identify areas of under or over-preparation.Results:Two hundred thirty-six paramedics completed the survey. The mean age was 39 years (range 22–59 years), and 222 (94%) were male. Twenty percent had >20 years of experience. Almost all participants (95%; 95% CI = 91–97%) agreed that prehospital providers should honor field ADs, and more than half (59%; 95% CI = 52–65%) felt that providers should honor verbal wishes to limit resuscitation at the scene. Ninety-eight percent of the participants (95% CI = 96–100%) had questioned whether specific life support interventions were appropriate for patients who appeared to have a terminal disease. Twenty-six percent (95% CI = 20–32%) reported to have used their own judgment during the past two years to withhold or end resuscitation in a patient who appeared to have a terminal disease. Significant discrepancies between the importance in practice and the level of preparation during training for the four EOL situations included: (1) understanding ADs (75% very important vs. 40% well prepared; difference 35%: 95% CI = 26–43%); (2) knowing when to honor written ADs (90% very important vs. 59% well-prepared; difference 31%: 95% CI = 23–38%); and (3) verbal ADs (75% very important vs. 54% well-prepared, difference 21%: 95% CI = 12–29%); and (4) communicating death to family or friends (79% very important vs. 48% well prepared, difference 31%: 95% CI = 23–39%). Paramedics' preparation in EOL skills was significantly lower than that for clinical skills such as endotracheal intubation or defibrillation.Conclusions:There is a need to include more training in EOL care into prehospital training curricula, including how to verify and apply ADs, when to withhold treatments, and how to discuss death with victims' family or friends.

Neonatal ECMO: Current Controversies and Trends

2006 ◽  
Vol 25 (4) ◽  
pp. 229-238 ◽  
Author(s):  
Jesse Ford
Keyword(s):  
High Frequency ◽  
Distress Syndrome ◽  
Life Support ◽  
Meconium Aspiration Syndrome ◽  
High Frequency Oscillatory Ventilation ◽  
Ecmo Support ◽  
Respiratory Dysfunction ◽  
Meconium Aspiration ◽  
The Past ◽  
High Frequency Oscillatory

Extracorporeal membrane oxygenation (ECMO), a technique for providing life support to patients with cardiac and/or respiratory dysfunction, allows the heart and lungs to “rest.” The neonatal respiratory population has been a major benefactor of ECMO since 1982. Its use for neonatal respiratory disease increased dramatically until the past few years, when the number of neonatal respiratory ECMO cases began a downward trend. Fewer patients with persistent pulmonary hypertension of the newborn (PPHN), meconium aspiration syndrome, respiratory distress syndrome, or sepsis are requiring ECMO support as frequently as in the past. Many attribute this decline to the newer respiratory therapies—mainly, surfactant, high-frequency oscillatory ventilation, and inhaled nitric oxide. Neonates who continue to require ECMO today are sicker than the historic norm and have more complicated and lengthy ECMO runs. Patients with congenital diaphragmatic hernia, PPHN, and sepsis remain the most consistent in their representation among ECMO recipients within this author’s institution, suggesting that the newer respiratory therapies have not had the same impact on these patients’ needs for ECMO support. Better guidelines for determining which patients would benefit from earlier inititation of ECMO are needed.

Transplantation

2011 ◽  
Author(s):  
M. El-Sheikh ◽  
P. A. Lear
Keyword(s):  
Liver Transplantation ◽  
Kidney Transplantation ◽  
Lung Transplantation ◽  
Pancreas Transplantation ◽  
Cardiac Transplantation ◽  
Organ Donors ◽  
Cadaveric Donor ◽  
The Past ◽  
Number Of Patients ◽  
Donor Numbers

Organ donors 834Organ recipient preparation 836Immunosuppression 838Kidney transplantation 842Pancreas transplantation 846Liver transplantation 848Cardiac transplantation 852Lung transplantation 854• The number of patients waiting for transplantation increases by over 3% per year. Cadaveric donor numbers have declined over the past decade....

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