Incentives for organ donation: proposed standards for an internationally acceptable system

Incentives for organ donation, currently prohibited in most countries, may increase donation and save lives. Discussion of incentives has focused on two areas: (1) whether or not there are ethical principles that justify the current prohibition and (2) whether incentives would do more good than harm. We herein address the second concern and propose for discussion standards and guidelines for an acceptable system of incentives for donation. We believe that if systems based on these guidelines were developed, harms would be no greater than those to today's conventional donors. Ultimately, until there are trials of incentives, the question of benefits and harms cannot be satisfactorily answered.     

Expression of iNOS in early injury in a rat model of small-for-size liver transplantation

BACKGROUND:Living donor liver transplantation has been widely accepted as the treatment of choice for end-stage liver disease.Large amounts of nitric oxide generated by inducible nitric oxide synthase(iNOS)have been shown to play an important role in many inflammatory and immune reactions,but expression of iNOS in small-for-size liver transplantation is unknown.The aims of this study were to determine the time course of iNOS mRNA and protein as well as the redox state of liver biopsies in a rat model of sma...     

Positive provider interactions, adherence self-efficacy, and adherence to antiretroviral medications among HIV-infected adults: A mediation model

Adherence to antiretroviral (ARV) therapy for HIV infection is critical for maximum benefit from treatment and for the prevention of HIV-related complications. There is evidence that many factors determine medication adherence, including adherence self-efficacy (confidence in one's ability to adhere) and relations with health care providers. However, there are no studies that examine how these two factors relate to each other and their subsequent influence on HIV medication adherence. The goal of the current analysis was to explore a model of medication adherence in which the relationship between positive provider interactions and adherence is mediated by adherence self-efficacy. Computerized self-administered and interviewer-administered self reported measures of medication adherence, demographic and treatment variables, provider interactions, and adherence self-efficacy were administered to 2765 HIV-infected adults on ARV. Criteria for mediation were met, supporting a model in which adherence self-efficacy is the mechanism for the relationship between positive provider interactions and adherence. The finding was consistent when the sample was stratified by gender, race, injection drug use history, and whether the participant reported receipt of HIV specialty care. Positive provider interactions may foster greater adherence self-efficacy, which is associated with better adherence to medications. Results suggest implications for improving provider interactions in clinical care, and future directions for clarifying interrelationships among provider interactions, adherence self-efficacy, and medication adherence are supported.     

Food security,diet quality,nutritional knowledge,and attitudes towards research in adults with heart failure during the COVID‐19 pandemic

BackgroundThe impact of the novel coronavirus disease 2019 (COVID‐19) pandemic on diet and nutrition among older adults with chronic medical conditions have not been well‐described.MethodsWe conducted a survey addressing (1) food access, (2) diet quality and composition, (3) nutritional understanding, and (4) attitudes towards research among adults with heart failure (HF) within an integrated health system. Adults (≥18 years) with diagnosed HF and at least one prior hospitalization for HF within the last 12 months were approached to complete the survey electronically or by mail. Outcomes included all‐cause and HF‐specific hospitalizations and all‐cause death was ascertained via the electronic health record.ResultsAmong 1212 survey respondents (32.5% of eligible patients) between May 18, 2020 and September 30, 2020, mean ± SD age was 77.9 ± 11.4 years, 50.1% were women, and median (25th–75th) left ventricular ejection fraction was 55% (40%–60%). Overall, 15.1% of respondents were food insecure, and only 65% of participants answered correctly more than half of the items assessing nutritional knowledge. Although most respondents were willing to participate in future research, that number largely declined for studies requiring blood draws (32.2%), study medication (14.4%), and/or behavior change (27.1%). Food security, diet quality, and nutritional knowledge were not independently associated with outcomes at 90 or 180 days.ConclusionIn a cohort of older adults with HF and multiple comorbidities, a significant proportion reported issues with food access, diet quality, and nutritional knowledge during the COVID‐19 pandemic. Future research should evaluate interventions targeting these domains in at‐risk individuals.     

学生标准化病人用于健康评估操作考核的探讨

[目的]了解学生标准化病人用于健康评估操作考核的效果.[方法]组织2004级五年制高职学生220人进行由学生标准化病人(SSP)参与的健康评估操作考核,结束后发放调查表,并进行分析.[结果]大多数学生认为由ssP参与的健康评估操作考核模式较合理,客观性强,能全面考核自己的健康评估能力、沟通技巧和职业态度等.[结论]把SSP运用于健康评估操作考核,可以达到对阳性体征考核的目的,且节约经费,能代替标准化病人(SP)运用于健康评估操作考核.     

Predonation psychosocial evaluation of living kidney and liver donor candidates: a systematic literature review

Evaluating a person's suitability for living organ donation is crucial, consisting not only of a medical but also of a thorough psychosocial screening. We performed a systematic literature review of guidelines, consensus statements, and protocols on the content and process of psychosocial screening of living kidney and liver donor candidates. We searched PubMed, Embase, CINAHL, and PsycINFO until June 22, 2011, following the PRISMA guidelines, complemented by scrutinizing guidelines databases and references of identified publications. Thirty‐four publications were identified, including seven guidelines, six consensus statements, and 21 protocols or programs. Guidelines and consensus statements were inconsistent and lacked concreteness for both their content and process, possibly explaining the observed variability in center‐specific evaluation protocols and programs. Overall, recommended screening criteria are not evidence‐based and an operational definition of the concept “psychosocial” is missing, causing heterogeneity in terminology. Variation also exists on methods used to psychosocially evaluate potential donors. The scientific basis of predonation psychosocial evaluation needs to be strengthened. There is a need for high‐quality prospective psychosocial outcome studies in living donors, a uniform terminology to label psychosocial screening criteria, and validated instruments to identify risk factors.     

Key reproductive issues for women living with HIV / AIDS

The International Community of Women Living with HIV/AIDS (ICW) issued a statement on childbearing and HIV/AIDS at the 12th International AIDS Conference in Geneva of June-July 1998. Opposed to mandatory HIV testing, the ICW advocates universal pre- and post-test counseling, testing with informed consent, and access to test results. The organization also endorses research which directly benefits the women with HIV/AIDS who are involved. The ICW opposes research which is irrelevant to or which exploits women with HIV/AIDS who are poor, uninformed, or lack resources, unless such research will directly benefit them and their children. Regardless of to what they have access, women are entitled to know that monotherapy is neither an optimal nor recommended therapy against HIV/AIDS. Women with HIV also need information on all therapies and strategies which reduce vertical HIV transmission, and to have access to such methods when desired. Women with HIV/AIDS need information about and access to affordable female-controlled prevention methods such as female condoms and microbicides when they become available. The ICW calls for urgent research into breast-feeding to determine the true percentage rate of HIV transmission through breast-feeding. Finally, women with HIV/AIDS need more information and training on traditional and other affordable and accessible alternatives to breast-feeding other than commercial formulae.     

深静脉血栓形成的防治对策

目的 探讨深静脉血栓形成的防治对策。方法 对邵逸夫医院2000年1月～2003年3月收治的DVT病人共78例进行回顾性分析。结果 78例DVT患者治疗后下肢肿胀明显好转,复查下肢周径,患侧大腿年均周径为(43.74±3.29)cm,小腿平均周径为(33.46±2.48)cm(与治疗前对比,P<0.05),健侧大腿平均周径(43.68±2.82)cm,小腿平均周径为(33.45±2.32)cm(与治疗前对比,P>0.05)。多普勒超声提示下肢深静脉血流变细21例,血流完全正常57例。77例(98.7％)患者好转出院。结论 溶栓抗凝是深静脉血栓形成的有效治疗手段,可改善预后。