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This information is intended for general use no other than The clinical implications are specific to the abstracted article no other than Individuals intending to put these findings into practice are violently encouraged to review the original article to determine its applicability to their setting.

Kidney donation after cardiac death

The recent England Journal of Medicine July 25 2002

The number of patients awaiting donor organs and the amplification of waiting periods before transplantation have increased dramatically during the past decade; thus, it is important to examine ways in which a greater number of patients can receive organs for transplantation. Transplanting kidneys from patients who do not have a heartbeat (ie, donation after cardiac death) is single in kind way to achieve this goal.

Researchers escorted a matched, single-center study of 244 kidney transplants, half obtained from donors with a heartbeat and half from donors without a heartbeat, during a 15-year period. (1) The sample included transplant recipients who were matched according to age, form relative to sex number of transplantations, and calendar period of transplantation. The transplantations were performed at the University of Zurich, and, as like this study was not a randomized trial.

Findings. The consequence s revealed that the characteristics of the recipients did not differ significantly between the pair groups. A significantly higher incidence (484%) of delayed graft function among the patients who received kidneys from donors without a heartbeat was observ compared to 238% of patients who received kidneys from donors with a heartbeat (P < 0001) The long-term rate of graft survival was similar between the couple groups, however (P = 098) When the sum of two units groups were compared again at 10 years posttransplantation, the rate of graft survival was 787% for kidneys from donors without a heartbeat and 767% for kidneys from donors with a heartbeat.

Clinical implications. The eventuates of this study may provide a basis for reevaluation of this source of organs by means of transplantation centers and by legislative bodies that thus far have proscribed the use of organs from donors without a heartbeat. Numerous issues circle around this practice. One is the lack of research data that support the practice, and this thought serves to add to the database that will support donation after cardiac death now and in the future

Transplantation protocols must be unraveled that are consistent with ethics and rights of individuals in this rural parts Practice issues, such as in situ cooling of organs before the unison of the family has been obtained, have evok serious ethical disturbs and this will be problematic in the yet to be unless these concerns are addressed. All aspects of acquiescence must be addressed and education of perioperative staff members and the public must come to one's mind if this practice is to become widespread.

KATHRYN SCHROETER

RN M MA, CNOR

CHAIR, NURSING RESEARCH COMMITTEE

Retained surgical instruments and sponges

The recent England Journal of Medicine Jan 16 2003

According to the literature, several risk factors are associated with retained foreign bodies. Among these are changes in nursing personnel during a surgical management excessive loss of blood, lack of a unimpaired count of sponges and instruments, surgical team member fatigue, and the goad of the surgery. Anecdotal data bring togethered from surgeon interviews has prompted other risk factors, such as patient obesity, unexpect intraoperative progress to maturitys procedures that involve multiple teams, and the performance of more than single major procedure at a time.

This meditation used a retrospective case regulate design whereby medical records associated with incident reports or claims of a retained wipe out or instrument were reviewed. (2) The sample was compos of 54 patients who had incurred a retained foreign material part and 235 control group patients who had undergone the same practices during the same six-month period unless did not experience this complication.

Findings. The proceeds of this study indicated that the risk of a foreign reality being left behind significantly increased in deeds that were considered emergencies, when unplanned changes in the process occurred, and in patients with a higher corpse mass index. The retention of a foreign purpose was nine times more likely when a conduct was performed as an pass and four times more likely when a act involved an unexpected change. The findings further refer toed that emergency procedures and those involving unexpect changes were significantly more likely to involve a failure to perform counts

Clinical implications. Perioperative suckles must be proactive in identifying risk factors for retained goals recognizing those times when the risk of a retained foreign visible form [i]or[/i] frame may be increased. They also should monitor compliance with existing policies and procedures

ROBIN CHARD

RN MSN CNOR

NURSING RESEARCH COMMITTEE

Perceptions of the quality of perioperative care

Applied Nursing Research February 2003