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Procedure: Transplants
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Certification Circle: A Peer Support Model to Increase Certification Among Medical-Surgical Inpatient Nurses
This study describes an initiative to increase professional certification at the medical-surgical service of an academic medical center. The solid organ transplant unit had a certification rate of 2%. Three registered nurses developed Certification Circle, which focused on the process of earning certification rather than a traditional knowledge-based review course, to increase the number of certified nurses on the unit. Clinical nurses conducted a prospective pilot study that used a pre-/posttest study design with convenience sampling for medical-surgical nurses. Participants were evaluated on their knowledge and confidenc...
Source: Journal of Continuing Education in Nursing - October 5, 2021 Category: Nursing Authors: Brandon W Qualls Melanie D Bobry Mary A Feeney Source Type: research
Appendectomy in surgical residency : What has changed over the past 10 years?
CONCLUSION: Regardless of the surgical technique used, appendectomy is still a primary training operation for surgical residents. An early and focused training of minimally invasive visceral surgery in the new regulations for continuing medical education starts with laparoscopic appendectomy.
PMID: 26661947 [PubMed - as supplied by publisher]
Source: Der Chirurg - December 11, 2015 Category: Surgery Authors: Huber T, Paschold M, Bartsch F, Lang H, Kneist W Tags: Chirurg Source Type: research
Primary myelofibrosis: 2013 update on diagnosis, risk‐stratification, and management
Disease overviewPrimary myelofibrosis (PMF) is a myeloproliferative neoplasm characterized by stem cell‐derived clonal myeloproliferation, abnormal cytokine expression, bone marrow fibrosis, anemia, splenomegaly, extramedullary hematopoiesis (EMH), constitutional symptoms, cachexia, leukemic progression, and shortened survival.
DiagnosisDiagnosis is based on bone marrow morphology. The presence of fibrosis, JAK2/MPL mutation, or +9/13q− cytogenetic abnormality is supportive but not essential for diagnosis. Prefibrotic PMF mimics essential thrombocythemia in its presentation and the distinction is prognostically relevan...
Source: American Journal of Hematology - January 24, 2013 Category: Hematology Authors: Ayalew Tefferi Tags: A Continuing Medical Education Series Source Type: research
Overview: Cytomegalovirus and the Herpesviruses in Transplantation
Herpesviruses infect most animal species. Infections due to the eight human herpesviruses (HHV) are exacerbated by immunosuppression in organ transplantation. The special features of the herpesvirus life cycle include the ability to establish latent, nonproductive infection and the life‐long capacity for reactivation to productive, lytic infection. Interactions between latent virus and the immune system determine the frequency and severity of symptomatic infections. The immunologic and cellular effects of herpesvirus infections contribute to risk for opportunistic infections and graft rejection. Among the most important ...
Source: American Journal of Transplantation - January 24, 2013 Category: Transplant Surgery Authors: J. A. Fishman Tags: Continuing Medical Education Source Type: research
Immune Regulation of Human Herpesviruses and Its Implications for Human Transplantation
Human herpesviruses including cytomegalovirus, Epstein–Barr virus, HHV6, HHV7, HHV8, Herpes simplex virus (HSV)‐1 and HSV‐2 and varicella zoster virus (VZV) have developed an intricate relationship with the human immune system. This is characterized by the interplay between viral immune evasion mechanisms that promote the establishment of a lifelong persistent infection and the induction of a broad humoral and cellular immune response, which prevents the establishment of viral disease. Understanding the immune parameters that control herpesvirus infection, and the strategies the viruses use to evade immune recognitio...
Source: American Journal of Transplantation - January 24, 2013 Category: Transplant Surgery Authors: C. Smith, R. Khanna Tags: Continuing Medical Education Source Type: research
CMV: Prevention, Diagnosis and Therapy
Cytomegalovirus (CMV) is the most common infection after organ transplantation and has a major impact on morbidity, mortality and graft survival. Optimal prevention, diagnosis and treatment of active CMV infection enhance transplant outcomes, and are the focus of this section. Methods to prevent CMV include universal prophylaxis and preemptive therapy; each has its merits, and will be compared and contrasted. Diagnostics have improved substantially in recent years, both in type and quality, allowing for more accurate and savvy treatment; advances in diagnostics include the development of an international standard, which sh...
Source: American Journal of Transplantation - January 24, 2013 Category: Transplant Surgery Authors: C. N. Kotton Tags: Continuing Medical Education Source Type: research
Epstein–Barr Virus Infection and Posttransplant Lymphoproliferative Disorder
Epstein–Barr virus (EBV) is an important pathogen in recipients of solid organ transplants (SOT). Infection with EBV manifests as a spectrum of diseases/malignancies ranging from asymptomatic viremia through infectious mononucleosis to posttransplant lymphoproliferative disorder (PTLD). EBV disease and its associated PTLD is more frequently seen when primary EBV infection occurs after transplant, a common scenario in pediatric SOT recipients. Intensity of immunosuppressive therapies also influences the risk for PTLD. The use of EBV viral load monitoring facilitates the diagnosis and management of EBV/PTLD as well as bein...
Source: American Journal of Transplantation - January 24, 2013 Category: Transplant Surgery Authors: M. Green, M. G. Michaels Tags: Continuing Medical Education Source Type: research
Varicella Zoster Virus (VZV) and Herpes Simplex Virus (HSV) in Solid Organ Transplant Patients
Varicella zoster virus (VZV) and the two herpes simplex viruses (HSV) are human α‐herpesviruses that establish life‐long latency in neural ganglia after initial primary infection. In the solid organ transplant (SOT) population, manifestations of VZV or HSV may be seen in up to 70% of recipients if no prophylaxis is used, some of them life and organ threatening. While there are effective vaccines to prevent VZV primary infection and reactivation in immunocompetent adults, these vaccines are contraindicated after SOT because they are live‐virus vaccines. For HSV, prevention has focused primarily on antiviral strategie...
Source: American Journal of Transplantation - January 24, 2013 Category: Transplant Surgery Authors: R. A. Zuckerman, A. P. Limaye Tags: Continuing Medical Education Source Type: research
Human Herpesviruses 6, 7 and 8 in Solid Organ Transplant Recipients
Human herpesviruses (HHV) 6 and 7 are ubiquitous infections that reactivate commonly in transplant recipients. However, clinical diseases due to these viruses are reported only in 1% of solid organ transplant recipients. Fever, rash and bone marrow suppression are the most common manifestations, but symptoms of tissue invasive disease may be observed. Treatment of HHV‐6 and HHV‐7 disease includes antiviral therapy and cautious reduction in immunosuppression. HHV‐8 is an oncogenic gamma‐herpesvirus that causes Kaposi's sarcoma, Castleman's disease and primary effusion lymphomas in transplant recipients. Nonmalignant...
Source: American Journal of Transplantation - January 24, 2013 Category: Transplant Surgery Authors: R. R. Razonable Tags: Continuing Medical Education Source Type: research
Human Herpesvirus Vaccines and Future Directions
Over the last few years there has been an impressive increase in the virological and immunological tools available to detect both human herpesvirus (HHV) and immune control of replication post‐solid organ transplantation. This has allowed a greater appreciation of pathogenesis, studies to be designed to evaluate potential vaccines, new approaches adopted for antiviral deployment and the success of interventions to be judged. This chapter aims to summarize the state‐of‐the‐art in vaccine development and look forward to the role that vaccines, immune monitoring, viral kinetics and new antiherpesvirus agents may play ...
Source: American Journal of Transplantation - January 24, 2013 Category: Transplant Surgery Authors: V. C. Emery Tags: Continuing Medical Education Source Type: research
Multiple myeloma: 2013 update on diagnosis, risk‐stratification, and management
Disease overviewMultiple myeloma accounts for approximately 10% of hematologic malignancies.
DiagnosisThe diagnosis requires 10% or more clonal plasma cells on bone marrow examination or a biopsy proven plasmacytoma plus evidence of associated end‐organ damage. In addition, the presence of 60% or more clonal plasma cells in the marrow is also considered as myeloma regardless of the presence or absence of end‐organ damage.
Risk stratificationIn the absence of concurrent trisomies, patients with 17p deletion, t(14;16), and t(14;20) are considered to have high‐risk myeloma. Patients with t(4;14) translocation are consid...
Source: American Journal of Hematology - February 25, 2013 Category: Hematology Authors: S. Vincent Rajkumar Tags: A Continuing Medical Education Series Source Type: research
Acute myeloid leukemia: 2013 update on risk‐stratification and management
Disease overviewAcute myeloid leukemia (AML) results from accumulation of abnormal blasts in the marrow. These cells interfere with normal hematopoiesis, can escape into the peripheral blood, and infiltrate CSF and lung. It is likely that many different mutations, epigenetic aberrations, or abnormalities in micro RNA expression can produce the same morphologic disease with these differences responsible for the very variable response to therapy, which is AMLs principal feature.
DiagnosisThis rests on demonstration that the marrow or blood has > 20% blasts of myeloid lineage. Blast lineage is assessed by multiparamete...
Source: American Journal of Hematology - March 25, 2013 Category: Hematology Authors: Elihu H. Estey Tags: A Continuing Medical Education Series Source Type: research
Immunoglobulin light chain amyloidosis: 2013 update on diagnosis, prognosis, and treatment
Disease OverviewImmunoglobulin (Ig) light chain amyloidosis is a clonal, nonproliferative plasma cell disorder in which fragments of Ig light chain are deposited in tissues. Clinical features depend on organs involved but can include restrictive cardiomyopathy, nephrotic syndrome, hepatic failure, peripheral/autonomic neuropathy, and atypical multiple myeloma.
DiagnosisTissue biopsy stained with Congo red demonstrating amyloid deposits with apple‐green birefringence is required for diagnosis. Invasive organ biopsy is not required because amyloid deposits can be found in bone marrow biopsy or subcutaneous fat aspirate in ...
Source: American Journal of Hematology - April 18, 2013 Category: Hematology Authors: Morie A. Gertz Tags: A Continuing Medical Education Series Source Type: research
