Workplace experience of radiographers: impact of structural and interpersonal interventions

PURPOSE: Within the framework of organisational development, an assessment of the workplace experience of radiographers (RGs) was conducted. The aims of this study were to develop structural and interpersonal interventions and to prove their effectiveness and feasibility. METHODS: A questionnaire consisting of work-related factors, e.g. time management and communication, and two validated instruments (Workplace Analysis Questionnaire, Effort-Reward Imbalance Scale) was distributed to all RGs (n = 33) at baseline (T1). Interventions were implemented and a follow-up survey (T2) was performed 18 months after the initial assessment. RESULTS: At T1, areas with highest dissatisfaction were communication and time management for ambulant patients (bad/very bad, 57% each). The interventions addressed adaptation of work plans, coaching in developing interpersonal and team leadership skills, and regular team meetings. The follow-up survey (T2) showed significantly improved communication and cooperation within the team and improved qualification opportunities, whereas no significant changes could be identified in time management and in the workplace-related scales 'effort' expended at work and 'reward' received in return for the effort. CONCLUSION: Motivating workplace experience is important for high-level service quality and for attracting well-qualified radiographers to work at a place and to stay in the team for a longer period

Elevated Non-Esterified Fatty Acid Concentrations during Bovine Oocyte Maturation Compromise Early Embryo Physiology

Elevated concentrations of serum non-esterified fatty acids (NEFA), associated with maternal disorders such as obesity and type II diabetes, alter the ovarian follicular micro-environment and have been associated with subfertility arising from reduced oocyte developmental competence. We have asked whether elevated NEFA concentrations during oocyte maturation affect the development and physiology of zygotes formed from such oocytes, using the cow as a model. The zygotes were grown to blastocysts, which were evaluated for their quality in terms of cell number, apoptosis, expression of key genes, amino acid turnover and oxidative metabolism. Oocyte maturation under elevated NEFA concentrations resulted in blastocysts with significantly lower cell number, increased apoptotic cell ratio and altered mRNA abundance of DNMT3A, IGF2R and SLC2A1. In addition, the blastocysts displayed reduced oxygen, pyruvate and glucose consumption, up-regulated lactate consumption and higher amino acid metabolism. These data indicate that exposure of maturing oocytes to elevated NEFA concentrations has a negative impact on fertility not only through a reduction in oocyte developmental capacity but through compromised early embryo quality, viability and metabolism

Clinical outcomes of DCD type V liver transplantation: donation after euthanasia

Introduction: Due to shortage of donor organs, physicians and surgeons are forced to accept livers from donation after circulatory death (DCD) donors. One special group of DCD organs are those obtained after euthanasia (DCD type V). To create more awareness on the possibility of organ donation after euthanasia, it is important to evaluate the results of transplantation with this type of graft. The aim of our study was to evaluate the outcome of DCD type V liver transplantation (LT) in the Netherlands and Belgium. Methods: All DCD type V LT performed until 2018 in all three Dutch LT centers and four out of six Belgian LT centers, were included in this study. Grafts that have been preserved with machine perfusion were excluded. Continuous data are expressed as median (IQR), categorical data as number (percentage). Results: Until 2018, 44 DCD type V LT have been performed. Five cases in which the liver was preserved by machine perfusion were excluded. Median age of donor and recipient was 51 years (42–58) and 56 years (48–64), respectively. A neurological disease was the most common underlying disease in donors requesting euthanasia, followed by psychiatric disorders. Median time between administration of the euthanatics and cold perfusion was 19 min (14–25). Peak AST and ALT levels in the recipients were 904 U/l (586–2,478) and 709 U/l (448– 1,841) respectively. One-, three- and five-year patient survival was 90%, 83% and 83%, respectively (figure 1). Five patients (13%) required a retransplantation, due to PNF (n = 1), HAT (n = 1) or post-transplant cholangiopathy (n = 3), the majority within the first year after the prior LT. Conclusion: Liver transplantations with grafts from donors who underwent euthanasia yield satisfying results during the relatively short follow up period that is currently available. Comparison of these results with DCD type III LT and donation after brain death (DBD) LT is currently ongoing

Fewer pre-emptive renal transplantations and more rejections in immigrant children compared to native Dutch and Belgian children.

BACKGROUND: In the Netherlands and Belgium, an increasing number of children who have end-stage renal disease (ESRD) are of non-Western origin. We analysed renal transplantation practices and outcome for immigrant ESRD children as compared to native children in both countries. METHODS: All Dutch and Belgian children aged <19 years who received their first renal transplantation between 1 September 2007 and 1 January 2011 were included. Therapy characteristics and outcomes were registered prospectively on a 3-monthly basis. Immigrants were defined as children of whom one or both parents had been born outside Western European countries. Multivariable Cox regression analysis was used to quantify the hazard ratio for acute rejection. RESULTS: One hundred and nineteen first renal transplant recipients were included, of which 41 (34%) were immigrants. Median [range] follow-up time of transplantation was 18 [2-28] months. Compared to native children, immigrants had pre-emptive transplantations (15 versus 32%, P = 0.040) and transplantations with a kidney from a living donor less often (24 versus 59%, P < 0.001). Survival analysis in 96 children with at least 3 months of follow-up showed an increased risk for acute rejection in immigrants adjusted for donor source, duration of dialysis and number of HLA mismatches on the DR locus [hazard ratio (95% confidence interval) 2.5 (1.1-5.9)]. CONCLUSIONS: Immigrant children receive fewer pre-emptive and living donor transplantations compared to native children. After transplantation, immigrant children are at higher risk for acute rejection irrespective of the mode of transplantation

Children of non-Western origin with end-stage renal disease in the Netherlands, Belgium and a part of Germany have impaired health-related quality of life compared with Western children

Item does not contain fulltextBACKGROUND: Many children with end-stage renal disease (ESRD) living in Western Europe are of non-Western European origin. They have unfavourable somatic outcomes compared with ESRD children of Western origin. In this study, we compared the Health-related Quality of Life (HRQoL) of both groups. METHODS: All children (5-18 years) with ESRD included in the RICH-Q project (Renal Insufficiency therapy in Children-Quality assessment and improvement) or their parents were asked to complete the generic version of the Paediatric Quality-of-Life Inventory 4.0 (PedsQL). RICH-Q comprises the Netherlands, Belgium and a part of Germany. Children were considered to be of non-Western origin if they or at least one parent was born outside Western-European countries. Impaired HRQoL for children with ESRD of Western or non-Western origin was defined as a PedsQL score less than fifth percentile for healthy Dutch children of Western or non-Western origin, respectively. RESULTS: Of the 259 eligible children, 230 agreed to participate. One hundred and seventy-four children responded (response rate 67%) and 55 (32%) were of non-Western origin. Overall, 31 (56%) of the ESRD children of non-Western origin, and 58 (49%) of Western origin had an impaired total HRQoL score. Total HRQoL scores of children with ESRD of Western origin and non-Western origin were comparable, but scores on emotional functioning and school functioning were lower in non-Western origin (P=0.004 and 0.01, respectively). The adjusted odds ratios (95% confidence interval) for ESRD children of non-Western origin to have impaired emotional functioning and school functioning, compared with Western origin, were 3.3(1.5-7.1) and 2.2(1.1-4.2), respectively. CONCLUSION: Children with ESRD of non-Western origin in three Western countries were found to be at risk for impaired HRQoL on emotional and school functioning. These children warrant special attention

Important differences in management policies for children with end-stage renal disease in the Netherlands and Belgium--report from the RICH-Q study.

Item does not contain fulltextBACKGROUND: The low prevalence of childhood end-stage renal disease and the small centre sizes have been a barrier for clinical studies and the development of evidence-based guidelines for chronic renal replacement therapy (cRRT) in children. Few data exist on the quality of care for these patients and the applicability of existing guidelines. The aim of this study is to quantify variation in treatment policies and actually delivered care in nine centres that deliver cRRT for children. METHODS: We surveyed treatment policies in all nine centres in the Netherlands and Belgium and compared them with the actually provided therapies and with recommendations from available guidelines. Data on treatment policies were gathered by questionnaires; actually provided care and outcomes were registered prospectively from 2007 to 2010. RESULTS: Data on policies and actual patient care were obtained from all nine centres. We found relevant differences between centres in treatment policies on various topics, e.g. estimated glomerular filtration rate threshold as an indication for initiation of cRRT, preferred initial mode of cRRT, peritoneal dialysis catheter care, haemodialysis frequency and vascular access. Discrepancies were seen between stated treatment policies and actual performed therapies. For the majority of policies, no evidence-based guidelines are available. CONCLUSIONS: Health care disparities exist due to large and unwanted variation in treatment policies between hospitals providing cRRT for children. Delivered care does not live up to stated policies, for which clear and internationally accepted guidelines are lacking.1 mei 201

Fertigação do algodoeiro utilizando efluente doméstico tratado Fertigation of cotton with treated domestic sewage

Conduziu-se um experimento no Campus da Universidade Federal Rural do Semiárido em Mossoró, RN, com o objetivo de avaliar o comportamento do algodoeiro (Gossypium hirsutum L. raça latifolium Hatch) cultivar 8H, quanto ao aspecto crescimento, quando irrigado com efluentes domésticos tratados. O delineamento experimental adotado foi o de blocos casualizados com parcelas subdivididas e sendo testadas, nas parcelas, as diluições do efluente doméstico [25% - T1, 50% - T2, 75% - T3 e 100% de água residuária- T4 e água de abastecimento + adubação mineral do solo - T5] em dois solos de texturas contrastantes (Latossolo Vermelho Amarelo - S1 e Cambissolo - S2). A irrigação com água residuária influenciou significativamente o crescimento das plantas de algodoeiro, em referência ao índice de velocidade de emergência, à percentagem de germinação à altura de plantas, ao diâmetro caulinar e número de folhas e à área foliar e massa seca de parte aérea, crescendo com o aumento da proporção de uso do efluente doméstico. Houve efeito positivo do acúmulo de nutrientes no solo aplicados via fertirrigação sobre as variáveis estudadas. A fertirrigação com efluente doméstico tratado pode substituir a adubação convencional do algodoeiro.<br>An experiment was conducted at the Universidade Federal Rural do Semi-arid in Mossoró, RN with the aim of evaluating the behavior of cotton (Gossypium hirsutum L. race latifolium Hatch) 8H cultivar, in terms of growth when irrigated with treated domestic sewage. The experimental design was in randomized blocks with split plots and in plots were tested dilutions of wastewater [25% - T1, 50% - T2, 75% - T3 and 100% of wastewater - T4 and supply water with mineral fertilizer - T5] in two soils of contrasting textures. Irrigation with wastewater significantly influenced the growth of cotton plants, the rate of emergence, the germination percentage, plant height, stem diameter and leaf area, growing linearly until an optimal dose, as the proportion of use of domestic effluent. The positive effect of the accumulation of nutrient in soil applied by fertigation on the variables studied is also highlighted. The irrigation with treated wastewater can offset conventional fertilization of cotton