Effectiveness of “Escape Room” Educational Technology in Nurses’ Education: A Systematic Review

Escape room games are educational gamification technologies that consist of introducing a team of players into a physical or digital space in search of clues to answer puzzles, riddles or enigmas and solve a mystery or problem. This study aims to determine the effectiveness of escape room games on the training of nursing students in an international context. A systematic review was carried out in MEDLINE, WOS, SCOPUS, CINAHL and LILACS databases using the MeSH terms “Education, Nursing” and “Educational Technology”, and the free term “Escape room”, combined with Boolean operators AND/OR. Intervention studies in Spanish, English and Portuguese were included, without limitation for the year of publication. Selection and critical appraisal were conducted by two independent reviewers. A total of n = 13 interventional studies were included (n = 2 Randomized Clinical Trials and n = 11 quasi-experimental design). Escape rooms are a recent and growing educational methodology, increasingly used in academia and in the training of nurses and nursing students. However, it is necessary to expand their use and the quality of the studies in a greater number of contexts. Furthermore, it is necessary to homogenize and standardize validated instruments to evaluate the effectiveness of escape rooms in the nursing education area

Impact of acute kidney injury exposure period among liver transplantation patients

Background: Acute kidney injury is a common complication of liver transplantation. in this single-centre retrospective observational study, we investigated the impact of acute kidney disease on liver recipient survival.Methods: the study population consisted of patients who underwent a liver engraftment between January 2002 and November 2006, at a single transplantation centre in São Paulo, Brazil. Acute kidney injury diagnosis and staging were according to the recommendations of the Acute Kidney Injury Network and consisted of scanning the daily serum creatinine levels throughout the hospital stay. Patients requiring renal replacement therapy prior to transplantation, those who developed acute kidney injury before the procedure or those receiving their second liver graft were excluded from the study.Results: A total of 444 liver transplantations were performed during the study period, and 129 procedures (29%) were excluded. the remaining 315 patients constituted the study population. in 207 procedures, the recipient was male (65%). the mean age of the population was 51 years. Cumulative incidence of acute kidney injury within 48 h, during the first week after transplantation, and throughout the hospital stay was 32, 81 and 93%, respectively. Renal replacement therapy was required within a week after the transplantation in 31 procedures (10%), and another 17 (5%) required replacement therapy after that period. Mean follow-up period was 2.3 years. Time in days from acute kidney injury diagnosis to initiation of replacement therapy or reaching serum creatinine peak was associated with lower overall survival even when adjusted for significant potential confounders (HR 1.03; 95% CI 1.01, 1.05; p=0.002). Overall, patients experiencing acute kidney injury lasting for a week or more before initiation of replacement therapy experienced a threefold increase in risk of death (HR 3.02; 95% CI 2.04, 4.46; p<0.001).Conclusions: Acute kidney injury after liver transplantation is remarkably frequent and has a substantial impact on patient survival. Delaying the initiation of renal replacement therapy in such population may increase mortality by more than 20% per day.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Federal de São Paulo, Div Nephrol, São Paulo, BrazilHosp Transplantes Euryclides de Jesus Zerbini, Liver Unit, São Paulo, BrazilHosp Israelita Albert Einstein, São Paulo, BrazilTufts Univ, New England Med Ctr, Div Nephrol, Medford, MA 02155 USAUniversidade Federal de São Paulo, Div Nephrol, São Paulo, BrazilWeb of Scienc

Liver transplantation at Hospital Israelita Albert Einstein

Objective: To present patients and results of liver transplantationperformed by the Liver Unit team at the Hospital Israelita AlbertEinstein. Methods: The medical records of all patients transplantedby the team at the Liver Unit of the Hospital Israelita Albert Einstein,from January 2002 to June 2005, were analyzed. Results: Duringthis period, 328 transplants were performed and 64.3% were malerecipients; 64.9% were performed with cadaveric donor; 31.1%with living donors; and 4.3% were domino liver transplants. Thethree-year survival rate was 78% with cadaveric donors, 71.1%with living donor and 46.2% with domino liver transplant. The meanseverity index according to the Child-Pugh score was 8.7 (ChildB–9) and the median was 9 (Child B-9); the mean MELD score was17.6 and the median 18. Conclusion: The Liver Unit team has thelargest number of liver transplantation cases in Latin Americawith over 850 transplants performed and outcomes similar to theworld’s best centers

Splanchnic non-hepatic hemodynamics and metabolism during liver transplantation

Background/Aims: The aim of this study is to compare the splanchnic non-hepatic hemodynamics and the metabolic changes during orthotopic liver transplantation between the conventional with bypass and the piggyback methods. Methodology: A prospective, consecutive series of 59 primary transplants were analyzed. Oxygen consumption, glucose, potassium, and lactate metabolism were quantitatively estimated from blood samples from the radial artery and portal vein, collected up to 120 minutes after graft reperfusion. Mean arterial pressure, portal venous pressure, portal venous blood flow, and splanchnic vascular resistance were also measured or calculated at postreperfusion collection times. Results: There was a greater increase in portal venous blood flow (p=0.05) and lower splanchnic vascular resistance (p=0.04) in the piggyback group. Mean arterial pressure and portal venous pressure were similar for both groups. Oxygen, glucose and potassium consumption were higher in the piggyback group, but none of the metabolic parameters differed significantly between groups. Conclusions: In conclusion, the study detected a higher portal venous blood flow and a lower and splanchnic vascular resistance associated with the piggyback technique. After graft reperfusion, no difference in the splanchnic non-hepatic metabolic parameters was observed between the conventional with bypass and the piggyback methods of orthotopic liver transplantation

Liver transplants

Liver transplantation has always fascinated humanity, this fact issupported by historical reports of ancient civilizations. The firstliver transplant was performed in 1955, in experimental animals.Human liver transplant was first attempted by Thomas Starzl in1963, but was unsuccessful. Latter, in 1967, the same groupdescribed the first successful human ortotopic liver transplant inhistory. Many facts contributed for the triumph of this procedureand among them we can point out the improvements of surgicaltechniques, the development of preservation solutions, discoveryof better antibiotics, appearance of the concept of intensive careunit and the most important mark in transplant survival –cyclosporine as a new immunossuppression agent. In Brazil, thefirst human liver transplant with prolonged survival was in 1985and was fulfilled by the Liver Unit. This same team was latterresponsible for the world’s first description of living donor livertransplantation. Brazilian’s legislation has improved in order touse wisely the resources related to transplant programs and thisincludes the grafts that are so scarce for the demand of patientson our waiting lists. Another great necessity is to create aeducational effort aimed to general population and medical socialgroup to instruct and show the importance of organ donation, butall these efforts will be usefulness if public health policies fail toput in practice actions that will improve the organization andrationalization of equipment and human resources in emergencymedical centers

Inflammatory Cytokines during Liver Transplantation: Prospective Randomized Trial Comparing Conventional and Piggyback Techniques

Background/Aims: Cytokines have a significant role in the response to injury following liver transplantation, but the origin and course of such molecules are not completely known. The aim of this study was to evaluate the production and liver metabolism of the inflammatory cytokines interleukin (IL)-1 beta, IL-6, IL-8, interferon (IFN)-Y and tumor necrosis factor (TNF)-alpha in orthotopic liver transplantation (OLT), comparing the conventional and the piggyback methods. Methodology: We performed a study of 30 patients who underwent elective OLT and were randomized for the conventional or piggyback techniques at the beginning of the operation. The amount of cytokines and their hepatic metabolism were calculated based on plasma concentrations and vascular blood flow at 2, 5, 10, 15, 30, 60, 90, and 120 minutes after revascularization. Results: The amount of IL-1 beta in portal blood was higher in patients who underwent surgery using the conventional technique (estimate interest = 63,783.9 +/- 16,586.1 pg/min, versus 11,979.6 +/- 16,585.7 pg/min in the piggyback group, p=0.035). There were no significant differences between the two operative`s methods for IL-6, IL-8, IFN-Y and TNF-alpha production. The hepatic metabolism of cytokines was not different between groups. Although all the curves showed higher amounts of cytokines with the conventional technique, these were not statistically significant. Conclusion: The study shows the similarity between the two techniques concerning the stimuli for the production of inflammatory molecules.FAPESP-Fundcao de Amparo a Pesquisa do Estado de Sao Paulo[98/01760-7

Impact of acute kidney injury exposure period among liver transplantation patients

Abstract Background Acute kidney injury is a common complication of liver transplantation. In this single-centre retrospective observational study, we investigated the impact of acute kidney disease on liver recipient survival. Methods The study population consisted of patients who underwent a liver engraftment between January 2002 and November 2006, at a single transplantation centre in São Paulo, Brazil. Acute kidney injury diagnosis and staging were according to the recommendations of the Acute Kidney Injury Network and consisted of scanning the daily serum creatinine levels throughout the hospital stay. Patients requiring renal replacement therapy prior to transplantation, those who developed acute kidney injury before the procedure or those receiving their second liver graft were excluded from the study. Results A total of 444 liver transplantations were performed during the study period, and 129 procedures (29%) were excluded. The remaining 315 patients constituted the study population. In 207 procedures, the recipient was male (65%). The mean age of the population was 51 years. Cumulative incidence of acute kidney injury within 48 h, during the first week after transplantation, and throughout the hospital stay was 32, 81 and 93%, respectively. Renal replacement therapy was required within a week after the transplantation in 31 procedures (10%), and another 17 (5%) required replacement therapy after that period. Mean follow-up period was 2.3 years. Time in days from acute kidney injury diagnosis to initiation of replacement therapy or reaching serum creatinine peak was associated with lower overall survival even when adjusted for significant potential confounders (HR 1.03; 95% CI 1.01, 1.05; p=0.002). Overall, patients experiencing acute kidney injury lasting for a week or more before initiation of replacement therapy experienced a threefold increase in risk of death (HR 3.02; 95% CI 2.04, 4.46; p<0.001). Conclusions Acute kidney injury after liver transplantation is remarkably frequent and has a substantial impact on patient survival. Delaying the initiation of renal replacement therapy in such population may increase mortality by more than 20% per day

Low estimated glomerular filtration rate and chronic kidney failure following liver transplant: A retrospective cohort study

Background: Patients undergoing orthotropic liver transplant (LTx) often present with chronic kidney disease (CKD). Identification of patients who will progress to end-stage renal disease (ESRD) might allow not only the implementation of kidney protective measures but also simultaneous kidney transplant.Study Design: Retrospective cohort study in adults who underwent LTx at a single center. ESRD, death, and composite of ESRD or death were studied outcomes.Results: 331 patients, who underwent LTx, were followed up for 2.6 +/- 1.4 years; 31(10%) developed ESRD, 6 (2%) underwent kidney transplant after LTx and 25 (8%) remained on chronic hemodialysis. Patients with preoperative eGFR lesser than 60 ml/min per 1.73 m(2) had a 4-fold increased risk of developing ESRD after adjustment for sex, diabetes mellitus, APACHE II score, use of nephrotoxic drugs, and severe liver graft failure (HR = 3.95, 95% CI 1,73, 9.01; p = 0.001). Other independent risk factors for ESRD were preoperative diabetes mellitus and post-operative severe liver graft dysfunction.Conclusion: These findings emphasize low eGFR prior to LTx as a predictor for ESRD or death. the consideration for kidney after liver transplant as a treatment modality should be taken into account for those who develop chronic kidney failure after LTx.Albert Einstein Israelita Hosp HIAE, Learning & Res Inst, Transplantat Program, São Paulo, BrazilUniversidade Federal de São Paulo, Div Nephrol, São Paulo, BrazilEuryclides Jesus Zerbini Transplant Hosp Sao Paul, Liver Unit, São Paulo, BrazilTufts Univ, Sch Med, St Elizabeths Med Ctr, Brighton, MA USAUniversidade Federal de São Paulo, Div Nephrol, São Paulo, BrazilWeb of Scienc