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Introduction: The incidence of pressure ulcers remains high in patients with moderate to severe acute respiratory distress syndrome, ventilated in the prone position. A digital platform, dedicated to prone positioning and skin/tissue damage education was developed., Objective: To evaluate the impact of the PRONEtect Education Hub versus a traditional lecture on final-year nursing students' confidence levels and knowledge in a non-inferiority study., Design: A multicenter, non-blinded, parallel-group, non-inferiority study with equal randomization (1:1 allocation) was conducted at two nursing schools in Belgium., Clinicaltrials: gov (NCT05575869)., Methods: Following baseline assessments, the control group received a 1-h classroom lecture, and the experimental group gained access to the PRONEtect website. Three weeks later, participants completed the knowledge, confidence, and visual knowledge assessment., Results: At baseline, 67 of the 80 participants completed the assessments and post-intervention, 28 and 27 participants respectively completed the confidence, knowledge, and visual knowledge assessments (dropout rate of 66.25%). Confidence levels: a mean ratio of relative change from baseline = 0.96 (Control (C)/Experimental (E)); 97.5% confidence interval (CI): 0.74 to 1.26; p = 0.74. Knowledge assessment: a mean difference in change from baseline = 1.58 (C-E); 97.5% CI: -0.58 to 3.75; p = 0.1. Although confidence and knowledge scores increased in both groups, the study cannot conclude non-inferiority., Conclusions: The trade-off between the inability to conclude efficacy of the impact of the website and the benefit of having an accessible educational platform on prone positioning and skin damage prevention makes the PRONEtect Education Hub an acceptable adjunct to traditional lecturing., (Copyright © 2024 Tissue Viability Society / Society of Tissue Viability. Published by Elsevier Ltd. All rights reserved.)

The Foundation for Advancement of International Medical Education and Research (FAIMER), a member of Intealth, offers longitudinal faculty development programs (LFDPs) in health professions education (HPE) and leadership through its International FAIMER Institute (IFI) in the United States and FAIMER Regional Institutes (FRIs) globally. FAIMER fosters mutual collaboration and delineates shared responsibilities for FRI development in partnership with local institutions, using an adapted hub-and-spoke organizational design. This paper describes FAIMER's model, its sustainability, and its impacts at individual, institutional, and national levels. IFI was launched in 2001 in Philadelphia, Pennsylvania, as a 2-year part-time hybrid LFDP; with the COVID-19 pandemic onset, IFI transitioned to a fully online program. Since FAIMER's launch, 11 FRIs developed in Brazil, Chile, China, Egypt, India, Indonesia, and South Africa, each modeled on the IFI curriculum and adapted to local context. The more than 1,600 IFI and FRI graduates (fellows) from over 55 countries now form a global community of health professions educators who have shared exposure to HPE methods and assessment, leadership and management, educational scholarship and research, and project management and evaluation. Across all global locations and program formats, fellows self-reported a similar increase in knowledge and skills in HPE. All programs center on the fellows' institutional projects as experiential learning; these projects have focused primarily on educational methods and curriculum revisions. An increased quality of education was reported as the top impact resulting from fellows' projects. As a result of these programs, fellows have influenced education policy in their countries and established academic societies for HPE, thus contributing to recognition of the HPE academic specialty. FAIMER has successfully developed a sustainable model for advancing HPE globally, creating a vibrant network of health professions educators who have influenced country-specific educational policy and practice. FAIMER's model offers one approach to building global capacity in HPE., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Association of American Medical Colleges.)

Objective: The incidence of skin/tissue damage, such as pressure ulcers, remains high in mechanically ventilated patients in the prone position. According to guidelines, critically ill patients with acute respiratory distress syndrome (ARDS) should be prone for at least 12-16 hours to improve oxygenation and decrease mortality. Therefore, educating clinicians on how to reposition and manage the patient safely in a prone position plays a vital role in preventing adverse events. This project aimed to develop accessible online educational content to assist clinicians in safely executing the prone manoeuvre and minimise skin/tissue damage., Method: The development of the educational content was based on: a gap analysis and comprehensive review of available educational resources; evidence-based scientific literature; advice from international experts; and a qualitative study exploring the learning needs of 20 clinicians in Belgium and Sweden between February-August 2022., Results: Volunteer clinicians assisted with the creation of eight simulation videos which were professionally filmed and edited. The interactive videos included the supine-to-prone and prone-to-supine manoeuvres, endotracheal and nasogastric tube securement, eye care, stoma care, protecting high-risk areas from pressure damage, and incontinence-associated dermatitis prevention. A prone positioning protocol, a checklist summarising the key aspects of the protocol, and teaching aids (slide deck for didactic lecturing) were developed and validated by a review of the relevant evidence-based literature and the international expert panel. A website was designed to host the content, with free user access, at www.pronetection.com., Conclusion: Education is one strategy towards prevention of complications of prone positioning. Accessible education could assist clinicians unfamiliar with prone positioning or current clinicians requiring refresher training to safely manage patients in this position., Competing Interests: Declaration of interest: Authors AF, DB, AG, SS, YW, HHC and KL have no competing interests to declare. JB and FC declare being consultants and speakers for Mölnlycke Health Care AB, Sage: A Division of Stryker, and Mobility is Medicine. KV declares being a consultant and speaker for Sage: A Division of Stryker, and Mobility is Medicine. MA declares serving as an advisory board member for Mölnlycke Health Care AB during 2022. There was no external funding. The design and development of the educational resources were funded by the strategic research funds of the Skin Integrity Research Group (SKINT) at the University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium. Multimedia support costs were funded by an in-kind contribution from HOGENT University of Applied Sciences and Arts, Ghent, Belgium.

The use of cadaver donors for transplantation is often the only alternative in the treatment of patients with organ failure. The purpose of this study was to draw a comprehensive profile of solid organ donors in Ceará, northeastern Brazil, from 1998 to 2012. The study was retrospective and based on secondary data regarding sex, age, blood typing, and cause of brain death obtained from the solid organ donor database of the Ceará Transplantation Center covering the period November 1998 to December 2012. During the study period, 976 donors (69% male) were used. Donors were distributed in 4 age groups as follows: 12.9% <18 years, 50.9% 18-40 years, 28.5% 41-60 years, and 7.7% >60 years. The average age was 35 ± 16 years. On the average, female donors were older than male donors (38.4 ± 17 y vs 33.5 ± 16 y; P < .0001). Men were predominant in the age groups 18-40 y (75.3%; P < .0001) and 41-60 y (59.4%; P < .0001). The main causes of brain death were traumatic brain injury (TBI) (56.7%) and stroke (33.1%). The former was more common in men (P < .0001), the latter in women (P < .0001). TBI was caused by traffic accidents (51.4%), of which 50.7% were motorcycle accidents, and urban violence (22.6%), of which 71.2% were associated with firearms. The number of donations increased in the study period (11.2 donors per million population in 1998-2002 to 68.1 in 2008-2012). In Ceará, solid organ donation is on the rise. The predominant donor profile was young men aged 18-40 years with brain death due to TBI caused by traffic accidents and urban violence., (Copyright © 2014 Elsevier Inc. All rights reserved.)

This multicenter, randomized trial aimed to compare the safety and efficacy of an early reduction in corticosteroid dose vs. long-term maintenance in Brazilian patients on an immunosuppressive regimen based on tacrolimus and mycophenolate mofetil (MMF). In the control arm, prednisone was progressively reduced from days 8 to 90 and then kept for 12 months. In the experimental arm, prednisone was given for 12 months at the dose of 5 mg every other day. Endpoints were the composite occurrence of death, graft loss, or Banff III acute rejection, and safety. A total of 83 patients were enrolled, and 77 were analyzed for efficacy safety. One death occurred in each group. There were no cases of graft loss and one case of grade 3 acute rejection in the early reduction arm. There was no difference in the rate of the composite primary endpoint between both arms (p=0.215), and there were no significant differences between both arms in terms of adverse events. Except for higher incidence of hypertriglyceridemia levels among patients in the regular-dose arm, there were no significant differences between both arms in terms of adverse events. The results of this trial suggest that early reduction of corticosteroid can be feasible and safe within a timeframe of 12 months in patients receiving tacrolimus and MMF., (© 2009 John Wiley & Sons A/S.)

Visceral leishmaniasis (VL) is a parasitic infection that uncommonly affects renal transplantation recipients, even in endemic areas. It may be associated with other infections, or masked by these, and may present subclinically and/or atypically for extended periods. The evolution may be particularly severe and diagnosis is often delayed. If not adequately diagnosed and treated, VL can be fatal and so should be suspected in renal transplantation recipients presenting unexplained fever, splenomegaly, and pancytopenia. The authors report 8 cases of VL out of a total of 800 renal transplant recipients from two transplant hospitals centers in Brazil. The clinical, diagnostic, and therapeutic features are reviewed.

Corticosteroids are a cornerstone of immunosuppressive therapy in renal transplantation despite their side effects and morbidity. Newer immunosuppressive agents may be more effective to allow corticosteroid sparing. An interim analysis of 60 completed out of 100 planned primary kidney transplant recipients is presented. All patients on tacrolimus (Prograf) and MMF (Cellcept) were randomized into two groups following a 1:1 distribution for early steroid reduction at posttransplant day 7 (G1; n = 31) versus to long-term maintenance steroids (G2; n = 29). Primary efficacy endpoints were composite endpoint of death, graft loss, or severe acute rejection at 6 and 12 months follow-up. Safety evaluation included severity and frequency of diabetes mellitus, hypertension, hyperlipidemia, leukopenia, infection, malignancy, and severe adverse events. Mean age was 39.1 years, with 45.0% males and 66.7% Caucasians. African-Americans were 25.8% in G1 and 27.6% in G2. One death occurred in each group, as well as one case of severe (Banff III) rejection in G1 (P = 1.00). The incidence of rejection episodes between groups was not significant, namely, 41.9% in G1 and 20.7% in G2 (P = .077). There were no differences between groups concerning mean, systolic and diastolic blood pressure, HbA1c, or creatinine at 12 months. This interim analysis showed no evidence of an increased risk of poorer performance among the early steroid reduction or safety differences in kidney transplant recipients versus a regular dosage steroid group of patients. Further analysis of the complete study data is underway.

The cadaver organ shortage has pushed the transplant community to extend the boundaries beyond the traditional criteria used for living donor transplantation. This new liberal policy involves: (1) the type of donor, such as emotionally related individuals, the direct or indirect interchange of donors, anonymous as well as rewarded donation; (2) challenging immunological criteria, using incompatible ABO blood types and or transplantation across a positive cross-match; (3) relaxing clinical criteria related to elderly, hypertensive, or obese donors, or patients with nephrolithiasis, fibromuscular renal artery disease, hematuria, or renal cell carcinomas. However, these practices may be dangerous. They must be clearly validated to promote a liberal policy of donor acceptance since it may carry a risk for both the donor and the recipient as well as for society. It is crucial to ensure the physical integrity of the donor as well as to provide guarantees, for instance a 1-year policy of life insurance, an indefinite long-term medical follow-up and the assurance of going to the top of the waiting list if the donor becomes uremic in the future.

Purpose: To investigate the effect of mycophenolate mofetil on Walker's carcinosarcoma, without versus with the growth and regression of cyclosporine., Methods and Results: Wistar rats received water (control), MMF, and/or CsA-N 1 day before tumor inoculation. On day 10, tumor volume (TV) was lower among MMF (10.3 +/- 2.8 cm(3)) than control rats (14.9 +/- 4.2 cm(3), P <.05), and similar to that in CsA-N (13.9 +/- 3.0 cm(3)). However, tumor weight (TW) was significantly lower in MMF (5.2 +/- 2.0 g) than CsA-N (8.8 +/- 2.1g) or control hosts (7.3 +/- 2.0 g, P < or =.01). Growth was inhibited by MMF (-28.2%). In experiment II, CsA-N, MMF + CsA-N, or water were introduced 1 day before tumor inoculation. On day 10, TV and TW were similar for MMF + CsA-N as compared to CsA-N and control animals. In experiment III, water or MMF was introduced on the day 4 after tumor inoculation. On day 10, tumor growth are TW in the MMF group was similar to, that in the controls., Conclusions: MMF produces an anti-tumoral effect against Walker's carcinosarcoma. However, this inhibitory effect was lost when MMF was used in combination with CsA-N or administered in the presence of a well- established tumor.

The remarkable success achieved by organ transplantation has also engendered the major problem of organ shortage. As a consequence, the use of living unrelated donors (LURD) has been proposed as an ethically justifiable alternative for developed nations to minimize their waiting lists for organ transplantation (OTx). This change in attitude has caused an ethical dilemma for developing countries like Brazil, which is struggling to increase the cadaver donor pool. Due to a huge socioeconomic gap of values and needs among nations, the incentive to use LURD in developed countries may not only produce a disincentive to cadaver organ donation but also stimulate organ trade in developing countries. In this paper we aimed to show that in Brazil, we do not need to use LURD because we have not optimized our cadaver donor pool. The exploitation of LURD might be a good option for developed countries, but it is not useful for developing countries. The Transplantation Society urgently needs to solve and clarify this problem by establishing basic ethical and justice principles that can serve as a guide for every country, throughout the entire process required, to achieve an adequate pool of cadaver donors.

The antibody response obtained after one booster dose of rabies vaccine prepared in suckling mice brains at Serviço de Saúde Pública da Cidade do Rio de Janeiro is described. Four prime vaccinal groups were used: group I, persons who had received 16 doses 10 years before this investigation; group II, persons who had received 5 doses of the vaccine 10 years before; group III, persons who had received 9 doses 5 years before; and group IV, persons who had received 16 doses 5 years before. One booster dose of the vaccine was administered to all persons involved in the study. Blood samples were collected before vaccination (day 0), then 7 and 30 days after vaccination. Antibody titres were determined by seroneutralization test in mice (SWM). The results demonstrated that all persons who had been treated with 5, 9 or 16 doses of the vaccine 5 to 10 years before had their antibody titres increased on the 7th and 30th days after one booster dose.