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Hereditary hemochromatosis (HH) related to HFE-gene mutations is a well-known condition, yet its understanding remains complex. The BIOIRON classification emphasizes that only homozygosity for the C282Y mutation should be considered pathogenic. The penetrance of HFE-related HH is highly variable. Symptoms are often challenging to recognize at the time of presentation, and the systemic involvement may overlap with other diseases. Hyperferritinemia and elevated transferrin saturation levels are still the milestones in HH diagnosis, but they are also common findings in many other clinical conditions. Furthermore, current diagnostic and therapeutic guidelines are not always unequivocal in defining HH patients’ characteristics, as well as treatment management and goals. Our work provides a concise overview of the latest evidence regarding pathogenic mechanisms, clinical picture, differential diagnosis and diagnostic tools. Alongside this, it summarizes and compares the main recommendations from principal guidelines issued by the 2017 Hemochromatosis International Meeting, the American College of Gastroenterology, the European Association for the Study of the Liver, the European Molecular Genetics Quality Network, the DUTCH guidelines, and the British Society for Haematology. Summarizing tables for quick consultation are also provided.

Brazil is the largest producer of oranges in the world and the automatic detection of fruits has been a challenging task in the context of remote sensing, due to variations in fruit appearance, changes in lighting and occlusions of foliage and neighboring fruits. In this sense, this paper focus on the detection of oranges in multispectral images, with different spectral bands and exposures, using a convolutional neural network (CNN) known as YOU ONLY LOOK ONCE (YOLO). The results indicate that, after 300 epochs, the model demonstrated an accuracy of 81.5% and an approximate recovery rate of 85%. Shutter speeds 1/640s and 1/250s are not suitable for detection due to low light and overexposure, respectively. Intermediate values may be more suitable for identifying a larger number of fruits.

Due to the frequent road network changes, keeping them updated is fundamental for several purposes. Currently, models based on Deep Learning (DL), specifically, Convolutional Neural Networks (CNNs), such as encoder-decoder type, are state-of-the-art for this purpose. In this context, the high performance in CNNs has two aspects involved: the model needs a large labeled dataset, and the dataset belongs to the same probability distribution. In practical applications, however, this may not hold, since there is a domain shift effect, and it is not customary for the availability of labeled data. To approach these challenges, we propose to adapt the U-Net architecture (encoder-decoder) to the Unsupervised Domain Adaptation (UDA) that does not need labeling data to minimize the domain shift effect. Our results demonstrate that the proposed method contributes to road segmentation, whose model reaches 74.31% (IoU) and 85.04% (F1), against the same model without UDA that reaches 67.36% (IoU) and 80.02% (F1). This implies that the information that comes from the target domain, even unsupervised, contributes to adversarial learning, improving the generalization capacity of the model, enhancing aspects such as better discrimination surrounding classes, and in the geometric delineation of the road network.

Objective To evaluate the impact of coadministering statins with direct oral anticoagulants (DOACs) on the risk of major bleeding events in patients with venous thromboembolism (VTE).Design Observational cohort analysis based on a multicentre international registry.Setting Data were extracted from the Registro Informatizado de Enfermedad TromboEmbolica Registry, which involves 205 centres across 27 countries.Participants A total of 73 659 patients diagnosed with VTE were classified based on their anticoagulant therapy (DOACs) versus low-molecular-weight heparin (LMWH) or vitamin K antagonists (VKAs) and concurrent use of statins.Methods Multivariable Cox proportional hazards models adjusted for confounding variables to assess the risk of major bleeding events stratified by the type of anticoagulant use and statin use.Results From October 2013 to February 2023, 73 659 patients were recruited: 2573 were statin users on DOACs, 14 090 were statin users on LMWH or VKA therapy, 10 088 were non-statin users on DOACs and 46 908 were non-statin users on LMWH or VKA therapy. Statin users were 10 years older and more likely to have hypertension, diabetes, renal failure or prior artery disease. During anticoagulation (median, 187 days), 1917 patients (2.6%) suffered major bleeding. Rates of major bleeding per 100 patient-years were 2.33 (95% CI 1.72 to 3.09), 3.75 (95% CI 3.43 to 4.10), 1.39 (95% CI 1.13 to 1.69) and 3.10 (95% CI 2.93 to 3.27), respectively. On multivariable analysis, patients treated with DOACs had a significantly lower risk of major bleeding compared with those on LMWH or VKA therapy (adjusted HR 0.59; 95% CI 0.48 to 0.74). The adjusted HR in statin users versus non-users was 1.03 (95% CI 0.92 to 1.14), while in statin users on DOACs versus the rest of patients, it was 1.18 (95% CI 0.79 to 1.76).Conclusions In patients with VTE receiving statins, long-term anticoagulation with DOACs was associated with a reduced risk of major bleeding, regardless of the statin use. These findings support the safety profile of DOACs over VKAs or LMWH in the management of VTE in patients requiring statins.

Introduction. Intradialytic hypotension (IDH) is a common complication of renal replacement therapy (RRT) sessions and may be a particularly detrimental factor in heart recipients. Objective: to investigate the incidence of IDH in heart recipients with acute kidney injury (AKI). Patients and Methods: Two groups of recipients were compared – the study group (SG), n = 313, in which 49 patients required intermittent RRT (IRRT) and in which online hemodiafiltration (OL-HDF) sessions were performed using acetate-free hydrochloric acid-based dialysate fluid; and control group (CG) n = 387, in which 88 patients required IRRT, where standard dialysate with an acetate ion content of 3 mmol/L was used for OL-HDF. Results. There was a significantly lower incidence of IDH in the SG compared to the CG: 10.46% vs 20.47% (p < 0.05). Conclusions. In heart recipients for whom IDH can be considered as a significant adverse factor, the use of acetate-free dialysis fluid can significantly reduce the incidence of this complication.

This review paper aims to analyze the problem of diagnosis and treatment of coronary heart disease (CHD), also called ischemic heart disease (IHD), in patients with end-stage renal disease (ESRD). The analysis is based on current literature data. The issues of CHD risk stratification before patient listing for kidney transplantation (KT) and possible difficulties of diagnosing CHD using non-invasive examination methods in ESRD patients are considered. The effectiveness of myocardial revascularization and drug therapy, endovascular and surgical myocardial revascularization, is compared. The paper also discusses the peculiarities of drug therapy, particularly antiplatelet and antihyperlipidemic therapy in the treatment of CHD in dialysis-dependent patients and kidney recipients.

Summary: Background: The clinical relevance of recurrent venous thromboembolism (VTE) after discontinuing anticoagulation in patients with COVID-19-associated VTE remains uncertain. We estimated the incidence rates and mortality of VTE recurrences developing after discontinuing anticoagulation in patients with COVID-19-associated VTE. Methods: A prospective, multicenter, non-interventional study was conducted between March 25, 2020, and July 26, 2023, including patients who had discontinued anticoagulation after at least 3 months of therapy. All patients from the registry were analyzed during the study period to verify inclusion criteria. Patients with superficial vein thrombosis, those who did not receive at least 3 months of anticoagulant therapy, and those who were followed for less than 15 days after discontinuing anticoagulation were excluded. Outcomes were: 1) Incidence rates of symptomatic VTE recurrences, and 2) fatal PE. The rate of VTE recurrences was defined as the number of patients with recurrent VTE divided by the patient-years at risk of recurrent VTE during the period when anticoagulation was discontinued. Findings: Among 1106 patients with COVID-19-associated VTE (age 62.3 ± 14.4 years; 62.9% male) followed-up for 12.5 months (p25-75, 6.3–20.1) after discontinuing anticoagulation, there were 38 VTE recurrences (3.5%, 95% confidence interval [CI]: 2.5–4.7%), with a rate of 3.1 per 100 patient-years (95% CI: 2.2–4.2). No patient died of recurrent PE (0%, 95% CI: 0–7.6%). Subgroup analyses showed that patients with diagnosis in 2021–2022 (vs. 2020) (Hazard ratio [HR] 2.86; 95% CI 1.45–5.68) or those with isolated deep vein thrombosis (vs. pulmonary embolism) (HR 2.31; 95% CI 1.19–4.49) had significantly higher rates of VTE recurrences. Interpretation: In patients with COVID-19-associated VTE who discontinued anticoagulation after at least 3 months of treatment, the incidence rate of recurrent VTE and the case-fatality rate was low. Therefore, it conceivable that long-term anticoagulation may not be required for many patients with COVID-19-associated VTE, although further research is needed to confirm these findings. Funding: Sanofi and Rovi, Sanofi Spain.

RESUMO Introdução: Em julho de 2021, o Brasil tinha 373 cursos de Medicina autorizados pelo MEC, dos quais 229 de instituições privadas, com um valor médio de mensalidade de R$ 8.242,70. O grande volume de recursos envolvidos em mensalidades, bolsas e fomentos (Prouni, Fies etc.) justifica o esforço envolvido neste trabalho. Objetivo: A revisão visou identificar as metodologias de análise de custo de formação de médicos, classificando-as segundo categorias de nível de ensino e abrangência do custo. Método: A metodologia escolhida foi a revisão de escopo, dado que a produção na área de foco é irregular e com lacunas metodológicas. Resultado: As buscas em português e inglês resultaram na seleção de 24 textos, que foram agrupados em nove grupos, elaboradas a partir do foco de seus conteúdos combinados com os interesses da pesquisa. Conclusão: A inexistência de consenso metodológico e a busca por otimizar recursos e avaliar a eficácia do ensino reforçam a necessidade do desenvolvimento de metodologias de apuração de custos da graduação em Medicina.

Abstract Background Health and care workers (HCW) faced the double burden of the SARS-CoV-2 pandemic: as members of a society affected by a public health emergency and as HWC who experienced fear of becoming infected and of infecting others, stigma, violence, increased workloads, changes in scope of practice, among others. To understand the short and long-term impacts in terms of the COVID-19 pandemic and other public health emergencies of international concern (PHEICs) on HCW and relevant interventions to address them, we designed and conducted a living systematic review (LSR). Methods We reviewed literature retrieved from MEDLINE—PubMed, Embase, SCOPUS, LILACS, the World Health Organization COVID-19 database, the ClinicalTrials.org and the ILO database, published from January 2000 until December 2021. We included quantitative observational studies, experimental studies, quasi-experimental, mixed methods or qualitative studies; addressing mental, physical health and well-being and quality of life. The review targeted HCW; and interventions and exposures, implemented during the COVID-19 pandemic or other PHEICs. To assess the risk of bias of included studies, we used the Johanna Briggs Institute (JBI) Critical Appraisal Tools. Data were qualitatively synthetized using meta-aggregation and meta-analysis was performed to estimate pooled prevalence of some of the outcomes. Results The 1013 studies included in the review were mainly quantitative research, cross-sectional, with medium risk of bias/quality, addressing at least one of the following: mental health issue, violence, physical health and well-being, and quality of life. Additionally, interventions to address short- and long-term impact of PHEICs on HCW included in the review, although scarce, were mainly behavioral and individual oriented, aimed at improving mental health through the development of individual interventions. A lack of interventions addressing organizational or systemic bottlenecks was noted. Discussion PHEICs impacted the mental and physical health of HCW with the greatest toll on mental health. The impact PHEICs are intricate and complex. The review revealed the consequences for health and care service delivery, with increased unplanned absenteeism, service disruption and occupation turnover that subvert the capacity to answer to the PHEICs, specifically challenging the resilience of health systems.

Abstract Background The COVID-19 pandemic highlighted pre-existing weaknesses in health and care systems and services and shortages of health and care workers (HCWs). As a result, policymakers needed to adopt measures to improve the health and care workforce (HCWF) capacity. This review aims to identify countries’ range of policies and management interventions implemented to improve HCWs’ capacity to address the COVID-19 pandemic response, synthesize their evidence on effectiveness, and identify gaps in the evidence. Methods The literature was searched in PubMed, Embase, Scopus, LILACS–BVS, WHO’s COVID-19 Research Database and the ILO, OECD and HSRM websites for literature and documents published between January 2020 and March 2022. Eligibility criteria were HCWs as participants and policy and management interventions aiming to improve HCWF capacity to address the COVID-19 pandemic response. Risk of bias was assessed with Joanna Briggs Institute (JBI) Critical Appraisal Tools (CAT) and certainty of the evidence in presented outcomes with GRADE. Results The searches retrieved 3378 documents. A total of 69 were included, but only 8 presented outcomes of interventions implemented. Most of the selected documents described at least one intervention implemented by countries at the organizational environment level to increase the flexibility and capacity of the HCWF to respond to the pandemic, followed by interventions to attract and retain HCWs in safe and decent working environments. There was a lack of studies addressing social protection, human resources for health information systems, and regarding the role of community health workers and other community-based providers. Regarding the risk of bias, most of documents were rated as medium or high quality (JBI’s CAT), while the evidence presented for the outcomes of interventions was classified as mostly low-certainty evidence (GRADE). Conclusions Countries have implemented various interventions, some innovative, in response to the pandemic, and others had their processes started earlier and accelerated by the pandemic. The evidence regarding the impact and efficacy of the strategies used by countries during the pandemic still requires further research.

BackgroundCountries and health systems have had to make challenging resource allocation and capacity-building decisions to promote proper patient care and ensure health and care workers’ safety and well-being, so that they can effectively address the present COVID-19 pandemic as well as upcoming public health problems and natural catastrophes. As innovations are already in place and updated evidence is published daily, more information is required to inform the development and implementation of policies and interventions to improve health and care workforce capacity to address the COVID-19 pandemic response. ObjectiveThe objective of this protocol review is to identify countries’ range of experiences with policies and management interventions that can improve health and care workers’ capacity to address the COVID-19 pandemic response and synthesize evidence on the effectiveness of the interventions. MethodsWe will conduct a living systematic review of quantitative, qualitative, and mixed methods studies and gray literature (technical and political documents) published in English, French, Hindi, Portuguese, Italian, and Spanish between January 1, 2000, and March 1, 2022. The databases to be searched are MEDLINE (PubMed), Embase, SCOPUS, and Latin American and Caribbean Health Sciences Literature. In addition, the World Health Organization’s COVID-19 Research Database and the websites of international organizations (International Labour Organization, Economic Co-operation and Development, and The Health System Response Monitor) will be searched for unpublished studies and gray literature. Data will be extracted from the selected documents using an electronic form adapted from the Joanna Briggs Institute quantitative and qualitative tools for data extraction. A convergent integrated approach to synthesis and integration will be used. The risk of bias will be assessed with Joanna Briggs Institute critical appraisal tools, and the certainty of the evidence in the presented outcomes will be assessed with the Grading of Recommendations, Assessment, Development and Evaluation. ResultsThe database and gray literature search retrieved 3378 documents. Data are being analyzed by 2 independent reviewers. The study is expected to be published by the end of 2023 in a peer-reviewed journal. ConclusionsThis review will allow us to identify and describe the policies and strategies implemented by countries and their effectiveness, as well as identify gaps in the evidence. Trial RegistrationPROSPERO CRD42022327041; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=327041 International Registered Report Identifier (IRRID)RR1-10.2196/50306

Lo studio della costruzione discorsiva dell’identità è un campo fecondo ‒ e ancora poco esplorato ‒ per comprendere la migrazione. L’integrazione del migrante e dei suoi discendenti nella comunità di destinazione è collegata a rappresentazioni di sé, dell'altro e del mondo, che possono essere comprese meglio attraverso uno studio linguistico-discorsivo. Partendo dall’approccio metodologico della Storia Orale, il gruppo di ricerca “Língua, Identidade e Memória: os italianos no Brasil” realizza interviste con (discendenti di) migranti italiani, incentrate sull’esperienza migratoria diretta o trasmessa dai familiari per investigare in particolare la costruzione dell’italianità degli italo-brasiliani. In questo articolo, analizziamo le occorrenze di “eterogeneità discorsiva mostrata” in cinque interviste con discendenti di italiani arrivati a San Paolo durante la cosiddetta “Grande Emigrazione”. Le domande guida sono: (1) quali caratteristiche vengono associate all’italianità e come vengono presentate nelle occorrenze di eterogeneità mostrata?; (2) cosa possiamo inferire sull’io e sull’italianità dall’incorporazione del discorso altrui in quello degli intervistati? Le ricorrenze evidenziano un’italianità in genere associata a aspetti valutati positivamente, come l’etica del lavoro e la spiccata “allegria”, oltre a una tensione tra enunciatori e italianità. “HE SAID HE WAS ITALIAN”: THE SELF AND THE OTHER IN INTERVIEWS OF DESCENDANTS OF ITALIANS FROM SÃO PAULO The study of the discursive construction of identity is a fruitful – and a yet under-explored – field for understanding migration. The integration of the migrant and their descendants into the destination community is linked to representations of self, other, and world, which can be better understood through a linguistic-discursive study. Starting from the methodological approach of Oral History, the research group “Língua, Identidade e Memória: os italianos no Brasil” conducts interviews with (descendants of) Italian migrants, focusing on the direct migration experience or transmitted by family members to investigate in particular the construction of Italian-ness of Italian-Brazilians. In this paper, we analyze the occurrences of shown discursive heterogeneity in five interviews with descendants of Italians who arrived in São Paulo during the so-called “Great Emigration”. The guiding questions are (1) what characteristics are associated with Italian-ness and how are they presented in the occurrences of shown heterogeneity?; (2) what can we infer about the self and Italian-ness from the incorporation of others’ discourse into that of the interviewees? The occurrences show Italian-ness generally associated with positively valued aspects, such as work ethic and marked “cheerfulness”, as well as a tension between the subjects and Italian-ness.

In this article, a method for road network extraction is proposed, based on GPS (Global Positioning System) trajectories. Unlike existing methods, it is not necessary to resample the GPS trajectories into a raster structure; instead, all analyses are based on the polylines that represent the GPS trajectories. Basically, a morphological analysis and a skeletonization technique are used by the proposed method. Two main steps of the method can be identified: the first step consists in generating an elongated polygon (that delimitates an elongated ribbon) that represents the selected road; and the second step aims at reconstructing the road network. The proposed method was evaluated based on four GPS trajectory datasets and the results obtained can be considered good, but some inconsistencies were noted, as for example: extraction failures occur in places with very low trajectory density (such as 3–4 trajectories); merging of very close and parallel roads; some road crossings that are close to one another have been merged into a single point. The proposed method was also compared with existing methods in the literature and the obtained results showed good consistency between them.

Hereditary hemochromatosis (HH) related to HFE-gene mutations is a well-known condition, yet its understanding remains complex. The BIOIRON classification emphasizes that only homozygosity for the C282Y mutation should be considered pathogenic. The penetrance of HFE-related HH is highly variable. Symptoms are often challenging to recognize at the time of presentation, and the systemic involvement may overlap with other diseases. Hyperferritinemia and elevated transferrin saturation levels are still the milestones in HH diagnosis, but they are also common findings in many other clinical conditions. Furthermore, current diagnostic and therapeutic guidelines are not always unequivocal in defining HH patients' characteristics, as well as treatment management and goals. Our work provides a concise overview of the latest evidence regarding pathogenic mechanisms, clinical picture, differential diagnosis and diagnostic tools. Alongside this, it summarizes and compares the main recommendations from principal guidelines issued by the 2017 Hemochromatosis International Meeting, the American College of Gastroenterology, the European Association for the Study of the Liver, the European Molecular Genetics Quality Network, the DUTCH guidelines, and the British Society for Haematology. Summarizing tables for quick consultation are also provided. [ABSTRACT FROM AUTHOR]

Abstract Background Inadequate leadership capacity compounds the world's workforce lack of preparedness for outbreaks of all sizes, as illustrated by the COVID-19 pandemic. Traditional human resources for health (HRH) leadership has focused on determining the health workforce requirements, often failing to fully consider the unpredictability associated with issues such as public health emergencies (PHE). Main arguments The current COVID-19 pandemic demonstrates that policy-making and relevant leadership have to be effective under conditions of ethical uncertainty and with inconclusive evidence. The forces at work in health labor markets (HLM) entail leadership that bridges across sectors and all levels of the health systems. Developing and applying leadership competencies must then be understood from a systemic as well as an individual perspective. To address the challenges described and to achieve universal health coverage (UHC) by 2030, countries need to develop effective HRH leaderships relevant to the complexity of HLM in the most diverse contexts, including acute surge events during PHE. In complex and rapidly changing contexts, such as PHE, leadership needs to be attentive, nimble, adaptive, action oriented, transformative, accountable and provided throughout the system, i.e., authentic, distributed and participatory. This type of leadership is particularly important, as it can contribute to complex organizational changes as required in surge events associated with PHE, even in in the absence of formal management plans, roles, and structures. To deal with the uncertainty it needs agile tools that may allow prompt human resources impact assessments. Conclusions The complexity of PHE requires transformative, authentic, distributed and participatory leadership of HRH. The unpredictable aspects of the dynamics of the HLM during PHE require the need to rethink, adapt and operationalize appropriate tools, such as HRH impact assessment tools, to redirect workforce operations rapidly and with precision.

Abstract Background The study analyzes the allocation of specialized doctors’ orthopedists in a high-complex hospital, using the WHO’s Workload Indicators of Staffing Need (WISN) methodology and approach, which measures the workload pressure on the healthcare team (positive, negative, or well-adjusted). Methods In the first phase, the hospital’s operations and activities were analyzed using the information system. The duration of the tasks performed by the specialist physicians was observed and directly measured in the second phase. Finally, the indicators were analyzed, and the workload was calculated using the WISN application. The measurement was made using the available work time per year divided by the time unit over the previous 12 months. Results The hand surgery care unit was WISN 1.0 and the ratios for the spine surgery care unit was 1.22, indicating enough physicians and no work overload among the groups surveyed. The ratio in the knee unit was 1.69, indicating that there was an excess of staffing for the workload. Conclusion The workload findings and staffing calculations were useful in supporting and orienting the design and implementation of measures to increase the efficiency and effectiveness of health services.

Abstract Background Functioning health systems require a health workforce (HWF) that is qualified, available, equitably distributed, and accessible to the entire population as the basis for guaranteeing access to health. There is a global HWF crisis, manifested in Brazil by unequal distribution of healthcare personnel, particularly in rural areas, urban peripheries, and other hard-to-reach communities, posing a major obstacle to guaranteeing access to health systems and services. Based on the above, calculating the size and analyzing the workloads of the medical staff in the Obstetrics Department (OD) and Urgent Care Center (UCC) in a state maternity hospital is relevant for designing improvements in the work processes and future strategies for recruiting, selecting, and retaining these workers at the hospital, in turn favoring improvement in the quality of care for women and children at the state level. This scenario motivated the study’s design, in which the overall objective was to analyze the workload of staff physicians working in the Obstetrics Department and Urgent Care Center of a public maternity hospital in the state of Bahia, based on the WISN method. Methods This was an exploratory-descriptive intervention study with a quantitative approach and qualitative elements, using the methodological stages recommended by the WISN to calculate and analyze the workload of obstetricians working in the OD and UCC in the maternity hospital. Results The study found a deficit of 14 shift obstetricians at the hospital with a workload of 0.81. The study also found that the insufficient number of obstetricians at the hospital resulted from precarious hiring formats, idle medical positions, and poorly structured work processes and a shortage in the multidisciplinary staff. Conclusion The research sought to contribute to the reduction of the gap in models and methodologies for the staffing of gynecologists and obstetricians in Bahia Maternity Hospitals, without covering the whole subject, but to demonstrate that the findings of the workload analysis and its validation could be useful in promoting and directing the design and implementation of interventions to improve the quality of the workload.

Abstract Background The article describes a healthcare staffing exercise that took place in a Cancer Hospital IV, Brazil’s first public palliative care unit. There are numerous gaps in the literature on specialized cancer staffing. Palliative care is a therapy modality that should begin with the diagnosis of a chronic disease, at which point the personnel must be technically and numerically adequate, as well as well-distributed, to provide coverage of the population that requires this type of care. Methods The WISN tool was chosen after a systematic review of the use of workload studies in palliative care, because it fulfills this objective. The WISN method is based on a health worker's workload, was developed in the late 1990s in the health sector and has been field-tested and implemented in several countries. Direct observation was used as the fieldwork approach, which was carried out by 18 research assistants with the assistance of two supervisors. They monitored 60 professionals in seven categories for 2 weeks on weekdays in the morning and afternoon periods: nursing, pharmacy, physical therapy, medical, nutrition, psychology, and social services. Results Except for the medical staff, which at the time included additional physicians on loan from a partner institution to address a shortage in this professional group, all categories exhibited overload with WISN ratios ranging from 0.53 to 0.97. The analysis of time spent on individual activities indicated flaws with the services' informal organizations. The authors also noticed a strong emphasis on support activities and a lack of a clear schedule for training and research. The study's findings included a definition of standard activities for each professional group, an analysis and comparison of activities by categories, departments, and work shifts, a standard workload for training and research, and recommendations to include human resources planning as a fundamental part of a national policy for palliative care. Conclusions The WISN tool can be used to plan human resources in cancer centers that provide palliative care, and it provides for a variety of analyses that can be combined with other approaches in the literature.

Kidney injury in cardiac transplant recipients is one of the most severe complications affecting both short- and long-term transplant outcomes. The need for renal replacement therapy (RRT) is determined not only and not so much by the degree of renal dysfunction, as by the need for correction of fluid balance and metabolic disorders. These circumstances are associated with the specificity of extracorporeal renal replacement therapy in donor heart recipients. In this review, we discuss the problems of early versus delayed initiation of RRT, anticoagulation and vascular access, advantages and disadvantages of continuous and intermittent techniques. Special attention is paid to chronic kidney injury and peculiarities of kidney transplantation in heart recipients.