Examining the Potential Exploitation of UNOS Policies

The United Network for Organ Sharing (UNOS) waiting list was designed as a just and equitable system through which the limited number of organs is allocated to the millions of Americans in need of a transplant. People have trusted the system because of the belief that everyone on the list has an equal opportunity to receive an organ and also that allocation is blind to matters of financial standing, celebrity or political power. Recent events have revealed that certain practices and policies have the potential to be exploited. The policies addressed in this paper enable those on the list with the proper resources to gain an advantage over other less fortunate members, creating a system that benefits not the individual most in medical need, but the one with the best resources. These policies are not only unethical but threaten the balance and success of the entire UNOS system. This paper proposes one possible solution, which seeks to balance the concepts of justice and utility.

     

血小板计数与肝素耐药的相关性研究

研究心脏手术中的血小板（PLT）计数与肝素耐药的相关性。随机将120例行心脏手术患者根据PLT计数分成仍血小板组（PLT〈150×10^9·L^-1）和高血小板组（PLT〉250×10^9·L^-1）,每组各60例。麻醉后抽取中心静脉血监测浏活凝血时间（ACT）基础值,肝素化后ACT值,肝素总用量和鱼精蛋白用量,并计算鱼精蛋白／肝素用量。首次肝素化石静脉血ACT值两组间差异无统计学意义。但两组ACT基础值差异有统计学意义（P〈0．05）。高血小板组肝素抗凝并足者有26例（43．3％）,低血小板组仅4例（6．67％）,两组间差异有统计学意义（P〈0．01）。肝素及鱼精蛋白用量均有朔计学意义,前者用量较大（P〈O．01）而后者用量较少（P〈O．05）。心脏手术时血小板计数高者易出现肝素抗凝不足。肝素需要量较大而鱼精蛋白用量较少。高血小板组以先心病患儿为多。     

Interpreting coronary-prone behaviour: Relationships among type a behaviour,hopelessness, anger management and social contact

Abstract

Two approaches to interpreting relationships among psychosocial risk factors for coronary heart disease are contrasted: the profile approach which focuses on predictive validity and confounding; and the theoretical approach which emphasises internal validity. These approaches are explored by applying them to a set of correlations found among Type A behaviour, hopelessness, anger management and social contact in a female sample. Type A behaviour was positively correlated with hopelessness and with anger expression, whilst anger management was related to the availability of social contact. The relationships between Type A, anger expression and hopelessness also appeared to be moderated by degree of social contact. These results are interpreted from the profile perspective and from that of Price's cognitive social learning theory. The relative merits of the two approaches are considered and a case is made for encouraging more theoretically based research on coronary-prone behaviour.     

Impact of organ transplantation in heart,lung and liver recipients: Assessment of positive life changes

Objective: The majority of psychological studies with organ transplant recipients have examined negative psychological effects. This study aimed to further investigate the positive effects of organ transplantation and to construct a specific measurement instrument.

Design: The initial pool of 14 items for the Positive Effects of Transplant Scale (PETS) was derived from organ recipient interviews. A cross-sectional postal study included 87 heart, 46 lung and 193 liver transplant recipients. The PETS was subjected to principal components analysis (PCA) using varimax rotation, and associations with other measures investigated.

Main outcome measures: PETS and an open-ended item about positive effects.

Results: Coding of the open-ended item revealed that the majority of recipients attributed positive life changes to the transplant experience. PCA of the PETS indicated three factors that accounted for 58.82% of the variance. The 12-item questionnaire assesses improvements in: (1) life philosophy, (2) gratitude and (3) health. The total PETS scores exhibited adequate internal consistency and validity.

Discussion: Most transplant patients report positive psychological effects, which suggests this may be an understudied area. The initial development of an assessment tool provides researchers and clinicians a way to assess the degree and nature of these life changes.     

Associations of perceived stress and state anger with symptom burden and functional status in patients with heart failure

Abstract

Background: Psychosocial stress and anger trigger cardiovascular events, but their relationship to heart failure (HF) exacerbations is unclear. We investigated perceived stress and anger associations with HF functional status and symptoms.

Methods and Results: In a prospective cohort study (BETRHEART), 144 patients with HF (77% male; 57.5?±?11.5 years) were evaluated for perceived stress (Perceived Stress Scale; PSS) and state anger (STAXI) at baseline and every 2 weeks for 3 months. Objective functional status (6-min walk test; 6MWT) and health status (Kansas City Cardiomyopathy Questionnaire; KCCQ) were also measured biweekly. Linear mixed model analyses indicated that average PSS and greater than usual increases in PSS were associated with worsened KCCQ scores. Greater than usual increases in PSS were associated with worsened 6MWT. Average anger levels were associated with worsened KCCQ, and increases in anger were associated with worsened 6MWT. Adjusting for PSS, anger associations were no longer statistically significant. Adjusting for anger, PSS associations with KCCQ and 6MWT remained significant.

Conclusion: In patients with HF, both perceived stress and anger are associated with poorer functional and health status, but perceived stress is a stronger predictor. Negative effects of anger on HF functional status and health status may partly operate through psychological stress.     

Vital exhaustion measures and their associations with coronary heart disease risk factors in a sample of spanish-speakers

Abstract

The main purpose of this research was to study the reliability and conceptual validity of two Spanish language measures of Vital Exhaustion (VE), a short-term risk factor for coronary artery disease (CAD). The English version of the Maastricht Questionnaire for Vital Exhaustion was used to make a Spanish language questionnaire (VEQ) and a Spanish language interview (VEI) whose scoring systems were equal to the original version. These instruments were administered to a sample of healthy working men (n = 100) and women (n = 130) in Caracas, Venezuela. Participants also completed questionnaires designed to measure anger-expression and social support and were assessed by means of the Structured Interview to measure Type A Behaviour Pattern (TABP). Information about other CAD-risk factors, such as age, smoking behavior, and health habits, were collected.

High reliability coefficients, .85 and .91, were found for the VEI and VEQ, respectively. Principal component analysis provided one-factor solutions for each instrument. The pattern of correlations between VE, assessed by the VEI, and other personality characteristics was rather similar to the pattern observed in other cultures. In general significant, but modest, correlations were observed between VE and TABP, anger expression, a negative self-concept, and low social support. We conclude that VE appears to be a meaningful construct in this particular cultural context.     

从冠心病主要危险因素的流行特点谈医学模式的转变

随着人民生活水平的提高,冠心病的发病率呈逐年上升趋势,不仅造成个人很高的致残率或致死率,而且给家庭和社会带来沉重的经济负担,冠心病已成为当前一个重要的公共卫生问题。而冠心病是一个多病因疾病,是可防可控的。充分了解冠心病危险因素的流行现状及危害,转变理念,着眼预防,逐步改变目前"重治轻防"的医学模式,是我们心血管医生神圣的使命。     

临床心力衰竭判断中的问题与逻辑性

临床依据患者外在表征推断心衰的特异性低,缘于传统诊疗难以实测心功能。仅指患者耐受体力活动差异的心功能I级~IV级分级标准缺乏心脏实情的印证。用外在的,多歧义的,存在大量主观虚拟的推论诊治心衰,有悖医道的客观真实属性。对疑似心衰者,临床应优先用超声把握心脏形态与功能证据并判明病因,也是临床干预心衰的必要逻辑前提。     

Influence of the role of a partner on anxiety due to a physically threatening situation

This study aimed to examine the influence of the presence of a partner in terms of affiliation level and role on anxiety in a physically threatening situation.

In the first experiment, nine male subjects waited alone for the electric shock, and the other nine subjects waited with their partner.

In the second experiment, 36 female subjects were assigned to four experimental groups by the difference of the role of a partner (coactor or audience) and the affiliation level of a partner (friend or stranger), and subjects waited for the electric shock with their partner.

It was found that anxiety of subjects decreased when the partner was a coactor and/or a friend. It was suggested that these two functioned differently in anxiety reduction in a physically threatening situation.