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      Can education alter attitudes, behaviour and knowledge about organ donation? A pretest–post-test study

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          Abstract

          Objective

          The emergence of evidence suggests that student nurses commonly exhibit concerns about their lack of knowledge of organ donation and transplantation. Formal training about organ donation has been shown to positively influence attitude, encourage communication and registration behaviours and improve knowledge about donor eligibility and brain death. The focus of this study was to determine the attitude and behaviour of student nurses and to assess their level of knowledge about organ donation after a programme of study.

          Design

          A quantitative questionnaire was completed before and after participation in a programme of study using a pretest–post-test design.

          Setting

          Participants were recruited from a University based in Northern Ireland during the period from February to April 2011.

          Participants

          100 preregistration nurses (female : male=96 : 4) aged 18–50 years (mean (SD) 24.3 (6.0) years) were recruited.

          Results

          Participants’ knowledge improved over the programme of study with regard to the suitability of organs that can be donated after death, methods available to register organ donation intentions, organ donation laws, concept of brain death and the likelihood of recovery after brain death. Changes in attitude postintervention were also observed in relation to participants’ willingness to accept an informed system of consent and with regard to participants’ actual discussion behaviour.

          Conclusions

          The results provide support for the introduction of a programme that helps inform student nurses about important aspects of organ donation.

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          Most cited references36

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          The quality of life of patients with end-stage renal disease.

          We assessed the quality of life of 859 patients undergoing dialysis or transplantation, with the goal of ascertaining whether objective and subjective measures of the quality of life were influenced by case mix or treatment. We found that 79.1 per cent of the transplant recipients were able to function at nearly normal levels, as compared with between 47.5 and 59.1 per cent of the patients treated with dialysis (depending on the type). Nearly 75 per cent of the transplant recipients were able to work, as compared with between 24.7 and 59.3 per cent of the patients undergoing dialysis. On three subjective measures (life satisfaction, well-being, and psychological affect) transplant recipients had a higher quality of life than patients on dialysis. Among the patients treated with dialysis, those undergoing treatment at home had the highest quality of life. All quality-of-life differences were found to persist even after the patient case mix had been controlled statistically. Finally, the quality of life of transplant recipients compared well with that of the general population, but despite favorable subjective assessments, patients undergoing dialysis did not work or function at the same level as people in the general population.
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            The cost-effectiveness of increasing kidney transplantation and home-based dialysis.

            Renal replacement therapy (RRT) consumes sizable proportions of health budgets internationally, but there is considerable variability in choice of RRT modality among and within countries with major implications for health outcomes and costs. We aimed to quantify these implications for increasing kidney transplantation and improving the rate of home-based dialysis. A multiple cohort Markov model was used to assess costs and health outcomes of RRT for new end-stage kidney disease (ESKD) patients in Australia for 2005-2010, using a health-care funder perspective. Patient characteristics and current practice patterns were based on the ANZDATA Registry. Two proposed changes were modelled: (i) increasing kidney transplants by between 10% and 50% by 2010; and (ii) increasing home haemodialysis (HD) and peritoneal dialysis (PD) to the highest rates observed among Australian centres. We assessed costs (Australian dollars), survival and quality-adjusted survival, and cost-effectiveness. The number of new ESKD patients in 2010 was estimated to be 2700, with annual RRT costs of about $A700 million; cumulative costs (2005-2010) were $A5 billion. Increasing transplants by 10-50% saves between $A5.8 and $A26.2 million, and increases quality-adjusted life years (QALYs) by 130-658 QALYs. Switching new patients from hospital HD to (i) home HD saves $A46.6 million by 2010; or (ii) PD saves $A122.1 million. These clinical practice changes reduce costs, improve patient quality of life and, in the case of transplantation, increase survival. Planning for RRT services should incorporate efforts to maximize rates of transplantation and to encourage home-based over hospital-based dialysis to optimize cost-effectiveness in RRT service delivery.
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              Cost-effectiveness analysis of renal replacement therapy in Austria.

              Providing renal replacement therapy (RRT) for end-stage renal disease patients is resource intensive. Despite growing financial pressure in health care systems worldwide, cost-effectiveness studies of RRT modalities are scarce. We developed a Markov model of costs, quality of life and survival to compare three different assignment strategies to chronic RRT in Europe. Mean annual treatment costs for haemodialysis were €43,600 during the first 12 months, €40,000 between 13 and 24 months and €40,600 beyond 25 months after initiation of treatment. Mean annual treatment costs for peritoneal dialysis were €25,900 during the first 12 months, €15,300 between 13 and 24 months and €20,500 beyond 25 months. Mean annual therapy costs for a kidney transplantation during the first 12 months were €50,900 from a living donor, €51,000 from a deceased donor, €17,200 between 13 and 24 months and €12,900 beyond 25 months after engraftment. Over the next 10 years in Austria with a population of 8 million people, increased assignment to peritoneal dialysis of 20% incident patients saved €26 million with a discount rate of 3% and gained 839 quality-adjusted life years (QALYs); additionally, increasing renal transplants to 10% from live donations saved €38 million discounted and gained 2242 QALYs. Live donor renal transplantation is cost effective and associated with increase in QALYs. Therefore, preemptive live kidney transplantation should be promoted from a fiscal as well as medical point of view.

                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2013
                24 December 2013
                : 3
                : 12
                : e003961
                Affiliations
                Faculty of Science, Engineering and Computing, Kingston University , Kingston upon Thames, Surrey, UK
                Author notes
                [Correspondence to ] Professor Barbara Pierscionek; b.pierscionek@ 123456kingston.ac.uk
                Article
                bmjopen-2013-003961
                10.1136/bmjopen-2013-003961
                3884632
                24381257
                c817ea94-a080-4f5f-9371-53d875153f58
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

                History
                : 5 September 2013
                : 14 November 2013
                : 27 November 2013
                Categories
                Medical Education and Training
                Research
                1506
                1709
                1724
                1725

                Medicine
                primary care,public health,education & training (see medical education & training)

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