Heart transplant: An overview

Heart transplant: An overview Introduction Heart transplant is a transplant procedure surgery where the malfunctioning heart or end-stage heart-related disease are replaced by a function heart. Indeed, this is a very complicated, risky and time-consuming operation since it needs a function heart from the person who has just died and implant it into the patient. It is usually done in emergencies and to find a donor heart is difficult. Have you ever thought of how was the first heart transplant done? Who was actually the first person in the world that conducted this sound seemed â€Å"impossible† surgery? Who was the first courageous patient who willing to put his life in such a great risk? And have you ever wondered how exciting it would be to cause a breakthrough in medical world that could end up saving millions of lives from all over the world? This great success was from a heart surgeon, Dr. Christiaan (Neethling) Barnard from South Africa. He was the first person who carried out a human-to-human heart transplant on December 3, 1967 in Cape Town, South Africa. It was done at Groote Schuur Hospital in Cape Town on Louis Washkansky, a South African grocer who would most certainly die without the heart transplant. Meanwhile, the donor was from a young woman, Denise Darvell who was killed in an accident. The heart transplant surgery had surprised the whole world. Dr. Christiaan (Neethling) Barnard also became a well-known heart surgeon overnight. Besides heart transplant, he had other astonishing achievement in kidney transplant and gastrointestinal pathology. Dr. Barnard is also attributed in mounting a new design for artificial heart valves, doing heart transplanting on animals, and correcting the problem of the blood supply to the fetus during pregnancy. With the efforts of Dr. Barnard and his surgical team, the survival rates of 50% of the patients to at least 5 years of living after heart surgery. Background of Christiaan Barnard Christiaan Barnard was born in Beaufort West, Union of South Africa on 8 November 1922.[1] His father, Adam Barnard was a minister of the Dutch Reformed Church for the mixed race population of the town. When he was a child, he always pumped the bellows of the churchs primitive organ which his mother played during services. After a long time, he told a joke that the heart was not the first organ he had had to deal with in his life. One of his four brothers, Abrahim died at the age of five because of the heart problem. After that incident, Barnard determined to be a surgeon to help people who faced heart problem since he was young. Christiaan Barnard came from a very poor family and he studied at the local public school. He matriculated from the Beaufort West School in 1940. After that, Barnard got a place at the University of Cape Town Medical School. He obtained Bachelor of Medicine, Bachelor of Surgery in medicine at the University of Cape Town in 1946. He worked as a general practitioner in Ceres, South Africa when he was a resident doctor at the Groote Schuur Hospital in Cape Town. In 1951, he returned to Cape Town and worked as a Senior Resident Medical Officer at the City Hospital. Besides, he was also a registrar in the Department of Medicine at the Groote Schuur Hospital. Since Christiaan Barnard was interested in his research and gaining a new surgical skills and experiences, he furthered his postgraduate studies at the University of Cape Town and at the University of Minnesota. He acquired Master of Medicine in medicine for a dissertation entitled Meningitis† from the University of Cape Town in 1953[2] whereas he was awarded Doctor of Philosophy degree for his dissertation entitled The aetiology of congenital intestinal atresia at the University of Minnesota. [3]After that, he went back to South Africa to be a cardiothoracic heart surgeon. Before he left for America (1953-1955), Barnard had gained recognition for research in gastrointestinal pathology. He proved that the fatal birth defect known as congenital intestinal atresia (a gap in the small intestines) was due to the fetus receiving an inadequate supply of blood during pregnancy and that it could be remedied by a surgical procedure. [4] He was a specialist in cardiothoractic surgery and heart transplantation. His first successful open heart surgery program is at Groote Shuur Hospital. In 1967, he led a team to perform in the worlds first human-to-human heart transplant. Barnard was contributed the treatment of cardiac diseases, such as the Tetralogy of Fallot and Ebsteins anomaly. In 1972, he was promoted to be Professor of Surgical Science in the Department of Surgery at the University Of Cape Town. He got an appellation Professor Emeritus in 1984. Christiaan Barnards advances in heart surgery brought him honors from a host of foreign medical societies, governments, universities, and philanthropic (charitable) institutions. He had also been presented many honors, including the Dag Hammarskjold International Prize and Peace Prize, the Kennedy Foundation Award, and the Milan International Prize for Science. Since 1960, Christiaan Barnard had been bothered by rheumatoid arthritis (a severe swelling of the joints). This limited his surgical experimentation in later years. As a result, he turned to writing novels as well as books on health, medicine, and South Africa. At the same time, he also served as a scientific consultant. Christiaan Barnard died on September 2, 2001, when he was seventy-eight years old. Contributions of Christiaan Barnard in Science Doctor Barnard with some of his medical team 1. Proof Of The Fatal Birth Defect Christiaan Barnard showed that the fatal birth defect that was known as congenital intestinal atresia was a gap in the small intestines. The fetus did not receive sufficient blood during pregnancy cause the defect.[5] This research made him being recognised in gastrointestinal pathology which is about intestinal diseases. Besides, he also proved that surgical procedure could treat this condition. 2. Heart Transplantation Christiaan Barnard was a pioneering cardiac surgeon but his advances were based on work that came before him. The first use of hypothermia in 1952 and the introduction of a heart-lung machine in 1953 were crucial important for his advances. In 1960, these advances which combined with other techniques enabled him to undergo the first heart operation. Ø The First Heart Transplantation Preparation for the first heart transplant Upon he returned to South Africa, he introduced open-heart surgery and designed artificial valves for the human heart. During 1967, in the preparation for the first heart transplantation, he spent 3 months with the pioneer kidney transplant surgeon who was David Hume in Richmond, Virginia and another 2 weeks with Thomas Starzl in Denver, Colorado. He learnt the basics of immunosuppressive therapy in organ transplantation from these attachments. Furthermore, he got the chance to watch an orthotopic heart transplant on a dog which was performed by Richard Lower, head of cardiac surgery when he was at the Medical College of Virginia. Lower spent many years with Norman Shumway at Stanford University to develop, perfect the surgical technique and study other kinds of experimental heart transplantation. In addition, Christiaan Barnard underwent a single kidney transplant in Cape Town was to gain some experience about immunosuppressive therapy. The patient did exceptionally well. Therefore, Barnard claimed that he was the only kidney transplant surgeon in the world with a 100% 20-year patient and graft survival. The First Patient—Louis Washkansky Making history: The First Patient Louis Washkansky After a decade of heart surgery, Christiaan Barnard was ready to accept the challenge posed by the human heart transplantation. In 1967, he performed the first human-to-human orthotopic heart transplant in his patient, Louis Washkansky who was a fifty four years old patient, suffering from extensive coronary artery disease, peripheral vascular disease and also diabetic. He could either wait for death or risk transplant surgery with an 80% chance of surviving. He at last chose the surgery. As Barnard wrote, For a dying man it is not a difficult decision because he knows he is at the end. If a lion chases you to the bank of a river filled with crocodiles, you will leap into the water convinced you have a chance to swim to the other side. But you would never accept such odds if there were no lion. [6] On December 2, 1967, Washkanskys heart was replaced by the heart of a young woman killed in an accident. Barnards assistants immediately opened the chest, initiated pump-oxygenator support, cooled the heart to a low temperature, and excised it once medicolegal official announced that the young woman was dead. The heart was kept alive in a heart-lung machine that circulated Washkanskys blood before removing the patients diseased organ and replacing it with the healthy heart. All the procedures were run well and the heart functioned satisfactorily by using the technique which was developed in dogs by the Stanford group[7]. Washkanskys daily progress was followed intensely. In the beginning, he recovered very well. His peripheral edema was lost rapidly as his new heart functioned strongly. However, after 12 days, his condition started to deteriorate and his lungs were developed radiographic infiltrates. The surgical team was not sure if these were associated with cardiac failure from rejection or with infection. Mistakenly, they elected to treat for rejection and intensify the immunosuppressive therapy. They made a wrong decision because Washkansky had pneumonia. As a result, Louis Washkansky died on December 21, 1967. Ø The second patient—Philip Blaiberg Not daunted by the failure, within a year, Christiaan Barnard replaced the diseased heart of Philip Blaiberg who was a fifty eight years old retired dentist. On this occasion, Barnard slightly modified the surgical technique. The incision in the right atrium of the donor heart was extended from the inferior vena cava into the atrial appendage to avoid the area of the sinus node at the root of the superior vena cava.[8] This is the first time when antilymphocyte serum was used in the patient. After heart transplantation, Blaiberg recovered well and he was the first heart transplant patient who can leave hospital. Nevertheless, he died on the 19th month. His autopsy showed that he infected a severe and widespread coronary artery disease. The medical profession was shocked because he had not expected that atherosclerosis could develop such rapidly. This was the first example of graft atherosclerosis, otherwise known as chronic rejection that now dominates as the major cause of graft failure after the first post transplant year. Blaiberg wrote a short book about his experience which was Looking At My Heart[9] before he died. Ø Twin-Heart Operation Christiaan Barnard performed a twin-heart surgery in the year 1974, November 25 as the history of medical had been changed by him again. The only infected part of heart of Ivan Taylor (58 years old) was being removed and replaced with the heart of a child who was only 10 years old. The heart of the child was used to support the patients diseased organ. Although Barnard was confident in this new operation since this was less dangerous compared to the heart implantation, the patient passed away in four- month time. Double transplants was included in twin-heart operation by combining a well heart to the patients heart to produce a double pump, manipulating synthetic heart valves and making the lives of seriously ill people longer by using monkeys hearts. Ø Orthotopic heart transplantation Barnards medical team had only performed ten orthotopic heart transplants between the year 1967 and 1973.[10] The results were outstanding even though the medical standards last time were not as high as todays, as one considers the ancient nature of the immunosuppressive therapy accessible at the time which are mainly azathioprine, corticosteroids, and antilymphocyte serum, and the team was not expert enough in diagnosing and treating rejection episodes since they did not have many experiences in these aspects. Dirk Van Zyl who was the sixth patient was notable in orthotopic heart transplant. His ischemic heart disease was too bad that he had a cardiac arrest when he was anesthesia.[11] At the time of giving external cardiac massage, he was attached to the pump-oxygenator via cannulation of the femoral vessels. He made an ordinary healing from the heart transplant surgery. He did not receive any cyclosporine, only being maintained on azathioprine and prednisone. He died when he was 24 years old from a cerebrovascular accident. Ø Heterotopic heart transplantation Jaques Losman, a junior surgeon, was being set by Barnard on his team in order to develop a surgical technique of heterotopic heart transplantation. This is a kind of transplantation where the second heart is located in the chest and the two hearts have the chance to work in parallel. There are two techniques were successfully developed in the laboratory, in one of which the donor heart help the left ventricle only and another in which biventricular support was offered[12]. Only two left ventricular assist procedures were carried out in patients, the remaining processes were related to biventricular assist. Forty-nine following heterotopic heart transplants were done in Cape Town between 1974 and 1983 with rather excellent results for that period. 3 out of the first 5 of patients managed to live more than 10 years. Two 14-year-old boys, both of whom firstly received heterotopic transplants, went through second (orthotopic) heart transplants for joining atherosclerosis, and were thus the first patients in the world to have two donor hearts in their chest at the same time. The first of these two boys stays alive and healthy 20 years more. In the other, the second transplant also finally failed and he underwent a third graft, again in the orthotopic site, and therefore turned into one of the few humans to have had four hearts in his life-time. One of the advantages of heterotopic heart transplantation was that information on the retrenchment of both the recipient and donor left ventricles could be supplied by an outer pulse trace. The changes in the ratio of these two pulses as the donor pulse deteriorating in relation to the recipient pulse, recommended that rejection was happening.[13] Increase immunosuppressive therapy could then be controlled. If there were any doubts, an endomyocardial biopsy could be performed. The other hypothetical benefit is that, in patients with a severe myocarditis, the back-up that given by the transplant might allow the myocarditis to resolve and the patients own heart to recover. In fact, this had happened in one patient, making it feasible to remove the transplanted heart while it developed a fairly acute rejection episode. Ø Xenotransplantation The heterotopic heart is able to provide temporary circulatory support to a failing native heart, in the hope that the native heart would recover, was extended into the realm of xenotransplantation.[14] On two occasions in 1977, when a patients left ventricle failed acutely after routine open heart surgery and when no human donor organ was available, Barnard transplanted an animal heart heterotopically. On the first occasion, a baboon heart was transplanted, but this failed to support the circulation sufficiently, the patient dying some 6 hours after transplantation. In the second patient, a chimpanzee heart successfully maintained life until irreversible rejection occurred 4 days later, the recipients native heart having failed to recover during this period. Barnard abandoned further attempts at xenotransplantation since, in his own words, â€Å"I became too attached to the chimpanzees.†ÃƒËœ Hypothermic perfusion storage of the donor heart A young biochemist working in Barnards department, Winston Wicomb, a hypothermic perfusion system was developed for storing hearts ex vivo for up to 48 hours. It proved possible to remove a baboons heart, store it by hypothermic perfusion for 24 or 48 hours, and then replace it in the original baboon, the baboon having been maintained alive during this period by an orthotopic cardiac allograft. With the success of this storage system in the laboratory, Barnard encouraged his juniors to use it in the clinical transplant program. This phenomenon of delayed function, suggesting temporary depletion of myocardial energy stores, was believed to be related to the fact that, whereas in the baboon experiments the heart had been removed from a healthy anesthetized animal, in the clinical situation the heart had been excised from a brain-dead subject. 3. Books Barnard had been bothered by rheumatoid arthritis since he was young, and advancing stiffness in his hands forced his retirement from surgery in 1983. He took up writing, however, and wrote a cardiology text, a (sometimes sensational) autobiography, and several novels, including a thriller about organ transplants. Christiaan Barnard wrote two autobiographies. His first book, One Life, was published in 1969 and subsequently sold copies worldwide. Some of the proceeds were used to set up the Chris Barnard Fund for research into heart disease and heart transplants in Cape Town. His second autobiography, The Second Life, was published in 1993. Apart from his autobiographies, Dr Barnard also wrote several other books including The Donor, Your Healthy Heart, In The Night Season, The Best Medicine, Arthritis Handbook: How to Live With Arthritis, Good Life Good Death: A Doctors Case for Euthanasia and Suicide, South Africa: Sharp Dissection, 50 Ways to a Healthy Heart and Body Machine.[15] Christiaan Barnard had influenced much in the current scientific knowledge. His first heart transplant done in 1967 had contributed a lot in the knowledge of heart transplant. In December 1967, Dr. Barnard placed the heart of a 25-year-old woman who had died in an auto accident in the chest of Louis Washkansky, a 55-year-old man dying of heart damage. Barnard and his team of cardiac specialists gave the patient large doses of drugs in order to suppress the bodys defense mechanism that would normally reject a foreign organism. However, Washkanskys body was unable to defend itself against infection and only survived for 18 days.[16] However, Washkanskys brave election to be the first heart transplant recipient had proved the technique feasible. After Barnards successful operations, surgeons in Europe and the United States began performing heart transplants, improving upon the procedures first used in South Africa. Despite many failures worldwide in heart transplant, this relative success did much to generate guarded optimism that heart transplantation might eventually become a feasible therapeutic option. Barnard then developed the operation of heterotrophic heart transplantation which had some benefits in the pre-cyclosporine era when immunosuppressive therapy was very limited. In 1981, his group was the first in successfully transporting donor hearts using a hypothermic perfusion storage device. Several studies on the hemodynamic and metabolic sequelae of brain death were carried out in his Departments cardiovascular research laboratories at the University of Cape Town. The concept of hormonal replacement therapy in organ donors was also developed. In the Chris Barnard Division of Cardiothoracic Surgery at Groote Schuur Hospital and the University of Cape Town, an active heart transplant program still continues. The thrust of clinical activity within the Division and the research within its state-of-the-art cardiovascular research laboratories is now directed towards valvular and ischaemic heart which are common in the African population.[17] Dr. Barnard had learned much of his technique from studying with the Stanford group. This first clinical heart transplantation experience stimulated world-wide notoriety, and many surgeons quickly co-opted the procedure. However, because many patients were dying soon after, the number of heart transplants dropped from 100 in 1968, to just 18 in 1970. It was recognized that the major problem was the bodys natural tendency to reject the new tissues. Advances in tissue typing and immunosuppressant drugs Over the next 20 years, important advances in tissue typing and immunosuppressant drugs allowed more transplant operations to take place and increased patients survival rates. The most notable development in this area was the discovery of cyclosporine, an immunosuppressant drug derived from soil fungus, in the mid 1970s. It was the first immunosuppressive drug that allowed the selective immuneregulation of T cells without excessive toxicity. Todays surgical techniques and procedures are more sophisticated. Refinements in patient selection, newer immunosuppressants, better myocardial protection, and the use of right ventricular endomyocardial biopsy to identify rejection have resulted in better survival rates. After his breakthrough, he continued to work with a professional passion that excited the public and frightened his colleagues. He was the first to explore further cardiac techniques. These included double transplants which involved the of joining a healthy heart to the patients to create a double pump, designing artificial heart valves and using monkeys hearts to keep ill people alive. [18] Following the determination of Dr. Barnard, coronary assist devices and mechanical heartsare being developed to perform the functions of live tissues. Since the 1950s, artificial hearts have been under development. A booster pump was first implanted successfully as a temporary assist device in 1966. Barnard made medical history again when he performed a twin-heart operation in 1974, which is seven years after his first heart transplant. This time, he only removed the diseased part of the heart of a 58-year-old man and replaced it with the heart of a 10-year-old child. The donor heart acted as a booster and back-up for the patients disease-ravished organ.[19] However, the patient died within four months even though Barnard was optimistic about this new operation which he believed was less radical than a total implantation. Conclusion Barnard retired as Head of the Department of Cardiothoracic Surgery in Cape Town in 1983 after developing rheumatoid arthritis in his hands, which prevented him from operating. At the time of his retirement, Barnard investigated the controversial â€Å"rejuvenation† therapy offered by the Clinique La Prairie in Switzerland. In particular, he received considerable adverse publicity over his comments with regard to an anti-ageing skin cream, known as Glycel, which was intended to reduce wrinkling. Barnard was also invited to act as a consultant at Baptist Medical Center in Oklahoma City where a new heart transplant program was being planned. In later life spending much of his time at the Baptist Medical Centre in Oklahoma, where he tried to find a way of slowing the ageing process. It seemed he was searching for a miracle to match his first. Despite the problems and techniques faced, Barnard continued to further his knowledge and researches in heart transplant. This has become a n inspiration to the others in the aim to perform more successful heart transplant. The hard-work of Dr. Barnard and his team will be memorized by people forever. Reference 1. Barnard, Christiaan. (n.d.). Retrieved August 21, 2009, from http://www.encyclopedia.com/doc/1G2- 3437500078.html 2. Christiaan Barnard. (n.d.). Retrieved August 21, 2009, from http://en.wikipedia.org/wiki/Christiaan_Barnard 3. Christiaan Barnard. (n.d.). Retrieved August 21, 2009, from http://www.answers.com/main/ntquery?s=christiaan+barnardgwp=13 4. Christiaan N. Barnard. (n.d.). Retrieved August 21, 2009, from http://www.novelguide.com/a/discover/ewb_02/ewb_02_00449.html 5. Christiaan Barnard Biography. (n.d.). Retrieved August 24, 2009, from http://www.notablebiographies.com/Ba-Be/Barnard-Christiaan.html 6. Dr Christiaan Barnard. (n.d.). Retrieved August 24, 2009, from http://www.dinweb.org/dinweb/DINMuseum/Dr%20Christiaan%20Barnard.asp Christiaan Barnard. (n.d.). Retrieved August 24, 2009, from http://www.answers.com/main/ntquery?s=christiaan+barnardgwp=13 8. Heart Transplant, History of Heart Transplantation. (n.d.). Retrieved August 25, 2009, from http://www.cumc.columbia.edu/dept/cs/pat/hearttx/history.html 9. http://www.springerlink.com/content/q3266367g54588th/. Retrieved 24.8.2009. 10. BBC News | HEALTH | Christiaan Barnard: Single-minded surgeon. (2001). Retrieved August 25, 2009, from http://news.bbc.co.uk/2/hi/health/1470356.stm 11. Dr. Christiaan Barnard: Biography. (n.d.). Retrieved August 25, 2009, from http://www.answers.com/topic/dr-christiaan-barnard 12. Lower, R.R., Shumway, N.E. (1960). Studies on orthotopic homotransplantation of the canine heart. Surg Forum, 11, pp. 18-20. 13. Barnard, C.N. (1968). What we have learned about heart transplants. J Thorac Cardiovasc Surg, 56, pp. 457-468. 14. Blaiberg, P. (1969). Looking at my heart. London: Heinemann. 15. Cooper, D.K.C., Lanza, R.P. (1984). Heart transplantation at the University of Cape Town—an overview (appendix). In Cooper, D.K.C. Lanza, R.P. (Eds.), Heart transplantation (pp. 351-360). Lancaster: MTP Press. 16. Brink, J. (1996). Twenty-three year survival after orthotopic heart transplantation [letter]. J Heart Lung Transplant,15, pp. 430-431. 17. Barnard, C.N., Losman, J.G. (1975). Left ventricular bypass. S Afr Med J, 49, pp. 303-312. 18. Novitzky, D., Cooper, D.K.C., Rose, A.G., Barnard,C.N. (1984). The value of recipient heart assistance during severe acute rejection following heterotopic cardiac transplantation. J Cardiovasc Surg, 25, pp. 287-295. 19. Barnard, C.N., Wolpowitz, A., Losman, J.G. (1977). Heterotopic cardiac transplantation with a xenograft for assistance of the left heart in cardiogenic shock after cardiopulmonary bypass. S Afr Med J, 52, pp. 1035-1039. 20. Cooper, D.K.C. (2001). Christiaan Barnard and his contributions to heart transplantation. The Journal of Heart and Lung Transplantation, 20 (6), 599-610. 21. Brink, J. G., Cooper, D.K.C. (2005). Heart transplantation: The contributions of Christiaan Barnard and the University of Cape Town/Groote Schuur Hospital. World Journal of Surgery, 29 (8), 953-961. 22. (Heart Transplantation: The Contributions of Christiaan Barnard, 2005; Heart Transplantation: The Contributions of Christiaan Barnard, 2005) [1] Barnard, Christiaan. (n.d.). Retrieved August 21, 2009, from http://www.encyclopedia.com/doc/1G2- 3437500078.html [2] Christiaan Barnard. (n.d.). Retrieved August 21, 2009, from http://en.wikipedia.org/wiki/Christiaan_Barnard [3] Christiaan Barnard. (n.d.). Retrieved August 21, 2009, from http://www.answers.com/main/ntquery?s=christiaan+barnardgwp=13 [4] Christiaan N. Barnard. (n.d.). Retrieved August 21, 2009, from http://www.novelguide.com/a/discover/ewb_02/ewb_02_00449.html [5] Christiaan Barnard Biography. (n.d.). Retrieved August 24, 2009, from http://www.notablebiographies.com/Ba-Be/Barnard-Christiaan.html [6] Dr Christiaan Barnard. (n.d.). Retrieved August 24, 2009, from http://www.dinweb.org/dinweb/DINMuseum/Dr%20Christiaan%20Barnard.asp [7] Lower, R.R., Shumway, N.E. (1960). Studies on orthotopic homotransplantation of the canine heart. Surg Forum, 11, pp. 18-20. [8] Barnard, C.N. (1968). What we have learned about heart transplants. J Thorac Cardiovasc Surg, 56, pp. 457-468. [9] Blaiberg, P. (1969). Looking at my heart. London: Heinemann. [10] Cooper, D.K.C., Lanza, R.P. (1984). Heart transplantation at the University of Cape Town—an overview (appendix). In Cooper, D.K.C. Lanza, R.P. (Eds.), Heart transplantation (pp. 351-360). Lancaster: MTP Press. [11]Brink, J. (1996). Twenty-three year survival after orthotopic heart transplantation [letter]. J Heart Lung Transplant,15, pp. 430-431. [12] Barnard, C.N., Losman, J.G. (1975). Left ventricular bypass. S Afr Med J, 49, pp. 303-312. [13] Novitzky, D., Cooper, D.K.C., Rose, A.G., Barnard,C.N. (1984). The value of recipient heart assistance during severe acute rejection following heterotopic cardiac transplantation. J Cardiovasc Surg, 25, pp. 287-295. [14] Barnard, C.N., Wolpowitz, A., Losman, J.G. (1977). Heterotopic cardiac transplantation with a xenograft for assistance of the left heart in cardiogenic shock after cardiopulmonary bypass. S Afr Med J, 52, pp. 1035-1039. [15] Christiaan Barnard. (n.d.). Retrieved August 24, 2009, from http://www.answers.com/main/ntquery?s=christiaan+barnardgwp=13 [16] Heart Transplant, History of Heart Transplantation. (n.d.). Retrieved August 25, 2009, from http://www.cumc.columbia.edu/dept/cs/pat/hearttx/history.html [17] (Heart Transplantation: The Contributions of Christiaan Barnard, 2005; Heart Transplantation: The Contributions of Christiaan Barnard, 2005) [18] BBC News | HEALTH | Christiaan Barnard: Single-minded surgeon. (2001). Retrieved August 25, 2009, from http://news.bbc.co.uk/2/hi/health/1470356.stm [19] Dr. Christiaan Barnard: Biography. (n.d.). Retrieved August 25, 2009, from http://www.answers.com/topic/dr-christiaan-barnard

Equality diversity and inclusion in dementia Essay

The term consent capacity means for an adult to have the ability to understand information relevant to making an informal or voluntary decision. A wide range of diseases, disorders, conditions and injuries can affect a person’s ability to understand and give consent to information that has been relayed to them. Informed consent is a phrase often used in law to indicate that the consent from the individual meets the certain minimum standards. In order to give informed consent the individual concerned must have adequate reasoning faculties and be in possession of all relevant facts at the time that the consent is given. Impairments to reasoning and judgment which may make it impossible for someone to give informed consent include such factors as basic intellectual or emotional immaturity, high levels of stress such as post-traumatic stress disorder or as severe mental retardation, severe mental illness, intoxication, severe sleep deprivation, Alzheimer’s disease, or being in a coma. Questioning and challenging decisions that are made by others this would depends on the mental capacity of the individual you want to support. First, you would obtain their permission and then you must get them to explain as exactly as possible what help they reckon they need. Then you can offer further information, suggestions, and a plan to challenge such decisions. You could offer to be their spokesperson if they weren’t confident enough to speak out, or to accompany them to any hearing or appointment. However if the person is mentally impaired, you would have to get their signed permission to speak and act on their behalf before any health or social care workers would listen to you because of issues of confidentiality, you either have to be next of kin, or obtain powers of attorney or guardianship. How identity, self-image and self-esteem are linked is that self-esteem is how much you value yourself, in an ideal world this would be an equal to anyone purely on the basis of being human. Self-Image is the spinoff of countless self-esteem choices, and is basically your mental image of you as you are, usually not accurate. Identity is linked with this because everyone has their own identity and this is unique to each person. People’s identity is built up on their self-image and self-esteem. Every part of your life is influenced by your state of wellbeing. These factors enhance person’s wellbeing; a happy relationship with a partner, enjoyable and fulfilling career, a good network of close  friends, a supporting family, enough money, regular exercise, a balanced diet and fun hobbies and leisure. There is lots of different uses for risk assessments for example there will always be a risk assessment carried out and the start of the day or the start of a shift, this is normally and formal risk assessment. You will also risk assess things as you are getting on with your work for example if there is an object in the middle of your path you will may move it out of the way or to the side so you and others can get past safely, these risk assessments you may not realise that you are doing them because they just seem obvious and come so easy to you. You may also risk assess whether people that are in your care are not likely to get injured or lost by contractors that are also using the facilities. Every individual has rights of their own choices and decisions weather it is putting them at risk, this is why risk assessments are carried out to make sure the risks that the individual are willing to take is kept down to the lowest risk. As a carer you have responsibilities to make sure you and your service user are kept out of risks and danger. Risk assessments need to be regularly revised because peoples abilities change which could mean that they can no longer use stairs so you will have to risk assess what may happen if they were to use the stairs and how to prevent them from being at any danger. You also have to risk assess your ability to carry out some activities. So they need to regularly revised because you never know when an environment is going to change.

Economic Development

The accelerated economic growth has compelled the employers and firms to hire a set of highly skilled and well educated workforce to keep up the pace with the dynamic developments. Employees worldwide have several reasons for their inability to take up a job like unsuitable geographic conditions, not being up to the mark with certain qualifications etc. but on the other hand, India is one such country where workforce is available in abundance but there are only limited candidates suitable to fill up the jobs and thus employer finds it difficult to find a perfect candidate. Shortage of relevant skills including hard and soft skills, being uneducated or unqualified results in less or no employability. Moreover, unlike other countries which are facing a burden of ageing population, India has a benefitting edge with a unique 20-30 years window of majority of the population and thus has a supporting demographic dividend. The main focus for the paper has turned to skill gap in the economy. A study by Rupam Jyoti Deka and Bhavika Batra (2016) has focused on the skill gap prevailing in the country. Indian workforce needs to acquire skills and knowledge in order to gain employability. As per the Planning Commission Reports of 2008, India has a huge skill gap compared to other countries. Percentage of workforce receiving skill training (2008) With the rising influence of globalization, India has immense opportunities to establish its distinctive position in the world economy. The rural workforce still lacks in skill development and good quality education for them to qualify and secure a job {Radhika Kapur, (2014)}. They need to develop skills for the purpose of obtaining skill sufficiency in resource utilization, governance, leadership, technology, management and so on. A study by A. Mahendra (2015) suggests that education alone does not suffice. For proper execution, skills are necessary. The importance of skill is an unattended area except in few areas like Medicine, Engineering etc. that too in very few institutes. The graduates are still struggling in free and confident communication, lack of boldness to present the presentations and projects. India is composed by demographic dividend with multiple languages, cultures, religion etc. So teaching in common language is not possible, if we continue doing this, other issues are cropped up. In 2014, the Prime Minister Mr. Narendra Damodar Das Modi announced and requested the global economies to ‘produce in India' by launching a campaign ‘Make in India'. About 63% of Indian youth indicated a dire need to create employment in manufacturing sector, a study by Ankul Pandey and Prof. D.K. Nema (2017) indicated. Another paper by Ankul Pandey, Prof. D.K. Nema (2017) and AnnaLee Saxenian (2002) raised the concerns about an issue of Brain Drain or Brain Circulation. Brains of Indian people are immeasurably intellectual and has proved the worth and stand of India at various Global Levels including NASA, or holding a well reputed and respected positions in global firms including Google, Microsoft, Pepsi co. to name a few. But due to lack of job opportunities, the Indian talent is draining out to other countries which are willing to offer better positions with higher opportunities and perks. The emigration of highly skilled personnel to other countries represents a huge economic loss and brain drain. The main causes for this drain to happen be obviously lack of growing opportunities and availability of very few seats for huge number of job applicants. Also, higher salaries and perks attract huge number of job seekers improving their standards of living. AnnaLee Saxenian (2002) introduced a new concept of ‘Brain Circulation'. Brain circulation widely means returning of a personnel back to his own country after learning and experiencing the advancements in education, skill or work and contributing his part in the growth and development of the domestic economy instead of permanently settling down in the foreign country. Brain circulations would definitely prove a game changer if it is honestly practiced and this would be possible only if India would improve its skill development and increase the job opportunities and offer more perks and employee benefits. As per the study by Aya Okada (2012), the difficulties faced by youth for seeking jobs are:Intense globalization has led to intense competition among firms which is leading to improvement in their efficiency forcing them to hire few but highly skilled personnel.Global economy has led firms to engage in massive restructuring resulting in fewer job openings.Rapid technological advancements require workers to have moral complex and cognitive skills than ever. The economy now is more of ‘knowledge based'.Due to increase in migration of labour, the youth is exposed to increased intense competition even from workers globally who offer more knowledge, skills and competencies.To improve the conditions of employability and to produce more efficient labour, the government has launched several campaigns and movements. There is a measurable skill gap between what industries demand and the acquired skills of the youth. Youth's access to vocational training is limited because the vocational education and training systems across the nation is not large enough to be able to accommodate many schools and graduates. However, the government has formulated National Skills Development Policy, Pradhan Mantri Kaushal Vikas Yojana, and Skill India; set up a new institutional framework to coordinate the skill development efforts and National Vocational Education Qualification Framework.

All About Summer Homeschooling

If your children are currently in public or private school, but youre thinking of homeschooling,  you may think that summer is the perfect time to test the homeschooling waters. But is it a good idea totry out homeschooling during your childs summer break? Learn about the pros and cons to a summer homeschool trial, along with some tips for setting up a successful trial run.   Pros for Trying Homeschooling During the Summer Many kids thrive on routine. Many children function best with  a predictable schedule. Moving right into a school-like routine may be ideal for your family and result in a more peaceful, productive summer break for everyone. You may also enjoy year-round homeschooling. A six weeks on/one week off schedule  allows for regular breaks throughout the year and longer breaks as needed. A four-day week is another year-round homeschool schedule that may provide just enough structure for the summer months. Finally, consider doing formal studies only two or three mornings each week during the summer, leaving afternoons and a few full days open for social activities or free time. It gives struggling learners a chance to catch up. If you have a student who is struggling academically, the summer months may be an excellent time to strengthen weak areas and see what you think of homeschooling at the same time. Don’t focus on the trouble spots with a classroom mindset. Instead, practice skills actively and creatively. For example, you might recite times tables while bouncing on the trampoline, jumping rope, or playing hopscotch. You can also use the summer months to try an entirely different approach to areas of struggle. My oldest had difficulty with reading in first grade. Her school used a whole word approach. When we began homeschooling, I chose a phonics program that taught reading skills in a systematic way with lots of games. It was just what she needed. It gives advanced learners an opportunity to dig deeper. If you have a gifted learner, you may find that your student isn’t challenged by the pace at his school or is frustrated at only skimming the surface of concepts and ideas. Schooling during the summer provides the opportunity to dig deeper into the topics that intrigue him. Perhaps he’s a Civil War buff who wants to learn more than names and dates. Maybe he is fascinated by science and would love to spend the summer conducting experiments. Families can take advantage of summer learning opportunities. There are  many fantastic learning opportunities during the summer. Not only are they educational, but they can provide insight into your childs talents and interests. Consider options such as: Day camps—art, drama, music, gymnasticsClasses—cooking, driver’s education, writingVolunteer opportunities—zoos, aquariums, museums Check with community colleges, businesses, libraries, and museums for opportunities. A history museum on a college campus in our area  offers summer classes for teens. You may also want to check your favorite social media outlets for local homeschool groups. Many offer summer classes or activities, providing you with educational opportunities and a chance to get to know other homeschooling families. Some public and private schools send children home with a summer bridge program that includes reading and activity assignments. If your childs school does, you can incorporate those into your homeschooling trial. Cons to Summer Homeschooling Kids may resent losing their summer break. Children learn early to embrace summer break with excitement. Jumping into full-fledged academics when your kids know that their friends are enjoying a more relaxed schedule could leave them feeling resentful. They may project that feeling onto you or onto homeschooling in general. Transitioning from public school to homeschool can be tricky anyway. You don’t want to start off with unnecessary negativity. Some students need time to reach developmental readiness. If you’re thinking about homeschooling because your child is struggling academically, consider the fact that he  may not be developmentally ready for that particular skill. Focusing on the concepts your child finds challenging may seem like a good idea, but doing so can prove counterproductive. Many times parents notice a marked improvement in a particular skill or understanding of a concept after children have taken a break from it for a few weeks or even a few months. Let your child use the summer months  to focus on his areas of strength. Doing so can provide a much-need boost of confidence without sending the message that hes not as smart as his peers. It can leave students feeling burnt out. Giving home education a try with a heavy focus on formal learning and seatwork will likely leave your child feeling burnt out and frustrated if you decide to continue with public or private school in the fall. Instead, read lots of great books and look for hands-on learning opportunities. You can also use those summer bridge activities. That way, your child is still learning and youre giving home educating a try, but your child can return to school refreshed and ready for the new year if you decide not to homeschool after all. A sense of commitment may be missing. One problem I’ve seen with a summer homeschooling trial run is a lack of commitment. Because parents know that they’re just trying homeschooling, they don’t work with their children consistently during the summer months. Then, when it’s time for school in the fall, they decide not to homeschool because they don’t think they can do it. It’s much different when you know that you’re responsible for your child’s education. Dont base your overall commitment to homeschooling on a summer trial. It doesn’t allow time to deschool. Deschooling is a foreign word to most people outside of the homeschooling community. It refers to allowing children a chance to let go of any negative feelings associated with learning and rediscover their natural sense of curiosity. During the deschooling period, textbooks and assignments are put aside allowing kids (and their parents) to rediscover the fact that learning happens all time time. It isnt constrained by school walls or blocked off into neatly-labeled subject headings. Instead of focusing on formal learning during summer break, leave that time for deschooling. Thats sometimes easier to do over the summer without stressing and worrying that your student is falling behind because you don’t see formal learning happening. Tips for Making a Summer Homeschool Test Run Successful If you choose to use the summer break to see if homeschooling might be a good fit for your family, there are some steps you can take to make it a more successful trial. Don’t recreate a classroom. First, don’t try to recreate a traditional classroom. You don’t need textbooks for summer homeschooling. Get outside. Explore nature, learn about your city, and visit the library. Play games together. Work puzzles. Travel and learn about the places you visit by exploring while youre there. Create a learning-rich environment. Kids are naturally curious. You may be surprised at how much they learn with little direct input from you if you’re intentional about creating a learning-rich environment. Make sure that books, art and craft supplies, and open-ended play items are easily accessible.   Allow kids to explore their interests. Use the summer months to help children rediscover their natural curiosity. Give them the freedom to explore the things that capture their interest. If you have a child who loves horses, take her the library to borrow books and videos about them. Check into horseback-riding lessons or visit a farm where she can see them up close. If you have a child who’s into LEGOs, allow time for building and exploring. Look for opportunities to capitalize on the educational element of LEGOs without taking over and turning it into school.  Use the blocks as math manipulatives or build simple machines. Use the time to establish a routine. Use the summer months to figure out a good routine for your family so that you’re ready whenever you determine it’s time to introduce formal learning. Does your family function better when you get up and do schoolwork first thing in the morning, or do you prefer a slow start? Do you need to get a few household chores out of the way first or do you prefer to save them until after breakfast? Do any of your children still take naps or could you all benefit from a daily quiet time? Does your family have any unusual schedules to work around, such as a spouse’s work schedule? Take some time during the summer to figure out the best routine for your family, keeping in mind that homeschooling doesn’t have to follow a typical 8-3 school schedule. Use the time to observe your child. Look at the summer months as a time for you to learn rather than teach. Pay attention to what sorts of activities and topics capture your child’s attention. Does he prefer reading or being read to? Is she always humming and moving or is she quiet and still when she’s concentrating? When playing a new game, does he read the directions from cover-to-cover, ask someone else to explain the rules, or want to play the game with  you explaining the steps as you play? If given the option, is she an early riser or a slow starter in the morning? Is he self-motivated or does he need some direction? Does she prefer fiction or non-fiction? Become a student of your student and see if you can pinpoint some of the ways he learns best. This knowledge will help you choose the best curriculum and determine the best homeschooling style for your family. Summer can be a good time for you to explore the possibility of homeschooling—or a great time to begin preparing for a successful start to homeschooling in the fall.