Rates of the demand for transplantation continue to rise and exceed the supply of available organs. 1 To maximize the successful transplantation of a limited number of available organs, research has highlighted the importance of identifying and treating psychosocial factors, including substance use, present at the pre-transplant evaluation, due to their association with poor post-transplant outcomes (ie, nonadherence, increased risk for rejection, and graft failure). [2][3][4] Studies have examined risk by organ type, but the existing literature largely focuses on marijuana and alcohol use within predominantly adult transplant populations. 5 Though less data exist on substance use rates in pediatric transplant patients, youth substance use in the general population remains a public health concern. 6 Several large longitudinal studies highlight increases in marijuana use as adolescent age increases,

Objective: The initial posttransplant period is high-risk in terms of susceptibility to rejection episodes and poor medical outcomes for pediatric solid organ transplant (SOT) patients. Psychologists play an important role on transplant medical teams to support patients and families in improving adherence and graft outcomes. This article describes a new psychology-integrated preventative care model implemented in 2019 and examines trends in service delivery pre-and postimplementation. Method: Universal health and behavior assessment and intervention were delivered to SOT (heart, liver, and kidney) patients according to a structured method of service delivery that identified distinct time points for follow-up within the first 3-year posttransplantation. Results: Preimplementation, the SOT psychology service delivered intervention and assessment services to 44% of patients who were transplanted during the preimplementation period; postimplementation, 97% of this patient population were seen by SOT psychology. Mean psychology contacts increased significantly postimplementation (M = 2.55) of this new preventative care model, compared to preimplementation (M = 1.59). Conclusions: Psychology support is an essential component of comprehensive pediatric SOT care. Increased psychology services posttransplantation can effectively identify and target psychosocial needs for patients and families. Implications for Impact StatementThis article describes a new integrated preventative care model of psychology service delivery within pediatric solid organ transplant that greatly increased assessments and interventions during the vulnerable first 3-year posttransplant. This preventative care model allows pediatric psychologists to address adherence, behavioral and emotional concerns, and coping with illness to support optimal posttransplant psychological and medical outcomes.

Potassium is an important ion capable to maintain intra-extracellular electric gradient. Variations in the intra-extracellular ionic fl ow may alter cells functions, skeletal and smooth muscle contractility and electric activity of myocardial cells.In this study we demonstrated that high level of serum potassium may be associated with cardiac and neurological life-threatening diseases.We describe two case reports in which one patient, chronic hemodialysed, presented with cardiogenic shock in setting of hyperkalemia; the other, with end-stage kidney disease, showed a fl accid paralysis associated to high level of serum potassium during potassium sparing diuretic therapy.Emergency haemodialysis was performed with a complete remission of the clinical manifestations.Indeed, the use of simply diagnostic instruments such as serum electrolyte assay and electrocardiographic study (ECG) are helpful in clinical practice solving in timely serious complications due to hyperkalemia.

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