Working Group Research Articles

Sharing is caring: An ethnographic approach to Spanish WhatsApp groups

Sharing is a key function of social media (Yus, 2022). This study aims to analyse the sharing practices of five Spanish WhatsApp groups from a pragmatic, ethnographic and qualitative perspective. The groups consist of family members, friends and three groups formed by work colleagues. Specifically, this study aims to respond three research questions: What do group members share? To what extent is the act of sharing explicitly and meta-pragmatically talked about and responded to? And to what extent do recipients respond to sharing also in a meta-pragmatically explicit way? Results show that both family and friends follow similar patterns, where interactants share good news and entertainment to boost rapport. Interestingly, this pattern is replicated by working groups, whose ultimate aim is rather different. This reveals that, independently of why the WhatsApp group was created, participants prefer boosting rapport by means of mutual enjoyment (Yus, 2023) rather than using these groups exclusively for their instrumental purpose, possibly because of Spanish culture's orientation to positive politeness (Iglesias Recuero, 2017). However, the meta-pragmatics of both types of groups seems to differ, with more explicit references performed in the working groups, probably due to the need to explicitly acknowledge that sharing might not be the groups' originally intended aim.

An Equity-Based Research Agenda to Promote Social Inclusion and Belonging for People With IDD.

Having a sense of social inclusion and belonging, typically characterized by our personal relationships and community participation, is the central essence of life for most people, yet it remains elusive for many people with intellectual and developmental disabilities (IDD). This article summarizes the work of a diverse group of researchers and advocates to propose 6 big-picture, equity-based goals to drive future research in the field: (1) understanding the role of intersectionality, (2) understanding intimate relationships, (3) promoting formation of communities of care to support social inclusion, (4) understanding life course trajectories of social inclusion, (5) understanding social inclusion in virtual spaces, and (6) understanding how to promote social inclusion in the entire research process.

A practical guide to bioimaging research data management in core facilities.

Bioimage data are generated in diverse research fields throughout the life and biomedical sciences. Its potential for advancing scientific progress via modern, data-driven discovery approaches reaches beyond disciplinary borders. To fully exploit this potential, it is necessary to make bioimaging data, in general, multidimensional microscopy images and image series, FAIR, that is, findable, accessible, interoperable and reusable. These FAIR principles for research data management are now widely accepted in the scientific community and have been adopted by funding agencies, policymakers and publishers. To remain competitive and at the forefront of research, implementing the FAIR principles into daily routines is an essential but challenging task for researchers and research infrastructures. Imaging core facilities, well-established providers of access to imaging equipment and expertise, are in an excellent position to lead this transformation in bioimaging research data management. They are positioned at the intersection of research groups, IT infrastructure providers, the institution´s administration, and microscope vendors. In the frame of German BioImaging - Society for Microscopy and Image Analysis (GerBI-GMB), cross-institutional working groups and third-party funded projects were initiated in recent years to advance the bioimaging community's capability and capacity for FAIR bioimage data management. Here, we provide an imaging-core-facility-centric perspective outlining the experience and current strategies in Germany to facilitate the practical adoption of the FAIR principles closely aligned with the international bioimaging community. We highlight which tools and services are ready to be implemented and what the future directions for FAIR bioimage data have to offer.

SUPRACHOROIDAL SPACE INJECTION TECHNIQUE: Expert Panel Guidance.

To develop professional guidelines for best practices for suprachoroidal space (SCS) injection, an innovative technique for retinal therapeutic delivery, based on current published evidence and clinical experience. A panel of expert ophthalmologists reviewed current published evidence and clinical experience during a live working group meeting to define points of consensus and key clinical considerations to inform the development of guidelines for in-office SCS injection. Core consensus guidelines for in-office SCS injection were reached and reported by the expert panel. Current clinical evidence and physician experience supported SCS injection as a safe and effective method for delivering retinal and choroidal therapeutics. The panel established consensus on the rationale for SCS injection, including potential benefits relative to other intraocular delivery methods and current best practices in patient preparation, pre- and peri-injection management, SCS-specific injection techniques, and postinjection management and follow-up. These expert panel guidelines may support and promote standardization of SCS injection technique, with the goal of optimizing patient safety and outcomes. Some aspects of the procedure may reasonably be modified based on the clinical setting and physician judgment, as well as additional study.

Evolution of work conditions for employees driving for work in France based on data from the 2003, 2010 and 2017 SUMER surveys (Surveillance Médicale des expositions aux risques Professionnels)

IntroductionThe occupational road-accident risk on public roads and the work conditions for professional driving is still an important issue in occupational health despite lower road-accident rates. This study presents the evolution over time of the work-related constraints for these employees based on the Sumer surveys carried out in 2003, 2010 and 2017. MethodData from the 2010 and 2017 surveys were restricted to match the scope of the 2003 survey in order to enable prevalence data to be compared in equivalent populations. The main variable of interest was “driving (car, truck, bus, and other vehicles) on public thoroughfares” for work (during the last week of work: yes/no). Work time characteristics, work rhythm, autonomy and scope for initiative, collective work group, standards and evaluations variables were completed by the occupational health physicians. A self-administered questionnaire was also provided to employees and contained the Job Content Questionnaire, which assesses decision latitude, social support and psychological demands, the reward scale of Siegrist questionnaire, the hostile behaviour with inspired questions for Leymann, sick leave and work accidents during the past 12 months and job satisfaction. Finally, prevention in the workplace was also completed by the occupational health physicians. ResultsAbout 25% of employees in France were exposed to work-related driving in 2017, which was stable in comparison with 2003 and 2010. However, the population was older and there were more females, more often from the clerical staff/middle manager category and working in companies with fewer than 10 employees. Employees exposed to work-related driving were also more frequently exposed to sustained work schedules and physical constraints, but less exposed to psychosocial risks. ConclusionsThe percentage of employees exposed to occupational road accident risk, i.e., exposure to work-related driving, remained stable at about 25% in 2017 compared with previous surveys. These employees were also more frequently exposed to sustained work schedules and physical constraints, but less exposed to psychosocial risks. Practical ApplicationsPrevention campaigns on work-related road accident risk should be provided to all employees in all companies since all jobs can be concerned.

FOCUS ON MELANOTIC NEUROECTODERMAL TUMOR OF INFANCY

Melanotic neuroectodermal tumor of infancy (MNTI) is a very rare benign neoplasm of probable neurocristic origin. It primarily affects children in the first year of life, with the median age at diagnosis of 4.5 months (range 0-804 months). It usually presents as a fast-growing, painless tumor developing within maxilla, skull bones or mandible but other locations are also possible, especially in older children. The cornerstone of treatment of MNTI is surgery, however local relapses after incomplete tumor excision are common, particularly in patients younger than 2 months of age. Rare cases of multiple recurrent, inoperable or metastatic MNTI pose therapeutic challenges. In such clinical scenarios, various regimens of neoadjuvant chemotherapy based on schemes for neuroblastoma or Ewing sarcoma have been used with partial regressions in some patients, enabling less mutilating delayed surgery. The use of radiotherapy is limited due to very young age of patients with MNTI. No targeted therapies have been found useful so far. Long-term prognosis of localized MNTI is favorable. However, extensive or recurrent lesions can result in functional or esthetic sequelae after surgical removal. Rare cases of malignant/metastatic tumors and MNTI diagnosed in older children have unfavorable outcomes. Further collaborative studies to establish standards of management in patients with MNTI are necessary to improve outcomes and diminish sequalae of surgery. This article presents a literature review on this very rare tumor entity, re-evaluated in the light of the experience gained in the national working groups joined together within the European Cooperative Study Group in Pediatric Rare Tumors (EXPeRT).

Safeguarding vitality and cognition: The role of sarcopenia in intrinsic capacity decline among octogenarians from multiple cohorts

BackgroundSarcopenia and intrinsic capacity (IC) declines pose significant challenges to healthy aging, particularly in the rapidly growing octogenarian population. This study aimed to elucidate the relationship between sarcopenia and declines in IC across multiple cohorts of community-dwelling older adults. MethodsData from four Taiwanese cohorts were analyzed. Sarcopenia was diagnosed based on the Asian Working Group for Sarcopenia (AWGS) 2019 criteria (algorithm 1: categorized as either having possible sarcopenia or not (robust); algorithm 2: categorized as robust, possible sarcopenia or sarcopenia). IC was operationalized using the World Health Organization's Integrated Care for Older People (ICOPE) framework (step 1 and step 2), encompassing six domains: locomotion, vitality, vision, hearing, cognition, and psychological well-being. Multivariable logistic regression models were adopted to assess the association between sarcopenia and IC decline. ResultsAmong 599 octogenarians (median age 82.2 years, 54.8% male), the prevalence of possible sarcopenia (algorithm 1) was 64.6%. When adopting algorithm 2, the prevalence of possible sarcopenia and sarcopenia was 46,2% and 32.1%, respectively. After adjusting for covariates, participants with possible sarcopenia or sarcopenia (algorithm 2) were more likely to exhibit declines in vitality (ICOPE Step 1: possible sarcopenia aOR 3.65, sarcopenia aOR 4.74; ICOPE Step 2: possible sarcopenia aOR 5.11, sarcopenia aOR 14.77) and cognition (ICOPE Step 1: possible sarcopenia aOR 2.40, sarcopenia aOR 2.12; ICOPE Step 2: possible sarcopenia aOR 2.02, sarcopenia aOR 2.51) compared to robust individuals. ConclusionsThis study underscores the robust association between sarcopenia and declines in vitality and cognition among octogenarians, highlighting the importance of sarcopenia screening and management in promoting healthy longevity in this vulnerable population.

Paroxysmal sympathetic hyperactivity during neurorehabilitation for severe acquired brain injury: current Scandinavian practice and Delphi consensus recommendations

ObjectivesTo document current practice and develop consensus recommendations for the assessment and treatment of paroxysmal sympathetic hyperactivity (PSH) during rehabilitation after severe acquired brain injury.DesignDelphi consensus process with three rounds,...

Modulation of the Association Between Corticospinal Tract Damage and Outcome After Stroke by White Matter Hyperintensities.

Motor outcomes after stroke relate to corticospinal tract (CST) damage. The brain leverages surviving neural pathways to compensate for CST damage and mediate motor recovery. Thus, concurrent age-related damage from white matter hyperintensities (WMHs) might affect neurologic capacity for recovery after CST injury. The role of WMHs in post-stroke motor outcomes is unclear. In this study, we evaluated whether WMHs modulate the relationship between CST damage and post-stroke motor outcomes. We used data from the multisite ENIGMA Stroke Recovery Working Group with T1 and T2/fluid-attenuated inversion recovery imaging. CST damage was indexed with weighted CST lesion load (CST-LL). WMH volumes were extracted with Freesurfer's SAMSEG. Mixed-effects beta-regression models were fit to test the impact of CST-LL, WMH volume, and their interaction on motor impairment, controlling for age, days after stroke, and stroke volume. A total of 223 individuals were included. WMH volume related to motor impairment above and beyond CST-LL (β = 0.178, 95% CI 0.025-0.331, p = 0.022). Relationships varied by WMH severity (mild vs moderate-severe). In individuals with mild WMHs, motor impairment related to CST-LL (β = 0.888, 95% CI 0.604-1.172, p < 0.001) with a CST-LL × WMH interaction (β = -0.211, 95% CI -0.340 to -0.026, p = 0.026). In individuals with moderate-severe WMHs, motor impairment related to WMH volume (β = 0.299, 95% CI 0.008-0.590, p = 0.044), but did not significantly relate to CST-LL or a CST-LL × WMH interaction. WMHs relate to motor outcomes after stroke and modify relationships between motor impairment and CST damage. WMH-related damage may be under-recognized in stroke research as a factor contributing to variability in motor outcomes. Our findings emphasize the importance of brain structural reserve in motor outcomes after brain injury.

Correlation of cardiometabolic index and sarcopenia with cardiometabolic multimorbidity in middle-aged and older adult: a prospective study

BackgroundResearch has demonstrated that sarcopenia and visceral obesity are significant risk factors for chronic disease in middle-aged and older adults. However, the relationship between sarcopenia, the cardiac metabolic index (CMI), a novel measure of visceral obesity, and cardiometabolic multimorbidity (CMM) remains unclear. In this study, data from the China Longitudinal Study of Health and Retirement (CHARLS) were analyzed to investigate the association between sarcopenia and CMI with CMM in the middle-aged and older adult population.MethodsThe study included 4,959 participants aged 45 and over. Sarcopenia was defined using the criteria of the Asian Sarcopenia Working Group 2019. CMM is defined as having two or more of the following conditions: physician-diagnosed heart disease, diabetes, stroke, and/or hypertension. CMI was calculated using the formula: CMI = (TG/HDL-C) × WHtR. To explore the association between CMI and sarcopenia and CMM, cox proportional risk regression models were used.ResultsThe median age of all participants was 57 years, with 47.1% being male. Over the 8-year follow-up, 1,362 individuals developed CMM. The incidence of CMM was 8.7/1,000 person-years in the group without sarcopenia or high CMI, 17.37/1,000 person-years in those with high CMI, 14.22/1,000 person-years in the sarcopenia group, and 22.34/1,000 person-years in the group with both conditions. After adjusting for covariates, the group with both sarcopenia and high CMI had a significantly increased risk of CMM (HR 2.48, 95% CI 1.12-5.51) and heart disease (HR 2.04, 95% CI 1.05-3.98). Among those over 65 years, sarcopenia was discovered to be associated with an increased risk of CMM [HR (95% CI: 4.83 (1.22, 19.06)]. The risk of CMM was further increased to 7.31-fold (95% CI:1.72, 31.15) when combined with high CMI.ConclusionsThe combination of sarcopenia and high CMI is associated with an increased risk of developing CMM. Early identification and intervention of sarcopenia and CMI not only enable the development of targeted therapeutic strategies but also provide potential opportunities to reduce the morbidity and mortality of CMM.

Breaking barriers: assessing the impact of clinical quality improvements on reducing health disparities in hypertension care among Mumbai’s urban slums

The clinical quality improvement initiatives, led by the organisation’s Health Equity Working Group (HEWG), aim to support healthcare providers to provide equitable, quality hypertension care worldwide. After coordinating with the...

To Evaluate the Efficacy of Training on IT industry Employee from Nagpur

Effective utilization of human resources within a business is critical to its success. Only human resources might be the primary source of value for all other resources. The company must prioritize the ability, knowledge, and skills of its employees in order to enhance its human resources and adapt to both internal and external changes. The foundation for the growth of human capital is "training." The purpose of training is to enhance the work culture of the group working on a task together as well as to meet individual and organizational needs connected to the duties being done. Participants' attitudes, abilities, and forward-thinking outlook on the activity should all be altered by an ideal training program. This paper discusses a quantitative research to evaluate a efficacy of training on employee using Chi-square at 5% level of significance. Keywords: Human Resource, Training, Quantitative Research, Efficacy, Chi-Square,

Trend in prevalence, associated risk factors, and longitudinal outcomes of sarcopenia in China: A national cohort study.

To estimate the contemporary trend in the prevalence of sarcopenia and evaluate its risk factors and the longitudinal associations with multiple chronic conditions and mortality among Chinese middle-aged and older adults. This was a nationwide, prospective cohort study using data from the China Health and Retirement Longitudinal Study. The definition of sarcopenia was based on the Asian Working Group for Sarcopenia 2019 algorithm. In the cross-sectional analysis, we estimated the trend in the weighted prevalence of sarcopenia from 2011 to 2015 and examined the associated risk factors for sarcopenia severity in 2011. In the longitudinal analysis, we assessed the longitudinal associations between sarcopenia and 14 chronic conditions and mortality during a 9-year follow-up. The weighted prevalence of sarcopenia remained consistently high in the overall population from 2011 (15.9%, 95% confidence intervals [CI]: 15.1, 16.6) to 2015 (15.0%, 95% CI: 14.3, 15.6; p for trend=0.075). A range of risk factors were independently associated with the severity of sarcopenia, including older age, female sex, lower socioeconomic status, smoking status, malnutrition, and several chronic conditions. Possible sarcopenic and sarcopenic individuals had higher odds of several chronic conditions (i.e., heart disease, chronic lung disease, and memory-related disease) and increased risks of mortality (possible sarcopenia: odds ratios (OR): 1.66, 95% CI: 1.37, 2.00; sarcopenia: OR: 1.69, 95% CI: 1.36, 2.11) in 9 years of follow-up. The prevalence of sarcopenia remained consistently high in the investigated population. Various risk factors were significantly associated with a higher prevalence of sarcopenia. Sarcopenic individuals had higher odds of several chronic conditions and increased risks of mortality, highlighting that the urgent need for dedicated efforts to improve the management of sarcopenic patients.

Management of Primary Immune Thrombocytopenia - Turkish Modified Delphi-Based Consensus Statement for Special Considerations.

Primary immune thrombocytopenia (ITP) is an acquired disorder of platelets with complex and unclear mechanism of increased immune distruction or impaired production of platelets. While management of ITP is evolving, there is a need for guidance particularly in certain circumstances such as pregnancy, emergency and for patients requiring co-medications. We aimed to determine the tendencies of hematologists in Turkiye on such special conditions. As a modified Delphi method, Turkish National ITP Working Group founded under Turkish Society of Hematology developed a questionnaire consisting of statements regarding pregnancy, emergency and circumstances regarding co-treatment with antiaggregant or anticoagulants. 107 Hematologists working either in university or state hospitals voted for their agreement or disagreement of the statements for two consequential rounds. Participant hematologists reached an agreement on the starting treatment in pregnant patients with platelets less than 30 x109/L and delivery of either normal or cesarian section to be safely performed above 50 x109/L. For emergency and rescue management of ITP, our panel have agreed against the use of high dose corticosteroids alone, preferred a combination with transfusion or IVIG. For patients who require interventions, platelet counts >50 x109/L were regarded as safe for low risk procedures as well as co-treatment with antiplatelets or anticoagulants. As National ITP study group, we have observed the need to increase the practice guidance in patients with primary ITP requiring additional treatments including invasive interventions, and co-treatments towards coagulation. Decisions on the management of ITP during pregnancy should be individualized. There is a certain lack of consensus on the thresholds of platelet counts as well as co-morbidities and co-medications. This lack of consensus may be due to the variations in the practices.

Exploration of Social Work Intervention Models in College Students' Youth Health Education—Taking University X as an Example

Based on the youth health program of colleges and universities, we carry out youth health education for X-school students based on the group work method of social work. It explores the practical path of youth health education in colleges and universities and develops a "trinity" youth health education model for colleges and universities, which promotes the organic integration of professional social work education, student peer education, community practice education, and youth health education, and finally provides suggestions for future youth health education in colleges and universities.

Coalition for Global Hearing Health Hearing Care Pathways Working Group: Guidelines for Clinical Guidance for Readiness and Development of Evidence-Based Early Hearing Detection and Intervention Programs.

Editor's Note: The following article discusses the timely topic Clinical Guidance in the areas of Evidence-Based Early Hearing Detection and Intervention Programs. This article aims to discuss areas of services needed, guidance to countries/organizations attempting to initiate early hearing detection and intervention systems. Expert consensus and systematic/scoping reviews were combined to produce recommendations for evidence-based clinical practice. In Ear and Hearing, our long-term goal for the Point of View article is to stimulate the field's interest in and to enhance the appreciation of the author's area of expertise. Hearing is an important sense for children to develop cognitive, speech, language, and psychosocial skills. The goal of universal newborn hearing screening is to enable the detection of hearing loss in infants so that timely health and educational/therapeutic intervention can be provided as early as possible to improve outcomes. While many countries have implemented universal newborn hearing screening programs, many others are yet to start. As hearing screening is only the first step to identify children with hearing loss, many follow-up services are needed to help them thrive. However, not all of these services are universally available, even in high-income countries. The purposes of this article are (1) to discuss the areas of services needed in an integrated care system to support children with hearing loss and their families; (2) to provide guidance to countries/organizations attempting to initiate early hearing detection and intervention systems with the goal of meeting measurable benchmarks to assure quality; and (3) to help established programs expand and improve their services to support children with hearing loss to develop their full potential. Multiple databases were interrogated including PubMed, Medline (OVIDSP), Cochrane library, Google Scholar, Web of Science and One Search, ERIC, PsychInfo. Expert consensus and systematic/scoping reviews were combined to produce recommendations for evidence-based clinical practice. Eight essential areas were identified to be central to the integrated care: (1) hearing screening, (2) audiologic diagnosis and management, (3) amplification, (4) medical evaluation and management, (5) early intervention services, (6) family-to-family support, (7) D/deaf/hard of hearing leadership, and (8) data management. Checklists are provided to support the assessment of a country/organization's readiness and development in each area as well as to suggest alternative strategies for situations with limited resources. A three-tiered system (i.e., Basic, Intermediate, and Advanced) is proposed to help countries/organizations at all resource levels assess their readiness to provide the needed services and to improve their integrated care system. Future directions and policy implications are also discussed.

Standardized regionalization of the atria for 3D cardiac imaging, electroanatomical mapping and computational modeling. A multidisciplinary consensus of the PersonalizeAF consortium

Abstract Background 3D imaging and high-resolution electroanatomical mapping have become an integral part of cardiac electrophysiology and the management of patients with arrhythmias. With further technological advances the significance of these modalities continues to grow. However, to perform regional quantitative analyses and intra- and inter-individual, as well as cross-modality comparisons, a universal definition of atrial regions and their boundaries is required. While for the left ventricle there is already an established standardized regionalization (AHA 18-segment model), there is no consensus for the regionalization of the atria. Purpose Here we propose standardized left and right atrial segments based on anatomical, electrophysiological and clinical considerations, with precise definition of regional boundaries allowing for reproducible and automated regionalization. Methods and results In a multidisciplinary task force of the European PersonalizeAF consortium involving cardiologists and cardiac electrophysiologists, as well as specialists in cardiac imaging and computational modeling we developed a standardized regionalization dividing the left atrium into eight, and the right atrium into seven segments (15-segment bi-atrial model) (Fig. 1A). As a proof-of-principle, two software algorithms for automatic regionalization of 3D atrial geometries based on the standardized 15-segment bi-atrial model were developed independently by different working groups of the PersonalizeAF consortium – one based on a commercially available software, the other being open-source. The algorithm based on the commercial software obtains the 15-segment bi-atrial model by dividing the surface mesh in the defined regions along geodesics using the Fast Marching Method (Fig. 1C). For the open-source solution, a publicly available semi-automatic bi-atrial division pipeline was developed: In this algorithm, after standardizing the surface mesh by remeshing and clipping the pulmonary veins, the orifices are annotated automatically. Based on these anatomical landmarks, the boundaries of each region are inferred by calculating geodesics using Dijkstra’s algorithm. Both algorithms were able to annotate the regions with high accuracy and very good agreement as indicated by interrater reliability testing (kappa &amp;gt;0.9), in geometries derived from 50 patients and 2 imaging modalities (CT and MRI), thus demonstrating the universal applicability and reproducibility of the standardized segments. Conclusion We propose a standardized regionalization of the cardiac atria for 3D cardiac imaging, electroanatomical mapping and computational modeling, based on anatomical, electrophysiological and clinical considerations. The reproducibility and universal applicability of this 15-segment bi-atrial model was demonstrated by two independently developed software algorithms for automatic regionalization.

Swallowed topical steroid therapy for eosinophilic oesophagitis in children: practical, evidence-based guidance by the BSPGHAN Eosinophilic Oesophagitis Working Group

ObjectiveTo develop evidence-based guidance for topical steroid use in paediatric eosinophilic oesophagitis (pEoE) in the UK for both induction and maintenance treatment.MethodsA systematic literature review using Cochrane guidance was carried...

Integrating Python data analysis in an existing introductory laboratory course

Abstract In this article we describe how we successfully incorporated data analysis in Python in a first-year laboratory course without significantly altering the course structure and without overburdening students. We show how we created and used carefully designed Jupyter Notebooks with exercises and physics application examples that allow students to master data analysis programming in the laboratory course. These Notebooks guide students through the fundamentals of data handling and analysis in Python as they conduct simple experiments. We present our teaching approach and the developed materials. The effectiveness of this intervention is assessed through results from pre- and post-course questionnaires and students’ group work. The results presented give insights about advantages and challenges of introducing computation at the early stage of the curriculum in a laboratory course setting and are informative for other instructors and the physics education research community.&amp;#xD;

#2313 Perspectives in immunosuppression management following post renal graft failure: a Portuguese national survey

Abstract Background and Aims The best approach to immunosuppression withdrawal post renal graft failure is controversial. Maintaining immunosuppressive therapy may preserve residual diuresis and prevent allosensitization, which is beneficial for a subsequent transplant. However, prolonged maintenance is associated with an increased risk of infection, metabolic side effects and neoplasia. No standardized protocol exists and immunosuppression is center and nephrologist dependent. Our aim was to document immunosuppression practices nationally amongst Portuguese nephrologists. Method A national survey of 5 short questions was conducted among residents and specialists in Nephrology in Portugal through email distribution by the Portuguese Society of Nephrology. Results We received a total of 90 responses, with 54.4% (n = 49) of participants working at a renal transplant unit. When faced with a patient returning to dialysis after graft loss, 66.7% (n = 60) immediately discontinue the antimetabolite, maintaining the calcineurin inhibitor and prednisolone, 33.3% (n = 30) maintain only the prednisolone and no respondent maintains mycophenolate mofetil or equivalent. Among those who maintain calcineurin inhibitors and steroids, 46.6% (n = 28) wean calcineurin inhibitor within 6 months to 1 year following graft loss, 23% (n = 14) discontinue calcineurin inhibitor within 3 to 6 months, and 30% (n = 18) discontinue calcineurin inhibitors before the first three months after graft loss. Considering steroids, 36.7% (N = 32) discontinue prednisone after one year post graft loss, and 64.3% (N = 58) of the Nephrologists maintain steroids indefinitely or until graft removal or steroid associated complications. The majority (83.3%, n = 75) agreed that the risk of the toxic rejection of the graft is the main factor deciding to maintain immunosuppression, followed by the possibility of re-transplantation (56.7%, n = 51) and the risk of infection was the major concern to withdrawal (55.6%, n = 50). All the participants considered this is an important or very important issue in kidney transplantation, that needs further investigation. Conclusion Immunosuppression management is one of the most challenging issues in patients with a failing or failed graft. Several working groups are being developed to discuss the best approach of the patients with a failing graft but only the British Transplantation Society have published guidelines. In this survey we can observe important disparity of different approaches, mostly physician/centre dependent. The current evidence is weak, calling the need for larger studies and a standardized protocol-based approach.