1
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Winder GS, Fernandez AC, Perumalswami PV, Mellinger JL, Clifton EG. Reexamining "psychosocial clearance": A procedural framework for psychosocial evaluation in liver transplantation. Liver Transpl 2024; 30:431-442. [PMID: 38009890 DOI: 10.1097/lvt.0000000000000306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/17/2023] [Indexed: 11/29/2023]
Abstract
Psychosocial and "nonmedical" phenomena are commonly encountered in liver transplantation (LT) evaluations. They are simultaneously crucial decision-making factors and some of the most difficult and controversial clinical matters clinicians confront. Epidemiology, societal trends, and the preponderance of psychological and behavioral factors underpinning common end-stage liver diseases ensure that LT teams will continue to encounter highly complex psychosocial patient presentations. Psychosocial policies, practices, and opinions vary widely among clinicians and LT centers. Liver clinicians already report insufficient psychosocial expertise, which creates a large gap between the stark need for psychosocial expansion, improvement, and innovation in LT and the lack of accompanying guidance on how to achieve it. While the clinical domains of an LT psychosocial evaluation have been well-described, few articles analyze the procedures by which teams determine candidates' "psychosocial clearance" and no conceptual frameworks exist. This article proposes a framework of core domains of psychosocial evaluation procedures, common pitfalls, and practical improvement strategies.
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Affiliation(s)
- Gerald Scott Winder
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Anne C Fernandez
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Ponni V Perumalswami
- Department of Internal Medicine, Veterans Affairs, Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jessica L Mellinger
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Erin G Clifton
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
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2
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Perry JM, Deutsch-Link S, Marfeo E, Serper M, Ladin K. Assessing reliability and validity of SIPAT and opportunities for improvement: A single-center cohort study. Liver Transpl 2024; 30:356-366. [PMID: 37938131 DOI: 10.1097/lvt.0000000000000299] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/30/2023] [Indexed: 11/09/2023]
Abstract
Psychosocial assessment is a standard component of patient evaluations for transplant candidacy. The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) is a widely used measure to assess psychosocial risk for transplant. However, there are questions regarding the SIPAT's reliability and validity. We examined the SIPAT's psychometric performance and its impact on equitable access to transplant in a diverse cohort of 2825 patients seeking liver transplantation between 2014 and 2021 at an urban transplant center. The SIPAT demonstrated good internal consistency reliability at the overall score [Cronbach's α = 0.85, 95% CI (0.83, 0.86)] and domain levels (0.80 > α > 0.70). There was mixed support for structural validity, with poor overall model fit in confirmatory factor analysis and 50% of questions achieving the 0.70-factor loadings threshold. Adjusting for sociodemographic variables, the odds of not being waitlisted for psychosocial reasons were three times higher for patients with Medicaid insurance than patients with private insurance [OR 3.24, 95% CI (2.09, 4.99)] or Medicare [OR 2.89, 95% CI (1.84, 4.53)], mediated by higher SIPAT scores. Black patients had nearly twice the odds of White patients [OR 1.88, 95% CI (1.20, 2.91)], partially mediated by higher social support domain scores. Patients with Medicaid, non-White patients, and those without a college degree scored significantly higher on collinear questions, disproportionately contributing to higher SIPAT scores. The SIPAT did not perform equally across insurance type, race/ethnicity, and education groups, with the lowest subgroup validity associated with patient readiness and psychopathology domains. The SIPAT should be interpreted with caution, especially as a composite score. Future studies should examine validity in other populations.
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Affiliation(s)
- Jennifer M Perry
- Department of Community Health, Tufts University, Medford, Massachusetts, USA
| | - Sasha Deutsch-Link
- Division of Gastroenterology & Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Elizabeth Marfeo
- Department of Community Health, Tufts University, Medford, Massachusetts, USA
| | - Marina Serper
- Division of Gastroenterology & Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Keren Ladin
- Department of Community Health, Tufts University, Medford, Massachusetts, USA
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3
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Spielmann H, Albert W, Semmig-Könze S, Lauenroth V, Spitz-Köberich C, Staus P, Tigges-Limmer K, Kugler C. High level of psychosocial adjustment in patients on ongoing ventricular assist device support in the years one to three after VAD implantation-A national multi-center Study. Heart Lung 2024; 63:92-97. [PMID: 37837720 DOI: 10.1016/j.hrtlng.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/03/2023] [Accepted: 10/09/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Advanced heart failure therapies such as durable ventricular assist device (VAD) support require psychosocial adjustment for those affected. Since VAD implantation has become an established treatment strategy, a focus on psychosocial factors is needed. OBJECTIVES To investigate the construct of psychosocial adjustment and to further understand the role of social support. METHODS In a nation-wide, multi-center, cross-sectional study, we recruited 393 participants with ongoing VAD support (3mts-3yrs on device; clinicaltrials.gov ID: NCT04234230). Patient demographics, psychosocial adjustment (perceived social support, anxiety, depression, and quality of life), and major adverse events (thromboembolic events, bleeding, driveline infections) were assessed. RESULTS Overall, 85.8 % of the sample were male; mean age was 58.3 years (range 18-85). The majority of the sample (89.3 %) reported normal to high perceived social support. Participants expressed symptoms of anxiety within the normal range (M=6.0±3.9), mildly elevated depressive symptoms (HADS: M=7.6±2.9; PHQ-9: M=6.2±4.7), and good quality of life (KCCQ: M=65.3±17.9). Higher perceived social support was associated with lower levels of anxiety and depression, and higher levels of quality of life within our sample (all p<0.001). Driveline infection was the most prevalent adverse event (0.304 infections per person-years [32.6 % of patients]). Binary logistic regression models did not identify significant associations for the occurrence of adverse events and variables of psychosocial adjustment. CONCLUSION Our sample perceived high levels of psychosocial adjustment. High perceived social support was associated with better outcomes in levels of anxiety, depression, and quality of life, demonstrating potential for the future development and evaluation of targeted multi-professional social support interventions including peer- and caregiver support.
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Affiliation(s)
- Hannah Spielmann
- Faculty of Medicine, Institute of Nursing Science, University of Freiburg, Breisacher Str. 153, Freiburg 79110, Germany
| | | | | | - Volker Lauenroth
- Heart and Diabetes Center North-Rhine Westphalia, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Christine Spitz-Köberich
- Department Pediatric Cardiology, Medical Center - University of Freiburg, University Heart Center Freiburg - Bad Krozingen, Germany
| | - Paulina Staus
- Faculty of Medicine and Medical Center, Institute of Medical Biometry and Statistics, University of Freiburg, Germany
| | - Katharina Tigges-Limmer
- Heart and Diabetes Center North-Rhine Westphalia, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Christiane Kugler
- Faculty of Medicine, Institute of Nursing Science, University of Freiburg, Breisacher Str. 153, Freiburg 79110, Germany.
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4
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Bitar A, Aaronson K. When all Else Fails, Try This: The HeartMate III Left Ventricle Assist Device. Cardiol Clin 2023; 41:593-602. [PMID: 37743081 DOI: 10.1016/j.ccl.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Heart failure (HF) is a progressive disease. It is estimated that more than 250,000 patients suffer from advanced HF with reduced ejection fraction refractory to medical therapy. With limited donor pool for heart transplant, continue flow left ventricle assist device (LVAD) is a lifesaving treatment option for patients with advanced HF. This review will provide an update on indications, contraindications, and associated adverse events for LVAD support with a summary of the current outcomes data.
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Affiliation(s)
- Abbas Bitar
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Cardiovascular Center, 1500 East Medical Center Drive SPC 5853, Ann Arbor, MI 48109, USA.
| | - Keith Aaronson
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Cardiovascular Center, 1500 East Medical Center Drive SPC 5853, Ann Arbor, MI 48109, USA
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5
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Thode S, Perry K, Cyr S, Ducharme A, Puissant D, Brouillette J. Psychosocial assessment tools for use before transplantation are predictive of post-operative psychosocial and health behavior outcomes: a narrative review of the literature. FRONTIERS IN TRANSPLANTATION 2023; 2:1250184. [PMID: 38993930 PMCID: PMC11235356 DOI: 10.3389/frtra.2023.1250184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/14/2023] [Indexed: 07/13/2024]
Abstract
Introduction In end-stage diseases, transplantation may be necessary. The limited number of donors led to the development of several pre-transplant psychosocial assessment tools. We summarized the predictive value of these tools before solid-organ transplantation. Methods The PRISMA search strategy and the MEDLINE database were used to review the literature. From 1,050 records, we found thirteen studies using four different scales (Millon Behavioral Health Inventory [MBHI], Psychosocial Assessment of Transplant Candidates [PACT], Stanford Integrated Psychosocial Assessment for Transplantation [SIPAT], and Transplant Evaluation Rating Scale [TERS]). Results TERS and MBHI were associated with the highest number of positive studies concerning pre-transplant scores and primary outcomes. Psychosocial scales predict in a systematic way psychosocial and health behavioural outcomes, but generated mixed results for mortality and rejection. Discussion This narrative review underlines the need for multidisciplinary evaluation and well-conducted clinical trials to assist transplant teams in utilizing psychosocial evaluation effectively during evaluation of candidates.
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Affiliation(s)
- Sorin Thode
- Research Center, Montreal Heart Institute, Montreal, QC, Canada
| | - Keith Perry
- Research Center, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Samuel Cyr
- Research Center, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
| | - Anique Ducharme
- Research Center, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
| | - David Puissant
- Research Center, Montreal Heart Institute, Montreal, QC, Canada
| | - Judith Brouillette
- Research Center, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
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6
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Sokos G, Kido K, Panjrath G, Benton E, Page R, Patel J, Smith PJ, Korous S, Guglin M. Multidisciplinary Care in Heart Failure Services. J Card Fail 2023; 29:943-958. [PMID: 36921886 DOI: 10.1016/j.cardfail.2023.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/01/2023] [Accepted: 02/05/2023] [Indexed: 03/18/2023]
Abstract
The American College of Cardiology/American Heart Association/Heart Failure Society of American 2022 guidelines for heart failure (HF) recommend a multidisciplinary team approach for patients with HF. The multidisciplinary HF team-based approach decreases the hospitalization rate for HF and health care costs and improves adherence to self-care and the use of guideline-directed medical therapy. This article proposes the optimal multidisciplinary team structure and each team member's delineated role to achieve institutional goals and metrics for HF care. The proposed HF-specific multidisciplinary team comprises cardiologists, surgeons, advanced practice providers, clinical pharmacists, specialty nurses, dieticians, physical therapists, psychologists, social workers, immunologists, and palliative care clinicians. A standardized multidisciplinary HF team-based approach should be incorporated to optimize the structure, minimize the redundancy of clinical responsibilities among team members, and improve clinical outcomes and patient satisfaction in their HF care.
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Affiliation(s)
- George Sokos
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Kazuhiko Kido
- Department of Clinical Pharmacy, West Virginia University School of Pharmacy, Morgantown, West Virginia.
| | - Gurusher Panjrath
- School of Medicine and Health Sciences, George Washington University, North Englewood, Maryland
| | - Emily Benton
- Department of Medicine, University of Colorado, Boulder, Colorado
| | - Robert Page
- Department of Clinical Pharmacy, at the University of Colorado Denver Skaggs School of Pharmacy, Denver, Colorado
| | - Jignesh Patel
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Patrick J Smith
- Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Shelly Korous
- Advanced Heart Failure Program, Indiana University Health, Indianapolis, Indiana
| | - Maya Guglin
- Department of Medicine, Indiana University Health, Indianapolis, Indiana
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7
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Kittleson MM, DeFilippis EM, Bhagra CJ, Casale JP, Cauldwell M, Coscia LA, D'Souza R, Gaffney N, Gerovasili V, Ging P, Horsley K, Macera F, Mastrobattista JM, Paraskeva MA, Punnoose LR, Rasmusson KD, Reynaud Q, Ross HJ, Thakrar MV, Walsh MN. Reproductive health after thoracic transplantation: An ISHLT expert consensus statement. J Heart Lung Transplant 2023; 42:e1-e42. [PMID: 36528467 DOI: 10.1016/j.healun.2022.10.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022] Open
Abstract
Pregnancy after thoracic organ transplantation is feasible for select individuals but requires multidisciplinary subspecialty care. Key components for a successful pregnancy after lung or heart transplantation include preconception and contraceptive planning, thorough risk stratification, optimization of maternal comorbidities and fetal health through careful monitoring, and open communication with shared decision-making. The goal of this consensus statement is to summarize the current evidence and provide guidance surrounding preconception counseling, patient risk assessment, medical management, maternal and fetal outcomes, obstetric management, and pharmacologic considerations.
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Affiliation(s)
- Michelle M Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
| | - Ersilia M DeFilippis
- Division of Cardiology, New York Presbyterian-Columbia University Irving Medical Center, New York, New York
| | - Catriona J Bhagra
- Department of Cardiology, Cambridge University and Royal Papworth NHS Foundation Trusts, Cambridge, UK
| | - Jillian P Casale
- Department of Pharmacy Services, University of Maryland Medical Center, Baltimore, Maryland
| | - Matthew Cauldwell
- Department of Obstetrics, Maternal Medicine Service, St George's Hospital, London, UK
| | - Lisa A Coscia
- Transplant Pregnancy Registry International, Gift of Life Institute, Philadelphia, Pennsylvania
| | - Rohan D'Souza
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Gaffney
- Lung Transplant Service, Alfred Hospital, Melbourne, Australia; Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | | | - Patricia Ging
- Department of Pharmacy, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Kristin Horsley
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Francesca Macera
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milan, Italy; Dept of Cardiology, Cliniques Universitaires de Bruxelles - Hôpital Erasme, Brussels, Belgium
| | - Joan M Mastrobattista
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine Houston, Texas
| | - Miranda A Paraskeva
- Lung Transplant Service, Alfred Hospital, Melbourne, Australia; Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - Lynn R Punnoose
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Quitterie Reynaud
- Cystic Fibrosis Adult Referral Care Centre, Department of Internal Medicine, Hospices civils de Lyon, Pierre Bénite, France
| | - Heather J Ross
- Peter Munk Cardiac Centre of the University Health Network, Toronto, Ontario, Canada; Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Mitesh V Thakrar
- Department of Medicine, Division of Respirology, University of Calgary, Calgary, Alberta, Canada
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8
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Koons B, Anderson MR, Smith PJ, Greenland JR, Singer JP. The Intersection of Aging and Lung Transplantation: its Impact on Transplant Evaluation, Outcomes, and Clinical Care. CURRENT TRANSPLANTATION REPORTS 2022; 9:149-159. [PMID: 36341000 PMCID: PMC9632682 DOI: 10.1007/s40472-022-00365-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
Abstract
Purpose Older adults (age ≥ 65 years) are the fastest growing age group undergoing lung transplantation. Further, international consensus document for the selection of lung transplant candidates no longer suggest a fixed upper age limit. Although carefully selected older adults can derive great benefit, understanding which older adults will do well after transplant with improved survival and health-related qualiy of life is key to informed decision-making. Herein, we review the epidemiology of aging in lung transplantation and its impact on outcomes, highlight selected physiological measures that may be informative when evaluating and managing older lung transplant patients, and identify directions for future research. Recent Findings In general, listing and transplanting older, sicker patients has contributed to worse clinical outcomes and greater healthcare use. Emerging evidence suggest that measures of physiological age, such as frailty, body composition, and neurocognitive and psychosocial function, may better identify risk for poor transplant outcomes than chronlogical age. Summary The evidence base to inform transplant decision-making and improvements in care for older adults is small but growing. Multipronged efforts at the intersection of aging and lung transplantation are needed to improve the clinical and patient centered outcomes for this large and growing cohort of patients. Future research should focus on identifying novel and ideally modifiable risk factors for poor outcomes specific to older adults, better approaches to measuring physiological aging (e.g., frailty, body composition, neurocognitive and psychosocial function), and the underlying mechanisms of physiological aging. Finally, interventions that can improve clinical and patient centered outcomes for older adults are needed.
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Affiliation(s)
- Brittany Koons
- M. Louise Fitzpatrick College of Nursing, Villanova University, 800 Lancaster Avenue, Driscoll Hall Room 350, Villanova, PA 19085, USA
| | - Michaela R. Anderson
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Patrick J. Smith
- Department of Psychiatry and Behavioral Sciences, Division of Behavioral Medicine and Neurosciences, Duke University Medical Center, Durham, NC, USA
| | - John R. Greenland
- Department of Medicine, University of California, San Francisco, CA, USA
- Medical Service, Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Jonathan P. Singer
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, UC San Francisco, San Francisco, CA, USA
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9
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Knoepke CE, Siry-Bove B, Mayton C, Latimer A, Hart J, Allen LA, Daugherty SL, McIlvennan CK, Matlock DD, Khazanie P. Variation in Left Ventricular Assist Device Postdischarge Caregiver Requirements: Results From a Mixed-Methods Study With Equity Implications. Circ Heart Fail 2022; 15:e009583. [PMID: 35862012 PMCID: PMC9388601 DOI: 10.1161/circheartfailure.122.009583] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left ventricular assist device (LVAD) evaluation includes a psychosocial assessment, conducted by social workers (SWs) on the advanced heart failure multidisciplinary team. Postdischarge caregiving plans are central to psychosocial evaluation. Caregiving's relationship with LVAD outcomes is mixed, and testing patients' social resources may disadvantage those from historically undertreated groups. We describe variation in policies defining adequate caregiving plans post-LVAD implant and possible impacts on patients from marginalized groups. METHODS This was a 2-phase sequential mixed-methods study: (1) phase 1, survey of US-based LVAD SWs, describing assessment structure and policies guiding candidacy outcomes; and (2) phase 2, individual interviews with SWs to further describe how caregiving plan adequacy impacts LVAD candidacy. RESULTS Sixty-seven SWs returned surveys (rr=47%) from unique programs. Caregiving plan inadequacy (n=30) was the most common psychosocial dealbreaker. When asked what duration of caregiving is required, 23% indicated ≥3 months, 27% 4 to 12 weeks, and 30% <4 weeks. Two reported no duration requirement, 6 stated an indefinite 24/7 commitment was necessary. Across 22 interviews, SWs mirrored that caregiving plans were the most common psychosocial contraindication. How caregiving is operationalized varied. Participants voiced a tension between extended caregiving improving outcomes and the sense that some people of color, women, or low socioeconomic status patients struggle to meet stringent requirements. CONCLUSIONS Policies regarding adequate duration of 24/7 caregiving vary, but inadequate caregiving plans are the most common psychosocial contraindication. Participants worry about patients' ability to meet restrictive requirements, particularly from historically undertreated groups. This highlights a need to operationalize quality caregiving, standardize assessment, and support medically appropriate patients with strained social resources.
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Affiliation(s)
- Christopher E Knoepke
- Division of Cardiology (C.E.K., L.A.A., S.L.D., C.K.M., P.K.), University of Colorado Anschutz Medical Campus, Aurora.,Adult and Child Center for Outcomes Research and Delivery Science (C.E.K., L.A.A., S.L.D.), University of Colorado Anschutz Medical Campus, Aurora
| | - Bonnie Siry-Bove
- Department of Emergency Medicine (B.S.-B.), University of Colorado Anschutz Medical Campus, Aurora
| | - Caitlin Mayton
- School of Social Work, Virginia Commonwealth University, Richmond (C.M.)
| | - Abigail Latimer
- College of Nursing, University of Kentucky, Lexington (A.L.)
| | - Jan Hart
- Ascension St. Vincent Medical Center, Indianapolis, IN (J.H.)
| | - Larry A Allen
- Division of Cardiology (C.E.K., L.A.A., S.L.D., C.K.M., P.K.), University of Colorado Anschutz Medical Campus, Aurora.,Adult and Child Center for Outcomes Research and Delivery Science (C.E.K., L.A.A., S.L.D.), University of Colorado Anschutz Medical Campus, Aurora
| | - Stacie L Daugherty
- Division of Cardiology (C.E.K., L.A.A., S.L.D., C.K.M., P.K.), University of Colorado Anschutz Medical Campus, Aurora.,Adult and Child Center for Outcomes Research and Delivery Science (C.E.K., L.A.A., S.L.D.), University of Colorado Anschutz Medical Campus, Aurora.,Institute for Health Research, Kaiser Permanente Colorado, Aurora (S.L.D.)
| | - Colleen K McIlvennan
- Division of Cardiology (C.E.K., L.A.A., S.L.D., C.K.M., P.K.), University of Colorado Anschutz Medical Campus, Aurora
| | - Daniel D Matlock
- Division of Geriatric Medicine (D.D.M.), University of Colorado Anschutz Medical Campus, Aurora
| | - Prateeti Khazanie
- Division of Cardiology (C.E.K., L.A.A., S.L.D., C.K.M., P.K.), University of Colorado Anschutz Medical Campus, Aurora
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10
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Winder GS, Andrews SR, Banerjee AG, Hussain F, Ivkovic A, Kuntz K, Omary L, Shenoy A, Thant T, VandenBerg A, Zimbrean P. Cannabinoids and solid organ transplantation: Psychiatric perspectives and recommendations. Transplant Rev (Orlando) 2022; 36:100715. [PMID: 35853383 DOI: 10.1016/j.trre.2022.100715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/10/2022] [Indexed: 01/01/2023]
Abstract
Cannabinoid use in patients seeking solid organ transplantation (SOT) is an important and unsettled matter which all transplantation clinicians regularly encounter. It is also a multifaceted, interprofessional issue, difficult for any specialty alone to adequately address in a research article or during clinical care. Such uncertainty lends itself to bias for or against cannabinoid use accompanied by inconsistent policies and procedures. Scientific literature in SOT regarding cannabinoids often narrowly examines the issue and exists mostly in liver and kidney transplantation. Published recommendations from professional societies are mosaics of vagueness and specificity mirroring the ongoing dilemma. The cannabinoid information SOT clinicians need for clinical care may require data and perspectives from diverse medical literature which are rarely synthesized. SOT teams may not be adequately staffed or trained to address various neuropsychiatric cannabinoid effects and risks in patients. In this article, authors from US transplantation centers conduct a systematized review of the few existing studies regarding clinician perceptions, use rates, and clinical impact of cannabinoid use in SOT patients; collate representative professional society guidance on the topic; draw from diverse medical literature bases to detail facets of cannabinoid use in psychiatry and addiction pertinent to all transplantation clinicians; provide basic clinical and policy recommendations; and indicate areas of future study.
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Affiliation(s)
| | - Sarah R Andrews
- Johns Hopkins Department of Psychiatry and Behavioral Sciences, Baltimore, Maryland, USA
| | | | - Filza Hussain
- Stanford University Department of Psychiatry and Behavioral Sciences, Palo Alto, California, USA
| | - Ana Ivkovic
- Massachusetts General Hospital Department of Psychiatry, Boston, Massachusetts, USA
| | - Kristin Kuntz
- Ohio State University Department of Psychiatry and Behavioral Health, Columbus, Ohio, USA
| | - Lesley Omary
- Vanderbilt University Department of Psychiatry and Behavioral Sciences, Nashville, Tennessee, USA
| | - Akhil Shenoy
- Columbia University Department of Psychiatry, New York City, New York, USA
| | - Thida Thant
- University of Colorado Department of Psychiatry, Aurora, Colorado, USA
| | - Amy VandenBerg
- University of Michigan Department of Psychiatry, Ann Arbor, Michigan, USA
| | - Paula Zimbrean
- Yale University Department of Psychiatry, New Haven, Connecticut, USA
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11
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Berardi C, Bravo CA, Li S, Khorsandi M, Keenan JE, Auld J, Rockom S, Beckman JA, Mahr C. The History of Durable Left Ventricular Assist Devices and Comparison of Outcomes: HeartWare, HeartMate II, HeartMate 3, and the Future of Mechanical Circulatory Support. J Clin Med 2022; 11:2022. [PMID: 35407630 PMCID: PMC9000165 DOI: 10.3390/jcm11072022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/25/2022] [Accepted: 03/31/2022] [Indexed: 12/13/2022] Open
Abstract
The utilization of left ventricular assist devices (LVADs) in end-stage heart failure has doubled in the past ten years and is bound to continue to increase. Since the first of these devices was approved in 1994, the technology has changed tremendously, and so has the medical and surgical management of these patients. In this review, we discuss the history of LVADs, evaluating survival and complications over time. We also aim to discuss practical aspects of the medical and surgical management of LVAD patients and future directions for outcome improvement in this population.
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Affiliation(s)
- Cecilia Berardi
- Division of Cardiovascular Medicine, Baystate Medical Center, Springfield, MA 01199, USA;
| | - Claudio A. Bravo
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA 98195, USA; (C.A.B.); (S.L.); (J.A.); (S.R.); (J.A.B.)
| | - Song Li
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA 98195, USA; (C.A.B.); (S.L.); (J.A.); (S.R.); (J.A.B.)
| | - Maziar Khorsandi
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WA 98195, USA; (M.K.); (J.E.K.)
| | - Jeffrey E. Keenan
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WA 98195, USA; (M.K.); (J.E.K.)
| | - Jonathan Auld
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA 98195, USA; (C.A.B.); (S.L.); (J.A.); (S.R.); (J.A.B.)
| | - Sunny Rockom
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA 98195, USA; (C.A.B.); (S.L.); (J.A.); (S.R.); (J.A.B.)
| | - Jennifer A. Beckman
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA 98195, USA; (C.A.B.); (S.L.); (J.A.); (S.R.); (J.A.B.)
| | - Claudius Mahr
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA 98195, USA; (C.A.B.); (S.L.); (J.A.); (S.R.); (J.A.B.)
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12
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Christon LM, Smith PJ. Psychosocial Evaluation for Lung Transplantation: an Empirically Informed Update. CURRENT TRANSPLANTATION REPORTS 2022. [DOI: 10.1007/s40472-022-00360-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Galiatsatos P, Ekpo P, Schreiber R, Barker L, Shah P. Smoking Mechanics and Impact on Smoking Cessation: Two Cases of Smoking Lapse Status Post Lung Transplantation. Tob Use Insights 2022; 15:1179173X211069634. [PMID: 35023981 PMCID: PMC8744156 DOI: 10.1177/1179173x211069634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Smoking behavior includes mechanisms taken on by persons to adjust for certain
characteristic changes of cigarettes. However, as lung function declines due to
lung-specific diseases, it is unclear how mechanical smoking behavior changes affect
persons who smoke. We review two cases of patients who stopped smoking prior to and then
subsequently resumed smoking after lung transplantation. Methods A retrospective review of two patients who were recipients of lung transplantation and
sustained from cigarette usage prior to transplantation. Results Patient A was a 54-year-old woman who received a double lung transplant secondary to
chronic obstructive pulmonary disease (COPD) in October 2017. She had stopped smoking
cigarettes in July 2015 (FEV1 .56 L). Patient B was a 40-year-old man who received a
double lung transplantation due to sarcoidosis in January 2015. He stopped smoking
cigarettes in February 2012 (FEV1 1.15 L). Post-transplant, Patient A resumed smoking on
March 2018 where her FEV1 was at 2.12 L (5 months post-transplantation), and Patient B
resumed smoking in April 2017 where his FEV1 was 2.37 L (26 months
post-transplantation). Conclusion We report on two patients who resumed smoking after lung transplantation. While
variations of smoking mechanics have been identified as a function of nicotine yield and
type of cigarette, it lung mechanics may play a role in active smoking as well.
Therefore, proper screening for tobacco usage post-lung transplantation should be
considered a priority in order to preserve transplanted lungs.
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Affiliation(s)
- Panagis Galiatsatos
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Tobacco Treatment Clinic, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Princess Ekpo
- Tobacco Treatment Clinic, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Raiza Schreiber
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Tobacco Treatment Clinic, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Lindsay Barker
- Office of Transplantation, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Pali Shah
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Office of Transplantation, Johns Hopkins Hospital, Baltimore, MD, USA
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14
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Gali K, Weidner G, Smits JMA, Beyersmann J, Spaderna H. Psychosocial Risk and Health Behaviors as Predictors of Clinical Events in Patients Wait-Listed for a New Heart: Results from 7 Years of Follow-Up. Life (Basel) 2021; 11:1438. [PMID: 34947969 PMCID: PMC8706706 DOI: 10.3390/life11121438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
We examined the long-term relationship of psychosocial risk and health behaviors on clinical events in patients awaiting heart transplantation (HTx). Psychosocial characteristics (e.g., depression), health behaviors (e.g., dietary habits, smoking), medical factors (e.g., creatinine), and demographics (e.g., age, sex) were collected at the time of listing in 318 patients (82% male, mean age = 53 years) enrolled in the Waiting for a New Heart Study. Clinical events were death/delisting due to deterioration, high-urgency status transplantation (HU-HTx), elective transplantation, and delisting due to clinical improvement. Within 7 years of follow-up, 92 patients died or were delisted due to deterioration, 121 received HU-HTx, 43 received elective transplantation, and 39 were delisted due to improvement. Adjusting for demographic and medical characteristics, the results indicated that frequent consumption of healthy foods (i.e., foods high in unsaturated fats) and being physically active increased the likelihood of delisting due improvement, while smoking and depressive symptoms were related to death/delisting due to clinical deterioration while awaiting HTx. In conclusion, psychosocial and behavioral characteristics are clearly associated with clinical outcomes in this population. Interventions that target psychosocial risk, smoking, dietary habits, and physical activity may be beneficial for patients with advanced heart failure waiting for a cardiac transplant.
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Affiliation(s)
- Kathleen Gali
- Hamburg Center for Health Economics, University of Hamburg, 20354 Hamburg, Germany;
- University Cancer Center Hamburg (UCCH), University Medical Center-Eppendorf (UKE), 20251 Hamburg, Germany
| | - Gerdi Weidner
- Department of Biology, Romberg Tiburon Campus, San Francisco State University, Tiburon, CA 94920, USA
| | | | - Jan Beyersmann
- Institute of Statistics, Ulm University, 89081 Ulm, Germany;
| | - Heike Spaderna
- Department of Nursing Science, Section Health Psychology, Trier University, 54286 Trier, Germany
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15
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Courtwright AM, Wilkey B, Devarajan J, Subramani S, Martin AK, Fritz AV, Cassara CM, Boisen ML, Bottiger BA, Pollak A, Maisonave Y, Gelzinis TA. The Year in Cardiothoracic Transplant Anesthesia: Selected Highlights From 2020 Part I - Lung Transplantation. J Cardiothorac Vasc Anesth 2021; 36:33-44. [PMID: 34670721 DOI: 10.1053/j.jvca.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 11/11/2022]
Abstract
This special article focuses on the highlights in cardiothoracic transplantation literature in the year 2020. Part I encompasses the recent literature on lung transplantation, including the advances in preoperative assessment and optimization, donor management, including the use of ex-vivo lung perfusion, recipient management, including those who have been infected with coronavirus disease 2019, updates on the perioperative management, including the use of extracorporeal membrane oxygenation, and long-term outcomes.
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Affiliation(s)
| | - Barbara Wilkey
- Department of Anesthesiology, University of Colorado, Boulder, CO
| | | | - Sudhakar Subramani
- Department of Anesthesiology, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Archer Kilbourne Martin
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic Florida, Jacksonville, FL
| | - Ashley Virginia Fritz
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic Florida, Jacksonville, FL
| | - Christopher M Cassara
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Michael L Boisen
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Angela Pollak
- Department of Anesthesiology, Duke University, Durham, NC
| | | | - Theresa A Gelzinis
- University of Pittsburgh, Corresponding Author, UPMC Presbyterian Hospital, Pittsburgh, PA.
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16
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Smith P, Kandakatla A, Frankel CW, Bacon DR, Bush E, Mentz RJ, Snyder LD. Sleep quality, depressive symptoms, and transplant outcomes: Follow-up analyses from the ADAPT prospective pilot study. Gen Hosp Psychiatry 2021; 72:53-58. [PMID: 34298477 DOI: 10.1016/j.genhosppsych.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 06/14/2021] [Accepted: 06/24/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Previous studies suggested that depressive symptoms and sleep quality may be important for long-term clinical outcomes following cardiothoracic transplant. Few studies, however, have systematically examined objective markers of these behavioral factors among ambulatory transplant recipients, or their association with clinical outcomes. METHODS We examined sleep quality and depressive symptoms with subsequent clinical outcomes (hospitalizations and death) in a sample of 66 lung or heart transplant recipients using a single-center, prospective cohort study. Recipients were assessed at approximately 6 months post-transplant and completed one week of actigraphy assessment to examine sleep quality and self-report measures of mood (Centers for Epidemiologic Studies of Depression [CESD]). Recipients were followed for clinical outcomes. RESULTS At 6-months following transplantation, recipients spent the majority of daytime activity at a sedentary level (61% of daily activity [SD = 10]) and elevated depressive symptoms were common (subclinical = 17%, mild = 12%, or moderate = 8%). Over a median follow-up of 4.5 years (IQR = 0.9, 5.1), 51 participants (77%) had at least one unplanned hospitalization and 11 (17%) participants died. In addition, sleep efficiency measurements suggested that a subset of participants exhibited suboptimal sleep (mean efficiency = 87% [SD = 7]). Poorer sleep quality, indexed by lower sleep efficiency and greater sleep fragmentation, was associated with greater depressive symptoms (r's = 0.37-0.50, P < .01). Better sleep quality at 6-months (HR = 0.75 [0.60, 0.95], P = .015), including sleep efficiency (HR = 0.74 [0.56, 0.99], P = .041) and sleep fragmentation (HR = 0.71 [0.53, 0.95], P = .020) were associated with lower risk of hospitalization or death. Compared with individuals without elevated depressive symptoms or sleep difficulties, individuals with either factor (HR = 1.72 [1.05, 2.81], P = .031) or both factors (HR = 2.37 [1.35, 4.18], P = .003) exhibited greater risk of clinical events in adjusted analyses. CONCLUSIONS Sleep quality is associated with depressive symptoms among cardiothoracic transplant recipients and enhances the prognostic association between biobehavioral risk factors and clinical outcomes.
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Affiliation(s)
- PatrickJ Smith
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, United States of America; Duke University Medical Center, Department of Medicine, Durham, NC, United States of America; Duke Clinical Research Institute, Durham, NC, United States of America.
| | - Apoorva Kandakatla
- Duke University Medical Center, Department of Medicine, Durham, NC, United States of America
| | - Courtney W Frankel
- Duke University Medical Center, Department of Medicine, Durham, NC, United States of America
| | - Daniel R Bacon
- University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC, United States of America
| | - Erika Bush
- Duke University Medical Center, Department of Medicine, Durham, NC, United States of America
| | - Robert J Mentz
- Duke University Medical Center, Department of Medicine, Durham, NC, United States of America; Duke Clinical Research Institute, Durham, NC, United States of America
| | - Laurie D Snyder
- Duke University Medical Center, Department of Medicine, Durham, NC, United States of America; Duke Clinical Research Institute, Durham, NC, United States of America
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17
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Patient names for mechanical circulatory support devices: Developing emotional insights. Heart Lung 2021; 50:953-967. [PMID: 34438307 DOI: 10.1016/j.hrtlng.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Patients with mechanical circulatory support devices regularly experience positive and negative emotions which are reinforced through interactions with their device. We explored emotional relationships between patients and their MCS devices through the names they assign to those devices. OBJECTIVES We sought to characterise device naming and suggest future developments which might capitalise on the naming phenomenon to improve patient wellbeing. METHODS Qualitative online ethnography extracted comments on device names and emotions from a social media group. Thematic analysis grouped the comments according to their explicit or implied emotions, and their potential consequences for designing future MCS treatment. RESULTS Thematic analysis identified 28 codes to characterise the names, from which we inferred 4 main themes for proposed emotional relationships. They centred on humour, coping, improving acceptance for family and friends, and reclaiming agency. CONCLUSION We suggest that by deliberately considering these factors in future research and development, clinicians and device manufacturers have scope to improve patient wellbeing.
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18
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Nöhre M, de Zwaan M, Bauer-Hohmann M, Ius F, Valtin C, Gottlieb J. The Transplant Evaluation Rating Scale Predicts Clinical Outcomes 1 Year After Lung Transplantation: A Prospective Longitudinal Study. Front Psychiatry 2021; 12:704319. [PMID: 34512417 PMCID: PMC8426579 DOI: 10.3389/fpsyt.2021.704319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/22/2021] [Indexed: 01/24/2023] Open
Abstract
Objectives: It has been recommended that all candidates for lung transplantation undergo pre-transplant psychosocial evaluation for risk assessment. However, psychosocial issues are only important if they correlate with outcomes after transplantation. Methods: In this prospective study patients who were referred for lung transplantation from 2016 to 2018 (n = 352) at Hannover Medical School were evaluated using the Transplant Evaluation Rating Scale (TERS). Clinical outcomes included listing, and post-transplant outcomes including mortality, medical aspects such as lung allograft dysfunction, hospitalizations, and renal function, behavioral aspects such as BMI and adherence, and mental issues such as levels of depression, anxiety, and quality of life. TERS scores were divided into tertiles and, in addition, the impact of the two subscale scores-"defiance" and "emotional sensitivity"-was investigated. Results: Of the patients who were transplanted (n = 271) and were still alive (n = 251), 240 had already reached their 1-year assessment at the end of 2020 and were evaluated 1 year after the operation. A subgroup of 143 received an extended mental assessment. BMI, adherence scores, levels of anxiety, depression, and quality of life 1 year post-transplantation differed significantly between TERS tertiles with higher TERS scores predicting less favorable outcomes. The TERS subscale "defiance" was predictive of BMI and adherence whereas the TERS subscale "emotional sensitivity" was predictive of symptoms of anxiety and depression, and quality of life 1 year after transplantation. Patients in the lowest TERS tertile were more likely to having been listed and-as a trend-to having survived the first year after transplantation Conclusions: Our findings show that psychosocial factors as measured by TERS score are predictors of behavioral and mental outcomes 1 year after lung transplantation. The TERS allows us to focus on psychosocial risk factors that can be treated or minimized before or after transplantation.
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Affiliation(s)
- Mariel Nöhre
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Biomedical Research in End-stage and Obstructive Lung Disease Hannover, Hannover, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Biomedical Research in End-stage and Obstructive Lung Disease Hannover, Hannover, Germany
| | - Maximilian Bauer-Hohmann
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Fabio Ius
- Member of the German Center for Lung Research (DZL), Biomedical Research in End-stage and Obstructive Lung Disease Hannover, Hannover, Germany
- Department of Cardiac, Thoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christina Valtin
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Jens Gottlieb
- Member of the German Center for Lung Research (DZL), Biomedical Research in End-stage and Obstructive Lung Disease Hannover, Hannover, Germany
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
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19
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Wessels-Bakker MJ, van de Graaf EA, Kwakkel-van Erp JM, Heijerman HG, Cahn W, Schappin R. The relation between psychological distress and medication adherence in lung transplant candidates and recipients: A cross-sectional study. J Clin Nurs 2021; 31:716-725. [PMID: 34216066 PMCID: PMC9292052 DOI: 10.1111/jocn.15931] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/17/2021] [Accepted: 06/07/2021] [Indexed: 12/30/2022]
Abstract
AIMS AND OBJECTIVES To explore the prevalence of psychological distress such as anxiety, depression and post-traumatic stress disorder and its associations with medication adherence in lung transplant patients. BACKGROUND Psychological distress after lung transplantation may impact clinical outcomes by associated behaviours such as non-adherence to medication. Evidence about the relation between psychological distress and medication adherence in lung transplant patients is limited and not well explained. DESIGN AND METHODS We conducted a single-centre study with a cross-sectional design in 73 lung transplant candidates and 116 recipients. Questionnaires were the Brief Symptom Inventory, Impact of Event Scale and Basel Assessment of Adherence to Immunosuppressive Medications Scale. The STROBE checklist was monitored. RESULTS In candidates, 39.7% reported (sub)clinical symptoms of depression, in recipients this was 21.6%. We observed suicidal ideation in recipients (8.6%), and candidates (5.5%). The prevalence of (sub)clinical symptoms of anxiety was 38.3% in candidates and 33.7% in recipients. After lung transplantation, 12% of the recipients reported clinical symptoms of PTSD related to the transplantation. Symptoms of anxiety and medication adherence were significantly and positively related in transplant recipients. We found no association between depressive or post-traumatic stress symptoms, and medication adherence. CONCLUSIONS In lung transplant patients, we found a high prevalence of symptoms of depression and anxiety. Recipients had high levels of post-traumatic stress symptoms related to the transplantation. The prevalence of suicidal ideation was unexpectedly high in recipients. After lung transplantation, higher levels of anxiety were related to better medication adherence. We propose that LTX recipients are very anxious to develop dyspnoea and therefore take their medication more conscientiously. RELEVANCE TO CLINICAL PRACTICE The clinical nurse specialist can play a key role in identifying and addressing psychological and behavioural problems. More prospective research on the role of anxiety and dyspnoea in lung transplant recipients is recommended.
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Affiliation(s)
- Marion J Wessels-Bakker
- Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Eduard A van de Graaf
- Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Harry G Heijerman
- Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wiepke Cahn
- Department of Mental Health, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Renske Schappin
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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20
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Schaenman JM, Diamond JM, Greenland JR, Gries C, Kennedy CC, Parulekar AD, Rozenberg D, Singer JP, Singer LG, Snyder LD, Bhorade S. Frailty and aging-associated syndromes in lung transplant candidates and recipients. Am J Transplant 2021; 21:2018-2024. [PMID: 33296550 PMCID: PMC8178173 DOI: 10.1111/ajt.16439] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 01/25/2023]
Abstract
Many lung transplant candidates and recipients are older and frailer compared to previous eras. Older patients are at increased risk for pre- and posttransplant mortality, but this risk is not explained by numerical age alone. This manuscript represents the product of the American Society of Transplantation (AST) conference on frailty. Experts in the field reviewed the latest published research on assessment of elderly and frail lung transplant candidates. Physical frailty, often defined as slowness, weakness, low physical activity, shrinking, and exhaustion, and frailty evaluation is an important tool for evaluation of age-associated dysfunction. Another approach is assessment by cumulative deficits, and both types of frailty are common in lung transplant candidates. Frailty is associated with death or delisting before transplant, and may be associated with posttransplant mortality. Sarcopenia, cognitive dysfunction, depression, and nutrition are other important components for patient evaluation. Aging-associated inflammation, telomere dysfunction, and adaptive immune system senescence may also contribute to frailty. Developing tools for frailty assessment and interventions holds promise for improving patient outcomes before and after lung transplantation.
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Affiliation(s)
- Joanna M. Schaenman
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Joshua M. Diamond
- Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John R. Greenland
- Department of Medicine, San Francisco VA Health Care System, San Francisco, CA and University of California, San Francisco CA
| | - Cynthia Gries
- Department of Medicine, AdventHealth Transplant Institute, Orlando FL
| | | | | | - Dmitry Rozenberg
- Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan P. Singer
- Department of Medicine, San Francisco VA Health Care System, San Francisco, CA and University of California, San Francisco CA
| | - Lianne G. Singer
- Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Sangeeta Bhorade
- Medical Affairs-Pulmonary, Veracyte Inc, South San Francisco, CA
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21
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DeBolt CL, Gao Y, Sutter N, Soong A, Leard L, Jeffrey G, Kleinhenz ME, Calabrese D, Greenland J, Venado A, Hays SR, Shah R, Kukreja J, Trinh B, Kolaitis NA, Douglas V, Diamond JM, Smith P, Singer J. The association of post-operative delirium with patient-reported outcomes and mortality after lung transplantation. Clin Transplant 2021; 35:e14275. [PMID: 33682171 PMCID: PMC11098451 DOI: 10.1111/ctr.14275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/16/2021] [Accepted: 02/22/2021] [Indexed: 12/14/2022]
Abstract
Post-operative delirium after lung transplantation is common. Its associations with health-related quality of life (HRQL), depression, and mortality remains unknown. In 236 lung transplant recipients, HRQL and depressive symptoms were assessed as part of a structured survey battery before and after transplantation. Surveys included the Geriatric Depressive Scale (GDS) and Short Form 12 (SF12). Delirium was assessed throughout the post-operative intensive care unit (ICU) stay with Confusion Assessment Method for ICU. Delirium and mortality data were extracted from electronic medical records. We examined associations between delirium and changes in depressive symptoms and HRQL using linear mixed effects models and association between delirium and mortality with Cox-proportional hazard models. Post-operative delirium occurred in 34 participants (14%). Delirium was associated with attenuated improvements in SF12-PCS (difference ₋4.0; 95%CI: -7.4, -0.7) but not SF12-MCS (difference 2.2; 95%CI: -0.7,5.7) or GDS (difference ₋0.4; 95%CI: -1.5,0.7). Thirty-two participants died during the study period. Delirium was associated with increased adjusted hazard risk of mortality (HR 17.9, 95%CI: 4.4,72.5). Delirium after lung transplantation identifies a group at increased risk for poorer HRQL and death within the first post-operative year. Further studies should investigate potential causal links between delirium, and poorer HRQL and mortality risk after lung transplantation.
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Affiliation(s)
- Claire L DeBolt
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Ying Gao
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Nicole Sutter
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Allison Soong
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Lorriana Leard
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Golden Jeffrey
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Mary Ellen Kleinhenz
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Daniel Calabrese
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Department of Medicine, San Francisco VA Health Care System, San Francisco, CA, USA
| | - John Greenland
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Department of Medicine, San Francisco VA Health Care System, San Francisco, CA, USA
| | - Aida Venado
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Steven R Hays
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Rupal Shah
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jasleen Kukreja
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Binh Trinh
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Nicholas A Kolaitis
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Vanja Douglas
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Joshua M Diamond
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Patrick Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Jonathan Singer
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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22
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Smith PJ, Potter G, Manson M, Martin M, Cendales LC. Psychosocial considerations in the assessment of hand transplant candidates: A single-center experience and brief literature review. Clin Transplant 2021; 35:e14268. [PMID: 33615558 DOI: 10.1111/ctr.14268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/27/2021] [Accepted: 01/31/2021] [Indexed: 11/27/2022]
Abstract
Vascularized composite allograft, including hand transplantation (HT), has gained wider usage as a reconstructive treatment over the past 30 years. HT recipients face unique psychosocial challenges compared to their solid organ and/or bone marrow transplant counterparts. Accordingly, the psychosocial evaluation among HT candidates continues to evolve, leaving a lack of consensus as to the critical psychosocial domains and psychometric testing instruments to help evaluate individuals considering HT. The present manuscript describes the psychosocial evaluation process within the Duke HT program, which been contacted by 80 potential candidates since 2014. The Duke HT evaluation process incorporates a comprehensive psychosocial assessment within domains including personality, cognitive function, mood, behavioral adherence, social support, and substance use history, among others. Our experience underscores the potential utility of collecting thorough psychosocial evaluations, supplemented by psychometric test data, to comprehensively assess potential HT candidates.
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Affiliation(s)
- Patrick J Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA
| | - Guy Potter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Maria Manson
- Duke Office of Clinical Research, Duke School of Medicine, Durham, NC, USA
| | - Michael Martin
- Atlanta VA Healthcare System, Mental Health Service Line, Decatur, GA, USA.,Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Linda C Cendales
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
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Hori M, Imamura T, Nakamura M, Nakagaito M, Kinugawa K. Therapeutic Strategy for a Patient with Advanced Heart Failure and Schizophrenia Without Cardiac Replacement Therapies. Int Heart J 2021; 62:441-444. [PMID: 33731533 DOI: 10.1536/ihj.20-624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We had a 58-year-old man with advanced heart failure and progressive end-organ dysfunction refractory to inotropes. Following detailed discussions, he decided not to receive ventricular assist device therapy considering his comorbidity of schizophrenia. A palliative care team initiated 2.5 mg of morphine together with low-dose anti-heart failure medications, which improved not only his heart failure symptoms but also the congestive heart failure itself. Aggressive commitments of the palliative care team might improve not only patients' quality of life but also advanced heart failure itself.
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Affiliation(s)
- Masakazu Hori
- Second Department of Internal Medicine, University of Toyama
| | | | - Makiko Nakamura
- Second Department of Internal Medicine, University of Toyama
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24
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A systematic review of psychosocial design considerations for the next generation of mechanical circulatory support. Heart Lung 2021; 50:397-406. [PMID: 33621838 DOI: 10.1016/j.hrtlng.2021.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/13/2021] [Accepted: 01/27/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Biomedical engineers are developing new mechanical circulatory support pumps. Clinicians are generating and analysing new evidence for their prescription and management. Industrial designers are generating usable solutions for wearable components and controllers. However, psychosocial considerations may be falling between the cracks of the three disciplines because of their multi-faceted nature. OBJECTIVES This article seeks to identify psychosocial needs raised in previous work, re-frame them as needs for future products and services, and discuss routes to solutions. METHODS SLR extracted 225 statements on psychosocial considerations from 42 included articles. 23 codes were inductively generated and applied to relevant datapoints. Codes were consolidated under 4 main themes and re-framed as solvable problems. RESULTS Identified themes: expanded remote care, improved multidisciplinary management tools, creating easier interactions; and extending patient engagement. CONCLUSIONS Design-driven methods have been used to solve analogous problems in other contexts and can address the identified psychosocial problems if implemented fully.
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Becker JH, Shemesh E, Shenoy A, Posillico A, Knight CS, Kim SK, Florman SS, Schiano T, Annunziato RA. The Utility of a Pre-Transplant Psychosocial Evaluation in Predicting Post-Liver Transplant Outcomes. Prog Transplant 2020; 31:4-12. [PMID: 33272096 DOI: 10.1177/1526924820978605] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND There is insufficient evidence about the ability of pretransplant psychosocial evaluations to predict posttransplant outcomes. While standardized assessments were developed to increase predictive validity, it is unclear whether the risk scores they yield predict outcomes. We investigated if the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), a scaling approach to those assessments, would have been a superior predictor than the standard psychosocial evaluation. METHODS In this retrospective study, medical records of 182 adult liver transplant recipients who were at least 1 year posttransplant and prescribed tacrolimus for immunosuppression were analyzed. Regression analyses predicted outcomes of interest, including immunosuppressant nonadherence and biopsy-proven rejection, obtained 1-year posttransplant to time of data collection. Nonadherence was determined using the medication level variability index (MLVI). RESULTS Approximately 49% of patients had MLVI > 2.5, suggestive of nonadherence, and 15% experienced rejection. SIPAT total score did not predict adherence either using the continuous (P = .70), or dichotimized score, above or below > 2.5 (P = .14), or rejection (P = 0.87). Using a SIPAT threshold (total score > 69) did not predict adherence (p = .16) nor was a superior predictor of the continuous adherence score (P = .45), MLVI > 2.5 (P = .42), or rejection (P = 0.49), than the standard evaluation. CONCLUSION Our findings suggest that the SIPAT is unable to predict 2 of the most important outcomes in this population, immunosuppressant adherence and rejection. Research efforts should attempt to evaluate the best manner to use psychosocial evaluations.
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Affiliation(s)
- Jacqueline H Becker
- Department of Medicine, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Pediatrics, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eyal Shemesh
- Department of Pediatrics, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Akhil Shenoy
- Center for Liver Disease and Transplantation, 21611Columbia University Medical Center, New York, NY, USA
| | - Ailie Posillico
- Department of Psychology, 5923Fordham University, Bronx, NY, USA
| | | | - Se-Kang Kim
- Department of Psychology, 5923Fordham University, Bronx, NY, USA
| | - Sander S Florman
- 52100Recanati/Miller Transplantation Institute/Division of Liver Disease, Mount Sinai Medical Center, New York, NY, USA
| | - Thomas Schiano
- 52100Recanati/Miller Transplantation Institute/Division of Liver Disease, Mount Sinai Medical Center, New York, NY, USA
| | - Rachel A Annunziato
- Department of Pediatrics, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA.,52100Recanati/Miller Transplantation Institute/Division of Liver Disease, Mount Sinai Medical Center, New York, NY, USA
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26
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Pierson RN, Burdorf L, Madsen JC, Lewis GD, D’Alessandro DA. Pig-to-human heart transplantation: Who goes first? Am J Transplant 2020; 20:2669-2674. [PMID: 32301262 PMCID: PMC9448330 DOI: 10.1111/ajt.15916] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/05/2020] [Accepted: 04/06/2020] [Indexed: 01/25/2023]
Abstract
Cardiac xenotransplantation has recently taken an important step towards clinical reality. In anticipation of the "first-in-human" heart xenotransplantation trial, we propose a set of patient characteristics that define potential candidates. Our premise is that, to be ethically justified, the risks posed by current state-of-the-art options must outweigh the anticipated risks of a pioneering xenotransplant procedure. Suitable candidates include patients who are at high immunologic risk because of sensitization to alloantigens, including those who have exhibited early onset or accelerated cardiac allograft vasculopathy. In addition, patients should be considered (1) for whom mechanical circulatory support would be prohibitively risky due to a hypercoagulable state, a contraindication to anticoagulation, or restrictive physiology; (2) with severe biventricular dysfunction predicting unsuccessful univentricular left heart support; and (3) adults with complex congenital heart disease. In conclusion, because the published preclinical benchmark for clinical translation of heart xenotransplantation appears within reach, carefully and deliberately defining appropriate trial participants is timely as the basis for ethical clinical trial design.
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Affiliation(s)
- Richard N. Pierson
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts,Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Lars Burdorf
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts,Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Joren C. Madsen
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts,Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Gregory D. Lewis
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - David A. D’Alessandro
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
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27
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Mariani S, Napp LC, Schmitto JD. Mens sana in corpore sano: Challenges beyond LVAD implantation. Artif Organs 2020; 44:1310-1311. [DOI: 10.1111/aor.13774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Silvia Mariani
- Department of Cardiothoracic, Transplantation and Vascular Surgery Hannover Medical School Hannover Germany
| | - Lars Christian Napp
- Department of Cardiology and Angiology Hannover Medical School Hannover Germany
| | - Jan D. Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery Hannover Medical School Hannover Germany
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28
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Smith PJ, Dunitz JM, Lucy A, Hempstead SE, Tallarico E, Faro A, Pilewski JM, Ramos KJ. Incorporating patient and caregiver feedback into lung transplant referral guidelines for individuals with cystic fibrosis-Preliminary findings from a novel paradigm. Clin Transplant 2020; 34:e14038. [PMID: 32654238 DOI: 10.1111/ctr.14038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/27/2020] [Accepted: 06/25/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lung transplantation is a common therapeutic option for individuals with cystic fibrosis (CF) and advanced lung disease, yet many individuals with CF are not appropriately referred for evaluation. The present study sought to enhance CF transplant referral guidelines by integrating patient-centered input to identify possible psychosocial barriers contributing to suboptimal referral for appropriate CF transplant candidates. METHODS As a component of developing the Cystic Fibrosis Foundation (CFF) Lung Transplant Referral Consensus Guidelines, we convened a focus group of lung transplant recipients with CF and two spouses of CF recipients. Each session involved standardized approaches to elicit qualitative, thematic content. RESULTS CF patients and caregivers characterized five areas for improvement, which were integrated into formal CFF referral guidelines. These included (a) timing of transplant discussion with CF providers, (b) accuracy of transplant-related knowledge and expectations, (c) stigma associated with the need for transplantation, (d) treatment team transition issues, and (e) social support and mental health concerns. Earlier introduction of transplant, greater details regarding manageable aspects of treatment, and greater provision of social support were all associated with better psychosocial experiences. CONCLUSIONS Integrating patient-centered input into guideline development yielded important and previously unknown psychosocial barriers contributing to suboptimal transplant referral.
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Affiliation(s)
- Patrick J Smith
- Departments of Psychiatry, Medicine, and Population Health Sciences, Duke University Medical Center, Durham, NC, USA
| | - Jordan M Dunitz
- Division of Pulmonary, Allergy, Critical Care Medicine and Sleep, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Amy Lucy
- Cystic Fibrosis Foundation, Bethesda, MD, USA
| | | | | | - Albert Faro
- Cystic Fibrosis Foundation, Bethesda, MD, USA
| | - Joseph M Pilewski
- Division of Pulmonary, Allergy & Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kathleen J Ramos
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
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29
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Gummert JF, Haverich A, Schmitto JD, Potapov E, Schramm R, Falk V. Permanent Implantable Cardiac Support Systems. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 116:843-848. [PMID: 31931951 DOI: 10.3238/arztebl.2019.0843] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 04/11/2019] [Accepted: 09/25/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Nearly 1000 permanent ventricular assist devices (VADs) are implanted in patients with severe congestive heart failure in Germany each year. VADs are miniaturized centrifugal pumps that generate continuous blood flow; they are powered and controlled through a cable that passes through the skin. Para- corporeal systems are only rarely implanted, usually in children. METHODS In this selective review of the literature, including guidelines and registry data, we discuss the indications, therapeutic effects, and complications of permanently implantable cardiac support systems. RESULTS The optimal time for VAD implantation cannot be precisely defined. A comparative assessment of the various available systems is not possible, as no randomized trials have been performed on this topic. Registry data indicate that 69% to 81% of patients survive one year after VAD implantation, which is signifi- cantly better than the natural course of (conservatively treated) severe congestive heart failure. The distance patients are able to walk is 129 to 220 m longer at six months, depending on the system implanted. Scores on the EQ-5D health status questionnaire are 28 to 37 points better at six months. The potential severe compli- cations include infection, right-heart failure, hemorrhage, pump thrombosis, stroke, and death. CONCLUSION A VAD system can be implanted as an alternative to cardiac transplan- tation or as a bridging treatment until the patient can be listed for transplantation and receive the transplant. Because of the organ s , only a minority of VAD patients ever receive a transplant.
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Affiliation(s)
- Jan F Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre, North Rhine Westphalia, Bad Oeynhausen, Germany; Department of Cardiovascular Surgery, Charité, Universitätsmedizin Berlin; German Center of Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung) - DZHK, Partner Site Berlin; Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany; Department of Thoracic and Cardiovascular Surgery, German Heart Center, Berlin, Germany
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30
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Soyseth TS, Dew MA, Lund MB, Haugstad GK, Soyseth V, Malt UF. Coping Patterns and Emotional Distress in Patients With Chronic Obstructive Lung Disease Who Are Undergoing Lung Transplant Evaluation. Prog Transplant 2020; 30:228-234. [PMID: 32578510 DOI: 10.1177/1526924820933817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Living with severe lung disease like chronic obstructive pulmonary disease (COPD) is a very stressful situation. The way patients cope may impact their symptoms of anxiety and depression and physical function as well. We studied how ways of coping are associated with levels of emotional distress and lung function in patients with COPD being evaluated for lung transplantation. METHODS Sixty-five (mean age 57 years, 46% females) patients completed the General Health Questionnaire-30 (GHQ-30) assessing emotional distress and the Ways of Coping Questionnaire. Measurements of lung function and 6-minute walk test were included. RESULTS Seventeen (26%) patients had elevated emotional distress. Logistic regression of chronic GHQ score with gender, age, body mass index, lung function, and coping scales as covariates showed that escape avoidance and self-controlling coping and forced vital lung capacity were significantly associated with high emotional distress. Odds ratio of emotional distress increased with 5.2 per tertile (P = .011) in escape avoidance coping score. Moreover, we revealed that emotionally distressed patients cope with their current situation by refusing to believe the current situation and taking their distress out on other people. CONCLUSION Among patients with COPD, a high level of emotional distress was uniquely associated with escape-avoidance coping and lung function. Future work should ascertain whether coping style predicts distress or whether distress increases the use of escape-avoidance coping. Nevertheless, our findings indicate that if either element is present, health care professionals should be attentive to the need for interventions to improve patients' well-being.
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Affiliation(s)
- Torunn S Soyseth
- Department of Clinical Service, Division of Cancer Medicine, 155272Oslo University Hospital, Oslo, Norway
| | - Mary Amanda Dew
- Department of Psychiatry, 6595University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA, USA
| | - May Brit Lund
- Department of Respiratory Medicine, Division of Cardiovascular and Pulmonary Diseases, 155272Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, 6305University of Oslo, Norway
| | - Gro Killi Haugstad
- Department of Physiotherapy, 60499Oslo Metropolitan University, Oslo, Norway.,Unit for C-L Psychiatry and Psychosomatic Medicine, Division of Mental health and Dependency, 155272Oslo University Hospital, Oslo, Norway
| | - Vidar Soyseth
- Faculty of Medicine, Institute of Clinical Medicine, 6305University of Oslo, Norway.,Department of Respiratory Diseases and Allergy, 60483Akershus University Hospital, Nordbyhagen, Norway
| | - Ulrik Fredrik Malt
- Faculty of Medicine, Institute of Clinical Medicine, 6305University of Oslo, Norway.,Unit for C-L Psychiatry and Psychosomatic Medicine, Division of Mental health and Dependency, 155272Oslo University Hospital, Oslo, Norway.,Department of Research and Education, Division of Clinical Neuroscience, 155272Oslo University Hospital, Oslo, Norway
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31
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Suarez L, Dunlay SM, Schettle SD, Stulak JM, Staab JP. Associations of depressive symptoms with outcomes in patients implanted with left ventricular assist devices. Gen Hosp Psychiatry 2020; 64:93-98. [PMID: 32008725 DOI: 10.1016/j.genhosppsych.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/11/2019] [Accepted: 12/30/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE We examined characteristics of depressive symptoms in patients who received left ventricular assist devices (LVAD) to assess their effects on negative outcomes post-implantation. METHODS We retrospectively identified 203 adults with pre-operative PHQ-9 scores who underwent LVAD placement as bridge to transplant (BTT) or destination therapy (DT). We analyzed effects of PHQ-9 total, somatic, and cognitive/affective scores and proportion of patients with clinical depression on all-cause mortality, rehospitalization, major bleeding, and neurologic events post-implantation, controlling for demographics and other medical comorbidities. RESULTS Mean total PHQ-9 scores did not differ between 81 BTT and 122 DT patients (BTT 6.4 vs. DT 7.5, p = 0.12). A higher proportion of DT patients had clinical depression (BTT 22% vs. DT 39%, p = 0.015). Somatic symptoms accounted for three-quarters of total scores in both groups. PHQ-9 domains were not associated with negative outcomes post-implantation. CONCLUSION Depression severity did not differ based on implant strategy, but more DT patients had clinical depression. Somatic symptoms were the biggest contributor to depressive symptoms. Pre-implantation PHQ-9 scores were not associated with outcomes, possibly because depression was mild in both groups. Additional work is needed in LVAD patients to better characterize depressive symptoms and their unique effects on clinical course and well-being.
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Affiliation(s)
- Laura Suarez
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America.
| | - Shannon M Dunlay
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America; Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America.
| | - Sarah D Schettle
- Department of Cardiovascular Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America.
| | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America.
| | - Jeffrey P Staab
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States of America.
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32
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Godinas L, Van Raemdonck D, Ceulemans LJ, Vos R, Verleden GM. Lung retransplantation: walking a thin line between hope and false expectations. J Thorac Dis 2020; 11:E200-E203. [PMID: 31903281 DOI: 10.21037/jtd.2019.11.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Laurent Godinas
- Lung Transplantation Unit, University Hospitals Leuven, Leuven, Belgium.,Department of Respiratory Disease, University Hospitals Leuven, Leuven, Belgium
| | - Dirk Van Raemdonck
- Lung Transplantation Unit, University Hospitals Leuven, Leuven, Belgium.,Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Laurens J Ceulemans
- Lung Transplantation Unit, University Hospitals Leuven, Leuven, Belgium.,Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Robin Vos
- Lung Transplantation Unit, University Hospitals Leuven, Leuven, Belgium.,Department of Respiratory Disease, University Hospitals Leuven, Leuven, Belgium
| | - Geert M Verleden
- Lung Transplantation Unit, University Hospitals Leuven, Leuven, Belgium.,Department of Respiratory Disease, University Hospitals Leuven, Leuven, Belgium
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33
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Psychosocial dimensions of hand transplantation: lessons learned from solid organ transplantation. Curr Opin Organ Transplant 2019; 24:705-713. [PMID: 31689261 DOI: 10.1097/mot.0000000000000712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW The present review examines psychosocial factors emerging as predictive of clinical outcomes among solid organ transplant (SOT) recipients, with possible extensions to vascular composite allograft (VCA) and hand transplantation, in particular. The Chauvet Workgroup report and International Society of Heart and Lung Transplantation consensus guidelines are used to delineate areas of commonality between SOT and VCA, as well as unique features contributing to post-VCA psychosocial risk. RECENT FINDINGS Increasing evidence suggests that depression, cognitive function, and other posttransplant psychosocial factors consistently associate with clinical risk in SOT. However, the mechanisms precipitating these psychosocial risk factors are likely diverse in their cause, with large individual differences across SOT and VCA. Transdiagnostic dimensions may serve as mechanistic factors, increasing the risk of adverse clinical outcomes and suggesting potential treatment strategies for risk mitigation. Psychosocial dimensions including psychological flexibility, self-efficacy, and posttraumatic growth are discussed as potential contributory factors. SUMMARY Psychosocial factors hold importance in predicting posttransplant clinical outcomes. Emerging transdiagnostic factors may provide insight into mechanisms and potential treatments.
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López‐Lazcano AI, López‐Pelayo H, Lligoña A, Sánchez N, Vilas‐Riotorto V, Priego A, Sánchez‐González R, Rodríguez‐Urrutia A, Quesada‐Franco M, Maldonado JR, Pintor L. Translation, adaptation, and reliability of the Stanford Integrated Psychosocial Assessment for Transplantation in the Spanish population. Clin Transplant 2019; 33:e13688. [DOI: 10.1111/ctr.13688] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 07/17/2019] [Accepted: 07/29/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Ana Isabel López‐Lazcano
- Grup Recerca Addicions Clínic (GRAC‐GRE), Department of Psychiatry, Clinical Institute of Neuroscience, Hospital Clínic i Universitari de Barcelona Universitat de Barcelona Barcelona Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona Spain
- Red de Trastornos Adictivos Madrid Spain
| | - Hugo López‐Pelayo
- Grup Recerca Addicions Clínic (GRAC‐GRE), Department of Psychiatry, Clinical Institute of Neuroscience, Hospital Clínic i Universitari de Barcelona Universitat de Barcelona Barcelona Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona Spain
- Red de Trastornos Adictivos Madrid Spain
| | - Anna Lligoña
- Grup Recerca Addicions Clínic (GRAC‐GRE), Department of Psychiatry, Clinical Institute of Neuroscience, Hospital Clínic i Universitari de Barcelona Universitat de Barcelona Barcelona Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona Spain
- Red de Trastornos Adictivos Madrid Spain
| | - Nuria Sánchez
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona Spain
- Consultation Liaison Psychiatry Unit, Psychiatry Department, Clinical Institute of Neurosciences, Hospital Clínic i Universitari de Barcelona Universitat de Barcelona Barcelona Spain
| | - Vanessa Vilas‐Riotorto
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona Spain
- Consultation Liaison Psychiatry Unit, Psychiatry Department, Clinical Institute of Neurosciences, Hospital Clínic i Universitari de Barcelona Universitat de Barcelona Barcelona Spain
| | - Angel Priego
- Consultation Liaison Psychiatry Unit, Psychiatry Department, Clinical Institute of Neurosciences, Hospital Clínic i Universitari de Barcelona Universitat de Barcelona Barcelona Spain
| | - Roberto Sánchez‐González
- Department of Psychiatry Centre Emili Mira Institut de Neuropsiquiatria i Addiccions Barcelona Spain
- IMIM (Hospital del Mar Medical Research Institute) Barcelona Spain
- Centro de Investigación Biomédica En Red de Salud Mental (CIBERSAM) Madrid Spain
| | - Amanda Rodríguez‐Urrutia
- Centro de Investigación Biomédica En Red de Salud Mental (CIBERSAM) Madrid Spain
- Department of Psychiatry Hospital Universitari Vall d'Hebron Barcelona Spain
- Group of Psychiatry, Mental Health and Addictions Vall d'Hebron Research Institut (VHIR) Barcelona Spain
| | - Marta Quesada‐Franco
- Centro de Investigación Biomédica En Red de Salud Mental (CIBERSAM) Madrid Spain
- Department of Psychiatry Hospital Universitari Vall d'Hebron Barcelona Spain
| | - Jose R. Maldonado
- Department of Psychiatry and Behavioral Sciences Stanford University School of Medicine Stanford California
| | - Luis Pintor
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona Spain
- Consultation Liaison Psychiatry Unit, Psychiatry Department, Clinical Institute of Neurosciences, Hospital Clínic i Universitari de Barcelona Universitat de Barcelona Barcelona Spain
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