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Kim SH, Kim KA, Chu SH, Kim H, Joo DJ, Lee JG, Choi J. Self-Management Using eHealth Technologies for Liver Transplant Recipients: Scoping Review. J Med Internet Res 2024; 26:e56664. [PMID: 38963937 PMCID: PMC11258531 DOI: 10.2196/56664] [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: 01/23/2024] [Revised: 03/24/2024] [Accepted: 06/03/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Liver transplantation has become increasingly common as a last-resort treatment for end-stage liver diseases and liver cancer, with continually improving success rates and long-term survival rates. Nevertheless, liver transplant recipients face lifelong challenges in self-management, including immunosuppressant therapy, lifestyle adjustments, and navigating complex health care systems. eHealth technologies hold the potential to aid and optimize self-management outcomes, but their adoption has been slow in this population due to the complexity of post-liver transplant management. OBJECTIVE This study aims to examine the use of eHealth technologies in supporting self-management for liver transplant recipients and identify their benefits and challenges to suggest areas for further research. METHODS Following the Arksey and O'Malley methodology for scoping reviews, we conducted a systematic search of 5 electronic databases: PubMed, CINAHL, Embase, PsycINFO, and Web of Science. We included studies that (1) examined or implemented eHealth-based self-management, (2) included liver transplant recipients aged ≥18 years, and (3) were published in a peer-reviewed journal. We excluded studies that (1) were case reports, conference abstracts, editorials, or letters; (2) did not focus on the posttransplantation phase; (3) did not focus on self-management; and (4) did not incorporate the concept of eHealth or used technology solely for data collection. The quality of the selected eHealth interventions was evaluated using (1) the Template for Intervention Description and Replication guidelines and checklist and (2) the 5 core self-management skills identified by Lorig and Holman. RESULTS Of 1461 articles, 15 (1.03%) studies were included in the final analysis. Our findings indicate that eHealth-based self-management strategies for adult liver transplant recipients primarily address lifestyle management, medication adherence, and remote monitoring, highlighting a notable gap in alcohol relapse interventions. The studies used diverse technologies, including mobile apps, videoconferencing, and telehealth platforms, but showed limited integration of decision-making or resource use skills essential for comprehensive self-management. The reviewed studies highlighted the potential of eHealth in enhancing individualized health care, but only a few included collaborative features such as 2-way communication or tailored goal setting. While adherence and feasibility were generally high in many interventions, their effectiveness varied due to diverse methodologies and outcome measures. CONCLUSIONS This scoping review maps the current literature on eHealth-based self-management support for liver transplant recipients, assessing its potential and challenges. Future studies should focus on developing predictive models and personalized eHealth interventions rooted in patient-generated data, incorporating digital human-to-human interactions to effectively address the complex needs of liver transplant recipients. This review emphasizes the need for future eHealth self-management research to address the digital divide, especially with the aging liver transplant recipient population, and ensure more inclusive studies across diverse ethnicities and regions.
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Affiliation(s)
- Soo Hyun Kim
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Kyoung-A Kim
- College of Nursing, Suwon Women's University, Suwon, Republic of Korea
| | - Sang Hui Chu
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Hyunji Kim
- School of Nursing, Yale University, Orange, CT, United States
| | - Dong Jin Joo
- Department of Surgery, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Jae Geun Lee
- Department of Surgery, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - JiYeon Choi
- College of Nursing, Mo-Im Kim Nursing Research Institute, Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Republic of Korea
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Jones LS, Serper M. Medication non-adherence among liver transplant recipients. CURRENT HEPATOLOGY REPORTS 2020; 19:327-336. [PMID: 33816051 PMCID: PMC8011544 DOI: 10.1007/s11901-020-00545-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/07/2020] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW We provide an overview of the recent evidence on the prevalence, risk factors, and consequences of medication non-adherence (NA) in liver transplant (LT) recipients. RECENT FINDINGS NA in LT is associated with socio-demographic and medication-related factors, low social support, and poor health literacy. Patient-reported adherence is one of the most common methods to measure NA using validated assessments; immunosuppression (IS) drug levels and electronic monitoring may also be used. Simplification of IS regimens such as the conversion from twice daily to once daily has been shown to be safe, effective, and improves adherence. Relatively few studies have prospectively investigated NA predictors or interventions to reduce NA in LT. SUMMARY Medication non-adherence is a multi-faceted issue that is common among LT recipients and associated with adverse outcomes. NA in LT recipients warrants further study as only a few interventions have been published focused on reducing NA in LT.
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Affiliation(s)
- Lauren S. Jones
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA
| | - Marina Serper
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine
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3
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Chen X, Zhang Y, Yu J. Symptom Experience and Related Predictors in Liver Transplantation Recipients. Asian Nurs Res (Korean Soc Nurs Sci) 2020; 15:8-14. [PMID: 33188944 DOI: 10.1016/j.anr.2020.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 08/25/2020] [Accepted: 11/08/2020] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Symptom experience after liver transplantation (LT) provides healthcare professionals with important information about the benefits and limitations of LT from patients' perspective. This study aims to explore the multidimensional symptom experience and analyze related predictive factors in LT recipients. METHODS This cross-sectional study evaluated the occurrence, frequency, intensity, and level of distress of 40 symptoms in 265 LT recipients. Stepwise multiple regression analysis was performed to analyze the influencing factors of symptom experience. RESULTS The analysis of patient-reported data indicated that the ten most common symptoms were fatigue (42.3%), frequent sleep interruptions (38.9%), difficulty falling asleep (35.9%), decreased memory (34.0%), dreaminess (29.8%), itch (28.7%), muscular weakness (26.4%), shortness of breath (25.3%), anxiety (24.5%), and hand tremor (21.9%). Patients were classified into four groups according to survival time (1-month, 2-6-month, 7-12-month, and >1-year groups) after LT, and the most common symptom was fatigue in the one-month and 2-6-month groups, difficulty falling asleep in the 7-12-month group, and decreased memory in the >1-year group. Type of the primary caregiver, complications, concerns about the decreased ability to perform household and outdoor activities, and concerns about being a burden to the family were predictors of symptoms burden. CONCLUSION LT recipients experienced complicated symptoms. In clinical practice, it is critical to integrate physicians, nurses, and social workers as a medical team to help LT recipients develop suitable coping strategies that can potentially address patients' concerns, increase the sense of confidence, and improve symptom outcomes.
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Affiliation(s)
- Xiao Chen
- Liver Disease Department, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Yuxia Zhang
- Nursing Department, Zhongshan Hospital of Fudan University, Shanghai, China.
| | - Jingxian Yu
- Liver Disease Department, Zhongshan Hospital of Fudan University, Shanghai, China
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Purnajo I, Beaumont JL, Polinsky M, Alemao E, Everly MJ. Trajectories of health-related quality of life among renal transplant patients associated with graft failure and symptom distress: Analysis of the BENEFIT and BENEFIT-EXT trials. Am J Transplant 2020; 20:1650-1658. [PMID: 31874117 DOI: 10.1111/ajt.15757] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 12/05/2019] [Accepted: 12/08/2019] [Indexed: 01/25/2023]
Abstract
Understanding the correlation between transplant symptoms, health-related quality of life (HRQoL), and graft outcomes is needed to support patient-focused drug development and posttransplant management. A post-hoc analysis of patient-reported outcomes from the Phase III belatacept trials was conducted in order to investigate the interrelationship between trajectories of HRQoL, symptom experience, and allograft outcomes. HRQoL and symptom experience were evaluated using Short-Form 36 Survey (SF-36) and Modified Transplant Symptom Occurrence and Distress Scale (MTSOSD-59R), respectively. HRQoL was captured in 831 eligible renal transplant patients at baseline, 12, 24, and 36 months posttransplant. Following transplantation, patients reported improvements in all SF-36 subscales compared to baseline. Latent class analysis revealed four trajectories in perceived general health, which were associated with graft failure after adjustment. Compared to patients with good perceived health, patients with fair and poor perceived health had 4.7 (95% confidence interval [CI] 1.5-14.8, P < .01) and 19.8 (95% CI 5.9-66.0, P < .01) times the risk of graft failure, respectively. Using multinomial logistic regression, different sets of symptoms were associated with perceived general health at baseline and 12 months posttransplant. The study supports monitoring HRQoL and symptom experience to capture each patient's health perspective, improve drug development, and optimize posttransplant management.
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Affiliation(s)
- Intan Purnajo
- Terasaki Research Institute, Los Angeles, California
| | | | | | - Evo Alemao
- Bristol Myers Squibb, Princeton, New Jersey
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Volpes R, Burra P, Germani G, Manini MA, Caccamo L, Strignano P, Rizza G, Tamè M, Pinna AD, Calise F, Migliaccio C, Carrai P, De Simone P, Valentini MF, Lupo LG, Cordone G, Picciotto FP, Nicolucci A. Switch from intravenous or intramuscular to subcutaneous hepatitis B immunoglobulin: effect on quality of life after liver transplantation. Health Qual Life Outcomes 2020; 18:99. [PMID: 32276633 PMCID: PMC7149917 DOI: 10.1186/s12955-020-01349-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 04/02/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Hepatitis B immunoglobulin (HBIG) therapy is available in intravenous (IV) or intra-muscular (IM) formulations. Recently, a subcutaneous (SC) formulation was introduced. This study evaluated changes in quality of life when liver transplant (LT) recipients were switched from IV or IM HBIG to the SC formulation. METHODS This multicentre, observational study involved adults who had undergone LT at least 1 year prior to study entry. Quality of life was evaluated using the ITaLi-Q questionnaire, assessing the impact of HBIG therapy on daily activities and patient satisfaction, and the SF-36 Health Survey. Patients completed the questionnaires prior to switching from IV or IM HBIG to SC HBIG and 6 months later. RESULTS Eighty-six patients were enrolled; before the switch, 68.6% were receiving IM HBIG and 31.4% IV HBIG. After 6 months, significant improvements in 7 of the 8 ITaLi-Q domains were found, particularly side effects, need for support to adhere to the therapy and satisfaction with the HBIG therapy. Significant improvements in several SF-36 domains were documented, including physical functioning, physical and emotional role limitations, pain, social functioning, physical and mental summary scores. CONCLUSIONS The SC route of administration reduces side effects and their interference with daily life, ameliorates negative feelings, and increases patient autonomy.
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Affiliation(s)
- Riccardo Volpes
- Mediterranean Institute for Transplantation and High Specialization Therapies, Palermo, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit (Gastroenterology), Department of Surgery, Oncology and Gastroenterology,Surgical and Gastroenterological Sciences, Padua University Hospital, Padua, Italy
| | - Giacomo Germani
- Multivisceral Transplant Unit (Gastroenterology), Department of Surgery, Oncology and Gastroenterology,Surgical and Gastroenterological Sciences, Padua University Hospital, Padua, Italy
| | - Matteo Angelo Manini
- 1st Division of Gastroenterology and Hepatology, Ca' Granda-Maggiore Polyclinic Hospital, Scientific Institute for Research, Hospitalization, and Health Care, Milan, Italy
| | - Lucio Caccamo
- 1st Division of Gastroenterology and Hepatology, Ca' Granda-Maggiore Polyclinic Hospital, Scientific Institute for Research, Hospitalization, and Health Care, Milan, Italy
| | - Paolo Strignano
- General Surgery and Liver Transplant Center, S. Giovanni Battista Hospital, Turin, Italy
| | - Giorgia Rizza
- General Surgery and Liver Transplant Center, S. Giovanni Battista Hospital, Turin, Italy
| | - Mariarosa Tamè
- Liver and Multiorgan Transplantation, Department of General Surgery, Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Antonio Daniele Pinna
- Liver and Multiorgan Transplantation, Department of General Surgery, Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Fulvio Calise
- Hepatobiliary Surgery and Transplant Unit, Cardarelli Hospital, Naples, Italy
| | - Carla Migliaccio
- Hepatobiliary Surgery and Transplant Unit, Cardarelli Hospital, Naples, Italy
| | - Paola Carrai
- Department of General Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy
| | - Paolo De Simone
- Department of General Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy
| | - Maria Filippa Valentini
- General Surgery and Liver Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Luigi Giovanni Lupo
- General Surgery and Liver Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | | | | | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology, Via Tiziano Vecellio, 2, 65124, Pescara, Italy.
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6
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Wang H, Du C, Liu H, Zhang S, Wu S, Fu Y, Zhao J. Exploration of symptom experience in kidney transplant recipients based on symptoms experience model. Qual Life Res 2020; 29:1281-1290. [PMID: 31898113 DOI: 10.1007/s11136-019-02404-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Kidney transplant recipients suffer from a variety of symptoms, and symptom management is crucial in improving their quality of life (QOL). Accordingly, this study aims to identify the symptoms experienced by kidney transplant recipients and examine the relationship amongst antecedents, symptom experience and QOL of recipients in China. METHODS A total of 300 kidney transplant recipients were investigated in one of the most first-rate hospitals in China by asking them to fill out a self-designed general questionnaire, the Symptom Experience Scale, the Sense of Coherence Scale (Chinese version), the Revised Life Orientation Test (Chinese version) and the 36-item Short Form Health Survey (Chinese version). RESULTS Kidney transplant recipients experienced multiple symptoms that were frequent, severe and bothersome. The final model showed significant consistency with the data. In the QOL model, post-transplant time, complications, immunosuppressive agents and sense of coherence explained 30.7% of the variance of symptom experience. Moreover, habitual residence, economic burden, post-transplant time, kidney function, optimism and symptom experience accounted for 70.6% of the variance on QOL. CONCLUSIONS We can explain the relationship between antecedents, symptom experience and QOL amongst Chinese kidney transplant recipients by using Symptoms Experience Model. Clinicians and caregivers can manage the recipient's symptoms during follow-up from psychological, physical and medication management perspectives. Improving sense of coherence, maintaining optimism and managing symptoms are essential for enhancing QOL.
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Affiliation(s)
- Han Wang
- School of Nursing, Beijing University of Chinese Medicine, Intersection of Yangguang South Street and Baiyang East Road, Fang Shan District, Beijing, 102488, China
| | - Chunyan Du
- School of Nursing, Beijing University of Chinese Medicine, Intersection of Yangguang South Street and Baiyang East Road, Fang Shan District, Beijing, 102488, China
| | - Hongxia Liu
- School of Nursing, Beijing University of Chinese Medicine, Intersection of Yangguang South Street and Baiyang East Road, Fang Shan District, Beijing, 102488, China.
| | - Shuping Zhang
- School of Nursing, Beijing University of Chinese Medicine, Intersection of Yangguang South Street and Baiyang East Road, Fang Shan District, Beijing, 102488, China
| | - Sisi Wu
- School of Nursing, Beijing University of Chinese Medicine, Intersection of Yangguang South Street and Baiyang East Road, Fang Shan District, Beijing, 102488, China
| | - Yingxin Fu
- Organ Transplant Centre, Tianjin First Central Hospital, Tianjin, China
| | - Jie Zhao
- Organ Transplant Centre, Tianjin First Central Hospital, Tianjin, China
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7
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Harrison JJ, Mansell H, Blydt-Hansen T. Adverse symptoms of immunosuppressants: A survey of Canadian transplant clinicians. Clin Transplant 2017; 31. [PMID: 28239910 DOI: 10.1111/ctr.12940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2017] [Indexed: 11/27/2022]
Abstract
Adverse symptoms of immunosuppressants (ASI) impact quality of life (QOL) in solid organ transplant recipients; however, standardized approaches for active ASI surveillance and intervention are lacking. While management is highly clinician dependent, clinician views remain largely unexplored. We surveyed Canadian Society of Transplantation members on their perceptions of ASI including frequency, perceived QOL impact, causal attribution, management strategies, and success. Sixty-one clinicians participated in the survey of 12 ASI (tremor, diarrhea, nausea, constipation, dyspepsia, insomnia, edema, dyspnea, arthralgia, acne, mouth sores, paresthesias), for a 22% response rate. Forty-nine completed the survey (80% completion rate). Diarrhea, dyspepsia, and insomnia were most frequent, requiring management in ≥ 2% of patients by 96%, 90%, and 82% of respondents, respectively. Diarrhea, insomnia, and dyspnea were deemed to have an important QOL impact by 92%, 82%, and 69%. Immunosuppressants were universally implicated as causative of tremor, diarrhea, acne, and mouth sores. Over 80% reported success in managing mouth sores, dyspepsia, and constipation. Management strategies included adjustment of immunosuppressant or other medications, drug therapy, and nonpharmacologic approaches and varied according to perceived causal attribution. More study is needed to compare clinician and patient views. These results will be used to establish priorities for further investigation of ASI.
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Affiliation(s)
- Jennifer J Harrison
- Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada.,Department of Pharmacy Services, Toronto General Hospital, University Health Network, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Holly Mansell
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada.,Saskatchewan Transplant Program, Saskatoon, SK, Canada
| | - Tom Blydt-Hansen
- Multi-Organ Transplant Program, BC Children's Hospital, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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8
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Oliveira RA, Turrini RNT, Poveda VDB. Adherence to immunosuppressive therapy following liver transplantation: an integrative review. Rev Lat Am Enfermagem 2016; 24:e2778. [PMID: 27579933 PMCID: PMC5016054 DOI: 10.1590/1518-8345.1072.2778] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 03/28/2016] [Indexed: 03/13/2023] Open
Abstract
OBJECTIVE to investigate the evidence available in the literature on non-adherence to immunosuppressive therapy among patients undergoing liver transplantation. METHOD integrative literature review, including research whose sample consisted of patients aged over 18 years undergoing liver transplantation. It excluded those containing patients undergoing multiple organ transplants. For the selection of articles, Medline / Pubmed, CINAHL, LILACS, Scopus and Embase were searched. The search period corresponded to the initial date of indexation of different bases, up to the deadline of February 10, 2015, using controlled and uncontrolled descriptors: liver transplantation, hepatic transplantation, liver orthotopic transplantation, medication adherence, medication non-adherence, medication compliance and patient compliance. RESULTS were located 191 investigations, 10 of which met the objectives of the study and were grouped into four categories, namely: educational process and non-adherence; non-adherence related to the number of daily doses of immunosuppressive medications; detection methods for non-adherence and side effects of therapy. CONCLUSION there were risk factors related to the health service, such as control and reduction of the number of doses; related to the individual, such as being male, divorced, alcohol or other substances user, exposed to low social support and being mentally ill.
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Affiliation(s)
- Ramon Antônio Oliveira
- Master's Student, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brazil
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9
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Teng S, Zhang S, Zhang W, Lin X, Shang Y, Peng X, Liu H. Symptom Experience Associated With Immunosuppressive Medications in Chinese Kidney Transplant Recipients. J Nurs Scholarsh 2015. [DOI: 10.1111/jnu.12157] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Sha Teng
- Master Degree Candidate; School of Nursing, Beijing University of Chinese Medicine; Beijing China
| | - Shuping Zhang
- Lecturer, School of Nursing; Beijing University of Chinese Medicine; Beijing China
| | - Wenxin Zhang
- Master Degree Candidate; School of Nursing, Beijing University of Chinese Medicine; Beijing China
| | - Xiaohong Lin
- Master Degree Candidate; School of Nursing, Beijing University of Chinese Medicine; Beijing China
| | - Yabin Shang
- Master Degree Candidate; School of Nursing, Beijing University of Chinese Medicine; Beijing China
| | - Xiao Peng
- Master Degree Candidate; School of Nursing, Beijing University of Chinese Medicine; Beijing China
| | - Hongxia Liu
- Associate Professor, School of Nursing; Beijing University of Chinese Medicine; Beijing China
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10
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Majernikova M, Rosenberger J, Prihodova L, Marcelli D, Roland R, Groothoff JW, van Dijk JP. Anemia has a negative impact on self-rated health in kidney transplant recipients with well-functioning grafts: findings from an 8-year follow-up study. Qual Life Res 2015; 25:183-92. [PMID: 26169231 DOI: 10.1007/s11136-015-1067-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE Anemia is a predictor of mortality and of self-rated health (SRH). However, studies on the relationship between SRH and changes in hemoglobin (Hb) value over time stratified by chronic kidney disease (CKD) stages are lacking. The aim is to explore whether a change in Hb-value over time associates with SRH at up to 8-year follow-up, stratified for CKD stages. METHODS A prospective study with a baseline measurement between the 3rd and 12th month after KT was performed on 337 consecutive patients. Demographic and clinical data were retrieved from medical records. CKD stages were estimated using the CKD-EPI formula and divided into two groups: CKD1-2 and CKD3-5. Generalized estimating equations (GEE) were performed to identify associations of SRH at follow-up in both CKD groups. RESULTS Male gender, new-onset diabetes mellitus after KT (NODAT), a decrease in estimated glomerular filtration rate (eGFR) and Hb-value over time contributed significantly to the GEE model on SRH at follow-up in CKD1-2. For SRH at follow-up in CKD3-5, older age, male gender and chronic renal allograft dysfunction (CRAD) contributed significantly to the GEE model. CONCLUSIONS At up to 8-year follow-up, male gender, NODAT, a decrease in eGFR and Hb-value over time are associated with poorer SRH in CKD1-2. In such patients, we suggest monitoring slight deteriorations in eGFR and Hb-values. In CKD3-5, higher age, male gender and higher presence of CRAD are associated with poorer SRH at up to 8-year follow-up. In these patients, adequate treatment would slow down CRAD progression.
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Affiliation(s)
- Maria Majernikova
- Nephrology and Dialysis Centre, Fresenius Medical Care - Dialysis Services Slovakia, Tr. SNP 1, 040 11, Kosice, Slovakia. .,Faculty of Medicine, Graduate School Kosice Institute for Society and Health, Safarik University, Kosice, Slovakia.
| | - Jaroslav Rosenberger
- Nephrology and Dialysis Centre, Fresenius Medical Care - Dialysis Services Slovakia, Tr. SNP 1, 040 11, Kosice, Slovakia.,Faculty of Medicine, Graduate School Kosice Institute for Society and Health, Safarik University, Kosice, Slovakia.,Department of Social Medicine, Faculty of Medicine, Institute of Public Health, Safarik University, Kosice, Slovakia.,Transplantation Department of the 1st Surgery Clinic, Faculty of Medicine, Safarik University, University Hospital, Kosice, Slovakia
| | - Lucia Prihodova
- Faculty of Medicine, Graduate School Kosice Institute for Society and Health, Safarik University, Kosice, Slovakia
| | | | - Robert Roland
- Nephrology and Dialysis Centre, Fresenius Medical Care - Dialysis Services Slovakia, Tr. SNP 1, 040 11, Kosice, Slovakia.,Transplantation Department of the 1st Surgery Clinic, Faculty of Medicine, Safarik University, University Hospital, Kosice, Slovakia
| | - Johan W Groothoff
- Department of Community and Occupational Health, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Jitse P van Dijk
- Faculty of Medicine, Graduate School Kosice Institute for Society and Health, Safarik University, Kosice, Slovakia.,Department of Community and Occupational Health, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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11
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Muehrer RJ, Brown RL, Lanuza DM. Depicting Changes in Multiple Symptoms Over Time. West J Nurs Res 2014; 37:1214-28. [PMID: 25027690 DOI: 10.1177/0193945914542163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ridit analysis, an acronym for Relative to an Identified Distribution, is a method for assessing change in ordinal data and can be used to show how individual symptoms change or remain the same over time. The purposes of this article are to (a) describe how to use ridit analysis to assess change in a symptom measure using data from a longitudinal study, (b) give a step-by-step example of ridit analysis, (c) show the clinical relevance of applying ridit analysis, and (d) display results in an innovative graphic. Mean ridit effect sizes were calculated for the frequency and distress of 64 symptoms in lung transplant patients before and after transplant. Results were displayed in a bubble graph. Ridit analysis allowed us to maintain the specificity of individual symptoms and to show how each symptom changed or remained the same over time. The bubble graph provides an efficient way for clinicians to identify changes in symptom frequency and distress over time.
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12
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Sullivan KM, Radosevich DM, Lake JR. Health-related quality of life: two decades after liver transplantation. Liver Transpl 2014; 20:649-54. [PMID: 24678028 DOI: 10.1002/lt.23855] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 02/08/2014] [Indexed: 02/07/2023]
Abstract
In this study, we describe a cohort of patients who received liver transplants before January 1, 1989 at the University of Minnesota Medical Center (UMMC), and we evaluate the health-related quality of life (HRQOL) of the survivors of this group. One hundred sixty-one patients--66 adults and 95 children--received whole deceased donor liver transplants. Thirteen transplants occurred before 1980, and all these patients died within 6 months; they were excluded from the survival analysis because they came from the pre-cyclosporine era. The survival rates at 1, 5, 10, and 20 years were 72%, 57%, 49%, and 37%, respectively (34% when pre-1980 patients were included). The median survival time was approximately 10 years for adult and pediatric recipients. The causes of death were ascertained by chart reviews. Technical failures were common between the years 1980 and 1984, and they decreased to 0% by 1988. As for HRQOL, 53 patients (36%) survived and were contacted to complete a 12-item health survey [Short Form 12 (SF-12)]. Retransplants were excluded. Sixty-eight percent returned the SF-12 survey. The median age for all respondents was 31.4 years: the median was 67.4 years for adult survivors and 28.8 years for pediatric survivors. The Mental Component Summary (MCS) score was 54.6 for adult survivors and 48.6 for pediatric survivors. The Physical Component Summary (PCS) score was 39.3 for adult survivors and 49.2 for pediatric survivors. Both the MCS and the PCS were norm-based to the US population with a mean of 50 and a standard deviation of 10. In conclusion, 35.8% of liver transplant recipients from UMMC were alive 20 years after liver transplantation. Technical failure-related deaths decreased dramatically from 1980 to 1988. The mental health of pediatric and adult survivors was similar to that of the general population. The physical health of the pediatric survivors was equivalent to that of the general population, but it was slightly less than what was expected with adjustments for age. The physical health of the adult survivors was approximately 1 standard deviation below that of the general population.
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Affiliation(s)
- Kara M Sullivan
- Department of Internal Medicine, University of Minnesota, Minneapolis, MN; Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, MN
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Ordin YS, Karayurt O, Cilengiroğlu OV. Validation and adaptation of the Modified Transplant Symptom Occurrence and Symptom Distress Scale-59 Items Revised into Turkish. Prog Transplant 2013; 23:392-400. [PMID: 24311405 DOI: 10.7182/pit2013743] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
CONTEXT The Modified Transplant Symptom Occurrence and Symptom Distress Scale-59 Items Revised (MTSOSD-59R) is a validated self-reported scale assessing patients' subjective experiences of adverse effects of immunosuppressants. It has been reported that the scale should be adapted and validated before it is used in patients of a different cultural (Brazilian, Dutch, German, French, Hindi, Italian, Spanish, and Swedish) background. OBJECTIVE To validate and adapt the MTSOSD-59R for use in Turkish transplant recipients. MATERIALS AND METHODS This cross-sectional study was performed between March 2010 and February 2011, and included 180 liver and kidney transplant recipients treated in 2 university hospitals in western Turkey. In addition, 180 healthy control participants were recruited from a community health service. Data were collected by using a demographic and clinical characteristics scale (MTSOSD-59R) and the Beck Depression Inventory. Items were translated in a culturally sensitive way by using forward-backward translation. Content validity was evaluated by using the content validity index. Ridit analysis and descriptive statistics helped to describe symptom experience in our population, and Mann Whitney U testing was used to compare patients versus healthy controls, depressed versus nondepressed patients, and male versus female patients for validity purposes. Split-half reliability analysis was used. RESULTS The content validity index was perfect (ie, value 1.0); the Turkish translation of the MTSOSD-59R had excellent known group validity. Split-half Spearman Brown corrected reliability coefficient was 0.991 for symptom occurrence and 0.992 for symptom distress. CONCLUSION The results suggest that the Turkish scale has appropriate language, content, and construct validity. This scale can now be used to assess the symptom experience related to immunosuppressive therapy in Turkish organ transplant recipients.
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Wang C, Wang G, Yi H, Tan J, Xu C, Fang X, Yang Y, Li H, Chen Q, Chen G. Symptom experienced three years after liver transplantation under immunosuppression in adults. PLoS One 2013; 8:e80584. [PMID: 24260427 PMCID: PMC3832465 DOI: 10.1371/journal.pone.0080584] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 10/04/2013] [Indexed: 01/12/2023] Open
Abstract
Background & Aims Immunosuppression-related symptom experience has not been covered thoroughly in long-term liver transplant recipients. The aim of this study was to assess the symptom experience of immunosuppressive therapy three years after liver transplantation and to correlate it with adherence to medications and sociodemographic or disease-related characteristics. Methods This study included 94 liver transplant recipients who had survived for more than 3 years after liver transplantation. Symptom experience was measured by the 59-Item Modified Transplant Symptom Occurrence and Symptom Distress Scale (MTSOSD-59R) at the outpatient visits. Adherence to immunosuppressive drugs was assessed using the Basel Assessment of Adherence with Immunosuppressive Medication Scale (BAASIS). Results Itching, concentration or memory problems, and fatigue were the three most frequent or most distressing symptoms. Factors significantly associated with a higher level of symptom frequency and distress were 3- to 5-year time cohort (i.e., time post-transplantation), and younger age. At the item level, concentration or memory problems were the most frequent and distressing symptoms in the 3- to 5-year time cohort. Itching was the most frequent and distressing symptom in the 5- to 9-year time cohort. Finally, relationship was found between symptom experience and nonadherence to immunosuppressive drugs. Conclusions Symptoms related to physical complaints or impairments were more often perceived and more distressing for liver transplant recipients 3 years after transplantation. Furthermore, the 3- to 5-year time cohort and younger age were associated with a higher degree of perceived symptom occurrence and symptom distress. Finally, recipients who perceived higher levels of symptom frequency and symptom distress reported higher levels of nonadherence.
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Affiliation(s)
- Chaoying Wang
- Nursing School, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Genshu Wang
- Department of Hepatic Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Huimin Yi
- Department of Hepatic Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jianling Tan
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Chi Xu
- Department of Hepatic Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaocui Fang
- Department of Hepatic Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yang Yang
- Department of Hepatic Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Hua Li
- Department of Hepatic Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qier Chen
- Department of Hepatic Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- * E-mail: (QC); (GC)
| | - Guihua Chen
- School of Nursing, Sun Yat-sen University, Guangzhou, China
- * E-mail: (QC); (GC)
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Reilly-Spong M, Park T, Gross CR. Poor sleep in organ transplant recipients: self-reports and actigraphy. Clin Transplant 2013; 27:901-13. [PMID: 24118416 PMCID: PMC3855625 DOI: 10.1111/ctr.12255] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2013] [Indexed: 12/26/2022]
Abstract
Solid organ transplant recipients are at increased risk of poor sleep due to pharmacotherapy and co-morbidities, but sleep problems are often unrecognized and untreated. Study aims were to measure rates of occurrence, characteristics, and correlates of poor sleep in recipients. The Pittsburgh Sleep Quality Index (PSQI) and sleep parameters measured by wrist actigraphy were obtained at baseline from 143 kidney, liver, heart, lung, or pancreas transplant recipients enrolled in a psychosocial intervention trial to improve symptoms and quality of life. Rates of poor sleep were determined using accepted clinical cutoffs; 41% (58 of 143) were poor sleepers (PSQI > 8) and 36% used sleep medications in the past month. Fifteen percent reported having obstructive sleep apnea (OSA) and 4% reported restless legs syndrome (RLS). Based on actigraphy (n = 73), 69% lacked sleep efficiency (SE), 32% took >30 min to fall asleep, 88% awakened during the night for more than 30 min, and 25% slept less than six h per night. Obesity and use of psychotropics or sleep medications, and pain were independent risk factors for poor objectively measured sleep. Poor sleep is an undertreated problem in transplantation. Screening for sleep problems and behavioral therapies with sleep hygiene instruction may benefit recipients.
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Affiliation(s)
- M Reilly-Spong
- College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
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16
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Lanuza DM, Lefaiver CA, Brown R, Muehrer R, Murray M, Yelle M, Bhorade S. A longitudinal study of patients' symptoms before and during the first year after lung transplantation. Clin Transplant 2012; 26:E576-89. [PMID: 22988999 DOI: 10.1111/ctr.12002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2012] [Indexed: 12/28/2022]
Abstract
BACKGROUND Lung transplantation provides a viable option for survival of end-stage respiratory disease. In addition to prolonging survival, there is considerable interest in improving patient-related outcomes such as transplant recipients' symptom experiences. METHODS A prospective, repeated measures design was used to describe the symptom experience of 85 lung transplant recipients between 2000 and 2005. The transplant symptom inventory was administered before and at one, three, six, nine, and 12 months post-transplant. Ridit analysis provided a unique method for describing symptom experiences and changes. RESULTS After lung transplantation, significant (p<0.05) improvements were reported for the most frequently occurring and most distressing pre-transplant symptoms (e.g., shortness of breath with activity). Marked increases in the frequency and distress of new symptoms such as tremors were also reported. Patterns of symptom frequency and distress varied with time since transplant. CONCLUSION The findings provide data-based information that can be used to inform pre- and post-transplant patient education and also help caregivers anticipate a general time frame for symptom changes to prevent or minimize symptoms and their associated distress. In addition, symptoms are described, using an innovative method of illustration which shows "at-a-glance" change or lack of change in patients' symptoms from pre- to post-lung transplant.
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Affiliation(s)
- Dorothy M Lanuza
- University of Wisconsin-Madison, School of Nursing, and Hospital and Clinics, Madison, WI 53792-2455, USA.
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17
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Forsberg A, Persson LO, Nilsson M, Lennerling A. The organ transplant symptom and well-being instrument - psychometric evaluation. Open Nurs J 2012; 6:30-40. [PMID: 22523527 PMCID: PMC3330362 DOI: 10.2174/1874434601206010030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 02/18/2012] [Accepted: 02/20/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is a need for instruments combining measurements of symptom distress and well-being in the organ transplant population. OBJECTIVES The aim of this study was to describe the development and initial psychometric evaluation of a measure of symptoms and well-being in organ transplant recipients labelled the Organ Transplant Symptom and Well-being instrument (OTSWI) and to provide descriptive data on these matters. METHOD In this cross sectional survey, the study sample (n=185) completed several measures including demographic information, the Short form- 36 items (SF-36), and the OTSWI to assess concurrent validity by exploring relationships between OTSWI and measures of health related quality of life (HRQOL). The expected scale dimensionality of the OTSWI questionnaire was examined both by the confirmatory multi-trait analysis program and by explorative principal component analysis (with oblique, varimax rotation). Scale reliability was further estimated using the Cronbach's alpha. RESULTS There were eight factors built up from twenty of the initial fifty one items and were labelled fatigue, joint and muscle pain, cognitive functioning, basic activities in daily life, sleeping problems, mood, foot pain and economy. For the remaining twenty-one items no consistent and meaningful factors could be found leading to relevant symptoms acting as single items. All eight factors had satisfying internal convergent validity as well as good item-scale discriminatory validity or 'success rate'. DISCUSSION Results support the internal consistency, reliability and concurrent validity of the OTSWI as an instrument to measure symptom distress and well-being in relation to organ transplantation. (Word count 244).
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Affiliation(s)
- Anna Forsberg
- The Sahlgrenska Academy at University of Gothenburg, Institute of Health and Caring Sciences
- The Faculty of Medicine at Lund University, Department of Health Sciences
| | - Lars-Olof Persson
- The Sahlgrenska Academy at University of Gothenburg, Institute of Health and Caring Sciences
| | - Madeleine Nilsson
- The Queen Silvia’s Children Hospital at Sahlgrenska University Hospital, Gothenburg
| | - Annette Lennerling
- The Sahlgrenska Academy at University of Gothenburg, Institute of Health and Caring Sciences
- The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
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18
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Burra P, Germani G, Gnoato F, Lazzaro S, Russo FP, Cillo U, Senzolo M. Adherence in liver transplant recipients. Liver Transpl 2011; 17:760-70. [PMID: 21384527 DOI: 10.1002/lt.22294] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Adherence to a medical regimen has been defined as the extent to which a patient's behavior coincides with clinical prescriptions. In liver transplant patients, adherence to immunosuppressive therapy and to medical indications in general is crucial for short- and long-term outcomes. Nonadherence to immunosuppression carries a risk of graft rejection and potential graft loss, whereas nonadherence to general medical indications (eg, avoiding alcohol intake and smoking after transplantation) may be associated with other complications such as de novo tumors and increasing health care costs. Among adult liver transplant patients, the rate of nonadherence to immunosuppressive drugs ranges from 15% to 40%, whereas the rate of nonadherence to clinical appointments ranges from 3% to 47%. The wide range of reported rates is due to different definitions of the term nonadherence and the variety of methods used to measure adherence in the medical literature. Nonadherence seems to be nearly 4 times higher in pediatric and adolescent patients versus adult transplant recipients. Several nonadherence risk factors, such as high medication costs, psychiatric disorders, the conviction that the medication is harmful, and side effects of immunosuppressive therapy, have been described among adult liver transplant patients. The risk factors for nonadherence in pediatric and adolescent liver transplant patients are psychological distress, the functional status of their families, and the impact of immunosuppressive side effects on their physical appearance. A single approach to promoting adherence to general medical prescriptions has been proved to be ineffectual, so a multidisciplinary strategy should be adopted to achieve significant improvements in this field. The aim of this review is to analyze the published literature on adherence in liver transplant patients with a particular focus on the reported prevalence and the identified risk factors. Patients have been split into 2 age groups (adults and children/adolescents) because the scale of the problem and the potential risk factors differ in the 2 groups.
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Affiliation(s)
- Patrizia Burra
- Gastroenterology, Multivisceral Transplant Unit, Department of Surgical and Gastroenterological Sciences, University of Padua, Padua, Italy.
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Medikamentenbezogene Non-Adherence und Symptombelastungen nach Herztransplantation. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2011. [DOI: 10.1007/s00398-011-0834-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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20
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Majernikova M, Prihodova L, Rosenberger J, Nagyova I, Roland R, Groothoff JW, van Dijk JP. Factors associated with self-rated health after kidney transplantation: a prospective study. Am J Nephrol 2011; 33:364-9. [PMID: 21447943 DOI: 10.1159/000326336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 02/21/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND This prospective study explores and compares the relationship between patients' self-rated health (SRH) after kidney transplantation (KT) at different follow-up periods and its medical and nonmedical predictors over time. METHODS Patients (n = 128) who completed a questionnaire (the SRH question of the SF-36 and the End-Stage Renal Disease Symptom Checklist - Transplantation Module) were enrolled. Clinical data were retrieved from medical files. The sample was stratified into early (n = 89) and late (n = 39) cohorts according to time since KT at baseline. Linear regression was used to identify predictors of SRH at follow-up. RESULTS In both cohorts, a change in glomerular filtration rate (GFR) over time remained a predictor of SRH; in the early cohort, age was an additional predictor; in the late cohort, a change in transplantation-associated psychological distress over time and the number of late acute rejection episodes during the observation period were additional predictors. CONCLUSIONS Improvement in GFR over time predicted better SRH at each period after KT. Decreased transplantation-associated psychological distress and fewer late acute rejection episodes seemed to predict better SRH at a later follow-up period. Despite these observations, higher SRH was associated with better clinical outcomes.
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Affiliation(s)
- Maria Majernikova
- Nephrology and Dialysis Centre, Fresenius Medical Care, Kosice, Slovakia.
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Driscoll CJ, Lyon D, McCain NL. Integrating genomics into biobehavioral research: a transplantation exemplar. Biol Res Nurs 2011; 13:340-5. [PMID: 21196421 DOI: 10.1177/1099800410389603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Biobehavioral research is becoming more established in nursing. This research paradigm includes a focus on the interactions of biological and behavioral variables and their impact on health outcomes. Nurse researchers have incorporated genomics as a research focus. However, biobehavioral and genomic approaches have often been viewed as separate paradigms. This article provides research exemplars from the liver transplantation population to illustrate how genomics can be integrated into a biobehavioral model of nursing research. Examples of how this integrated approach may be utilized to address gaps of knowledge are provided.
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Affiliation(s)
- Carolyn J Driscoll
- Virginia Commonwealth University School of Nursing, 1100 E. Leigh St, Richmond, VA 23298, USA.
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22
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Taylor RM, Franck LS, Gibson F, Donaldson N, Dhawan A. Study of the factors affecting health-related quality of life in adolescents after liver transplantation. Am J Transplant 2009; 9:1179-88. [PMID: 19422342 DOI: 10.1111/j.1600-6143.2009.02604.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The aim of the study was to identify factors affecting health-related quality of life (HRQL) in adolescents after liver transplantation. HRQL was measured using the CHQ-CF87 in 55 adolescents, aged 12-18 years. Factors associated with HRQL included allograft morbidity, psychological and family-related variables measured through standardized questionnaires. The domains of the CHQ-CF87 were reduced using factor analysis to give physical, psychological and social domains. Impacting factors were identified through stepwise, multiple regression analysis. Adolescents had significantly lower HRQL in every domain except for role/social-behavior and family cohesion compared to the general population. Adolescents experienced median 18 (range 4-31) symptoms related to immunosuppression, 40(75%) had one or more chronic illnesses related to immunosuppression and 12(22%) had a history of emotional difficulties. Self-esteem and emotional health were similar to the general population but behavior and aspects of family function were lower. Following regression analysis, the factors associated with HRQL were: age at transplant, secondary chronic illness, symptom distress, headaches, history of emotional difficulties, self-esteem and family conflict. These explained 57% of the variance in physical function, 61% of psychological function and 39% of social function. HRQL is significantly reduced in adolescents after transplantation, which could be related to immunosuppression and psychosocial factors.
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Affiliation(s)
- R M Taylor
- Paediatric Liver Centre, King's College London School of Medicine at King's College Hospital, NHS Foundation Trust, London, UK.
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