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Olkowski B, Marczak Z, Rostkowska OM, Miszewska-Szyszkowska D, Kozińska-Przybył O, Durlik M, Żak J. Sleep Patterns in Patients After Solid Organ Transplantation Including Gender and Age Differences. Survey Results From One Transplantation Centre in Poland. Transplant Proc 2024; 56:935-947. [PMID: 38584020 DOI: 10.1016/j.transproceed.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/24/2024] [Accepted: 02/29/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Sleep plays a crucial role in maintaining health. Transplant patients are exposed to numerous stressors and are at risk of sleep disturbances. The aim of this study was to assess the sleep patterns of transplant patients. METHODS An anonymous paper survey was carried out among patients from one transplant center in Poland. Respondents were asked about the quality and quantity of sleep and the overall impact of the transplantation on their night rest. Data were collected from June to November 2023. RESULTS Data were obtained from 212 respondents (122 males and 90 females), aged 48.38 ± 13.68. The positive impact of transplantation on sleep hygiene was indicated by 57.4% of respondents, 28.9% observed no impact, and 13.6% rated the impact as negative. Our study showed that sleep is more satisfying in males than in females (62.8% of males and 46.7% of females). The analysis revealed that 38.9% of females need 30 minutes more than men to fall asleep. Additionally, females tend to get up half an hour later compared to men. About 71.9% of males declared good well-being the next day compared to 62.2% of females. Furthermore females declared more sleepiness the next day. The study also showed that older transplant recipients (over 50 years-of-age) report more frequent awakenings at night. CONCLUSIONS The data collected showed differences in sleep patterns according to gender and age. Females and older patients should be screened for sleep disturbances during post-transplantation care.
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Affiliation(s)
- Bartosz Olkowski
- Students' Scientific Club by the Department of Transplantation, Immunology, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Zuzanna Marczak
- Students' Scientific Club by the Department of Transplantation, Immunology, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.
| | - Olga Maria Rostkowska
- Department of Transplantation, Immunology, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Dorota Miszewska-Szyszkowska
- Department of Transplantation, Immunology, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Olga Kozińska-Przybył
- Department of Transplantation, Immunology, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Durlik
- Department of Transplantation, Immunology, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Julia Żak
- Students' Scientific Group of Lifestyle Medicine, 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
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Bartoszewicz M, Prokop P, Kosieradzki M, Fiedor P. Are Current Educational and Therapeutic Programs, Directed at Rare Disease Transplant Candidates and Recipients, Sufficient to Support Them on the Path From Diagnosis to Life After Allogenic Transplantation?-Recommendations for Member State Policymakers. Transplant Proc 2024; 56:907-909. [PMID: 38811302 DOI: 10.1016/j.transproceed.2024.01.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/23/2024] [Indexed: 05/31/2024]
Abstract
For many rare disease (RD) patients, allogenic transplantation represents an effective therapy, improving overall survival rates and quality of life (QoL). Globally, ∼1% of liver transplants are performed for RDs and rare indications. However, patients and carers report unmet needs on their pathway toward treatment-in education and therapeutic measures, oftentimes shouldering expertise-building responsibility themselves. These issues are exacerbated in child patients. Estimates indicate that 6% to 8% of Poland's population (2.3-3 million persons) are burdened by RDs and potentially face such issues. This work aims to identify shortcomings of Polish policy in the field of educational and therapeutic measures for RD transplant candidates and recipients. Based on solutions introduced by pioneers, recommendations are formulated regarding priority actions. An analysis of national, transnational, and individual-center programs, directed at patients during their path from diagnosis to life post-transplant, was conducted. The investigation uncovered measure gaps not addressed by the National Plan for Rare Diseases-in fields of patient and stakeholder education (pre- and post-transplant), psychological care provision, specialized center creation, integration of data scattered among registries with the national insurer's database, and artificial intelligence (AI) tool implementation to support both early diagnostic efforts and tailoring of patient treatment. Programs directed at RD transplant candidates and recipients must aim to ensure that a satisfactory psychosomatic condition of the patient is maintained before and following the procedure, therefore lending credence to success. This necessitates early diagnosis schemes, and personalized medicine, multidisciplinary approaches to the individual, achievable only through big data system creation and AI introduction.
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Affiliation(s)
- Marcin Bartoszewicz
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Patrycja Prokop
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Kosieradzki
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Fiedor
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland; GA - European Joint Programme on Rare Diseases.
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Darsini D, Notobroto HB, Afiyah RK, Cahyono EA, Aryani HP, Rahman FS. Quality of Life of Hemodialysis Patients during COVID-19 Pandemic in Gatoel Hospital, Mojokerto City. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM: The purpose of this study was to analyze the quality of life of hemodialysis patients during the COVID-19 pandemic.
METHODS: This study used a descriptive design. The sample in this study was hemodialysis patients at the Gatoel Hospital, Mojokerto City, as many as 122 respondents who were determined using simple random sampling technique. The sample criteria in this study were hemodialysis patients at Gatoel Hospital, Mojokerto City, undergoing hemodialysis therapy <2 years, and willing to participate in research activities. The research instrument used was adopted from the WHOQOL-BREF questionnaire.
RESULTS: From the results of the study, it was found that more than half of the respondents had poor physical health dimensions as many as 62 respondents (50.8%), more than half of respondents had poor mental health dimensions as many as 68 respondents (55.7%), more than half of respondents had social health dimensions. Bad as many as 62 respondents (50.8%) and most respondents have poor functional health dimensions as many as 74 respondents (60.7%).
CONCLUSION: It was found that more than half of the respondents in this study had poor quality of life. More than half of the respondents had physical health dimensions in the poor category, more than half of the respondents had mental health dimensions in the bad category, more than half of the respondents had social health dimensions in the bad category and most of the respondents had functional health dimensions in the bad.
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Clinical factors and comorbidities affecting health-related quality of life in postrenal transplant patients. Porto Biomed J 2021; 6:e131. [PMID: 34136716 PMCID: PMC8202575 DOI: 10.1097/j.pbj.0000000000000131] [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] [Received: 11/04/2020] [Accepted: 01/25/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Health-related quality of life is different among different transplant cohorts with respect to different variables which predict mortality and graft survival. The aim of this study was to identify the effects of clinical factors on the health-related quality of life in postrenal transplant patients. Methods: This census study was conducted at the Institute of Kidney Diseases Peshawar, Pakistan. Data were collected on a questionnaire “ Kidney Diseases Quality of Life-Short Form-1.3 Urdu version” and were analyzed in the 3 main domains, for example, physical component summary (PCS), mental component summary, and kidney disease component summary using SPSS version 21. Mean scores for patients with diabetes mellitus (DM), hypertension, levels of hemoglobin, and serum creatinine were compared by unpaired t-test. Results: A total of 277 men (87.9%) and 38 (12.1%) women participated in the study. Mean age was 37.26 (±10.14) years (range 18–65 years). Hypertension was reported in 72.2% and DM in 10.8%. Hemoglobin was <12.5g% in 26.0% patients. Patients with DM had significant lower PCS (P = .001) and mental component summary (MCS; P = .001) scores. Patients with hypertension had significant lower MCS score (P = .01). Patients with hemoglobin <12.5g% had significantly lower PCS (P = .001) score than those with hemoglobin >12.5 g%. The PCS score in patients with serum creatinine level >2 mg% was significantly lower (P = .02) than those with serum creatinine <2 mg%. Conclusion: Lower graft function and DM were associated with lower PCS and MCS scores. Hypertension was associated with lower MCS score and anemia with lower PCS score.
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Amatya K, Monnin K, Steinberg Christofferson E. Psychological functioning and psychosocial issues in pediatric kidney transplant recipients. Pediatr Transplant 2021; 25:e13842. [PMID: 33012109 DOI: 10.1111/petr.13842] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/17/2020] [Accepted: 08/13/2020] [Indexed: 12/13/2022]
Abstract
Research demonstrates that psychological factors are important for positive transplant outcomes, though there is little literature that synthesizes these factors in a comprehensive model among pediatric kidney transplant patients. This review analyzes psychological and psychosocial factors related to medical outcomes and overall well-being post-transplant by utilizing the PPPHM and referencing the existing literature on risk and resilience. Pediatric kidney transplant recipients are more susceptible to mental health concerns such as depression, anxiety, and ADHD, as well as developmental and neurocognitive delays, compared to healthy peers. Complex medical care and psychosocial needs for patients have implications for family functioning, parental and sibling mental health, and youth readiness to transition to adult care. It is important to carefully monitor patient functioning with empirically validated tools and to intervene in a multidisciplinary setting as early as possible to identify patients at risk and reduce potential negative impact. Psychologists are uniquely trained to assess and address these issues and are a valuable component of multidisciplinary, culturally competent care. While research in this expansive field is improving, more data are needed to establish gold standard approaches to mental health and psychosocial care in this population.
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Affiliation(s)
- Kaushalendra Amatya
- Divisions of Nephrology and Cardiology, Children's National Hospital, Washington, DC, USA.,Pediatrics and Psychiatry & Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Kara Monnin
- Pediatric Mental Health Institute, Children's Hospital Colorado, Aurora, CO, USA
| | - Elizabeth Steinberg Christofferson
- Solid Organ Transplant Surgery, Children's Hospital Colorado, Aurora, CO, USA.,Departments of Psychiatry and Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
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6
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Zhao Q, Zhang S, Yu R. Impact of Pre-Transplantation Psychological Counseling in Improving the Mental Well-Being of Patients on Hemodialysis. Front Psychiatry 2021; 12:594670. [PMID: 33633604 PMCID: PMC7900497 DOI: 10.3389/fpsyt.2021.594670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 01/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Patients who are on hemodialysis (HD) and are waiting for kidney transplantation encounter various psychological issues. Objective: The current research aimed to compare the effectiveness of regular nursing care with that of nursing care coupled with dedicated psychological counseling in patients who were on HD before they underwent kidney transplantation. Methods: Baseline data were collected 1 month before kidney transplantation in patients of both the control (patients who received general nursing care between August 2011 and June 2015) and intervention (patients who received nursing care and psychological counseling between June 2015 and July 2018) groups. The Mental Status Scale in Non-Psychiatric Settings (MSSNS) was administered to assess and record the psychological status. Clinicodemographic and end-stage renal disease (ESRD)-related details, including duration of dialysis, causes for ESRD, the number of dialysis sessions performed before transplantation, and MSSNS scores, were recorded and compared between the groups. Results: A total of 37 patients were enrolled, including 19 in the control group and 18 in the intervention group. The number of dialysis sessions performed before transplantation was 143 (26, 564) and 227.5 (39, 767), and dialysis duration was 20.4 ± 14.5 and 14.4 ± 12.1 months in the intervention and control groups, respectively. There was no significant difference in baseline negative emotions between the two groups (P > 0.05). The psychological intervention group reported significantly lower anxiety, depression, anger, and loneliness scores than the control group (P < 0.05). Conclusion: Psychological counseling before kidney transplantation in patients on HD could reduce their negative emotions and enhance mental well-being.
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Affiliation(s)
- Qianyun Zhao
- Blood Purification Center, The Second Hospital of Anhui Medical University, Hefei, China
| | - Sen Zhang
- Department of Nephrology, The Second Hospital of Anhui Medical University, Hefei, China
| | - Ran Yu
- Blood Purification Center, The Second Hospital of Anhui Medical University, Hefei, China
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Ranabhat K, Khanal P, Mishra SR, Khanal A, Tripathi S, Sigdel MR. Health related quality of life among haemodialysis and kidney transplant recipients from Nepal: a cross sectional study using WHOQOL-BREF. BMC Nephrol 2020; 21:433. [PMID: 33046010 PMCID: PMC7552453 DOI: 10.1186/s12882-020-02085-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/02/2020] [Indexed: 12/05/2022] Open
Abstract
Background Very less is known about health-related quality of life (HRQOL) among patients with kidney diseases in Nepal. This study examined HRQOL among haemodialysis and kidney transplant recipients in Nepal. Methods The Nepali version of World Health Organization Quality of Life Instruments -(WHOQOL-BREF) questionnaire was administered using face to face interviews among end stage renal disease (ESRD) patients, from two large national referral centers in Nepal. The differences in socio-demographic characteristics among ESRD patients were examined using the Chi-square test. The group differences in quality of life (QOL) were examined using the Mann-Whitney U test and Kruskal-Wallis tests. Results Of the 161 participants, 92 (57.1%) were renal transplant recipients and 69 (42.9%) patients were on maintenance haemodialysis. Hypertension (70.9%) was the most common co-morbidity among ESRD patients. Haemodialysis patients scored significantly lower than the transplant recipients in all four domains as well as in overall perception of quality of life and general health. Ethnicity (p = 0.020), socio-economic status (p < 0.001), educational status (p < 0.001) and employment status (p = 0.009) were significantly associated with the overall QOL in ESRD patients. Across patient groups, educational status (p = 0.012) was positively associated with QOL in dialysis patients, while urban residence (p = 0.023), higher socio-economic status (p < 0.001), higher educational status (p = 0.004) and diabetes status (p = 0.010) were significantly associated with better QOL in transplant recipients. Conclusion The overall QOL of the renal transplant recipients was higher than that of the patients on maintenance haemodialysis; this was true in all four domains of the WHOQOL-BREF. ESRD patients with low HRQOL could benefit from targeted risk modification intervention.
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Affiliation(s)
- Kamal Ranabhat
- Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal.,Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Pratik Khanal
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
| | | | - Anu Khanal
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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Grubman-Nowak M, Jeżewska M, Szafran-Dobrowolska J, Ślizień AD, Renke M. Occupational Activity After Renal Transplantation vs Quality of Life, Personality Profile, and Stress Coping Styles. Transplant Proc 2020; 52:2423-2429. [PMID: 32576475 DOI: 10.1016/j.transproceed.2020.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/09/2020] [Accepted: 03/30/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Kidney transplantation (KT) increases the quality of life (QoL) of patients with chronic kidney disease. Employment is one the objective indicators of KT success. The aim of the presented study was to assess the psychological predispositions of KT and hemodialysis (HD) patients, such as stress coping styles, chosen personality features, and their relationship with employment and QoL. MATERIAL AND METHODS One hundred and sixty-one persons were examined, 101 after KT, and 60 HD patients. The following methods were applied: NEO-FFI Personality Inventory; Coping Inventory for Stressful Situations (CISS); WHOQoL-BREF; and general survey, measuring sociodemographic data and work experience. RESULTS In the KT group, 58 persons were employed and 43 were unemployed. HD patients were mostly unemployed, with only 15 persons working. Significant differences were identified between the results of the following variables: WHOQoL environmental scale (employed m= 16.8, standard deviation [SD] = 3; unemployed m= 15, SD = 2.8); extraversion (employed m = 6.7, SD = 2; unemployed m = 5.6, SD = 2); somatic WHOQoL scale (HD m = 12.2, SD = 2.7; KT m = 14.2, SD = 3.5). In the KT group, the following correlations were identified: extraversion with contact seeking strategy (r = 0.553), agreeableness (r = 0.245), and conscientiousness (r = 0.384); agreeableness with conscientiousness (r = 0.336). In the HD group, the following correlations were identified: task-oriented style with conscientiousness (r = 0.474); avoidance-oriented style with conscientiousness (r = -0.466); contact seeking with extraversion (r = 0.402) and agreeableness (r = 0.469). CONCLUSIONS The following conclusions were reached: Social competence, such as seeking and maintaining contacts, positively translates to features connected with occupational activity. Social skills strengthen the organization of healthier environment and increase QoL. Employed patients have higher social skills and QoL.
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Affiliation(s)
- Marta Grubman-Nowak
- Clinic of Occupational, Metabolic and Internal Diseases, Medical University of Gdańsk, Gdańsk, Poland.
| | - Maria Jeżewska
- Clinic of Occupational, Metabolic and Internal Diseases, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Alicja Dębska Ślizień
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdańsk, Gdańsk, Poland
| | - Marcin Renke
- Clinic of Occupational, Metabolic and Internal Diseases, Medical University of Gdańsk, Gdańsk, Poland
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9
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McKeaveney C, Noble H, Courtney AE, Gill P, Griffin S, Johnston W, Maxwell AP, Teasdale F, Reid J. Understanding the holistic experiences of living with a kidney transplant: an interpretative phenomenological study (protocol). BMC Nephrol 2020; 21:222. [PMID: 32527229 PMCID: PMC7289222 DOI: 10.1186/s12882-020-01860-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/20/2020] [Indexed: 11/11/2022] Open
Abstract
Background Currently very little is known about the perceptions and experiences of kidney transplant recipients from a qualitative perspective. As highlighted by the European Kidney Health Alliance recommendations, providing holistic care to kidney patients is important however this is currently an unmet care need in renal disease. It is imperative to understand patient experiences to ensure that they are included in key strategies and future renal service planning. Ignoring these important patient views means that there is a significant risk of inappropriate renal service provision and lack of adequate support impacting on overall health. Method A purposive sampling strategy will recruit individuals currently living with a kidney transplant, 6 months to 5 years post-transplant. A maximum of 30 patients will be recruited between two Regional Nephrology units within the United Kingdom via clinical gatekeepers. In-depth interviews will be undertaken with participants living with a kidney transplant across the two sites. Interviews will be digitally-recorded, transcribed verbatim and subjected to interpretative phenomenological analysis. Discussion Renal healthcare professionals need to understand more than the biological impact of receiving a kidney transplant. Understanding the holistic and multi-domain experiences that these patients experience will help healthcare professionals to recognize the needs of this group and ensure more responsive care.
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Affiliation(s)
| | - H Noble
- Queen's University Belfast, Belfast, UK
| | | | - P Gill
- Cardiff University, Cardiff, UK
| | - S Griffin
- University Hospital of Wales, Cardiff, UK
| | - W Johnston
- Northern Ireland Kidney Patients Association, Belfast, UK.,Kidney Care UK, Alton, UK
| | - A P Maxwell
- Queen's University Belfast, Belfast, UK.,Belfast Health & Social Care Trust, Belfast, UK
| | | | - J Reid
- Queen's University Belfast, Belfast, UK.
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Jabali SS, Saleem ZSM, Mohammed AA, Mahmood NM. Erectile dysfunction pre and post kidney transplant recipients in Duhok city; cross sectional study. Ann Med Surg (Lond) 2020; 55:107-110. [PMID: 32477507 PMCID: PMC7251300 DOI: 10.1016/j.amsu.2020.04.038] [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: 12/20/2019] [Revised: 04/17/2020] [Accepted: 04/25/2020] [Indexed: 01/29/2023] Open
Abstract
Introduction Sexual dysfunction is a common problem in patients with chronic kidney disease. Disturbances in sexual function are noticed in early stages of chronic kidney diseases and deteriorate further as renal function declines. This is due to uremic effects, comorbid illness, anemia, hormonal disturbances, autonomic neuropathy, vascular diseases, hyperparathyroidism, hyperprolactinemia, side effects of medications, and psychosocial factors. Patients and method This is a cross-sectional study which included 59 male patients who underwent renal transplantation for more than 6 months. The International Index of Erectile Function (IIEF-5) was adopted in our study to record the erectile function. Results The mean age was 49.41 years, and the mean number of hemodialysis per month was 5.31. The cause of the chronic kidney disease was diabetes mellitus in 35.59%, glomerulonephritis in 20.34%, and hypertension in 16.95%, other causes were diagnosed in order of decreasing frequency. Most patients developed improvement in the erectile function after transplantation. There was significant correlation with 3 of the elements of the IIFE-5.i.e; penile hardness pre-penetration, Maintaining erection during intercourse, and Difficulty to maintain erection to complete the intercourse (p values 0.015, 0.011, and 0.023) respectively, and the overall improvement after transplantation which showed a p-value of less than 0.031, while there was no significant correlation with Confidence with erection and Satisfaction with intercourse before and after transplantation (p values 0.113 and 0.121) respectively. One of the patients (1.7%) developed severe dysfunction after that. Conclusion ED is common sequel of chronic kidney disease. The etiology is multifactorial and may be worsen by advanced age, presence of diabetes mellitus and prolonged duration of hemodialysis. Renal transplantation has a positive impact on sexual function and lead to improvement of erectile dysfunction. Erectile dysfunction that persists after kidney transplantation is usually attributed to multiple preexisting comorbidities. Sexual dysfunction is a common problem in patients with chronic kidney disease. The etiology of Sexual dysfunction is multifactorial. Renal transplantation has a positive impact on sexual function.
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Affiliation(s)
- Shakir Saleem Jabali
- Urologist, Department of Surgery, College of Medicine, University of Duhok, Kurdistan Region, Iraq
| | - Zana Sidiq M Saleem
- Nephrologist, Department of Medicine, College of Medicine, University of Duhok, Kurdistan Region, Iraq
| | - Ayad Ahmad Mohammed
- General Surgeon, Department of Surgery, College of Medicine, University of Duhok, Kurdistan Region, Iraq
| | - Newar M Mahmood
- Urologist, Duhok Directorate General of Health, Kurdistan Region, Iraq
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Jones J, Damery S, Allen K, Nicholas J, Baharani J, Combes G. 'You have got a foreign body in there': renal transplantation, unexpected mild-to-moderate distress and patients' support needs: a qualitative study. BMJ Open 2020; 10:e035627. [PMID: 32234745 PMCID: PMC7170619 DOI: 10.1136/bmjopen-2019-035627] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To explore why transplant patients experience unexpected mild-to-moderate distress and what support they may need. DESIGN Qualitative study using individual in-depth interviews. SETTING Four National Health Service (NHS) Trusts in the Midlands, UK. PARTICIPANTS Fifteen renal transplant patients meeting the criteria for mild-to-moderate distress from their responses to emotion thermometers. MAIN OUTCOME MEASURES Identification of the reasons for distress and support options acceptable to renal transplant patients. RESULTS Three themes were interpreted from the data: 'I am living with a "foreign body" inside me', 'why am I distressed?' and 'different patients want different support'. Following their transplant, participants felt that they should be happy and content, but this was often not the case. They described a range of feelings about their transplant, such as uncertainty about the lifespan of their new kidney, fear of transplant failure or fear of the donor having health conditions that may transfer to them. A few experienced survivors' guilt when others they had met at the dialysis unit had not received a transplant or because someone had died to enable them to receive the transplant. No longer having regular contact with the renal unit made participants feel isolated. Some participants did not initially attribute the source of their distress to their transplant. Participants' preferred support for their distress and their preferences about who should deliver it varied from peer support to seeing a psychologist. CONCLUSIONS Raising the issue of post-transplant mild-to-moderate distress with patients and encouraging them to think about and plan coping strategies pretransplant may prove beneficial for the patient and healthcare provider. Patients should be able to choose from a variety of support options.
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Affiliation(s)
- Janet Jones
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sarah Damery
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kerry Allen
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Johann Nicholas
- Renal Unit, Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, Shropshire, UK
| | - Jyoti Baharani
- Renal Unit, Birmingham Heartlands Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gill Combes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Employment Status and Associations with Workability, Quality of Life and Mental Health after Kidney Transplantation in Austria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041254. [PMID: 32075277 PMCID: PMC7068411 DOI: 10.3390/ijerph17041254] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 12/20/2022]
Abstract
Kidney transplantation (KTx) in end-stage renal disease is associated with a significant increase in quality of life (QoL) and self-perceived health, optimally leading to the maintenance of employment or return to work (RTW) in working-age patients. The aim of this study was to assess individual factors including the QoL and mental health of kidney transplant recipients (KTRs) associated with employment after transplantation. A cross-sectional study including working-age patients with a history of KTx after 2012 was conducted at two Austrian study centers (Vienna and Graz). Brief Symptom Inventory (BSI-18), World Health Organization Quality of Life (WHOQOL-Bref) and Workability Index (WAI) were assessed along with detailed questionnaires on employment status. Out of n = 139 KTRs (43.2 ± 9.07 years; 57.6% male), 72 (51.8%) were employed. Employed patients were more frequently in a partnership (p = 0.018) and had higher education levels (p = 0.01) and QoL scores (<0.001). Unemployed KTRs reported fatigue and mental health issues more often (p < 0.001), and had significantly higher anxiety, depression and somatization scores (BSI-18). In unadjusted logistical regression, workability score (WAS; odds ratio (OR) = 3.39; 95% confidence interval (CI) = 1.97–5.82; p < 0.001), partnership (OR = 5.47; 95% CI 1.43–20.91; p = 0.013) and no psychological counseling after KTx (OR = 0.06; 95% CI = 0.003–0.969; p = 0.048) were independently associated with employment. Self-assessed mental health, workability and QoL were significantly associated with employment status after KTx. Thus, in order to facilitate RTW after KTx in Austria, vocational rehabilitation and RTW programs addressing KTRs should focus on increasing social support and care for their mental health.
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Health-related quality of life of transplant recipients: a comparison between lung, kidney, heart, and liver recipients. Qual Life Res 2020; 29:1631-1639. [DOI: 10.1007/s11136-020-02434-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2020] [Indexed: 12/21/2022]
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14
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Guzel H, Korkmaz M. Life Quality and Compliance After Transplant: The Case of Turkey. Transplant Proc 2019; 51:1029-1037. [PMID: 31101166 DOI: 10.1016/j.transproceed.2019.01.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 01/30/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Chronic renal failure is one of the most significant health problems in Turkey, as it is all over the world, and negatively affects quality of life. The aim of this study is to find factors affecting compliance levels and quality of life of patients undergoing kidney transplant. MATERIALS AND METHODS The population of the study consisted of 244 patients who underwent kidney transplant. Although the study aimed to cover the entire target population in the sampling selection, it was conducted among 206 patients. The data were collected by face-to-face interview. RESULTS Of the patients, 92.7% were between 46 and 59 years of age, 54.4% had a living donor transplant, 54.9% had adverse effects, and 2.9% had rejection due to incompatibility. There was a significant relationship between compliance and quality of life; increasing frequency of adverse effects would decrease in direct proportion to compliance, which would, therefore, increase quality of life. All the subscale scores of the 36-Item Short Form Health Survey were found to have an average of 60 and above. The mean of the compliance scale was 48.33 (SD, 3.21), and, with the maximum score at 55, the mean of the group was high. In our country, patients view transplant as a final and definite treatment method. This might be related to fact that the longer the time after transplant, the lower the level of compliance.
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Affiliation(s)
- H Guzel
- Sanko University Health Sciences Faculty Nursing Department, Turkey.
| | - M Korkmaz
- Malatya Inonu University Nursing Faculty, Turkey
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15
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Tang E, Ekundayo O, Peipert JD, Edwards N, Bansal A, Richardson C, Bartlett SJ, Howell D, Li M, Cella D, Novak M, Mucsi I. Validation of the Patient-Reported Outcomes Measurement Information System (PROMIS)-57 and -29 item short forms among kidney transplant recipients. Qual Life Res 2018; 28:815-827. [DOI: 10.1007/s11136-018-2058-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2018] [Indexed: 12/20/2022]
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16
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Lee E. Influencing Factors on Health-Related Quality of Life in Middle-Aged Adults With Hypertension. INTERNATIONAL JOURNAL OF E-HEALTH AND MEDICAL COMMUNICATIONS 2018. [DOI: 10.4018/ijehmc.2018100105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This article aims to examine the influencing factors on health-related quality of life (HRQOL) in middle-aged adults with hypertension. HRQOL was assessed using EQ-5D from 263 middle-aged adults (40-60 years) with hypertension who participated in the 6th Korean National Health and Nutrition Examination Survey (2014). There were statistically significant differences in health-related quality of life according to income, education, subjective health status, experience of discomfort, activity limitation, stress, and aerobic physical activity. Factors influencing on health-related quality of life in middle-aged adults with hypertension were subjective health status, experience of discomfort, activity limitation, depression, and stress, which explained about 50% of total variance. These factors should be included in the nursing intervention, and psychological aspects such as depression should be emphasized.
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Patel PH, Bibee K, Lim G, Malik SM, Wu C, Pugliano-Mauro M. Evaluating Retention of Skin Cancer Education in Kidney Transplant Recipients Reveals a Window of Opportunity for Re-education. Transplant Proc 2018; 49:1318-1324. [PMID: 28736001 DOI: 10.1016/j.transproceed.2017.03.079] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 03/30/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Skin cancer is the most common malignancy after solid organ transplant and can lead to significant morbidity. The likelihood of developing squamous cell carcinomas and melanomas is 100 and 2.4 times more likely, respectively, in kidney transplant recipients when compared with the general population. There are few data regarding the assessment and influence of solid organ transplant recipient (SOTR) knowledge of skin cancer and its effect on short- and long-term awareness and behavior. METHODS The purpose of this study was to assess the baseline knowledge of SOTR immediately after transplantation, and then to reassess their knowledge following a 5-minute educational video. We also wanted to determine whether lifestyle modifications had been implemented 4 to 8 months after the intervention. RESULTS Forty patients were enrolled within 2 months of transplantation. Eighty-seven percent of patients were renal transplant recipients, and 75% of patients were available for long-term follow-up. There was a significant increase in knowledge in the immediate postintervention period, which was sustained at 4- to 8-month follow-up, as assessed by patient questionnaire. Patients appeared to be applying this knowledge by participating in lifestyle risk modification and positive sun-protective behavior. CONCLUSIONS Our study suggests that incorporating additional skin cancer education into the early transplant timeline (perhaps in the first one or two outpatient follow-up visits) with an easy to administer educational video and question and answer form increases patient knowledge and influences positive sun-protective behavior.
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Affiliation(s)
- P H Patel
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
| | - K Bibee
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - G Lim
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - S M Malik
- Department of Medicine, University of Pittsburgh Medical Center, Thomas E. Starzl Transplantation Institute, Pittsburgh, Pennsylvania, USA
| | - C Wu
- Department of Medicine, University of Pittsburgh Medical Center, Thomas E. Starzl Transplantation Institute, Pittsburgh, Pennsylvania, USA
| | - M Pugliano-Mauro
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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18
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van Ek GF, Krouwel EM, van der Veen E, Nicolai MPJ, Ringers J, Den Oudsten BL, Putter H, Pelger RCM, Elzevier HW. The Discussion of Sexual Dysfunction Before and After Kidney Transplantation From the Perspective of the Renal Transplant Surgeon. Prog Transplant 2017; 27:354-359. [PMID: 29187127 DOI: 10.1177/1526924817731885] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Sexual dysfunction (SD) is a common problem in chronic kidney disease (CKD) and endures in 50% of patients after kidney transplantation (KTx), diminishing patients' expectations of life after KTx. Unfortunately, SD is often ignored by renal care providers. Research questions as part of a research project among all renal care providers, transplant surgeons' perspectives were obtained on sexual health care for KTx recipients, including their opinion on who should be accountable for this care. In addition, surgeons' practice and knowledge regarding SD were evaluated. DESIGN A 39-item questionnaire was sent to all Dutch surgeons and residents specialized in KTx (n = 47). RESULTS Response was 63.8%. None of the respondents discussed SD with their patients, before or after surgery. Most important barrier was that surgeons do not feel accountable for it (73.9%); 91.7% thought this accountability should lie with the nephrologist. Another barrier was insufficient knowledge (39.1%). In 75% of the respondents, (almost) no knowledge regarding SD was present and 87.5% noticed education on SD was insufficient during residence training. DISCUSSION Dutch renal transplant surgeons rarely discuss SD with their patients with CKD, as they do not feel accountable for it; this accountability was appointed to the nephrologist. Knowledge and education regarding SD were found insufficient in enabling surgeons and for some it reflects in barriers toward discussing SD. Results emphasize that accountability for providing sexual health care to patients with CKD should lie elsewhere; however, surgeons could briefly provide information on sexual health after KTx, so unfulfilled expectations may be prevented.
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Affiliation(s)
- Gaby F van Ek
- 1 Department of Urology, Leiden University Medical Center, Leiden, The Netherlands.,5 Department of Medical Decision Making, Leiden University Medical Center, The Netherlands
| | - Esmée M Krouwel
- 1 Department of Urology, Leiden University Medical Center, Leiden, The Netherlands.,5 Department of Medical Decision Making, Leiden University Medical Center, The Netherlands
| | - Els van der Veen
- 1 Department of Urology, Leiden University Medical Center, Leiden, The Netherlands
| | - Melianthe P J Nicolai
- 1 Department of Urology, Leiden University Medical Center, Leiden, The Netherlands.,5 Department of Medical Decision Making, Leiden University Medical Center, The Netherlands
| | - Jan Ringers
- 2 Department of Transplant Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Brenda L Den Oudsten
- 3 Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders, Tilburg University, Tilburg, The Netherlands
| | - Hein Putter
- 4 Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob C M Pelger
- 1 Department of Urology, Leiden University Medical Center, Leiden, The Netherlands
| | - Henk W Elzevier
- 1 Department of Urology, Leiden University Medical Center, Leiden, The Netherlands.,5 Department of Medical Decision Making, Leiden University Medical Center, The Netherlands
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Posttransplant Outcomes of Kidneys Donated After Brain Death Followed by Circulatory Death: A Cohort Study of 128 Chinese Patients. Transplant Direct 2017; 3:e189. [PMID: 28795141 PMCID: PMC5540627 DOI: 10.1097/txd.0000000000000704] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 05/31/2017] [Indexed: 11/26/2022] Open
Abstract
Background Donation after brain death followed by circulatory death (DBCD) is a new class in the unique Chinese donor classification system. Currently, in China, the organ transplantation of DBCD is rising. However, there is a dearth of research on the characteristics and outcomes of DBCD kidney transplantation. Method We collected 128 DBCD renal transplant patients who underwent surgery between June 2013 and May 2016 at our center to analyze clinical outcomes and to share our experience to enhance perioperative management in DBCD kidney transplantation. Results At the end of follow-up, no patients experienced primary nonfunction, but delayed graft function occurred in 25.8%. One- and 3-year graft survivals were 97.7% and 94.5%, respectively. The average length of stay was 20.88 ± 14.6 days, the incidence of posttransplant complications was 46.1% (59 patients), and 31 patients suffered more than 1 complication. In addition, the average length of stay of patients without complications and with at least 1 complication was 13.07 ± 2.01 days and 30.02 ± 17.4 days, respectively. There was a significantly higher incidence of complications associated with the postoperative hospital stay in DBCD patients. Conclusions Patients who received a DBCD kidney demonstrated a good outcome in terms of both graft survival and graft function. Hence, DBCD is suitable for national reality and conditions and offers a feasible option for deceased-donor kidney transplantation in China. To prevent complications and reduce the duration of hospital stay, we should strengthen preoperative and postoperative management.
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Raymond J, Johnson ST, Diehl-Jones W, Vallance JK. Walking, Sedentary Time and Health-Related Quality Life Among Kidney Transplant Recipients: An Exploratory Study. Transplant Proc 2016; 48:59-64. [PMID: 26915844 DOI: 10.1016/j.transproceed.2015.12.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 12/22/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The primary objectives of this study were to: 1) establish walking and physical activity prevalence and sedentary time estimates; and 2) determine associations of health-related quality of life (HRQoL) with objectively assessed walking, self-reported physical activity, and sedentary time among kidney transplant recipients. METHODS Using a cross-sectional design, kidney transplant recipients received a survey package containing measures of sedentary time, moderate-to-vigorous physical activity, and HRQoL, and a step pedometer. RESULTS Thirty-two participants returned a completed survey, for a response rate of 82% (32 of 39 interested participants). The average steps per day were 9752 steps (SD = 3685) and 59% achieved public health guidelines of at least 150 minutes of moderate-to-vigorous physical activity per week. Total sedentary time during the week was 11.6 h/d whereas total sedentary time during the weekend was 8.9 h/d. Compared to those not achieving at least 10,000 steps/d, respondents who were achieving at least 10,000 steps/d had a significantly higher physical component score for HRQoL (Mdiff = 7.8, P = .018). Similar patterns emerged for meeting physical activity guidelines and sedentary time. CONCLUSION For kidney transplant recipients, greater participation in walking, overall physical activity, and lower engagement in sedentary activity, was associated with better HRQoL.
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Affiliation(s)
- J Raymond
- Faculty of Health Disciplines, Athabasca University, Athabasca, Canada
| | - S T Johnson
- Faculty of Health Disciplines, Athabasca University, Athabasca, Canada
| | - W Diehl-Jones
- Faculty of Health Disciplines, Athabasca University, Athabasca, Canada
| | - J K Vallance
- Faculty of Health Disciplines, Athabasca University, Athabasca, Canada.
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21
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Seminars in Dialysis: The 100 Most Highly Cited Papers. Semin Dial 2016; 29:518-520. [PMID: 27774673 DOI: 10.1111/sdi.12536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Cukor D, Ver Halen N, Pencille M, Tedla F, Salifu M. A Pilot Randomized Controlled Trial to Promote Immunosuppressant Adherence in Adult Kidney Transplant Recipients. Nephron Clin Pract 2016; 135:6-14. [PMID: 28049201 DOI: 10.1159/000448627] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 07/20/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Nonadherence to immunosuppressant medication is a prevalent practice among kidney transplant recipients and has been associated with increased risk for graft failure and economic burden. The aim of this pilot study was to test whether a culturally sensitive cognitive-behavioral adherence promotion program could significantly improve medication adherence to tacrolimus prescription as measured by telephone pill counts among kidney transplant recipients. METHODS Thirty-three adult transplant recipients were less than 98% adherent to tacrolimus prescription based on 3 telephone pill counts and were randomized either to the 2-session cognitive-behavioral adherence promotion program or to standard care. The curriculum was developed from an iterative process with transplant recipients into a 2-session group program that provided psychoeducation, addressed barriers to adherence, fostered motivation to improve adherence behavior, and discussed cultural messages on adherence behavior. RESULTS The intervention group displayed significantly higher levels of adherence when compared to the control group (t = 2.2, p = 0.04) and. similarly, when the amount of change was compared between the groups, the intervention group showed more change than the control condition (F (22,1) = 12.005, p = 0.003). Tacrolimus trough concentration levels were used as a secondary measure of adherence and, while there were no significant between-group differences for mean trough concentration levels, the variability in the trough levels did significantly decrease over time indicating more consistent pill-taking behavior in the intervention group. CONCLUSIONS There is preliminary support for the pilot program as a successful intervention in helping patients with their immunosuppressant medication.
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Affiliation(s)
- Daniel Cukor
- Department of Psychiatry and Behavioral Science, SUNY Downstate Medical Center,Brooklyn, N.Y., USA
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23
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Gremigni P, Cappelli G. Psychosocial well-being after kidney transplantation: A matched-pair case-control study. J Health Psychol 2016; 21:599-606. [DOI: 10.1177/1359105314532506] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
A number of outcome studies showed that kidney transplantation is associated with improvements in health-related quality of life relative to the pre-transplant period, but comparisons with the general population produced mixed results. This study aimed to compare 30 successful (>1 year) kidney transplantation recipients with 30 matched-pair healthy controls on psychosocial well-being. Independent of gender, age and time since transplantation, transplanted patients equalled healthy people in the intrapersonal domains but scored worse in the interpersonal domains of psychosocial well-being. Identifying aspects of life that remain impaired after kidney transplantation may assist the development of interventions targeted at improving patients’ adjustment.
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24
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Rao S, Ghanta M, Moritz MJ, Constantinescu S. Long-Term Functional Recovery, Quality of Life, and Pregnancy After Solid Organ Transplantation. Med Clin North Am 2016; 100:613-29. [PMID: 27095649 DOI: 10.1016/j.mcna.2016.01.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article reviews the salient features of functional recovery, health-related quality of life (HR-QOL), and reproductive health, with special emphasis on pregnancy outcomes in kidney and liver recipients. Transplantation results in improved functional status and HR-QOL. Addressing factors that limit the optimal rehabilitation of transplant recipients can improve transplant outcomes. After successful transplantation, there is a rapid return of fertility, warranting counseling regarding contraception. Practitioners should be aware of the teratogenic potential of mycophenolic acid products. Posttransplant pregnancies are high risk, with increased incidences of hypertension, preeclampsia, and prematurity. Most pregnancies in kidney and liver recipients have successful maternal and newborn outcomes.
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Affiliation(s)
- Swati Rao
- Section of Nephrology, Hypertension and Kidney Transplantation, Temple University School of Medicine, 3440 North Broad Street, Kresge West, Suite 100, Philadelphia, PA 19140, USA
| | - Mythili Ghanta
- Pancreas Transplant Program, Section of Nephrology, Hypertension and Kidney Transplantation, Temple University School of Medicine, 3440 North Broad Street, Kresge West, Suite 100, Philadelphia, PA 19140, USA
| | - Michael J Moritz
- Transplant Services, Lehigh Valley Health Network, Allentown, PA 18103, USA; Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA; National Transplantation Pregnancy Registry, Gift of Life Institute, 401 North 3rd Street, Philadelphia, PA 19123, USA
| | - Serban Constantinescu
- National Transplantation Pregnancy Registry, Gift of Life Institute, 401 North 3rd Street, Philadelphia, PA 19123, USA; Kidney Transplant Program, Section of Nephrology, Hypertension and Kidney Transplantation, Temple University School of Medicine, 3440 North Broad Street, Kresge West, Suite 100, Philadelphia, PA 19140, USA.
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25
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Grijpma JW, Tielen M, van Staa AL, Maasdam L, van Gelder T, Berger SP, Busschbach JJ, Betjes MGH, Weimar W, Massey EK. Kidney transplant patients' attitudes towards self-management support: A Q-methodological study. PATIENT EDUCATION AND COUNSELING 2016; 99:836-843. [PMID: 26682972 DOI: 10.1016/j.pec.2015.11.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 11/11/2015] [Accepted: 11/20/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Kidney transplant recipients face many self-management challenges. We aimed to identify profiles of attitudes towards self-management support (SMS) shortly after kidney transplantation. METHODS Profiles were generated using Q-methodology: In face-to-face interviews participants rank-ordered opinion statements on aspects of SMS according to agreement. Socio-demographic and medical characteristics were assessed using a questionnaire. By-person factor analysis was used to analyze the rankings and qualitative data was used to support choice of profiles. The resulting factors represent clusters of patients with similar attitudes towards SMS. RESULTS Forty-three patients (mean age=56; 77% male) participated. Four profiles were identified: (A) transplant-focused and obedient; (B) holistic and collaborative; (C) life-focused and self-determined; and (D) was bipolar. The positive pole (D+) minimalizing and disengaged and the negative pole (D-) coping-focused and needy represent opposing viewpoints within the same profile. Socio-demographic and medical characteristics were not related to profile membership. DISCUSSION Each profile represents a specific attitude on post-transplant life, responsibility for health and decision-making, SMS needs, and preferences for SMS. PRACTICAL IMPLICATIONS Patients vary in their attitude, needs and preferences for SMS indicating the necessity of providing personalized support after kidney transplantation. Health professionals should explore patients' SMS needs and adapt support accordingly.
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Affiliation(s)
- J W Grijpma
- Erasmus MC, Department of Internal Medicine, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - M Tielen
- Erasmus MC, Department of Internal Medicine, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - A L van Staa
- Rotterdam University of Applied Sciences, Research Centre Innovations in Care, P.O. Box 25035, 3001 HA Rotterdam, The Netherlands; Erasmus University Rotterdam, Institute of Health Policy & Management (iBMG), Rotterdam, The Netherlands.
| | - L Maasdam
- Erasmus MC, Department of Internal Medicine, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - T van Gelder
- Erasmus MC, Department of Internal Medicine, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - S P Berger
- Erasmus MC, Department of Internal Medicine, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - J J Busschbach
- Erasmus MC, Department of Psychiatry, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - M G H Betjes
- Erasmus MC, Department of Internal Medicine, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - W Weimar
- Erasmus MC, Department of Internal Medicine, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - E K Massey
- Erasmus MC, Department of Internal Medicine, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
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Sommerer C, Zeier M. Reporting Quality-of-Life Outcomes in Clinical Trials of Immunosuppressive Therapy in Kidney Transplantation. Am J Kidney Dis 2016; 67:722-3. [DOI: 10.1053/j.ajkd.2015.09.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 09/11/2015] [Indexed: 11/11/2022]
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Abstract
As medical advances are made in the care of persons with chronic illnesses including those with end-stage renal disease (ESRD), patients are not only experiencing increasing life expectancy but also bearing the burden of illness and treatment for a longer duration of time. With this in mind, it is increasingly important for health care providers to pay close attention to their individual patient's perceptions of their health, fitness, life satisfaction, and well-being. This assessment of Health-Related Quality of Life (HRQOL) also includes an evaluation of the patient's level of satisfaction with treatment, outcome, and health status, also taking into account their perspective on future prospects. In addition to improving patient-provider communication by helping in the identification and prioritization of problems, it is important to note that high HRQOL has been shown to be associated with better medical outcomes, including reduction in hospitalizations and death. In this review, we outline several validated tools that are used to quantitatively measure HRQOL in the ESRD population and incorporate these instruments in a review of specific, evidence-based measures by which we can measurably improve health-related quality of life in dialysis patients.
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Affiliation(s)
- Donald Mitema
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Bernard G Jaar
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Nephrology Center of Maryland, Baltimore, Maryland
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28
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Lee SJ, Son H, Shin SK. Influence of frailty on health-related quality of life in pre-dialysis patients with chronic kidney disease in Korea: a cross-sectional study. Health Qual Life Outcomes 2015; 13:70. [PMID: 26021987 PMCID: PMC4460686 DOI: 10.1186/s12955-015-0270-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 05/20/2015] [Indexed: 12/24/2022] Open
Abstract
Background Chronic kidney disease (CKD) is a progressive and lifelong condition with multiple medical comorbidities. Patients with CKD experience frailty more frequently and have lower health-related quality of life than do those with other chronic diseases. The purpose of this study was to examine the prevalence of frailty and investigate the contribution of frailty to quality of life in pre-dialysis CKD patients in Korea. Methods Using a cross-sectional survey design, data were collected at an outpatient CKD clinic in a general hospital in Korea. The frailty criterion was modified from previous studies. The Short Form-36 Health Survey version 2 was used to measure physical and mental component summary scores. Data were analyzed using chi-square, t-tests, and hierarchical linear regression. Results Of the 168 CKD patients, 63 (37.5 %) were frail. Frail patients were significantly older and had lower physical and mental quality of life than those who were non-frail. In hierarchical regression evaluating the influence of frailty on physical and mental quality of life, the initial model was significantly improved when frailty was included. Frail patients had lower physical and mental quality of life. Conclusions Frailty affected both physical and mental quality of life in pre-dialysis patients with CKD. More attention should be paid to the potential role of early detection and prevention of frailty to improve patients’ quality of life.
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Affiliation(s)
- Suk Jeong Lee
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul, South Korea.
| | - Heesook Son
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul, South Korea.
| | - Sug Kyun Shin
- National Health Insurance Cooperation Ilsan Hospital Clinical Professor, Yonsei University Medical College, Seoul, South Korea
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Nour N, Heck CS, Ross H. Factors related to participation in paid work after organ transplantation: perceptions of kidney transplant recipients. JOURNAL OF OCCUPATIONAL REHABILITATION 2015; 25:38-51. [PMID: 24871373 DOI: 10.1007/s10926-014-9519-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE Following kidney transplantation, recipients often have difficulty returning to meaningful occupations, including paid employment. The purpose of the current study was to describe the sociodemographic profile of kidney transplant recipients at a major Canadian Transplant Centre and to identify factors perceived to affect participation in paid work post-transplant. METHODS Of the 530 kidney recipients who had received a kidney transplant at our facility between 2003 and 2008, 144 recipients were randomly selected, and mailed a questionnaire. RESULTS There were 60 returned questionnaires (41.7 % response rate). The average age of responders was 49.4 years and the majority were male (68.3 %). While the rate of employment decreased significantly (p = 0.00) from 68.3 % pre- to 38.3 % post-transplant, retirement rates increased significantly (p = 0.00) from 8.3 % pre- to 18.3 % post-transplant. The responders, who were not working post-transplant, more likely lived alone (p = 0.05), had a lower level of education (p = 0.02), and had lower perceived emotional (p = 0.00) and physical (p = 0.00) health status compared to those who returned to work post-transplant. Gender, donor type, age, and post-transplant complications did not differ (p > 0.05) between the working and not working groups. Both person- and work-related factors impacted on return to paid work post-transplant. Most responders (working and not working) reported feeling emotionally and physically ready to work after their transplant. Work-related enablers included positive employer attitude towards medical history and employer agreement that recipients could take time off for medical appointments. Of those returning to work, the nature of their jobs changed from heavy physical demands to sedentary work. There was a 20.0 % increase in reliance on government disability insurance post-transplant. Responders recommended the development of a rehabilitation program focused on working and consulting with transplant recipients' employers to further enable successful reintegration into the workplace after transplantation. CONCLUSIONS The ability to return to paid work after kidney transplant is a complex phenomenon, likely impacted by a combination of person- and work-related factors, which contributed to how individuals perceived their abilities to attain or return to paid work. It is important that in facilitating renal transplant recipients to resume valued life occupations such as paid work, the dynamic interactions between personals values, perception of one's abilities, skills, job requirements and employer characteristics be considered.
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Affiliation(s)
- Nazanin Nour
- Toronto General Hospital, University Health Network, 4EB-316-200 Elizabeth Street, Toronto, ON, M2G 2C4, Canada,
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Kugler C, Bara C, von Waldthausen T, Einhorn I, Haastert B, Fegbeutel C, Haverich A. Association of depression symptoms with quality of life and chronic artery vasculopathy: a cross-sectional study in heart transplant patients. J Psychosom Res 2014; 77:128-34. [PMID: 25077854 DOI: 10.1016/j.jpsychores.2014.06.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 06/15/2014] [Accepted: 06/16/2014] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Depression represents a relevant co-morbidity in patients with chronic heart disease and may diminish the overall success for long-term survival after heart transplantation (HTx). This study aimed to assess the prevalence of depression symptoms in long-term HTx survivors, and to compare depressive patients to those without depression with respect to chronic artery vasculopathy (CAV). METHODS A sample of 203 HTx patients, median 11.5 (IQR 7-17) years after transplant, provided detailed data of depression symptoms, and other psychosocial symptoms including anxiety, family support, professional re-integration, and health-related quality of life (HRQoL). Data were analyzed for an association with CAV. RESULTS Overall, 14.8% patients (95% CI: 10.2-20.4) showed relevant depression symptoms. No significant differences were seen between non-depressed vs. depressed patients with respect to demographics, clinical variables, and cardiovascular risk factors. Anxiety was prevalent in 9.0% (95% CI: 5.4-13.9) of the sample. Depression symptoms showed impaired HRQoL in the SF-36 physical (P=.012) and psychosocial (P=.0001) components. CAV was prevalent in 34.0% (95% CI: 27.5-41.0), and depression symptoms and CAV were not significantly associated. CAV-patients did not report their physical HRQoL being lower relative to those without CAV (P=.40). Multivariate analysis revealed overweight BMI (OR=2.20; P=.04), longer time since transplant (OR=1.10; P=.001), and older age (OR=1.04; P=.01) being associated with CAV. CONCLUSION Depression symptoms are prevalent in long-term survivors after HTx, and psychological impairments decrease patients' perceptions of HRQoL. More research seems necessary to identify the inter-relationship between depression symptoms and CAV, in order to develop targeted interventions to overcome this problem.
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Affiliation(s)
- Christiane Kugler
- Division of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Germany; Integrated Research and Treatment Center Transplantation, Hannover Medical School, Hannover, Germany; University of Witten, Faculty of Health, Witten, Germany.
| | - Christoph Bara
- Division of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Germany
| | | | - Ina Einhorn
- Division of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Germany; Integrated Research and Treatment Center Transplantation, Hannover Medical School, Hannover, Germany
| | | | - Christine Fegbeutel
- Division of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Germany
| | - Axel Haverich
- Division of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Germany
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Pistorio ML, Veroux M, Corona D, Sinagra N, Giaquinta A, Zerbo D, Giacchi F, Gagliano M, Tallarita T, Veroux P, De Pasquale C. The study of personality in renal transplant patients: possible predictor of an adequate social adaptation? Transplant Proc 2014; 45:2657-9. [PMID: 24034016 DOI: 10.1016/j.transproceed.2013.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND This study explored the personality characteristic traits within a sample of renal transplant patients, seeking to obtain predictive index for likely clinical impacts. PATIENTS AND METHODS The personality study was performed using the Structured Clinical Interview Axis II Personality Disorders for Diagnostic and Statistical Manual of Mental Disorders fourth edition, text revision in 60 recipients of kidney transplantations from deceased donors. RESULTS The personality trait that prevailed in the female gender was borderline, while in the male gender it appeared to be predominantly obsessive-compulsive personality trait. CONCLUSIONS The personality study proved to be a good index to predict effects on the level of social adjustment. In this way, patients who have shown pathologic personality traits can be identified early to provide adequate psychologic-psychiatric support and follow-up.
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Affiliation(s)
- M L Pistorio
- Vascular Surgery and Organ Transplant Unit, Department of Surgery, Transplantation and Advanced Technologies, University Hospital of Catania, Italy
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Kugler C, Gottlieb J, Warnecke G, Schwarz A, Weissenborn K, Barg-Hock H, Bara C, Einhorn I, Haverich A, Haller H. Health-related quality of life after solid organ transplantation: a prospective, multiorgan cohort study. Transplantation 2014; 96:316-23. [PMID: 23715048 DOI: 10.1097/tp.0b013e31829853eb] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Short-term posttransplantation survival and health-related quality of life (HRQoL) is exceptionally high for all patients after organ transplantation; however, predictors of the HRQoL outcome are not well understood. Trajectories of patients' perceived benefit/burden ratio associated with the transplant procedure may differ when taking the organ type for transplantation into account. METHODS A prospective, single-center cohort study assessed the trajectories of 354 patients after kidney (n=165), liver (n=53), heart (n=24), and lung (n=112) transplantation at 2, 6, 12, and 24 months with respect to psychosocial outcomes (HRQoL, anxiety, depression, social support, and work performance). RESULTS Mean age was 50±13 years, and 61.6% were male in the overall sample. Demographics differed with respect to organ type. HRQoL measured by the mean SF-36 Physical Component Scale was 36.8 (95% confidence interval, 35.7-37.8) and 48.9 (95% confidence interval, 47.2-49.7) for the Psychosocial Component Scale for the entire sample at 2 months and showed a marginal decrease until 24 months after transplantation. Overall, HRQoL increased for all organ types with differing trajectories. Liver patients reported the lowest HRQoL benefit for the majority of the physical (P≤0.01) and psychosocial (P≤0.01) SF-36 subscales. Anxiety (17.4%) and depression (13.8%) were prevalent in the overall sample. Depression symptoms impaired HRQoL outcomes in both SF-36 components and unemployment impacted the SF-36 psychosocial outcomes. CONCLUSIONS HRQoL improved after transplantation for all four types of transplant, but the trajectories were different. Regular screening for depression symptoms may diminish psychologic disorders and distress after transplantation and thus may further improve outcomes.
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Affiliation(s)
- Christiane Kugler
- Hannover Thoracic Transplant Program, Division of Cardiac, Thoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany.
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Rapo C, Piot-Ziegler C. Psychological stress in transplantation: a unified concept? What is measured and how: a literature review. Prog Transplant 2013; 23:247-52. [PMID: 23996944 DOI: 10.7182/pit2013376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This article describes how the concept of stress is studied in the field of solid-organ transplantation. Sixty-five articles or reviews of scientific research on stress are analyzed. The question addressed was how stress is explored and defined in transplant research, as it is often referred to as affecting psychological and/or physical transplant outcomes.
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Analysis, evaluation and adaptation of the ReTransQoL: a specific quality of life questionnaire for renal transplant recipients. Health Qual Life Outcomes 2013; 11:148. [PMID: 24001187 PMCID: PMC3766072 DOI: 10.1186/1477-7525-11-148] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 08/14/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND End stage renal disease (ESRD) profoundly impacts the lives of patients. Kidney transplantation provides the greatest health-related quality of life (HRQOL) improvement. Its measurement has become an important outcome parameter and a very important criterion in the evaluation of any type of medical treatment, especially in the field of renal transplantation.In 2007, a specific self-administered questionnaire for renal transplant recipients was developed in the French language: the ReTransQol (RTQ).After 5 years of use, the properties of the RTQ needed to be re-evaluated in a larger sample.This paper describes the analysis of the ReTransQol and its adaptation to achieve an improved and revised version. METHODS The study design included three analysis phases for two samples of adult renal transplant recipients which came from two cross-sectional multicenter studies carried out in France in 2007 and 2012. Psychometrics properties like construct validity, acceptability and feasibility, reliability and convergent validity were evaluated and every analysis resulted in a new version of the questionnaire: the RTQ V2. The construct validity of the new RTQ was assessed with a Confirmatory Factor Analysis on a large sample of patients. RESULTS The study samples included 1,059 patients and 1,591 patients, respectively. After a principal component analysis, item reduction was performed and a total of 13 items were deleted. A final version of the RTQ V2 was created and comprised of 32 items describing 5 domains: Physical Health, Social Functioning, Medical Care, Treatment and Fear of Losing Graft.The explained variance between the first and second RTQ versions improved from 46.3% to 53.1%. All psychometric properties of RTQ V2 were satisfactory: IIC >0.4, IDV (%) of 100% and Cronbach's Alpha >0.7 in every dimension. The confirmatory analysis showed that the overall scalability of the RTQ V2 was satisfactory; all items showed a good fit to the Rasch model within each dimension, and showed INFIT statistics inside the acceptable range. CONCLUSIONS Psychometric properties allow this new version of the questionnaire to be used to assess different specific dimensions for the renal transplant population, more effectively than previously possible.
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Segatto BL, Sabiston CM, Harvey WJ, Bloom GA. Exploring relationships among distress, psychological growth, motivation, and physical activity among transplant recipients. Disabil Rehabil 2013; 35:2097-103. [PMID: 23829354 DOI: 10.3109/09638288.2013.807882] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE To examine relationships among transplant-specific psychological growth and distress, motivational regulations and health-enhancing physical activity (HEPA) among transplant recipients. METHODS Participants (N = 138; Mage = 48 years; 58% male), who were primarily heart, liver, lung, and kidney transplant recipients, completed scientifically-supported questionnaires. The associations among transplant-specific emotional health, motivation, and HEPA were examined in a path model. RESULTS In the path model (Χ(2)(3) = 2.12, RMSEA = 0.02, CFI = 0.98, NNFI = 0.97, SRMR = 0.04), distress was significantly related to introjected regulation and psychological growth was associated with autonomous self-regulation (a combined score of identified and intrinsic regulations), which was a significant correlate of HEPA (R(2)= 0.12). There were no significant direct associations between distress, psychological growth, and HEPA. CONCLUSION Transplant-specific distress and psychological growth may be factors to target in clinical intervention and rehabilitation. Furthermore, exercise motivation regulations are modifiable factors that relate to HEPA among transplant recipients and could be targeted in the development of rehabilitation strategies aimed at enhancing physical activity in this population. IMPLICATIONS FOR REHABILITATION Organ transplant recipients should maintain a healthy lifestyle in order to prevent rejection and other risk factors associated with transplantation. Physical activity is a promising lifestyle factor linked to many health benefits. This study shows how a mix of stress and growth following transplantation is related to physical activity motivation and behavior.
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Affiliation(s)
- Bianca L Segatto
- Department of Kinesiology and Physical Education, McGill University , Montreal, Quebec , Canada and
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36
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de Groot IB, Veen JIE, van der Boog PJM, van Dijk S, Stiggelbout AM, Marang-van de Mheen PJ. Difference in quality of life, fatigue and societal participation between living and deceased donor kidney transplant recipients. Clin Transplant 2013; 27:E415-23. [PMID: 23808752 DOI: 10.1111/ctr.12165] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2013] [Indexed: 11/27/2022]
Abstract
Purpose of this study was to assess whether living (LD) and deceased donor (DD) kidney transplant recipients differ in health-related quality of life (HRQoL), fatigue and societal participation, depending on time since transplantation and after adjustment for clinical and demographic variables. A questionnaire study was performed among 309 LD and 226 DD recipients (response rate 74% and 61%) transplanted between 1997 and 2009. After adjustment for age, sex, and education, LD recipients transplanted less than or equal to five yr ago experienced better HRQoL than DD recipients on the domains' role limitations due to physical problems, general health perception, and on the physical component summary score (all p < 0.05) and a better societal participation (all subscales, p < 0.05). No differences were found in the mental health domains. The LD recipients also had better renal clearance than DD recipients (62.1 vs. 55.9 mL/min, p = 0.01). After additional adjustment for renal clearance, the differences in HRQoL and societal participation between LD and DD recipients remained. No differences were found in recipients transplanted more than five yr ago. We conclude that LD recipients on average have better HRQoL and societal participation than DD recipients, in the first years after transplantation.
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Affiliation(s)
- Ingrid B de Groot
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
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Bragazzi NL, Puente GD. Chronic Kidney Disease, Spirituality and Religiosity: A Systematic Overview with the List of Eligible Studies. Health Psychol Res 2013; 1:e26. [PMID: 26973911 PMCID: PMC4768585 DOI: 10.4081/hpr.2013.e26] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 02/04/2013] [Accepted: 02/04/2013] [Indexed: 11/25/2022] Open
Abstract
Chronic Kidney Disease (CKD) has a tremendous psychological burden, which sometimes is overlooked or underestimated in the daily clinical routine practice, since in the health care process physicians prefer to focus on the objective aspects of the pathology. In this contribution, we make a systematic overview of the relationship between spirituality/religiosity and CKD, an emerging theme which only recently has raised interest from the scientific community despite its importance. We investigate different variables, axis and categories (from the quality of life to customer’s satisfaction, treatment adherence and therapeutic alliance, clinical parameters, as well as overall survival, and coping strategies adopted by the patient). Moreover, we underpin the principal clinically relevant implications (like the possibility of psycho-therapeutic interventions based on the spiritual and religious attitudes of the patient) and we discuss the main gaps, methodological barriers and difficulties in the field, fostering and advocating further research and clinical studies. This last aspect, together with the quality assessment of the studies, will be further explored in the second part of the study.
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Affiliation(s)
| | - Giovanni Del Puente
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa , Italy
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38
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Abstract
End-stage renal disease (ESRD) and dialysis have negative impact on lifestyle. Renal transplantation improves many facets of daily life. Male sexuality is a significant predictor of quality of life. This brief review summarizes the impacts of ESRD and renal replacement on a range of sexual domains as presented at the European Association of Urology meeting in Vienna.
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Afshar M, Rebollo-Mesa I, Murphy E, Murtagh FEM, Mamode N. Symptom burden and associated factors in renal transplant patients in the U.K. J Pain Symptom Manage 2012; 44:229-38. [PMID: 22578312 DOI: 10.1016/j.jpainsymman.2011.08.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 08/18/2011] [Accepted: 09/09/2011] [Indexed: 01/22/2023]
Abstract
CONTEXT Renal transplantation is gold standard care in end-stage kidney disease, but little is known about symptom prevalence in transplanted patients. OBJECTIVES This study assesses symptom prevalence in this population. METHODS This was a U.K.-based, cross-sectional symptom survey of end-stage kidney disease patients transplanted more than one year previously. Patient-reported data were collected using the renal Patient Outcome Scale. Demographic/clinical data also were collected, including estimated glomerular filtration rate (eGFR), renal diagnosis, and comorbidity. RESULTS One hundred ten patients participated; mean age was 47 years (SD 13.6), and mean eGFR was 46 mL/min (SD 16.8, range 14-101). Symptom burden was high, with a mean of seven symptoms, but marked variance (SD 5.2, range 0-22). The most prevalent symptoms were weakness (56%, 95% CI 47-65), difficulty sleeping (46%, 95% CI 37-56), dyspnea (42%, 95% CI 33-51), feeling anxious (36%, 95% CI 28-46), and drowsiness (36%, 95% CI 28-46). Certain symptoms-weakness, difficulty sleeping, dyspnea, and drowsiness-were commonly reported as severe. A significant inverse relationship between renal function, as measured by eGFR, and number of symptoms (P<0.05) emerged. CONCLUSION For renal transplant recipients, symptom burden is similar to dialysis, although with less pain, anorexia, and immobility. Routine symptom assessment should be undertaken in transplant patients to identify these often undisclosed symptoms.
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Griva K, Davenport A, Harrison M, Newman SP. The impact of treatment transitions between dialysis and transplantation on illness cognitions and quality of life - a prospective study. Br J Health Psychol 2012; 17:812-27. [PMID: 22536819 DOI: 10.1111/j.2044-8287.2012.02076.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Treatment transitions are frequent in end-stage renal disease (ESRD) but little is known about cognitive responses pre- to post-transplantation or after transplant failure. The purpose of this study was to examine changes in illness cognitions across treatment transitions between dialysis and transplantation and their impact on quality of life (QOL). METHODS In this longitudinal study, ESRD patients (N= 262) patients were followed up across treatment transitions over a 7-year observation window using the Illness Perceptions Questionnaire, the Illness Effects Questionnaire, and measures of QOL. Study sample comprised the patients from this cohort who switched treatment modality (N= 60 post-transplantation; N= 28 transplant failure). Data were collected while on dialysis or transplantation and at 6 months post-treatment change. RESULTS Significant changes in QOL and illness perceptions were found in treatment transitions with opposite patterns of either improvement or deterioration following transplantation or transplantation failure. Pre- to post-transplantation, QOL improves and patients report less symptoms, lower consequences, and illness intrusiveness, more acute timeline and stronger control beliefs (ps < .01). QOL is diminished following transplant failure and patients report more symptoms, consequences, illness disruptiveness, more chronic timeline, and lower control. Changes in cognitions are associated with changes in QOL (R(2) = .469-.789). CONCLUSIONS Treatment transitions marked significant changes in illness perceptions that were associated with changes in QOL. Interventions to prepare patients for treatment transitions and prevent increasingly negative patterns of illness perceptions with transplant failure may serve towards maintaining or improving adjustment outcomes.
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Affiliation(s)
- Konstadina Griva
- Department of Psychology, National University of Singapore, Singapore
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Halen NV, Cukor D, Constantiner M, Kimmel PL. Depression and mortality in end-stage renal disease. Curr Psychiatry Rep 2012; 14:36-44. [PMID: 22105534 DOI: 10.1007/s11920-011-0248-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
End-stage renal disease is growing in prevalence and incidence. With technical advancements, patients are living longer on hemodialysis. Depression is the most prevalent comorbid psychiatric condition, estimated at about 25% of end-stage renal disease samples. The identification and assessment of depression are confounded by the overlap between depression symptomatology and uremia. Several recent studies have employed time-varying models and identified a significant association between depression and mortality. Due to the high prevalence of depression and the potential impact on survival, well-constructed investigations are warranted.
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Affiliation(s)
- Nisha Ver Halen
- SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 1203, Brooklyn, NY 11203, USA.
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Constantinou CS. “Now, I Am a Proper Human Being”: Kidney Transplantation in Cyprus. Med Anthropol 2012; 31:29-43. [DOI: 10.1080/01459740.2011.603400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Prospective Changes in Health-Related Quality of Life and Emotional Outcomes in Kidney Transplantation over 6 Years. J Transplant 2011; 2011:671571. [PMID: 21822474 PMCID: PMC3142681 DOI: 10.1155/2011/671571] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 03/30/2011] [Accepted: 05/03/2011] [Indexed: 01/22/2023] Open
Abstract
Little is known on long-term outcomes in kidney transplantation. This study evaluated changes and predictors of generic and transplantation-specific health-related quality of life (HQoL) over six years in N = 102 kidney transplant survivors using the Short-form Health Survey-36 and the Transplant Effects questionnaire. Mixed models analysis was used to determine long-term outcomes. Emotional HQoL improved over time: Mental Component score, Mental Health, Energy (Ps = .000). Physical HQoL deteriorated: Physical Component Score (P = .001), Pain (P = .002). LRD transplant recipients had greater decline in physical functioning (P = .003) and PCS (P = .000) compared to cadaver recipients. Worry about the transplant (P = .036) and feelings of responsibility (P = .008) increased significantly over time. Worry about the transplant and perceived ability to work predicted 12.7% and 31.1% in variance in MCS and PCS, respectively. Efforts should be made to maintain HQoL and emotional outcomes with ongoing monitoring and support programs throughout the course of posttransplant care.
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Reduction of Gastrointestinal Complications in Renal Graft Recipients after Conversion from Mycophenolate Mofetil to Enteric-coated Mycophenolate Sodium. Transplant Proc 2011; 43:1641-6. [DOI: 10.1016/j.transproceed.2011.01.184] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 01/07/2011] [Indexed: 11/23/2022]
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Abstract
LaR Pediatric solid-organ transplantation is an increasingly successful treatment for organ failure. Five- and 10-yr patient survival rates have dramatically improved over the last couple of decades, and currently, over 80% of pediatric patients survive into adolescence and young adulthood. Waiting list mortality has been a concern for liver, heart, and intestinal transplantation, illustrating the importance of transplant as a life-saving therapy. Unfortunately, the success of pediatric transplantation comes at the cost of long-term or late complications that arise as a result of allograft rejection or injury, immunosuppression-related morbidity, or both. As transplant recipients enter adolescence treatment, non-adherence becomes a significant issue, and the medical and psychosocial impacts transition to adulthood not only with regard to healthcare but also in terms of functional outcomes, economic potential, and overall QoL. This review addresses the clinical and psychosocial challenges encountered by pediatric transplant recipients in the current era. A better understanding of pediatric transplant outcomes and adult morbidity and mortality requires further ongoing assessment.
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Affiliation(s)
- Christopher LaRosa
- Division of Nephrology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA
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46
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Robinson JK, Turrisi R, Mallett KA, Stapleton J, Boone SL, Kim N, Riyat NV, Gordon EJ. Efficacy of an educational intervention with kidney transplant recipients to promote skin self-examination for squamous cell carcinoma detection. ACTA ACUST UNITED AC 2011; 147:689-95. [PMID: 21339418 DOI: 10.1001/archdermatol.2011.10] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To develop easily disseminated educational materials that enable early detection of skin cancer, and to examine the effectiveness of the materials to promote skin self-examination (SSE) among kidney transplant recipients (KTRs). DESIGN Randomized controlled trial of an educational intervention in comparison with a group that received only the assessment, education, and treatment as part of usual care with a nephrologist. SETTING Academic ambulatory nephrology practice. PATIENTS Seventy-five KTRs returning for routine care to their nephrologists 1 to 1.2 years or 3 to 7 years after transplantation. INTERVENTION Educational workbook. MAIN OUTCOME MEASURES Skin self-examination performance and new appointments with a dermatologist if a concerning skin lesion was found. RESULTS Twenty-two percent of those in the control group checked their skin after the visit compared with 89% of the treatment condition; thus, KTRs receiving the intervention were significantly more likely to have checked their skin (χ(2); P < .001). Among the 8 control KTRs who checked their skin, none found areas of concern. Of the 34 intervention KTRs who checked their skin, 12 participants (35%) found areas of concern. All 12 of these individuals made appointments with a dermatologist for follow-up. CONCLUSIONS The KTRs were receptive to performing SSE and acted on the recommendation made in the workbook to make an appointment with a dermatologist when a concerning lesion was discovered. Printed educational materials can be initiated in the tertiary care center 1 year after transplantation and used across a continuum of time during which KTRs may be transferred from the tertiary care center to community nephrologists. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01127737.
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Affiliation(s)
- June K Robinson
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 132 E Delaware Pl, No. 5806, Chicago, IL 60611, USA.
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Robinson JK, Alam M, Ashourian N, Khan M, Kundu R, Laumann AE, Schlosser BJ, Yoo S, Gordon EJ. Skin cancer prevention education for kidney transplant recipients: a systematic evaluation of Internet sites. Prog Transplant 2011. [PMID: 21265287 DOI: 10.7182/prtr.20.4.9877500752888660] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Repeated patient education about skin cancer prevention is important to self-care after transplant. OBJECTIVE Examine educational materials for kidney transplant recipients available on the Internet that address sun protection and skin self-examination for early detection of squamous cell carcinoma. DESIGN Systematic review of Web sites for kidney transplant recipients endorsed by transplant physicians and dermatologists. PARTICIPANTS An expert panel of 8 dermatologists providing care for kidney transplant recipients and 1 research medical anthropologist. MAIN OUTCOME MEASURES Reading grade level, inclusion of people with skin of color, sufficient content to support effective sun protection, and description of 4 sun-protection strategies and skin self-examination. Results-Of the 40 sites identified, 11 contained information about sun protection or increased risk of any type of cancer. The Web sites had a ninth-grade median reading level (range, seventh grade to college senior). Interrater reliability for the 25-item assessment tool was assessed by Fleiss' kappa (kappa = 0.87). Skin cancer risk was presented as relevant to those with fair skin. Sites recommended regular use of sunscreen with sun-protection factor of 15 or greater (n=3) to reduce the risk of skin cancer (n=4). Few sites recommended using protective clothing (n=5), seeking shade (n=4), and avoiding deliberate tanning with indoor or outdoor light (n=1). Five sites recommended skin self-examination. CONCLUSION Because many patients seek self-management information from the Internet, Web sites must provide more thorough educational information about skin cancer prevention and health promotion at a lower reading grade level.
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Affiliation(s)
- June K Robinson
- Northwestern University Feinberg School of Medicine, Chicago, Ilinois, USA.
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Spencer BWJ, Chilcot J, Farrington K. Still Sad after Successful Renal Transplantation: Are We Failing to Recognise Depression? An Audit of Depression Screening in Renal Graft Recipients. ACTA ACUST UNITED AC 2011; 117:c106-12. [DOI: 10.1159/000319657] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Accepted: 04/23/2010] [Indexed: 12/22/2022]
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49
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Robinson JK, Alam M, Ashourian N, Khan M, Kundu R, Laumann AE, Schlosser BJ, Yoo S, Gordon EJ. Skin Cancer Prevention Education for Kidney Transplant Recipients: A Systematic Evaluation of Internet Sites. Prog Transplant 2010; 20:344-9. [DOI: 10.1177/152692481002000407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Context Repeated patient education about skin cancer prevention is important to self-care after transplant. Objective Examine educational materials for kidney transplant recipients available on the Internet that address sun protection and skin self-examination for early detection of squamous cell carcinoma. Design Systematic review of Web sites for kidney transplant recipients endorsed by transplant physicians and dermatologists. Participants An expert panel of 8 dermatologists providing care for kidney transplant recipients and 1 research medical anthropologist. Main Outcome Measures Reading grade level, inclusion of people with skin of color, sufficient content to support effective sun protection, and description of 4 sun-protection strategies and skin self-examination. Results Of the 40 sites identified, 11 contained information about sun protection or increased risk of any type of cancer. The Web sites had a ninth-grade median reading level (range, seventh grade to college senior). Interrater reliability for the 25-item assessment tool was assessed by Fleiss' kappa (κ = 0.87). Skin cancer risk was presented as relevant to those with fair skin. Sites recommended regular use of sunscreen with sun-protection factor of 15 or greater (n=3) to reduce the risk of skin cancer (n= 4). Few sites recommended using protective clothing (n = 5), seeking shade (n=4), and avoiding deliberate tanning with indoor or outdoor light (n = 1). Five sites recommended skin self-examination Conclusion Because many patients seek self-management information from the Internet, Web sites must provide more thorough educational information about skin cancer prevention and health promotion at a lower reading grade level.
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Affiliation(s)
- June K. Robinson
- Northwestern University Feinberg, School of Medicine, Chicago, Ilinois
| | - Murad Alam
- Northwestern University Feinberg, School of Medicine, Chicago, Ilinois
| | - Neda Ashourian
- Northwestern University Feinberg, School of Medicine, Chicago, Ilinois
| | - Misbah Khan
- Northwestern University Feinberg, School of Medicine, Chicago, Ilinois
| | - Roopal Kundu
- Northwestern University Feinberg, School of Medicine, Chicago, Ilinois
| | - Anne E. Laumann
- Northwestern University Feinberg, School of Medicine, Chicago, Ilinois
| | | | - Simon Yoo
- Northwestern University Feinberg, School of Medicine, Chicago, Ilinois
| | - Elisa J. Gordon
- Northwestern University Feinberg, School of Medicine, Chicago, Ilinois
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White C, Gallagher P. Effect of patient coping preferences on quality of life following renal transplantation. J Adv Nurs 2010; 66:2550-9. [DOI: 10.1111/j.1365-2648.2010.05410.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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