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Wakeel F, Hannah J, Gorfinkel L. Stress, coping, and quality of life in the United States during the COVID-19 pandemic. PLoS One 2023; 18:e0277741. [PMID: 37163470 PMCID: PMC10171688 DOI: 10.1371/journal.pone.0277741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/06/2023] [Indexed: 05/12/2023] Open
Abstract
While research has widely explored stress, coping, and quality of life (QOL) individually and the potential links between them, a critical dearth exists in the literature regarding these constructs in the context of the COVID-19 pandemic. Our study aims to identify the salient stressors experienced, describe the coping strategies used, and examine the relationships between stressors, coping, and QOL among individuals during the pandemic. Data are from a sample of 1,004 respondents who completed an online survey. Key measures included stressful life events (SLEs), coping strategies, and the physical and psychological health domains of QOL. Staged multivariate linear regression analyses examined the relationships between SLEs and the two QOL domains, controlling for sociodemographic and pre-existing health conditions and testing for the effects of coping strategies on these relationships. The most common SLEs experienced during the pandemic were a decrease in financial status, personal injury or illness, and change in living conditions. Problem-focused coping (β = 0.42, σ = 0.13, p < 0.001 for physical QOL; β = 0.57, σ = 0.12, p < 0.001 for psychological QOL) and emotion-focused coping (β = 0.86, σ = 0.13, p < 0.001 for psychological QOL) were significantly related to higher levels of QOL, whereas avoidant coping (β = -0.93, σ = 0.13, p < 0.001 for physical QOL; β = -1.33, σ = 0.12, p < 0.001 for psychological QOL) was associated with lower QOL. Avoidant coping partially mediated the relationships between experiencing SLEs and lower physical and psychological QOL. Our study informs clinical interventions to help individuals adopt healthy behaviors to effectively manage stressors, especially large-scale, stressful events like the pandemic. Our findings also call for public health and clinical interventions to address the long-term impacts of the most prevalent stressors experienced during the pandemic among vulnerable groups.
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Affiliation(s)
- Fathima Wakeel
- Department of Community and Population Health, College of Health, Lehigh University, Bethlehem, Pennsylvania, United States of America
| | - Jacelyn Hannah
- Department of Community and Population Health, College of Health, Lehigh University, Bethlehem, Pennsylvania, United States of America
| | - Leah Gorfinkel
- Department of Community and Population Health, College of Health, Lehigh University, Bethlehem, Pennsylvania, United States of America
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Dew MA, DiMartini AF, Posluszny DM, Myaskovsky L, Switzer GE, Puttarajappa C, Hickey GW, Sanchez PG, DeVito Dabbs AJ. Health-related quality of life and psychological indicators of thriving 15-19 years after heart or lung transplantation. Clin Transplant 2022; 36:e14768. [PMID: 35801650 PMCID: PMC9756395 DOI: 10.1111/ctr.14768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/29/2022] [Accepted: 07/05/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Survival into the second decade after cardiothoracic transplantation (CTX) is no longer uncommon. Few data exist on any health-related quality of life (HRQOL) impairments survivors face, or whether they may even experience positive psychological outcomes indicative of "thriving" (e.g., personal growth). We provide such data in a long-term survivor cohort. METHODS Among 304 patients prospectively studied across the first 2 years post-CTX, we re-interviewed patients ≥15 years post-CTX. We (a) examined levels of HRQOL and positive psychological outcomes (posttraumatic growth related to CTX, purpose in life, life satisfaction) at follow-up, (b) evaluated change since transplant with mixed-effects models, and (c) identified psychosocial and clinical correlates of study outcomes with multivariable regression. RESULTS Of 77 survivors, 64 (83%) were assessed (35 heart, 29 lung recipients; 15-19 years post-CTX). Physical HRQOL was poorer than the general population norm and earlier post-transplant levels (P's < .001). Mental HRQOL exceeded the norm (P < .001), with little temporal change (P = .070). Mean positive psychological outcome scores exceeded scales' midpoints at follow-up. Life satisfaction, assessed longitudinally, declined over time (P < .001) but remained similar to the norm at follow-up. Recent hospitalization and dyspnea increased patients' likelihood of poor physical HRQOL at follow-up (P's ≤ .022). Lower sense of mastery and poorer caregiver support lessened patients' likelihood of positive psychological outcomes (P's ≤ .049). Medical comorbidities and type of CTX were not associated with study outcomes at follow-up. CONCLUSIONS Despite physical HRQOL impairment, long-term CTX survivors otherwise showed favorable outcomes. Clinical attention to correlates of HRQOL and positive psychological outcomes may help maximize survivors' well-being.
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Affiliation(s)
- Mary Amanda Dew
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Departments of Psychology, Epidemiology, and Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrea F. DiMartini
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Donna M. Posluszny
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Larissa Myaskovsky
- Department of Internal Medicine, University of New Mexico School of Medicine and Center for Healthcare Equity in Kidney Disease, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Galen E. Switzer
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Chethan Puttarajappa
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Gavin W. Hickey
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- UPMC Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | - Pablo G. Sanchez
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Annette J. DeVito Dabbs
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
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Rates and Predictors of Nonadherence to the Post-Allogeneic Hematopoietic Cell Transplantation Medical Regimen in Patients and Caregivers. Transplant Cell Ther 2022; 28:165.e1-165.e9. [PMID: 34875403 PMCID: PMC9004486 DOI: 10.1016/j.jtct.2021.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/18/2021] [Accepted: 11/28/2021] [Indexed: 11/20/2022]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) requires a complex, multicomponent medical regimen after hospital discharge. Patients must manage multiple medications; care for their catheter; minimize exposure to sources of potential infection; follow diet, exercise, and self-care guidelines; and attend frequent follow-up medical appointments. Their caregivers are tasked with helping them manage the regimen. Despite the importance of this management in preventing adverse clinical outcomes, there has been little study of regimen nonadherence and its predictors. We sought to prospectively determine rates and predictors of nonadherence to components of the post-HCT medical regimen during the first 8 weeks after hospital discharge. Patients (n = 92) and their caregivers (n = 91) (total n = 183) completed interview assessments pre-HCT, and at 4 weeks and 8 weeks after hospital discharge post-HCT. Sociodemographic factors (eg, age, sex), patient clinical status (eg, disease type, donor type), patient and caregiver self-reported health-related factors (eg, medical comorbidities), and patient and caregiver psychosocial factors (eg, anxiety, depression, HCT task-specific and general self-efficacy, relationship quality) were assessed pre-HCT. Nonadherence to each of 17 regimen tasks was assessed at 4 and 8 weeks after hospital discharge via self and caregiver collateral reports. Nonadherence rates varied among tasks, with 11.2% to 15.7% of the sample reporting nonadherence to immunosuppressant medication, 34.8% to 38.6% to other types of medications, 14.6% to 67.4% to required infection precautions, and 27.0% to 68.5% to lifestyle-related behaviors (eg, diet/exercise). Nonadherence rates were generally stable but worsened over time for lifestyle-related behaviors. The most consistent nonadherence predictors were patient and caregiver pre-HCT perceptions of lower HCT task efficacy. Higher caregiver depression, caregiver perceptions of poorer relationship with the patient, having a nonspousal caregiver, and having diseases other than acute myelogenous leukemia also predicted greater nonadherence in 1 or more areas. Rates of nonadherence varied across tasks, and both patient and caregiver factors, particularly self-efficacy, predicted nonadherence. The findings highlight the importance of considering not only patient factors, but also caregiver factors, in post-HCT regimen nonadherence.
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Soyseth TS, Dew MA, Lund MB, Haugstad GK, Soyseth V, Malt UF. Coping Patterns and Emotional Distress in Patients With Chronic Obstructive Lung Disease Who Are Undergoing Lung Transplant Evaluation. Prog Transplant 2020; 30:228-234. [PMID: 32578510 DOI: 10.1177/1526924820933817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Living with severe lung disease like chronic obstructive pulmonary disease (COPD) is a very stressful situation. The way patients cope may impact their symptoms of anxiety and depression and physical function as well. We studied how ways of coping are associated with levels of emotional distress and lung function in patients with COPD being evaluated for lung transplantation. METHODS Sixty-five (mean age 57 years, 46% females) patients completed the General Health Questionnaire-30 (GHQ-30) assessing emotional distress and the Ways of Coping Questionnaire. Measurements of lung function and 6-minute walk test were included. RESULTS Seventeen (26%) patients had elevated emotional distress. Logistic regression of chronic GHQ score with gender, age, body mass index, lung function, and coping scales as covariates showed that escape avoidance and self-controlling coping and forced vital lung capacity were significantly associated with high emotional distress. Odds ratio of emotional distress increased with 5.2 per tertile (P = .011) in escape avoidance coping score. Moreover, we revealed that emotionally distressed patients cope with their current situation by refusing to believe the current situation and taking their distress out on other people. CONCLUSION Among patients with COPD, a high level of emotional distress was uniquely associated with escape-avoidance coping and lung function. Future work should ascertain whether coping style predicts distress or whether distress increases the use of escape-avoidance coping. Nevertheless, our findings indicate that if either element is present, health care professionals should be attentive to the need for interventions to improve patients' well-being.
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Affiliation(s)
- Torunn S Soyseth
- Department of Clinical Service, Division of Cancer Medicine, 155272Oslo University Hospital, Oslo, Norway
| | - Mary Amanda Dew
- Department of Psychiatry, 6595University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA, USA
| | - May Brit Lund
- Department of Respiratory Medicine, Division of Cardiovascular and Pulmonary Diseases, 155272Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, 6305University of Oslo, Norway
| | - Gro Killi Haugstad
- Department of Physiotherapy, 60499Oslo Metropolitan University, Oslo, Norway.,Unit for C-L Psychiatry and Psychosomatic Medicine, Division of Mental health and Dependency, 155272Oslo University Hospital, Oslo, Norway
| | - Vidar Soyseth
- Faculty of Medicine, Institute of Clinical Medicine, 6305University of Oslo, Norway.,Department of Respiratory Diseases and Allergy, 60483Akershus University Hospital, Nordbyhagen, Norway
| | - Ulrik Fredrik Malt
- Faculty of Medicine, Institute of Clinical Medicine, 6305University of Oslo, Norway.,Unit for C-L Psychiatry and Psychosomatic Medicine, Division of Mental health and Dependency, 155272Oslo University Hospital, Oslo, Norway.,Department of Research and Education, Division of Clinical Neuroscience, 155272Oslo University Hospital, Oslo, Norway
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Geramita EM, DeVito Dabbs AJ, DiMartini AF, Pilewski JM, Switzer GE, Posluszny DM, Myaskovsky L, Dew MA. Impact of a Mobile Health Intervention on Long-term Nonadherence After Lung Transplantation: Follow-up After a Randomized Controlled Trial. Transplantation 2020; 104:640-651. [PMID: 31335759 PMCID: PMC7170004 DOI: 10.1097/tp.0000000000002872] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND In a randomized controlled trial, lung transplant recipients (LTRs) using a mobile health intervention, Pocket Personal Assistant for Tracking Health (Pocket PATH), showed better adherence to the medical regimen than LTRs receiving usual care during the first year posttransplant. We examined whether these effects were maintained beyond the end of the trial and evaluated other potential risk factors for long-term nonadherence. METHODS Adherence in 8 areas was evaluated at follow-up in separate LTR and family caregiver (collateral) assessments. Pocket PATH and usual care groups' nonadherence rates were compared; multivariable regression analyses then examined and controlled for other patient characteristics' associations with nonadherence. RESULTS One hundred five LTRs (75% of survivors) were assessed (M = 3.9 years posttransplant, SD = 0.8). Nonadherence rates in the past month were 23%-81% for self-care and lifestyle requirements (diet, exercise, blood pressure monitoring, spirometry), 13%-23% for immunosuppressants and other medications, and 4% for tobacco use, with 31% clinic appointment nonadherence in the past year. In multivariable analysis, the Pocket PATH group showed lower risk of nonadherence to lifestyle requirements (diet/exercise) than the usual care group (P < 0.05). Younger age and factors during the first year posttransplant (acute graft rejection, chronically elevated anxiety, less time rehospitalized, nonadherence at the final randomized controlled trial assessment) were each associated with nonadherence in at least 1 area at follow-up (P < 0.05). CONCLUSIONS Pocket PATH did not have sustained impact on most areas of the regimen, although we identified other risk factors for long-term nonadherence. Future work should explore strategies to facilitate sustained effects of mobile health interventions.
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Affiliation(s)
- Emily M. Geramita
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Annette J. DeVito Dabbs
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA
| | - Andrea F. DiMartini
- Departments of Psychiatry and Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Joseph M. Pilewski
- Departments of Medicine, Pediatrics, and Cell Biology, University of Pittsburgh, Pittsburgh, PA
| | - Galen E. Switzer
- Department of Medicine, University of Pittsburgh, and Center for Health Equity Research and Promotion, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, PA
| | | | - Larissa Myaskovsky
- Department of Internal Medicine, and Center for Healthcare Equity in Kidney Disease, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Mary Amanda Dew
- Departments of Psychiatry, Psychology, Epidemiology, Biostatistics, Nursing, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA
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Mena SS, Trejo SD, Álvarez MJDY, Gafas ADP. Variables Psicológicas en pacientes candidatos a trasplante pulmonar. CLÍNICA CONTEMPORÁNEA 2019. [DOI: 10.5093/cc2019a4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Correlates of anxiety and depression symptoms among patients and their family caregivers prior to allogeneic hematopoietic cell transplant for hematological malignancies. Support Care Cancer 2018; 27:591-600. [PMID: 30022348 DOI: 10.1007/s00520-018-4346-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 07/06/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE Given the complexities and risks of allogeneic HCT, patients and their family caregivers may experience elevated psychological distress, including symptoms of anxiety and depression, in anticipation of the procedure. Patients and caregivers also bring with them their pre-HCT experiences of diagnosis, prior treatment, and associated burdens, thus potentially compounding their acute distress. Identification of clinical, psychosocial, and sociodemographic factors related to pre-HCT distress would allow targeting of patients and caregivers who may require assistance during the HCT process. METHODS Consecutive patients (n = 111) and their caregivers (n = 110) completed measures of anxiety, depression, cancer distress, perceived threat, perceived control, self-efficacy, relationship quality, and physical quality of life in the week before HCT. Multivariate linear regression analysis was used to identify factors associated with patient and caregiver anxiety or depression, including disease type, donor type, and patient and caregiver sociodemographic, health-related, and psychosocial factors. RESULTS Family caregivers had higher levels of anxiety and depression symptoms than patients. Thirty percent of caregivers vs. 17% of patients met criteria for clinically significant anxiety and a lesser amount (5% for both) met criteria for clinically significant depression. Patient anxiety was related to younger age (b = - 0.22, p = 0.005) and greater cancer-related distress (b = 0.59, p < 0.001), while caregiver anxiety was related to lower self-efficacy (b = - 0.19, p = 0.011) and greater cancer-related distress (b = 0.58, p < 0.001). Similarly, patient depression was related to lower perceived control (b = - 0.17, p = 0.050), greater cancer-related distress (b = 0.34, p = 0.005), and lower physical functioning (b = - 0.26, p = 0.008), while caregiver depression was related to greater cancer-related distress (b = 0.46, p < 0.001). CONCLUSIONS Family caregivers may be more emotionally vulnerable than patients before HCT and in need of additional assistance. Cancer-related distress was the strongest correlate of anxiety and depression in both patients and caregivers, suggesting that distress related to their cancer experience and its consequences plays a major role in their emotional functioning prior to HCT.
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Dobbels F, Verleden G, Dupont L, Vanhaecke J, De Geest S. To transplant or not? The importance of psychosocial and behavioural factors before lung transplantation. Chron Respir Dis 2016; 3:39-47. [PMID: 16509176 DOI: 10.1191/1479972306cd082ra] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The gratifying results of lung transplantation in terms of survival and quality of life stimulate the referral of an ever-increasing number of patients with end-stage lung disease. This in turn compounds the organ shortage, which is the limiting factor in the transplantation rate. In the absence of good alternative treatment modalities, an evidence-based pretransplant screening process is a prerequisite to detennine which patients will benefit most from transplantation. Within this evidence-based screening process, medical selection criteria are well established. There is a growing awareness that psychosocial and behavioural factors may determine outcome after transplantation as well. This paper reviews the available evidence for psychosocial and behavioural factors in the screening process for lung transplantation. The relation of various factors with post-transplant outcome was explored. Psychosocial characteristics before transplantation consist of 1) anxiety and depression, 2) personality disorders, 3) neurocognitive problems, and 4) lack of social support. Pretransplant behavioural factors include 1) noncompliance with medication, 2) alcohol abuse or dependence, 3) smoking, 4) noncompliance with dietary guidelines, and 5) noncompliance with monitoring of vital parameters and infections. It appears that the lack of rigorous studies limit the feasibility of an evidence-based screening process. Prospective studies are crucial to this further investigation of the relationship between psychosocial and behavioural determinants before transplantation and outcomes after transplantation, in terms of compliance, morbidity, and mortality. Identification of modifiable risk factors for poor outcome before transplantation is a first step in developing interventions.
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Affiliation(s)
- F Dobbels
- Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Belgium.
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Denny B, Kienhuis M, Gavidia-Payne S. Explaining the quality of life of organ transplant patients by using crisis theory. Prog Transplant 2015; 25:324-31. [PMID: 26645927 DOI: 10.7182/pit2015904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
CONTEXT Ubiquitous findings regarding the quality of life (QOL) of transplant patients have yet to be explained from a theoretical perspective. OBJECTIVE To investigate transplant patients' QOL by using the conceptual framework of crisis theory. DESIGN Cross-sectional study to explore differences in transplant patients' experiences of stress, coping, and QOL. Regression analysis was used to test crisis theory in relation to QOL, stress, and coping. PARTICIPANTS A total of 226 participants representing transplant candidates, transplant recipients, and nontransplant individuals participated via survey-based data collection. RESULTS Results showed that transplant candidates experience lower QOL than transplant recipients and nontransplant individuals. No significant differences were detected regarding stress levels or coping styles. Stress made a significant contribution to patients' QOL. CONCLUSIONS Current findings suggest important QOL benefits of organ transplant. Using a theoretical model is an effective way to investigate the QOL of people experiencing chronic illness such as end-stage organ failure. Further investigation is required to reach a conclusive understanding of the complex interaction between transplant patients' QOL, stress, and coping.
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Hundt NE, Bensadon BA, Stanley MA, Petersen NJ, Kunik ME, Kauth MR, Cully JA. Coping mediates the relationship between disease severity and illness intrusiveness among chronically ill patients. J Health Psychol 2013; 20:1186-95. [DOI: 10.1177/1359105313509845] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Reducing perceptions of illness intrusiveness may improve quality of life and mental health among patients with cardiopulmonary disease. To better understand relationships between coping style, locus of control, perceived illness intrusiveness, and disease severity, we analyzed data from 227 older Veterans with chronic obstructive pulmonary disease or congestive heart failure. Regressions revealed illness intrusiveness to be associated with younger age and greater disease severity, less internal locus of control, and avoidant/emotion-focused coping. Avoidant/emotion-focused coping but not active coping mediated the relationship between illness severity and illness intrusiveness. Findings suggest that supportive psychological interventions may reduce illness intrusiveness by targeting an avoidant/emotion-focused coping style and associated behaviors.
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Affiliation(s)
- Natalie E Hundt
- Michael E. DeBakey VA Medical Center (MEDVAMC), USA
- Baylor College of Medicine, USA
- VA South Central Mental Illness Research, Education and Clinical Center, USA
| | - Benjamin A Bensadon
- University of Oklahoma Health Sciences Center, USA
- Oklahoma City VA Medical Center, USA
| | - Melinda A Stanley
- Michael E. DeBakey VA Medical Center (MEDVAMC), USA
- Baylor College of Medicine, USA
- VA South Central Mental Illness Research, Education and Clinical Center, USA
| | - Nancy J Petersen
- Michael E. DeBakey VA Medical Center (MEDVAMC), USA
- Baylor College of Medicine, USA
| | - Mark E Kunik
- Michael E. DeBakey VA Medical Center (MEDVAMC), USA
- Baylor College of Medicine, USA
- VA South Central Mental Illness Research, Education and Clinical Center, USA
| | - Michael R Kauth
- Michael E. DeBakey VA Medical Center (MEDVAMC), USA
- Baylor College of Medicine, USA
- VA South Central Mental Illness Research, Education and Clinical Center, USA
| | - Jeffrey A Cully
- Michael E. DeBakey VA Medical Center (MEDVAMC), USA
- Baylor College of Medicine, USA
- VA South Central Mental Illness Research, Education and Clinical Center, USA
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Singer J, Chen J, Blanc PD, Leard LE, Kukreja J, Chen H. A thematic analysis of quality of life in lung transplant: the existing evidence and implications for future directions. Am J Transplant 2013; 13:839-850. [PMID: 23432992 PMCID: PMC3622720 DOI: 10.1111/ajt.12174] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Health-related quality of life (HRQL) has been assessed in various lung transplantation (LT) investigations but never analyzed systematically across multiple studies. We addressed this knowledge gap through a systematic literature review. We searched the PubMed, CINAHL and PsychInfo databases for publications from January 1, 1983 to December 31, 2011. We performed a thematic analysis of published studies of HRQL in LT. Using a comparative, consensus-based approach, we identified themes that consistently emerged from the data, classifying each study according to primary and secondary thematic categories as well as by study design. Of 749 publications initially identified, 73 remained after exclusions. Seven core themes emerged: (1) Determinants of HRQL; (2) Psychosocial factors in HRQL; (3) Pre- and posttransplant HRQL comparisons; (4) Long-term longitudinal HRQL studies; (5) HRQL effects of therapies and interventions; (6) HRQL instrument validation and methodology; (7) HRQL prediction of clinical outcomes. Overall, LT significantly and substantially improves HRQL, predominantly in domains related to physical health and functioning. The existing literature demonstrates substantial heterogeneity in methodology and approach; relatively few studies assessed HRQL longitudinally within the same persons. Opportunity for future study lies in validating existing and potential novel HRQL instruments and further elucidating the determinants of HRQL through longitudinal multidimensional investigation.
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Affiliation(s)
- Jonathan Singer
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, USA, Cardiovascular Research Institute, UC San Francisco, San Francisco, USA
| | - Joan Chen
- Cardiovascular Research Institute, UC San Francisco, San Francisco, USA
| | - Paul D. Blanc
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, USA, Cardiovascular Research Institute, UC San Francisco, San Francisco, USA, Division of Occupational and Environmental Medicine, UC San Francisco, USA
| | - Lorriana E. Leard
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, USA
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Abstract
BACKGROUND Although end-stage kidney disease in African Americans (AAs) is four times greater than in whites, AAs are less than one half as likely to undergo kidney transplantation (KT). This racial disparity has been found even after controlling for clinical factors such as comorbid conditions, dialysis vintage and type, and availability of potential living donors. Therefore, studying nonmedical factors is critical to understanding disparities in KT. METHODS We conducted a longitudinal cohort study with 127 AA and white patients with end-stage kidney disease undergoing evaluation for KT (December 2006 to July 2007) to determine whether, after controlling for medical factors, differences in time to acceptance for transplant is explained by patients' cultural factors (e.g., perceived racism and discrimination, medical mistrust, religious objections to living donor KT), psychosocial characteristics (e.g., social support, anxiety, depression), or transplant knowledge. Participants completed two telephone interviews (shortly after initiation of transplant evaluation and after being accepted or found ineligible for transplant). RESULTS Results indicated that AA patients reported higher levels of the cultural factors than did whites. We found no differences in comorbidity or availability of potential living donors. AAs took significantly longer to get accepted for transplant than did whites (hazard ratio=1.49, P=0.005). After adjustment for demographic, psychosocial, and cultural factors, the association of race with longer time for listing was no longer significant. CONCLUSIONS We suggest that interventions to address racial disparities in KT incorporate key nonmedical risk factors in patients.
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Denny B, Kienhuis M. Using Crisis Theory to Explain the Quality of Life of Organ Transplant Patients. Prog Transplant 2011; 21:182-8; quiz 189. [DOI: 10.1177/152692481102100302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Stilley CS, DiMartini AF, de Vera ME, Flynn WB, King J, Sereika S, Tarter RE, Dew MA, Rathnamala G. Individual and Environmental Correlates and Predictors of Early Adherence and Outcomes after Liver Transplantation. Prog Transplant 2010; 20:58-66; quiz 67. [DOI: 10.1177/152692481002000110] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Context Little is known about patients' contribution to health outcomes after liver transplantation. Yet, in other transplant recipients, nonadherent behavior is directly related to the leading causes of morbidity and mortality in liver transplant recipients. Objective To examine patient and environmental factors in relation to all aspects of adherence to the posttransplantation regimen and health outcomes in the first 6 months after transplantation. Design A descriptive analysis of individual and environmental factors in relation to adherence and health outcomes at 6 months after liver transplantation. Participants, Setting One hundred fifty-two adult liver transplant recipients at the University of Pittsburgh Medical Center. Main Outcome Measures Adherence to medication taking, appointment keeping, lifestyle changes, mood, quality of life, and clinical markers of liver function. Results Nonadherence was prevalent (47% with appointments, 73% with medication); relapse to drug/alcohol use occurred among a few recipients (5.6%), all with a history of substance abuse before transplantation. Patterns of coping, decision making, attitude, and social support were correlated with adherence, clinical markers, and psychological function (r = 0.22–0.45). Avoidant coping, affective dysregulation, and caregiver support emerged as robust predictors of negative clinical and mental health outcomes (β = .224-.363). Conclusion This information about liver transplant recipients is important for researchers and clinicians. Researchers can develop guidelines by using stable but modifiable characteristics of patients to identify transplant candidates at risk of nonadherence. Such guidelines would enable clinicians to prepare patients better to manage the posttransplant regimen.
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Affiliation(s)
- Carol S. Stilley
- University of Pittsburgh (CSS, AFD, WBF, JK, SS, RET, MAD, GR), Montefiore Hospital (MEdV), Pittsburgh, Pennsylvania
| | - Andrea F. DiMartini
- University of Pittsburgh (CSS, AFD, WBF, JK, SS, RET, MAD, GR), Montefiore Hospital (MEdV), Pittsburgh, Pennsylvania
| | - Michael E. de Vera
- University of Pittsburgh (CSS, AFD, WBF, JK, SS, RET, MAD, GR), Montefiore Hospital (MEdV), Pittsburgh, Pennsylvania
| | - William B. Flynn
- University of Pittsburgh (CSS, AFD, WBF, JK, SS, RET, MAD, GR), Montefiore Hospital (MEdV), Pittsburgh, Pennsylvania
| | - Jennifer King
- University of Pittsburgh (CSS, AFD, WBF, JK, SS, RET, MAD, GR), Montefiore Hospital (MEdV), Pittsburgh, Pennsylvania
| | - Susan Sereika
- University of Pittsburgh (CSS, AFD, WBF, JK, SS, RET, MAD, GR), Montefiore Hospital (MEdV), Pittsburgh, Pennsylvania
| | - Ralph E. Tarter
- University of Pittsburgh (CSS, AFD, WBF, JK, SS, RET, MAD, GR), Montefiore Hospital (MEdV), Pittsburgh, Pennsylvania
| | - Mary Amanda Dew
- University of Pittsburgh (CSS, AFD, WBF, JK, SS, RET, MAD, GR), Montefiore Hospital (MEdV), Pittsburgh, Pennsylvania
| | - Geetha Rathnamala
- University of Pittsburgh (CSS, AFD, WBF, JK, SS, RET, MAD, GR), Montefiore Hospital (MEdV), Pittsburgh, Pennsylvania
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16
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Lefaiver CA, Keough VA, Letizia M, Lanuza DM. Quality of Life in Caregivers Providing Care for Lung Transplant Candidates. Prog Transplant 2009; 19:142-52. [DOI: 10.1177/152692480901900208] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Context Caregivers are essential members of the health care team who provide care, valued at more than $250 billion each year, to millions of persons who require assistance with health and daily care. Patients with respiratory diseases who are waiting for a lung transplant are required to have an identified caregiver. The caregivers are rarely studied. Objective To explore the relationships among the health status of caregivers of lung transplant candidates, caregivers' reaction to caregiving, and caregivers' perceived quality of life. Design This descriptive study examined the quality of life of lung transplant caregivers from a multidimensional perspective. Setting and Participants Twenty-nine dyads of lung transplant candidates and their caregivers were recruited from a Midwestern medical center. Measures Data were collected by self-report: caregivers completed the Quality of Life Index, SF-12 health survey, Profile of Mood States-Short Form, and the Caregiver Reaction Assessment. Results Caregivers reported favorable levels of quality of life, physical health, and mood during the pretransplant waiting phase. However, problem areas for caregivers during this time included fatigue, depression, and the financial impact of the transplant. Data analyses indicated that depression, caregiver general health, impact on finances, and lack of family support had the greatest effect on caregivers' quality of life. Nurses are urged to recognize the role of caregivers in the transplant process, ask about and listen to caregivers' needs, and include caregivers in the plan of care.
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Affiliation(s)
- Cheryl A. Lefaiver
- Advocate Christ Medical Center/Advocate Hope Children's Hospital, Oak Lawn, Illinois (CAL), Loyola University, School of Nursing, Chicago, Illinois (VK, ML), University of Wisconsin-Madison School of Nursing (DML)
| | - Vicki A. Keough
- Advocate Christ Medical Center/Advocate Hope Children's Hospital, Oak Lawn, Illinois (CAL), Loyola University, School of Nursing, Chicago, Illinois (VK, ML), University of Wisconsin-Madison School of Nursing (DML)
| | - Marijo Letizia
- Advocate Christ Medical Center/Advocate Hope Children's Hospital, Oak Lawn, Illinois (CAL), Loyola University, School of Nursing, Chicago, Illinois (VK, ML), University of Wisconsin-Madison School of Nursing (DML)
| | - Dorothy M. Lanuza
- Advocate Christ Medical Center/Advocate Hope Children's Hospital, Oak Lawn, Illinois (CAL), Loyola University, School of Nursing, Chicago, Illinois (VK, ML), University of Wisconsin-Madison School of Nursing (DML)
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17
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Abdel-Kader K, Myaskovsky L, Karpov I, Shah J, Hess R, Dew MA, Unruh M. Individual quality of life in chronic kidney disease: influence of age and dialysis modality. Clin J Am Soc Nephrol 2009; 4:711-8. [PMID: 19339411 DOI: 10.2215/cjn.05191008] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Novel individualized quality-of-life (IQOL) measures permit patients with chronic kidney disease (CKD) to nominate unique areas of their lives that contribute to their well-being. This study assessed for differences in domains nominated by patients with CKD. We also examined the strength of association between (1) multidimensional health-related quality-of-life measures and IQOL and (2) psychosocial factors and IQOL. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We performed a cross-sectional study of 151 patients who were undergoing peritoneal dialysis or hemodialysis or had stages 4 through 5 CKD. Patients completed the Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQOL-DW), an instrument that assesses IQOL on the basis of patient-identified domains. Patients also completed health-related quality-of-life and psychosocial health measures. RESULTS Patients with CKD nominated many domains on the SEIQOL-DW, but family and health were the most common for all groups. Kidney disease was listed more frequently by peritoneal dialysis compared with hemodialysis patients or patients with CKD (31 versus 14 versus 5%, respectively). There were no significant differences in SEIQOL-DW scores between subgroups. SEIQOL-DW scores correlated with mental well-being and inversely correlated with chronic stress and depression. CONCLUSIONS Patients with advanced CKD demonstrate compromised quality-of-life scores comparable to dialysis patients. IQOL measures provide unique information that may help guide interventions that are better tailored to address patients' concerns about their well-being. These findings also suggest that renal clinics should have staff available to address psychosocial aspects of patient well-being.
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Affiliation(s)
- Khaled Abdel-Kader
- Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA.
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18
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Telles-Correia D, Barbosa A, Mega I, Monteiro E. Importance of depression and active coping in liver transplant candidates' quality of life. Prog Transplant 2009. [DOI: 10.7182/prtr.19.1.p72r07523vl3660j] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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19
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Telles-Correia D, Barbosa A, Mega I, Monteiro E. Importance of Depression and Active Coping in Liver Transplant Candidates' Quality of Life. Prog Transplant 2009; 19:85-9. [DOI: 10.1177/152692480901900112] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objective To investigate the importance of psychiatric and psychological factors such as depression, anxiety, personality traits, and coping strategies in liver transplant candidates' quality of life. Methods A total of 131 consecutive liver transplant candidates attending outpatient clinics at a liver transplantation central unit were assessed by means of the Medical Outcomes Study Short Form quality-of-life questionnaire, psychiatric diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, a personality inventory (NEO Five-Factor Inventory), the Hospital Anxiety and Depression Scale, and the Brief COPE scale. Results and Conclusions Both physical and mental components of quality of life are far more correlated with depression and active coping strategy than with clinical and sociodemographic factors. Neuroticism was also strongly correlated with the mental component of quality of life, and employment was correlated with the physical component of quality of life.
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Affiliation(s)
- Diogo Telles-Correia
- Curry Cabral Hospital (DT-C, IM, EM), Faculty of Medicine, University of Lisbon (DT-C, AB, EM)
| | - A. Barbosa
- Curry Cabral Hospital (DT-C, IM, EM), Faculty of Medicine, University of Lisbon (DT-C, AB, EM)
| | - I. Mega
- Curry Cabral Hospital (DT-C, IM, EM), Faculty of Medicine, University of Lisbon (DT-C, AB, EM)
| | - E. Monteiro
- Curry Cabral Hospital (DT-C, IM, EM), Faculty of Medicine, University of Lisbon (DT-C, AB, EM)
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20
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Rapoport-Hubschman N, Gidron Y, Reicher-Atir R, Sapir O, Fisch B. "Letting go" coping is associated with successful IVF treatment outcome. Fertil Steril 2008; 92:1384-1388. [PMID: 18930223 DOI: 10.1016/j.fertnstert.2008.08.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Revised: 07/21/2008] [Accepted: 08/07/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine whether women's baseline coping strategies are associated with IVF outcomes. Psychologic factors have been found to be prospectively associated with the outcome of IVF treatments in several studies. However, the exact role of coping strategies, which are modifiable, remains unclear. Problem-focused coping may be more adaptive for controllable situations, whereas emotion-focused coping (EFC) may be more adaptive for uncontrollable situations, such as most stages of IVF treatment. DESIGN Prospective study. Coping strategies were assessed before IVF treatment began. SETTING Infertility and IVF unit in a university-affiliated tertiary medical center. PATIENT(S) Eighty-eight women undergoing IVF treatment in our unit. MAIN OUTCOME MEASURE(S) Pregnancy. RESULT(S) Of 88 women participating in the study, 23.9% became pregnant. In the male and female factor infertility groups, the EFC strategy of "letting go" was positively and significantly associated with pregnancy. Adjusting for age, cause of infertility, and number of cycles, the relative risk for pregnancy by "letting go" was 1.88 (95% confidence interval 1.1-3.2). CONCLUSION(S) These findings support the notion that in the context of a low-control situation such as IVF treatment, women who try to be actively in control may pay a higher price in terms of pregnancy probabilities. Means of increasing "letting go" are discussed.
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Affiliation(s)
- Nathalie Rapoport-Hubschman
- IVF and Infertility Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel.
| | | | - Rivka Reicher-Atir
- IVF and Infertility Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
| | - Onit Sapir
- IVF and Infertility Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
| | - Benjamin Fisch
- IVF and Infertility Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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21
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Girard F, Chouinard P, Boudreault D, Poirier C, Richard C, Ruel M, Ferraro P. Prevalence and impact of pain on the quality of life of lung transplant recipients: a prospective observational study. Chest 2006; 130:1535-40. [PMID: 17099034 DOI: 10.1378/chest.130.5.1535] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVE To study the prevalence and impact of pain on the quality of life (QOL) of lung transplant recipients. DESIGN AND PATIENTS Prospective, observational, cross-sectional study. Ninety-six lung transplant recipients (> 3 months after transplantation) completed questionnaires measuring the severity and impact of pain (Brief Pain Inventory), anxiety (State Trait Anxiety Inventory), QOL (Short Form-36 version 2 [SF-36v2]), and depression (Beck Depression Inventory [BDI]). SETTING University medical center lung transplant outpatient clinic. RESULTS The prevalence of pain in lung transplant recipients was 49%. Patients with pain were older, more likely to have undergone unilateral lung transplantation (64% vs 40%, p = 0.03), and were more likely to have lung emphysema (55% vs 38%, p = 0.004). Only a pulmonary diagnosis of lung emphysema remained an independent predictor for postoperative pain in a logistic regression model. Average (+/- SD) score of the BDI was 9.6 +/- 7.8 and 5.8 +/- 5.8 (p = 0.005) for patients with and without pain, respectively. Patients with and without pain did not significantly differ in terms of anxiety. Pain-free patients had a significantly higher physical component score than patients with pain in the SF-36v2 (mean, 48.7 +/- 8.6 vs 38.6 +/- 9.8, p < 0.0001, respectively), while the mental component scores were not statistically different between the two groups. CONCLUSIONS Lung transplant recipients have a high prevalence of pain. Patients with lung emphysema as their preoperative diagnosis are more likely to have pain. The occurrence of pain is associated with a decreased QOL in lung transplant recipients.
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Affiliation(s)
- François Girard
- Department of Anesthesiology, CHUM Hopital Notre-Dame, Montreal, Canada, H2L 4M1.
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