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Kayler LK, Nie J, Solbu A, Handmacher M, Feeley TH, Noyes K. Feasibility of providing web-based education to patients prior to kidney transplant evaluation. Clin Transplant 2024; 38:e15174. [PMID: 37897216 DOI: 10.1111/ctr.15174] [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: 05/02/2023] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND We previously developed web-based education to be used by patients prior to kidney transplant (KTX) evaluation. The current feasibility study evaluated patients' intervention uptake and barriers, and staff experiences of the clinic-wide implementation in preparation for a definitive comparative effectiveness trial. METHODS Web links and login instructions to view 17 educational videos designed to promote KTX access were delivered via email or text to adults referred to a single transplant center between 10/2020 and 3/2021. Patient barriers were recorded. Non-completers were allowed to view the resources in the clinic. N = 7 clinic staff were interviewed about their experiences of in-clinic delivery of the web-education. Interviews were recorded with field notes and coded using simple content analysis. Patient characteristics and 30-month KTX access were examined with Chi-square, t-tests, and log-rank tests. RESULTS Of 210 patients, 71% completed the self-education remotely (completers), 16% attempted but did not complete remotely (attempters), and 13% declined the web link invitation (decliners). Implementation barriers included technology access and use difficulties, unstable internet connectivity, limited staff time in clinic to facilitate technology use by patients, and limited technology attentiveness by patients in clinic. In 3-group comparisons, remote decliners were older with worse estimated posttransplant survival scores, and attempters were younger, more often Medicaid insured, and lived in higher area deprivation; both were more often deemed ineligible for KTX than completers. Between-group time-to-transplantation was non-significant (p = .571). CONCLUSION The majority of patients accessed the web-education remotely; however, more vulnerable demographic populations reported greater problems accessing web-education. In-clinic delivery was burdensome to staff and patients. Future adaptive implementation strategies are needed to allow for adequate patient education.
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Affiliation(s)
- Liise K Kayler
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York, USA
- Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center, Buffalo, New York, USA
- Department of Surgery, University at Buffalo, Buffalo, New York, USA
| | - Jing Nie
- Department of Epidemiology and Environmental Health, University at Buffalo School of Public Health and Health Professions, Buffalo, New York, USA
| | - Anne Solbu
- Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center, Buffalo, New York, USA
- Department of Surgery, University at Buffalo, Buffalo, New York, USA
| | - Matthew Handmacher
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York, USA
- Department of Surgery, University at Buffalo, Buffalo, New York, USA
| | - Thomas H Feeley
- Department of Communication, University at Buffalo, Buffalo, New York, USA
| | - Katia Noyes
- Department of Epidemiology and Environmental Health, University at Buffalo School of Public Health and Health Professions, Buffalo, New York, USA
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Tesfaye W, Parrish N, Sud K, Grandinetti A, Castelino R. Medication Adherence Among Patients With Kidney Disease: An Umbrella Review. ADVANCES IN KIDNEY DISEASE AND HEALTH 2024; 31:68-83. [PMID: 38403396 DOI: 10.1053/j.akdh.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/07/2023] [Accepted: 08/15/2023] [Indexed: 02/27/2024]
Abstract
Chronic kidney disease (CKD) imposes a significant medication burden on patients due to the necessity of multiple treatments to slow disease progression, manage coexisting conditions, and address complications. The complex medication regimen, in turn, has implications for clinical and patient-centered outcomes. This umbrella review provides comprehensive evidence on extent of medication nonadherence among adults with CKD, as well as associated risk factors, outcomes, and the effectiveness of interventions by synthesizing evidence from published systematic reviews and/or meta-analyses. We identified 37 works that met our inclusion criteria. These reviews covered various aspects of treatment adherence in people with CKD, which can be categorized into four main themes: (i) prevalence of treatment nonadherence; (ii) factors associated with (non)adherent behaviors; (iii) outcomes associated with treatment (non)adherence; and (iv) interventions to improve treatment adherence or overall self-management practices. Approximately half of the included studies (15/34) focused on interventions aimed at improving medication adherence or overall CKD management, while outcomes associated with medication (non)adherence were relatively underexplored in the literature. The reported prevalence rates of medication nonadherence varied widely among reviews and stages of CKD. The determinants of adherence identified included socioeconomic variables, disease or clinical conditions, and psychosocial factors. Common interventions to improve adherence included nurse-led interventions, pharmaceutical services, and eHealth technologies, which had varying effects on medication adherence or dialysis sessions.
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Affiliation(s)
- Wubshet Tesfaye
- The University of Sydney School of Pharmacy, Sydney, New South Wales, Australia.
| | | | - Kamal Sud
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Nepean Kidney Research Centre, Department of Renal Medicine, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Amanda Grandinetti
- Population Health Partnership, National Kidney Foundation of Illinois, IL
| | - Ronald Castelino
- The University of Sydney School of Pharmacy, Sydney, New South Wales, Australia; Pharmacy Department, Blacktown Hospital, Sydney, New South Wales, Australia
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Oliveira JGRD, Sanders-Pinheiro H, Freitas Filho RAD, Vasconcelos Filho JE, Askari M, Silva Júnior GBD. Evaluación del uso de la Aplicación Renal Health por parte de los receptores de trasplante renal. Rev Lat Am Enfermagem 2023. [DOI: 10.1590/1518-8345.6039.3821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Resumen Objetivo: evaluar el uso de la aplicación Renal Health por parte de los receptores de trasplante renal. Método: estudio observacional retrospectivo con una muestra compuesta por usuarios que se registraron en la sección de trasplantados renales dentro de la aplicación desde julio de 2018 hasta abril de 2021. Se recolectaron las siguientes variables: datos demográficos, ingreso de datos, tiempo de uso, registros de peso, presión arterial, glucosa en sangre, creatinina, esquemas de medicación, consultas y exámenes. Se realizó un análisis descriptivo de los datos. Resultados: Ocurrieron 1.823 descargas de la aplicación y 12,3% se registró en la sección de trasplantados, la mayoría del sudeste de Brasil (44,9%), con edad de 36±11 años y del sexo femenino (59,1%). De la muestra, 35,1% ingresó información como: creatinina (62%), peso (58,2%) y presión arterial (51,8%). La mayoría utilizó la aplicación durante un día (63,3%) y el 13,9% más de cien días. Quienes lo usaron por más de un día (36,7%), agregaron peso (69%), programación de consultas (69%), medicación (65,5%) y creatinina (62%). Conclusión: la sección para trasplantados renales de la aplicación Renal Health despertó interés en la población joven, pero mostró baja adherencia en los meses evaluados. Estos resultados ofrecen una perspectiva relevante en la implementación de tecnologías mHealth en el trasplante renal.
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Oliveira JGRD, Sanders-Pinheiro H, Freitas Filho RAD, Vasconcelos Filho JE, Askari M, Silva Júnior GBD. Avaliação do uso do aplicativo Renal Health por transplantados renais. Rev Lat Am Enfermagem 2023. [DOI: 10.1590/1518-8345.6039.3823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Resumo Objetivo: avaliar o uso do aplicativo Renal Health por transplantados renais. Método: estudo observacional retrospectivo com amostra composta por usuários que realizaram cadastro na seção para transplantados renais do aplicativo de julho de 2018 a abril de 2021. Foram coletadas as seguintes variáveis: dados demográficos, inserção de dados, tempo de uso, registros de peso, pressão arterial, glicemia, creatinina, horários das medicações, consultas e exames. Realizou-se análise descritiva dos dados. Resultados: houve 1.823 downloads do aplicativo e 12,3% cadastraram-se na seção para transplantados renais, a maioria do Sudeste do Brasil (44,9%), com 36±11 anos e do sexo feminino (59,1%). Da amostra, 35,1% inseriram informações como creatinina (62%), peso (58,2%) e pressão arterial (51,8%). A maioria utilizou o aplicativo por um dia (63,3%) e 13,9% por mais de cem dias. Os que utilizaram por mais de um dia (36,7%), inseriram peso (69%), agendaram consultas (69%), medicações (65,5%) e creatinina (62%). Conclusão: a seção para transplantados renais do aplicativo Renal Health despertou interesse na população jovem, mas apresentou baixa adesão ao longo dos meses avaliados. Esses resultados oferecem perspectiva relevante na implementação de tecnologias mHealth no transplante renal.
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Gholamzadeh M, Safdari R, Amini S, Abtahi H. Feasibility study and determination of prerequisites of telecare programme to enhance patient management in lung transplantation: a qualitative study from the perspective of Iranian healthcare providers. BMJ Open 2023; 13:e073370. [PMID: 37349094 PMCID: PMC10314650 DOI: 10.1136/bmjopen-2023-073370] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/02/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Non-adherence to treatment plans, follow-up visits and healthcare advice is a common obstacle in the management of lung transplant patients. This study aims to investigate experts' views on the needs and main aspects of telecare programmes for lung transplantation. DESIGN A qualitative study incorporating an inductive thematic analysis. SETTING Lung transplant clinic and thoracic research centre. PARTICIPANTS Clinicians: four pulmonologists, two cardiothoracic surgeons, two general physicians, two pharmacotherapists, one cardiologist, one nurse and one medical informatician. METHOD This study adopted a focus group discussion technique to gather experts' opinions on the prerequisites and features of a telecare programme in lung transplantation. All interviews were coded and combined into main categories and themes. Thematic analysis was performed to extract the key concepts using ATLAS.Ti. Ultimately, all extracted themes were integrated to devise a conceptual model. RESULTS Ten focus groups with 13 participants were conducted. Forty-six themes and subthemes were extracted through the thematic analysis. The main features of the final programme were extracted from expert opinions through thematic analysis, such as continuous monitoring of symptoms, drug management, providing a specific care plan for each patient, educating patients module, creating an electronic medical record to collect patient information, equipping the system with decision support tools, smart electronic prescription and the ability to send messages to the care team. The prerequisites of the system were summarised in self-care activities, clinician's tasks and required technologies. In addition, the barriers and benefits of using a telecare system to enhance the quality of care were determined. CONCLUSION Our investigation recognised the main factors that must be considered to design a telecare programme to provide ideal continuous care for lung transplant patients. Users should further explore the proposed model to support the development of telecare interventions at the point of care.
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Affiliation(s)
- Marsa Gholamzadeh
- Health Information Management and Medical Informatics Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Safdari
- Health Information Management and Medical Informatics Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahideh Amini
- Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Abtahi
- Pulmonary and Critical Care Medicine Department, Tehran University of Medical Sciences, Tehran, Iran
- Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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Kaplan A, Korenjak M, Brown RS. Post-liver transplantation patient experience. J Hepatol 2023; 78:1234-1244. [PMID: 37208108 DOI: 10.1016/j.jhep.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/02/2023] [Accepted: 01/12/2023] [Indexed: 05/21/2023]
Abstract
Given improvements in post-transplant patient and graft survival, there is a growing need to focus on patient experience and health-related quality of life (HRQOL). Though liver transplantation can be life-saving, it can also be associated with significant morbidity and complications. Patient HRQOL improves after transplantation, but it may not improve to that of age-matched cohorts. Understanding patient experience and the factors that contribute to it, including physical and psychological health, immunosuppression and medication adherence, return to employment or school, financial burden, and expectations, helps when thinking creatively about potential interventions to improve HRQOL.
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Affiliation(s)
- Alyson Kaplan
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell School of Medicine, New York Presbyterian, New York, NY, USA
| | | | - Robert S Brown
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell School of Medicine, New York Presbyterian, New York, NY, USA.
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Weng LC, Huang HL, Tsai YH, Tsai HH, Lee WC, Shieh WY. The effect of a web-based self-care instruction on symptom experience and quality of life in living liver donors: A randomized controlled trial. Heliyon 2023; 9:e17333. [PMID: 37484234 PMCID: PMC10361383 DOI: 10.1016/j.heliyon.2023.e17333] [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: 11/17/2022] [Revised: 06/05/2023] [Accepted: 06/14/2023] [Indexed: 07/25/2023] Open
Abstract
Objective Living liver donors need help to manage symptom distress and improve their quality of life. This study aims to test the effectiveness of a web-based symptom self-care instruction on symptom experience and health-related quality of life of living liver donors. Methods This study was a randomized controlled trial. Participants were recruited from January 2019 to August 2020. Participants in the experimental group had access to a web-based symptom self-care instruction, which included text and video. The control group received routine care. The primary outcomes were symptom distress and quality of life. Results A total of 90 living liver donors recruited in this study were assigned randomly to the web group (n = 46) and control group (n = 44). The symptom distress was significantly negatively correlated with quality of life at each data collection time. There was an interaction effect with the participants in the web group experiencing more symptom distress at three months after surgery than the control group (B = 3.616, 95% CI: 7.163-3.990, p = 0.046). There was no significant effect on the quality of life. Conclusion Patients in the web-based self-care group had higher symptom distress than those in the control group three months after surgery, but there was no difference in quality of life. Future studies could add some interactive elements to the website and include a larger sample size. Registration This study was registered at the Chinese Clinical Trial Registry (ChiCTR1900020518).
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Affiliation(s)
- Li-Chueh Weng
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of General Surgery, Liver Transplantation, Chang Gung Medical Foundation, Linkuo Medical Center, Taoyuan, Taiwan
| | - Hsiu-Li Huang
- Department of Long-Term Care, College of Health Technology, National Taipei University of Nursing and Health Science, Taipei, Taiwan
| | - Yu-Hsia Tsai
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Cardiovascular Medicine, Chang Gung Medical Foundation, Linkuo Medical Center, Taoyuan, Taiwan
| | - Hsiu-Hsin Tsai
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Psychiatry, Chang Gung Medical Foundation, Linkuo Medical Center, Taoyuan, Taiwan
| | - Wei-Chen Lee
- Department of General Surgery, Liver Transplantation, Chang Gung Medical Foundation, Linkuo Medical Center, Taoyuan, Taiwan
| | - Wann-Yun Shieh
- Department of Computer Science and Information Engineering, Chang Gung University, Taoyuan, Taiwan
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Fukuhara H, Nawano T, Kanda A, Tomosugi T, Okada M, Futamura K, Hiramitsu T, Takeda A, Tsuchiya N, Goto N, Narumi S, Watarai Y. Short-term outcomes of second kidney transplantation compared with those of first transplantation in Japanese patients: a single-center, retrospective, observational study. Clin Exp Nephrol 2023; 27:188-196. [PMID: 36318396 DOI: 10.1007/s10157-022-02290-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/16/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Among patients who undergo kidney transplantation, a subsequent second kidney transplantation (TX2) is often necessary. The TX2 outcomes remain controversial, however, and only limited data are available on clinical outcomes of TX2 in Japanese patients. This study aimed to assess graft and patient survival rates of TX2 and compared these rates with those of first kidney transplantation (TX1) in Japanese patients. METHODS Of the 898 kidney transplantations performed between 2010 and 2019 at our institution, 33 were TX2. We performed survival analysis using weighted Kaplan-Meier analysis and Cox proportional hazards analysis with propensity score matching, specifically inverse probability of treatment weighting (IPTW). RESULTS Death-censored graft survival (DCGS) rates at 1, 3, and 5 years for the TX1 versus TX2 groups were 99.3, 97.9, and 95.0% versus 100, 96.0, and 91.2%, respectively. Overall survival (OS) rates at 1, 3, and 5 years for the TX1 versus TX2 groups were 99.4, 98.9, and 97.8% versus 100, 100, and 94.4%, respectively. Using the log-rank test, IPTW-weighted Kaplan-Meier curves showed no significant differences for TX1 versus TX2 in DCGS (p = 0.535) and OS (p = 0.302). On Cox proportional hazards analysis for TX2 versus TX1, the IPTW-adjusted hazard ratio (HR) for DCGS was 1.75 (95% CI, 0.28-10.9; p = 0.550) and for OS was 2.71 (95% CI, 0.40-18.55; p = 0.311). CONCLUSIONS For patients who require TX2, this treatment is an acceptable option based on the short-term outcomes data for DCGS and OS.
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Affiliation(s)
- Hiroki Fukuhara
- Transplant Nephrology and Surgery, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan. .,Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, Japan.
| | - Takaaki Nawano
- Transplant Nephrology and Surgery, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan
| | - Akiko Kanda
- Transplant Nephrology and Surgery, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan
| | - Toshihide Tomosugi
- Transplant Nephrology and Surgery, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan
| | - Manabu Okada
- Transplant Nephrology and Surgery, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan
| | - Kenta Futamura
- Transplant Nephrology and Surgery, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan
| | - Takahisa Hiramitsu
- Transplant Nephrology and Surgery, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan
| | - Asami Takeda
- Department of Nephrology, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan
| | - Norihiko Tsuchiya
- Department of Urology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, Japan
| | - Norihiko Goto
- Transplant Nephrology and Surgery, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan
| | - Shunji Narumi
- Transplant Nephrology and Surgery, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan
| | - Yoshihiko Watarai
- Transplant Nephrology and Surgery, Kidney Disease Center, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myouken-Cho, Nagoya City, Aichi, Japan
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Jobst S, Stadelmaier J, Zöller P, Grummich K, Schmucker C, Wünsch A, Kugler C, Rebafka A. Self-management in adults after solid-organ transplantation: a scoping review protocol. BMJ Open 2023; 13:e064347. [PMID: 36693696 PMCID: PMC9884941 DOI: 10.1136/bmjopen-2022-064347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION After solid-organ transplantation (SOTx), recipients must adhere to a lifelong medical regimen, change their lifestyle and cope with physiological and psychosocial challenges. This requires active participation in their care and self-management abilities. The concept of self-management after SOTx has only been described regarding specific organs and focused on adherence to medical treatment. A comprehensive conceptualisation of self-management entailing all solid organs and beyond medical aspects does not exist. This might lead to unmet self-management support needs of SOTx recipients and hinder a more holistic and integrative approach in self-management support. Therefore, a better understanding of the concept of self-management after SOTx is needed to facilitate a comprehensive evidence base for healthcare providers and researchers. The purpose of this scoping review is to explore existing evidence on self-management in adults after SOTx. METHODS AND ANALYSIS To identify relevant evidence, six electronic databases and three study registers will be searched, supplemented by handsearches, reference checking and expert recommendations. Screening and selection of available evidence will be carried out in a two-step process by two independent reviewers. International evidence published in English or German reporting on adults after heart, lung, liver, pancreas, kidney or small bowel transplantation will be considered. To meet inclusion criteria, articles have to focus on either: self-management, self-management support or recipients' or healthcare providers' perspectives of challenges and needs potentially addressable by self-management. Data extraction will be performed by two reviewers independently using a structured form. Data will be analysed descriptively and using content analysis procedures. Findings will be summarised narratively and presented in tabular format. ETHICS AND DISSEMINATION The consultation and approval of an ethics committee is not required for this scoping review. Findings of the scoping review will be published in a peer-reviewed open-access journal and presented at conferences.
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Affiliation(s)
- Stefan Jobst
- Institute of Nursing Science, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julia Stadelmaier
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Petra Zöller
- Dean's Office, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Kathrin Grummich
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
- Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Christine Schmucker
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Alexander Wünsch
- Freiburg university Medical Center, Department of Psychosomatic Medicine and Psychotherapy, Freiburg, Germany
| | - Christiane Kugler
- Institute of Nursing Science, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anne Rebafka
- Institute of Nursing Science, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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de Oliveira JGR, Sanders-Pinheiro H, de Freitas RA, Vasconcelos JE, Askari M, da Silva GB. Evaluation of the use of a Renal Health application by kidney transplant recipients. Rev Lat Am Enfermagem 2023; 31:e3822. [PMID: 36722638 PMCID: PMC9886082 DOI: 10.1590/1518-8345.6039.3822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/24/2022] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE to evaluate the use of a renal health application by kidney transplant recipients. METHOD a retrospective, observational study with a sample composed of individuals registered in the kidney transplant section of the application from July of 2018 to April of 2021. Demographic data, data entry, time of use, weight, blood pressure, blood glucose, creatinine, medication schedules, appointments, and tests were the variables collected. Descriptive analysis of the data was performed. RESULTS eight hundred and twenty-three downloads of the application were identified, and 12.3% of those were registered as kidney transplant recipients, the majority from southeastern Brazil (44.9%), 36±11 years old, and female (59.1%). Of the sample, 35.1% entered information such as creatinine (62%), weight (58.2%), and blood pressure (51.8%). Most used the application for one day (63.3%) and 13.9% for more than one hundred days. Those who used it for more than one day (36.7%) recorded weight (69%), medication intake (65.5%) and creatinine (62%), and scheduled appointments (69%). CONCLUSION the kidney transplant recipient section of the Renal Health application generated interest in the young population, but showed low adherence throughout the assessed months. These results offer a relevant perspective on the implementation of mHealth technologies in kidney transplantation.
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Affiliation(s)
- Juliana Gomes Ramalho de Oliveira
- Universidade de Fortaleza, Fortaleza, CE, Brazil. , Scholarship holder at the Fundação Cearense de Apoio ao Desenvolvimento Científico e Tecnológico (FUNCAP), Brazil. , Juliana Gomes Ramalho de Oliveira E-mail:
| | | | - Ronaldo Almeida de Freitas
- Scholarship holder at the Fundação Cearense de Apoio ao Desenvolvimento Científico e Tecnológico (FUNCAP), Brazil. , Universidade de Fortaleza, Núcleo de Aplicação em Tecnologia da Informação, Fortaleza, CE, Brazil
| | - José Eurico Vasconcelos
- Universidade de Fortaleza, Núcleo de Aplicação em Tecnologia da Informação, Fortaleza, CE, Brazil
| | - Marjan Askari
- Erasmus University, School of Health Policy & Management, Rotterdam, South Holland, Netherlands
| | - Geraldo Bezerra da Silva
- Universidade de Fortaleza, Fortaleza, CE, Brazil. , Scholarship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
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11
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Muacevic A, Adler JR, Akıncı S. Assessment of the Effectiveness of Patient Education and Interviews in Improving Medication Adherence of Renal Transplant Recipients. Cureus 2022; 14:e33010. [PMID: 36712742 PMCID: PMC9879593 DOI: 10.7759/cureus.33010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2022] [Indexed: 12/29/2022] Open
Abstract
Background Non-compliance with immunosuppressive drugs has been reported as the most significant cause of graft loss. Since non-compliance with immunosuppressive drugs is preventable, certain approaches based on the risk factors and causes of non-compliance can help eliminate this problem. Aims The purpose of this study is to assess the effectiveness of patient education and interviews in improving medication adherence of renal-transplant recipients. Materials and methods This study was designed as a randomized controlled trial. Using the G*Power program, the sample size was calculated as 60 subjects, with 30 in both the intervention group and control group. Data collection tools included a patient information form, a pretest-posttest, a drug monitoring form for kidney transplant patients, the Immunosuppressive Therapy Adherence Scale, measurement of tacrolimus blood levels, and a training booklet. Results The mean knowledge score in the intervention group was 12.17±3.39 at baseline, and it increased to 20.73±1.57 after the intervention. The mean scores on the Immunosuppressant Therapy Adherence Scale were 11.67±0.55 and 10.70±0.99 in the intervention group and control group, respectively. There was a statistically significant difference between the pre-test and post-test means on the Immunosuppressant Therapy Adherence Scale in the intervention group. The mean Immunosuppressant Therapy Adherence Scale score was higher in the intervention group. In the measurement of tacrolimus blood levels, medication adherence was found the be higher in the intervention group. The difference between the groups was statistically significant. There was a positive correlation between the tacrolimus blood levels and the Immunosuppressant Therapy Adherence Scale scores in both groups. Conclusions To conclude, our results have demonstrated that patient education and interviews improve immunosuppressant medication adherence in renal transplant recipients. Using direct or indirect methods proved similar outcomes, suggesting that both evaluation methods are safe.
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Abtahi H, Safdari R, Gholamzadeh M. Pragmatic solutions to enhance self-management skills in solid organ transplant patients: systematic review and thematic analysis. BMC PRIMARY CARE 2022; 23:166. [PMID: 35773642 PMCID: PMC9247970 DOI: 10.1186/s12875-022-01766-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/06/2022] [Indexed: 02/07/2023]
Abstract
Background In organ transplantation, all patients must follow a complex treatment regimen for the rest of their lives. Hence, patients play an active role in the continuity of the care process in the form of self-management tasks. Thus, the main objective of our study was to investigate the pragmatic solutions applied by different studies to enhance adherence to self-management behaviors. Method A systematic review was conducted in five databases from 2010 to August 2021 using keywords. Eligible studies were all English papers that developed self-management programs to enhance patient care in solid organ transplantation. The interventions were analyzed using thematic analysis to determine the main descriptive areas. The quality of the included articles was evaluated using the research critical appraisal program (CASP) tool. Results Of the 691 retrieved articles, 40 met our inclusion criteria. Of these, 32 studies were devoted to the post-transplantation phase. Five main areas were determined (e-health programs for telemonitoring, non-electronic educational programs, non-electronic home-based symptom-monitoring programs, electronic educational plans for self-monitoring, and Telerehabilitation) according to thematic analysis. Most studies (72.5%) declared that developed programs and applied solutions had a statistically significant positive impact on self-management behavior enhancement in transplant patients. Conclusion The results showed that an effective solution for improving organ transplantation needs patient collaboration to address psychological, social, and clinical aspects of patient care. Such programs can be applied during candidate selection, waiting list, and after transplantation by putting the patient at the center of care. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01766-z.
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Affiliation(s)
- Hamidreza Abtahi
- Pulmonary and Critical care Medicine Department, Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Safdari
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Marsa Gholamzadeh
- Ph.D. Candidate in Medical Informatics, Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Fardanesh Alley, 5th FloorQods Ave, Tehran, Iran.
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McKeaveney C, Noble H, Courtney AE, Griffin S, Gill P, Johnston W, Maxwell AP, Teasdale F, Reid J. Dialysis, Distress, and Difficult Conversations: Living with a Kidney Transplant. Healthcare (Basel) 2022; 10:healthcare10071177. [PMID: 35885704 PMCID: PMC9321787 DOI: 10.3390/healthcare10071177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 11/19/2022] Open
Abstract
Background: Providing holistic care to kidney patients is important; however, without full consideration of the perspectives of people living with a kidney transplant, the provision of truly ‘holistic healthcare’ cannot be possible. It is imperative to understand patient experiences by including kidney patients 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 overall health. The aim of this study was to develop an in-depth understanding of the lived experiences of kidney transplant recipients. Methods: A total of 23 participants were recruited between two regional nephrology units within the United Kingdom via clinical gatekeepers. In-depth interviews were undertaken. Interviews were digitally recorded, transcribed verbatim, and subjected to interpretative phenomenological analysis. Results: Two themes emerged: “managing ongoing fears of dialysis, distress, and COVID-19” and “dealing with difficult conversations”. Conclusions: Renal healthcare professionals need to understand more than the biological impact of receiving a kidney transplant. Understanding the holistic and multidomain experiences that these participants experience will help healthcare professionals to recognize the needs of this group and ensure more responsive psychosocial care.
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Affiliation(s)
- Clare McKeaveney
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (C.M.); (H.N.)
| | - Helen Noble
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (C.M.); (H.N.)
| | | | - Sian Griffin
- Department of Nephrology and Transplantation, Cardiff & Vale University Health Board, Cardiff CF14 4XW, UK;
| | - Paul Gill
- School of Healthcare Sciences, Cardiff University, Cardiff CF24 0AB, UK;
| | - William Johnston
- Northern Ireland Kidney Patients Association, Belfast BT9 7AB, UK;
| | | | | | - Joanne Reid
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (C.M.); (H.N.)
- Correspondence:
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