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Akıncı N, Varışoğlu Y. Investigating Body Image and Self-Esteem in Kidney Transplant Patients: A Qualitative Study. Niger J Clin Pract 2024; 27:785-791. [PMID: 38943305 DOI: 10.4103/njcp.njcp_138_24] [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: 02/14/2024] [Accepted: 04/15/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Kidney transplantation is one of the life-saving therapies for patients with end-stage renal disease, which affects a person's psychological, social, and physical well-being. How transplanted patients perceive their illness and their body can affect their physical and psychological recovery. AIM This qualitative study was designed to evaluate self-esteem and body image in kidney transplant patients. METHODS The study involved 16 female renal transplanted patients. Data were collected using a two-part interview form developed by the investigators in accordance with the literature. We used Lundman's method to transcribe the interviews and coded the data from the interviews. The results of the study were discussed using the themes. The first three interviews were entered into MAXQDA, and then, additional interviews were analyzed. RESULTS Six main themes and 15 subthemes were generated based on the thematic analysis of the interviews with participants about body image and self-esteem. Themes included body acceptance, changes in body image, deterioration of social relationships, changes in self-esteem, spousal concerns, and organ perceptions. This study collected detailed data on body image, self-esteem, social relationships, and spouse/partner relationships after kidney transplantation. CONCLUSION The change in participants' body image and self-esteem after kidney transplantation caused having negative feelings regarding sexual life, relationships, and social life and feeling unfamiliar with the transplanted organ.
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Affiliation(s)
- N Akıncı
- Nursing Department, Faculty of Health Sciences, Fenerbahçe University, Istanbul, Turkey
| | - Y Varışoğlu
- Midwifery Department, Faculty of Health Sciences, Atlas University, Istanbul, Turkey
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Lu D, Shi L, Chen J, Zhi J, Han L, Wang Y. Status and Influencing Factors of Social Participation in Renal Transplantation Recipients: A Cross-Sectional Study From a Single Center in China. Transplant Proc 2023; 55:354-362. [PMID: 36841703 DOI: 10.1016/j.transproceed.2023.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 01/08/2023] [Accepted: 01/24/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND To investigate the social participation (SP) of renal transplantation (RT) recipients and analyze the influencing factors. DESIGN Cross-sectional study. METHODS Data were collected from RT recipients reviewed within the Urology Outpatient Clinic of a tertiary class-A hospital in Hebei, China between October 2018 and October 2019. RESULTS The total mean score of an SP questionnaire for RT recipients was 37.77 ± 2.74. The mean score per item in each dimension showed that the scores for leisure, activity, and voluntary participation in social life were the highest, indicating low participation. Educational level, household income, occupation, preoperative employment, creatinine level in the transplanted kidney, medication compliance, depression, and anxiety could explain 77% of the variation in the SP level. CONCLUSIONS There are many factors affecting the SP levels of RT recipients. Clinicians should comprehensively evaluate RT recipients before and after surgery, formulate health education programs, and improve the SP level.
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Affiliation(s)
- Di Lu
- Urology Department, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Lei Shi
- Urology Department, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Junxiao Chen
- Urology Department, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jingfen Zhi
- Urology Department, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Liyun Han
- Urology Department, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yaxuan Wang
- Urology Department, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
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Szabo G, Fornaro M, Dome P, Varbiro S, Gonda X. A bitter pill to swallow? Impact of affective temperaments on treatment adherence: a systematic review and meta-analysis. Transl Psychiatry 2022; 12:360. [PMID: 36056016 PMCID: PMC9440110 DOI: 10.1038/s41398-022-02129-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Predominant affective temperament may affect adherence to prescribed pharmacotherapeutic interventions, warranting systematic review and meta-analysis. METHODS The Scopus, Web of Science, PubMed, and OVID MedLine databases were inquired since inception up to 31st of March 2022 for records of any study design documenting quantitative evidence about affective temperaments as measured by the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego (TEMPS-A) questionnaire and treatment adherence measured by the means of major rating scales on the matter. People with low vs. high levels of treatment adherence, matched for otherwise clinically relevant variables, were deemed as cases and controls, respectively, using standardized mean differences (SMDs) in pertinent scores under random-effects meta-analysis. RESULTS Nine studies encompassing 1138 subjects pointed towards significantly higher cyclothymic (SMD = -0.872; CI: [-1.51 to -0.24]; p = 0.007), irritable (SMD = -0.773; CI: [-1.17 to -0.37]; p < 0.001) and depressive (SMD = -0.758; CI: [-1.38 to -0.14]; p = 0.017) TEMPS-A scores both for psychiatric and nonpsychiatric samples with poorer adherence. LIMITATIONS Intrinsic limitations of the present report include the heterogeneity of the operational definitions documented across different primary studies, which nonetheless reported on the sole medication-treatment adherence, thus limiting the generalizability of the present findings based on a handful of comparisons. CONCLUSIONS Though further primary studies need to systematically account for different clinical and psychosocial moderators across different clinical populations and operational definitions, cyclothymic, depressive, and irritable temperament scores may nonetheless predict treatment adherence and, thus, overall treatment outcomes.
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Affiliation(s)
- Georgina Szabo
- Doctoral School of Mental Health Sciences, Semmelweis University, Budapest, Hungary
| | - Michele Fornaro
- Department of Psychiatry, Federico II University of Naples, Naples, Italy
| | - Peter Dome
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - Szabolcs Varbiro
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary.
- NAP-2-SE New Antidepressant Target Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary.
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De Pasquale C, Pistorio ML, Veroux P, Gioco R, Giaquinta A, Privitera F, Veroux M. Quality of Life and Mental Health in Kidney Transplant Recipients During the COVID-19 Pandemic. Front Psychiatry 2021; 12:645549. [PMID: 34177645 PMCID: PMC8219878 DOI: 10.3389/fpsyt.2021.645549] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/10/2021] [Indexed: 12/17/2022] Open
Abstract
Introduction: The COVID-19 pandemic has led to an increase in mental distress such as phobic anxieties, depressive reactions, hypochondriac concerns, and insomnia. Among the causes are risk of infection and prolonged isolation. This study aimed to analyze psychopathological variables and dysfunctional lifestyles related to adequate therapeutic compliance in kidney transplant recipients. Methods: Eighty-nine kidney transplant recipients were evaluated using an online protocol including a questionnaire concerning habits, lifestyle and psychophysical well-being in the COVID-19 period, the Middlesex Hospital Questionnaire (MHQ) and the SF-36 Health Survey to evaluate the perception of their physical and emotional health. Results: Of these recipients, 28.6% reported changes in their emotional state. Sleep quality deteriorated for 16.1%. Anxiety (M = 5.57, r = 0.33; p < 0.05) and phobia (M = 6.28, r = 0.26; p < 0.05) correlated with concerns related to physical health. There was no negative impact on relational and socialization aspects, which were likely well compensated by the use of remote technologies such as video phone calls, Zoom meetings and use of computers (r = 0.99; r = 0.80; p < 0.05). Conclusions: It would be interesting to maintain this remote visit and interview mode to monitor, on a clinical and psychological level, kidney transplant recipients in subsequent follow-ups (12-18 months), to check for any psychopathological disorders and/or changes in their resilience capacity in the Coronavirus emergency.
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Affiliation(s)
- Concetta De Pasquale
- Vascular Surgery and Organ Transplant Unit, Department of Educational Science, University of Catania, Catania, Italy
| | - Maria Luisa Pistorio
- Vascular Surgery and Organ Transplant Unit, Department of General Surgery and Medical-Surgical Specialties, University Hospital of Catania, Catania, Italy
| | - Pierfrancesco Veroux
- Vascular Surgery and Organ Transplant Unit, Department of General Surgery and Medical-Surgical Specialties, University Hospital of Catania, Catania, Italy
| | - Rossella Gioco
- Organ Transplant Unit, Department of Surgical and Medical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Alessia Giaquinta
- Vascular Surgery and Organ Transplant Unit, Department of General Surgery and Medical-Surgical Specialties, University Hospital of Catania, Catania, Italy
| | - Francesca Privitera
- Endocrine Surgery Unit, Department of Surgical and Medical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Massimiliano Veroux
- Organ Transplant Unit, Department of Surgical and Medical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
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Analysis of Psychopathologic Elements as a Compliance Limitation: Team Work as a Therapeutic Response. Transplant Proc 2020; 52:1577-1580. [PMID: 32439333 DOI: 10.1016/j.transproceed.2020.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/24/2020] [Accepted: 03/12/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The psychological evaluation of the patient, carried out through psychodiagnostic tests, clinical interviews, and a joint work with the medical-surgical team, provided useful information to assess the compliance of the kidney transplant recipient. METHODOLOGY Two hundred and forty-five visits were carried out between September 2018 and May 2019 in the General Surgery and Organ Transplant Department of the San Salvatore Hospital, L'Aquila. The visits consisted of clinical interviews, targeted psychodiagnostic evaluations, graphic-projective tests, and personality and cognitive structure evaluation tests. These assessments were key not only to defining the patient's personality picture but also to offering suitable psychological support to patients on waiting lists for transplantation, during hospitalization, and during follow-up visits from transplantation phases. RESULTS From the analysis of the tests and from the clinical and support interviews, some of the patients presented forms of psycho-emotional immaturity that impaired the predisposition to compliance and ultimately the establishment of the therapeutic alliance. During 8 months, 18 compliance limit cases were observed, 5 patients were sent to mental health centers, and 13 psychological support courses were activated within the Regional Transplant Center-Abruzzo Region Molise Region. No structured psychological support courses were deemed necessary for 9 of these 13 cases, whereas 4 were sent to the mental health centers. CONCLUSIONS By assessing the complexity of each patient from a medical and a psychological point of view and by considering the high number of transplant surgeries currently occurring, it can be noted that compliance to therapy is strongly linked to the reliability of the relationships between patients and caregivers.
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De Pasquale C, Pistorio ML, Veroux M, Indelicato L, Biffa G, Bennardi N, Zoncheddu P, Martinelli V, Giaquinta A, Veroux P. Psychological and Psychopathological Aspects of Kidney Transplantation: A Systematic Review. Front Psychiatry 2020; 11:106. [PMID: 32194453 PMCID: PMC7066324 DOI: 10.3389/fpsyt.2020.00106] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 02/07/2020] [Indexed: 12/21/2022] Open
Abstract
Kidney transplantation is a serious event that involves profound psychological, relational and social changes both for the patient and his family context. Assessment of personality profile, awareness of disease, family and social support of the patient candidate for kidney transplantation are necessary because factors not adequately considered, can influence the success of the transplant and alter the psychological stability of the patient. The present study aims to provide a systematic review of the literature of the last twelve years (2006-2018), focusing in particular on patient's readiness level and illness management and on possible psychopathology. Sixty-two studies were examined. Based on the Downs and Black checklist, most studies (n = 32) were of high quality; 15 of which related to lifestyle, health education, and therapeutic adherence in post-renal transplantation, 17 studies concerned the possible existence of psychopathology and cognitive impairment of renal deceased transplanted subjects. The literature used has shown that the population of kidney transplant patients is exposed to a high risk of psychiatric disorders with repercussions on the quality of life and the risk of rejection. Therefore, an adequate pre-transplant psychosocial assessment is necessary, which allows a more in-depth knowledge of the candidate to plan coping strategies and possible post-transplant psychotherapy.
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Affiliation(s)
- Concetta De Pasquale
- Department of Educational Sciences, University of Catania, Catania, Italy.,Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Catania, Italy.,SIPsiTO, Italian Society of Psychology and Psychiatry of Organ Transplants, Catania, Italy
| | - Maria Luisa Pistorio
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Catania, Italy.,SIPsiTO, Italian Society of Psychology and Psychiatry of Organ Transplants, Catania, Italy.,Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Massimiliano Veroux
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Catania, Italy.,Department of Surgery, Transplantation and Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
| | - Luisa Indelicato
- Department of Educational Sciences, University of Catania, Catania, Italy
| | - Gabriella Biffa
- SIPsiTO, Italian Society of Psychology and Psychiatry of Organ Transplants, Catania, Italy.,Clinical Psychology and Psychotherapy Unit, San Martino Hospital-Genoa, Genoa, Italy
| | - Nunzialinda Bennardi
- SIPsiTO, Italian Society of Psychology and Psychiatry of Organ Transplants, Catania, Italy.,University Hospital, City of Health and Science, Turin, Italy
| | - Pietro Zoncheddu
- SIPsiTO, Italian Society of Psychology and Psychiatry of Organ Transplants, Catania, Italy.,Department of Mental Health, Bergamo Local Health Authority, Bergamo, Italy
| | | | - Alessia Giaquinta
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Catania, Italy.,Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Pierfrancesco Veroux
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Catania, Italy.,Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
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De Pasquale C, Pistorio ML, Veroux M, Sciacca F, Martinelli V, Carbonaro A, Giaquinta A, Carbone F, Palermo C, Veroux P. Nonverbal Communication and Psychopathology in Kidney Transplant Recipients. Transplant Proc 2019; 51:2931-2935. [PMID: 31607624 DOI: 10.1016/j.transproceed.2019.05.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/23/2019] [Accepted: 05/13/2019] [Indexed: 02/06/2023]
Abstract
Transplant recipients have difficulty expressing, identifying, and describing their emotional experiences. The Machover human figure test allows us to bring out the deepest contents of a patient's personality, which are normally hidden and not explained to structured quantitative tests. The study analyzed possible situations of distress and possible symptoms of psychopathology in kidney transplant recipients, emerged from the projective test of the human figure and not easily verbalized to the common standardized tests. The sample included 80 kidney transplant patients (51 men and 29 women; mean age, 47.74 [SD, 12.39] years) during follow-up visits at 12 months after transplant. The Machover test was used to evaluate body image, affective aspects, and personality variables by projective method; the Symptom Checklist-90-R was used for the evaluation of possible psychopathology, and the 36-Item Short Form Health Survey was used for the assessment of perceived quality of life. RESULTS: showed that the more anxiety there is in the human figure test, the less somatization dimensions (ANX/SOM R = -331, P < .05), depression (ANX/DEP R = -326, P < .05), and the global index of psychic symptomatology (ANX/GSI R = -367, P < .05) of the Symptom Checklist-90-R are present. This research has confirmed the hypothesis that the spontaneous graphic production of the recipients, through the projective methods, allows them to identify and deepen their psychological contents and to activate and maintain a good psychophysical balance post transplant.
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Affiliation(s)
- Concetta De Pasquale
- Vascular Surgery and Organ Transplant Unit, Department of Surgery, Transplantation and Advanced Technologies GF Ingrassia, University Hospital of Catania, Catania, Italy; Department of Formative Science, University of Catania, Catania, Italy.
| | - Maria Luisa Pistorio
- Vascular Surgery and Organ Transplant Unit, Department of Surgery, Transplantation and Advanced Technologies GF Ingrassia, University Hospital of Catania, Catania, Italy
| | - Massimiliano Veroux
- Vascular Surgery and Organ Transplant Unit, Department of Surgery, Transplantation and Advanced Technologies GF Ingrassia, University Hospital of Catania, Catania, Italy
| | - Federica Sciacca
- Department of Formative Science, University of Catania, Catania, Italy
| | | | - Anna Carbonaro
- Vascular Surgery and Organ Transplant Unit, Department of Surgery, Transplantation and Advanced Technologies GF Ingrassia, University Hospital of Catania, Catania, Italy
| | - Alessia Giaquinta
- Department of Medical and Surgical Sciences, University of Catania, Catania, Italy
| | - Fausto Carbone
- Vascular Surgery and Organ Transplant Unit, Department of Surgery, Transplantation and Advanced Technologies GF Ingrassia, University Hospital of Catania, Catania, Italy
| | - Chiara Palermo
- Vascular Surgery and Organ Transplant Unit, Department of Surgery, Transplantation and Advanced Technologies GF Ingrassia, University Hospital of Catania, Catania, Italy
| | - Pierfrancesco Veroux
- Department of Medical and Surgical Sciences, University of Catania, Catania, Italy
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Rahamimov R, Tifti-Orbach H, Zingerman B, Green H, Schneider S, Chagnac A, Mor E, Fox BD, Rozen-Zvi B. Reduction of exposure to tacrolimus trough level variability is associated with better graft survival after kidney transplantation. Eur J Clin Pharmacol 2019; 75:951-958. [PMID: 30762079 DOI: 10.1007/s00228-019-02643-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 01/30/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE High tacrolimus trough drug level variability was found to be associated with reduced graft survival. The primary goal of this study was to find whether reduction of exposure to high tacrolimus trough level variability in patients in which previously had high variability was associated with better graft survival. METHODS All tacrolimus drug level values in patients that underwent kidney transplantation at our center between 2006 and 2015 were collected. Exposure to variability was calculated using a time-weighted coefficient of variability (TWCV). Time-dependent univariate and multivariate Cox proportional hazard models were used to analyze the primary outcome of graft survival and to determine a cutoff value for TWCV as a predictor of this outcome. RESULTS A total of 878 patients were included in the study with a median follow-up of 1263 days. TWCV above 25% was significantly associated with reduced graft survival (HR3.66, 95% CI 2.3-5.8, p < 0.001). Of the 480 patients (54.7%) who had a cumulative TWCV of > 25% at a certain time during the follow-up, 110 (22.9%) later returned to a cumulative TWCV of less than 25%. Reduction of TWCV to values below 25% was associated with a hazard of graft loss that was not different from patients who had cumulative TWCV of less than 25% during the entire follow-up period (HR 1.81, 95% CI 0.71-4.62, p = 0.218 and HR 1.08, 95% CI 0.39-2.99, p = 0.780) in univariate and multivariate analyses, respectively. CONCLUSIONS Monitoring TWCV can help detect the high-risk patients. Interventions intended to reduce variability on long-term graft survival may have a positive effect on graft survival.
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Affiliation(s)
- Ruth Rahamimov
- Department of Nephrology and Hypertension, Rabin Medical Center, Beilinson campus, 39, Jabutinsky st., Petah Tikva, Israel. .,Department of Transplantation, Rabin Medical Center, Beilinson campus, Petah Tikva, Israel. .,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | | | - Boris Zingerman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Nephrology and Hypertension, Rabin Medical Center, HaSharon campus, Petah Tikva, Israel
| | - Hefziba Green
- Department of Nephrology and Hypertension, Rabin Medical Center, Beilinson campus, 39, Jabutinsky st., Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shira Schneider
- Department of Nephrology and Hypertension, Rabin Medical Center, Beilinson campus, 39, Jabutinsky st., Petah Tikva, Israel
| | - Avry Chagnac
- Department of Nephrology and Hypertension, Rabin Medical Center, Beilinson campus, 39, Jabutinsky st., Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Nephrology and Hypertension, Rabin Medical Center, HaSharon campus, Petah Tikva, Israel
| | - Eytan Mor
- Department of Transplantation, Rabin Medical Center, Beilinson campus, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Benjamin D Fox
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Pulmonology, Assaf Harofeh (Yitzhak Shamir) Medical Center, Zrifin, Israel
| | - Benaya Rozen-Zvi
- Department of Nephrology and Hypertension, Rabin Medical Center, Beilinson campus, 39, Jabutinsky st., Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Yıldız E, Kılınç G. The relationship between anxiety-depression status and psychosocial adjustments in the patients undergoing liver transplantation. Perspect Psychiatr Care 2018; 54:221-229. [PMID: 28556990 DOI: 10.1111/ppc.12226] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 04/26/2017] [Accepted: 05/10/2017] [Indexed: 11/28/2022] Open
Affiliation(s)
- Erman Yıldız
- Department of Psychiatric Nursing, Faculty of Health Sciences, Inonu University, Malatya, Turkey
| | - Gülsen Kılınç
- Department of Psychiatric Nursing, Faculty of Health Sciences, Inonu University, Malatya, Turkey
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