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Tang J, Kerklaan J, Wong G, Howell M, Scholes-Robertson N, Guha C, Kelly A, Tong A. Perspectives of solid organ transplant recipients on medicine-taking: Systematic review of qualitative studies. Am J Transplant 2021; 21:3369-3387. [PMID: 33866675 DOI: 10.1111/ajt.16613] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/16/2021] [Accepted: 04/02/2021] [Indexed: 01/25/2023]
Abstract
Medicine-taking among transplant recipients is a complex and ubiquitous task with significant impacts on outcomes. This study aimed to describe the perspectives and experiences of medicine-taking in adult solid organ transplant recipients. Electronic databases were searched to July 2020, and thematic synthesis was used to analyze the data. From 119 studies (n = 2901), we identified six themes: threats to identity and ambitions (impaired self-image, restricting goals and roles, loss of financial independence); navigating through uncertainty and distrust (lacking tangible/perceptible benefits, unprepared for side effects, isolation in decision-making); alleviating treatment burdens (establishing and mastering routines, counteracting side effects, preparing for the unexpected); gaining and seeking confidence (clarity with knowledge, reassurance through collective experiences, focusing on the future outlook); recalibrating to a new normal posttransplant (adjusting to ongoing dependence on medications, in both states of illness and health, unfulfilled expectations); and preserving graft survival (maintaining the ability to participate in life, avoiding rejection, enacting a social responsibility of giving back). Transplant recipients take medications to preserve graft function, but dependence on medications jeopardizes their sense of normality. Interventions supporting the adaptation to medicine-taking and addressing treatment burdens may improve patient satisfaction and capacities to take medications for improved outcomes.
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Affiliation(s)
- James Tang
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Jasmijn Kerklaan
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia.,Department of Pediatric Nephrology, Academic Medical Center, Emma Children's Hospital, Amsterdam, the Netherlands
| | - Germaine Wong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia
| | - Martin Howell
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Nicole Scholes-Robertson
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Chandana Guha
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Ayano Kelly
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
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2
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Xiao P, Liu M, Cui L, Ding S, Xie J, Cheng AS. Sexual dysfunction and activity avoidance in female kidney transplant patients. Clin Transplant 2021; 35:e14363. [PMID: 33998698 DOI: 10.1111/ctr.14363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/27/2021] [Accepted: 05/10/2021] [Indexed: 02/05/2023]
Abstract
Sexual dysfunction is common after kidney transplantation and has an adverse effect on patients' quality of life. This paper aims to evaluate the female sexual function, activity avoidance, and kidney function among a convenience sample of patients who had a kidney transplant. A cross-sectional study was conducted that included 250 patients had undergone a kidney transplant procedure >3 months ago, from multiple transplant centers and answered a self-reported sociodemographic questionnaire, the female version of the Arizona Sexual Experience Scale, and the Tampa Scale for Kinesiophobia-13. A correlation was found between sexual function and activity avoidance (r = .361, p < .001, n = 250) as well as between activity avoidance and kidney function (r = .198, p = .012, n = 250). Less education, having no child, post-transplant time for <36 months, and smoking (active and passive) were risk factors for female sexual dysfunction after kidney transplantation. The results suggest that physicians that the importance of recognize the relationship between fear of sexual activity and sexual function and that they should provide patients with more education and guidance on post-transplant sexual behaviors.
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Affiliation(s)
- Panpan Xiao
- Xiangya Nursing School, Central South University, Changsha, China
| | - Min Liu
- The Third Xiangya Hospital, Central South University, Changsha, China
| | - Lina Cui
- The Third Xiangya Hospital, Central South University, Changsha, China
| | - Siqing Ding
- The Third Xiangya Hospital, Central South University, Changsha, China.,Clinical Nursing Safety Management Research Center, Central South University, Changsha, China
| | - Jianfei Xie
- The Third Xiangya Hospital, Central South University, Changsha, China
| | - Andy Sk Cheng
- Department of Rehabilitation Sciences, the Hong Kong Polytechnic University, Kowloon, Hong Kong
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3
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Kristensen IV, Birkelund R, Henriksen J, Norlyk A. Living in limbo while one's identity is changing: Patients' existential experiences 6 months after a kidney transplantation with a living donor. J Adv Nurs 2020; 77:1403-1410. [PMID: 33277747 DOI: 10.1111/jan.14683] [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: 01/29/2020] [Revised: 09/25/2020] [Accepted: 10/29/2020] [Indexed: 11/27/2022]
Abstract
AIM To investigate patients' existential experiences in everyday life after a kidney transplantation with a living donor. DESIGN A qualitative study anchored in a hermeneutic-phenomenological approach inspired by Ricoeur's theory of narrative and interpretation. METHOD Eleven patient interviews were conducted approximately 6 months after a kidney transplantation with a living donor. The interviews were conducted between August 2017-May 2019. Analysis and interpretation are based on Ricoeur's theory of interpretation. RESULTS Four themes were identified: Experiencing bodily vulnerability while getting back to life; Feeling guilt while experiencing gratitude; Living in limbo while one's identity is changing; and Facing the future with hope while having reservations. CONCLUSION This study reveals that patients experience multifaceted existential challenges in their everyday lives during the transition of the kidney transplantation process. Post-surgery complications for donors lead to feelings of guilt in patients; plus, they must adapt to a new existence, including a new identity. The patients feel they are in limbo, as they experience their existence as uncertain and their identity as unknown. IMPACT The study highlights a need for developing a rehabilitation programme to address the individual and various existential challenges faced by patients who need to undergo a kidney transplantation.
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Affiliation(s)
- Ingrid Villadsen Kristensen
- Section for Nursing, Department of Public Health, Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University College, Aarhus University, Holstebro, Denmark
| | - Regner Birkelund
- Lillebaelt Hospital, Vejle & Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Annelise Norlyk
- Section for Nursing, Department of Public Health, Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University College, Aarhus University, Holstebro, Denmark
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4
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Chang YH, Lai YH, Tsai MK, Shun SC. Care Needs for Organ Transplant Recipients Scale: Development and psychometric testing. J Ren Care 2020; 47:123-132. [PMID: 32799380 DOI: 10.1111/jorc.12345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/03/2020] [Accepted: 05/05/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Needs assessment can determine how large the gap is between needs and available services; however, no tools are available to assess the unmet needs of renal transplant recipients. OBJECTIVES The aim of this study was to develop the Care Needs for Organ Transplant Recipients Scale (CNOTRS) and examine its psychometric properties. DESIGN A cross-sectional design for instrument development and psychometric testing. PARTICIPANTS In total, 217 renal transplant recipients were recruited through convenience sampling. METHODS An initial 36-item CNOTRS was developed after a comprehensive literature review. After the CNOTRS was tested through content validity and face validity, the factor structure was explored using exploratory factor analysis (EFA). Convergent validity was examined using Pearson's correlation between the CNOTRS and Hospital Anxiety and Depression Scale (HADS). Known-group validity was tested by comparing CNOTRS scores of patients grouped based on whether they had experienced complications or rejection. RESULTS Twenty-eight items with three factors (namely daily care and social interaction needs, psychological needs, and health system and service needs) were identified in EFA by parallel analysis and Velicer's MAP test. The psychological needs domain had a stronger positive correlation with the HADS than the other two domains. The known-group validity was supported as a significant association between complications or rejection occurrence and unmet needs. The Cronbach's α of the CNOTRS was 0.94. CONCLUSIONS The CNOTRS demonstrated satisfactory reliability and validity to assess the care needs for renal transplant recipients and can assist health care professionals to tailor more personalised care for their individual needs.
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Affiliation(s)
- Yu Hsuan Chang
- Department of Nursing, National Tainan Junior College of Nursing, Tainan, Taiwan.,School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yeur Hur Lai
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Meng Kun Tsai
- Department of Surgery, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shiow Ching Shun
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
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5
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Ranahan M, Von Visger J, Kayler LK. Describing barriers and facilitators for medication adherence and self-management among kidney transplant recipients using the information-motivation-behavioral skills model. Clin Transplant 2020; 34:e13862. [PMID: 32199030 DOI: 10.1111/ctr.13862] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 03/05/2020] [Accepted: 03/13/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND We aimed to develop an adapted information-motivation-behavioral skills (IMB) model to describe barriers and facilitators for adherence and self-management among kidney transplant recipients. METHODS We conducted a review of literature about kidney transplant recipients' knowledge, perceptions, and experiences and organized our results using the IMB framework. We then conducted interviews with transplant recipients and transplant providers to supplement our literature search. RESULTS Our proposed adaption of the IMB model describes informational, motivational, and behavioral skills barriers and facilitators for medication adherence and self-management among kidney transplant recipients. Moderating factors influence not only behavioral skills, but also recipients' understanding of information and motivation to adhere and practice self-management. CONCLUSION By using the IMB model to organize current research and interviews with recipients and providers, we developed an adapted model for medication adherence and self-management. Results are promising to impact future educational and behavioral interventions for kidney transplant recipients.
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Affiliation(s)
- Molly Ranahan
- 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
| | - Jon Von Visger
- 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
| | - 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
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6
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Kristensen IV, Birkelund R, Henriksen J, Agerskov H, Norlyk A. Living in one's own world, while life goes on: Patients' experiences prior to a kidney transplantation with a living donor. J Clin Nurs 2019; 29:638-644. [DOI: 10.1111/jocn.15117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 11/19/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Ingrid V. Kristensen
- Section for Nursing Department of Public Health Aarhus University Aarhus Denmark
- VIA Faculty of Health Sciences VIA Nursing Holstebro Denmark
| | - Regner Birkelund
- Institute of Regional Health Research Lillebaelt Hospital, VejleUniversity of Southern Denmark Odense Denmark
| | | | - Hanne Agerskov
- Clinical Department Department of Nephrology Odense University HospitalUniversity of Southern Denmark Odense Denmark
| | - Annelise Norlyk
- Section for Nursing Department of Public Health Aarhus University Aarhus Denmark
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7
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Jeong HW, So HS. [Structural Equation Modeling of Self-Care Behaviors in Kidney Transplant Patients Based on Self-Determination Theory]. J Korean Acad Nurs 2019; 48:731-742. [PMID: 30613060 DOI: 10.4040/jkan.2018.48.6.731] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 12/10/2018] [Accepted: 12/10/2018] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this study was to test a hypothesis explaining direct and indirect relationships among the factors affecting self-care behaviors of kidney transplant patients, based on self-determination theory. METHODS Data were collected from 222 outpatients with kidney transplantation. The endogenous and exogenous variables of the hypothetical model consisted of healthcare provider's autonomy support, duration after kidney transplantation, basic psychological need satisfaction, autonomous and controlled motivation, depression, and self-care behaviors. Collected data were analyzed using SPSS/WIN 24.0 and AMOS 24.0. RESULTS The hypothetical model demonstrated a good fit: RMSEA=.06, SRMR=.04, TLI=.94, CFI=.97. Statistically significant explanatory variables for the self-care behaviors of kidney transplant patients were duration after transplantation and basic psychological need satisfaction. Healthcare provider's autonomy support was indirectly significant, while autonomous motivation, controlled motivation and depression were not statistically significant for self-care behaviors. The variables accounted for 59.5% of the self-care behaviors of kidney transplant patients. CONCLUSION It is necessary to develop an autonomy support program for healthcare providers to enhance the self-care behaviors of kidney transplant patients. Preventing the deterioration of self-care behaviors will be possible by conducting this program at one year and six years post-transplantation. In addition, the results suggest the need to developing personalized autonomy support programs for healthcare providers that can meet the basic psychological need satisfaction of kidney transplant patients.
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Affiliation(s)
- Hye Won Jeong
- Department of Nursing, Chonnam National University Hospital, Gwangju, Korea
| | - Hyang Sook So
- College of Nursing · Research Institute of Nursing Science, Chonnam National University, Gwangju, Korea.
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8
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Ladin K, Daniels A, Osani M, Bannuru RR. Is social support associated with post-transplant medication adherence and outcomes? A systematic review and meta-analysis. Transplant Rev (Orlando) 2018; 32:16-28. [PMID: 28495070 PMCID: PMC5658266 DOI: 10.1016/j.trre.2017.04.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/23/2017] [Accepted: 04/18/2017] [Indexed: 11/18/2022]
Abstract
Although social support is used to determine transplant eligibility, the relationship between social support, medication adherence, and survival among transplant recipients remains unclear. We estimated the relationship between social support and post-transplant medication adherence and outcomes using 10 electronic databases from inception to January 2016. Study quality was assessed and all review stages were conducted independently by 2 reviewers. Systematic review and meta-analysis were conducted. Thirty-two studies (9102 participants) met inclusion criteria: 21 assessed medication adherence (5197 participants), and 13 assessed clinical outcomes (3905 participants). Among high quality studies, neither social support nor marital status was predictive of medication adherence or post-transplant outcomes. Social support was not associated with medication adherence. It was associated with superior post-transplant outcomes, but the relationship was not significant among high quality studies. Compared to unmarried recipients, married recipients were more likely to adhere to medication post-transplant, but this relationship was not significant among high quality studies. Marital status was not significantly associated with transplant success. Social support is weakly and inconsistently associated with post-transplant adherence and outcomes. Larger prospective studies using consistent and validated measures are needed to justify the use of inadequate social support as a contraindication to transplantation.
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Affiliation(s)
- Keren Ladin
- Department of Occupational Therapy, Tufts University, Medford, MA; Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA; Research on Ethics, Aging, and Community Health (REACH Lab).
| | - Alexis Daniels
- Department of Occupational Therapy, Tufts University, Medford, MA; Research on Ethics, Aging, and Community Health (REACH Lab)
| | - Mikala Osani
- Center for Treatment Comparison and Integrative Analysis (CTCIA), Tufts Medical Center, Boston, MA
| | - Raveendhara R Bannuru
- Center for Treatment Comparison and Integrative Analysis (CTCIA), Tufts Medical Center, Boston, MA
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9
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Grover S, Nehra R, Thakur A. Bipolar affective disorder and its impact on various aspects of marital relationship. Ind Psychiatry J 2017; 26:114-120. [PMID: 30089956 PMCID: PMC6058431 DOI: 10.4103/ipj.ipj_15_16] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Bipolar disorder (BD) is a severe mental disorder, which not only has negative consequences on the life of the patient, but also affects the immediate family members. As it often starts early in life, patients who get married often suffer from many negative consequences in their marital life due to the illness. This review focuses on studies which have evaluated marital rates, rate of marital failure, divorce, infertility, and procreation among patients with BD. In addition, this review evaluates the existing literature pertaining to marital adjustment, marital satisfaction, sexual dysfunction, and sexual satisfaction among patients with BD and their partners/spouses. Data suggest that very high proportion of patients with BD get married and marital rates are higher for patients with BD, when compared with those suffering from schizophrenia. In terms of divorce rates, studies suggest that patients with BD have higher rates of divorce. In terms of fertility rates, studies suggest that compared to those without the illness, the fertility rates among patients with BD are lower. In terms of marital adjustment, results are mixed with some studies suggesting poorer marital adjustment among patients and their spouses too. In terms of sexual dysfunction, studies suggest the presence of sexual dysfunction among one-third to half of the patients receiving lithium. To conclude, this review suggests that patients with BD experience multiple negative marital and sexual consequences.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritu Nehra
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anita Thakur
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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10
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Rosaasen N, Mainra R, Shoker A, Wilson J, Blackburn D, Mansell H. Education Before Kidney Transplantation. Prog Transplant 2017; 27:58-64. [DOI: 10.1177/1526924816685862] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Context: Poor knowledge about immunosuppressive (IS) medications remains a major problem for patients in the posttransplant setting. Therefore, more effective educational strategies in the pretransplant setting are being considered as a possible method to improve knowledge and readiness for the challenges of posttransplant care. However, the most effective/relevant content of a pretransplant educational program is yet to be determined. Objective: To identify pretransplant education topics from the posttransplant patient perspective. Design: A focus group meeting was conducted among 7 high-functioning, stable adult kidney transplant recipients recruited from the Saskatchewan Transplant Program. Demographic information including age, gender, occupation, background/ethnicity, and time since transplant were recorded. A moderator, assistant moderator, and research assistant facilitated the 90-minute focus group meeting using a predetermined semistructured interview guide. The session was audio recorded and transcribed verbatim. Nvivo software was used to code the data and identify emerging themes exploring views of participants relating to the educational information required for pretransplant patients. Results: Patients were satisfied with the education they had received. Ideas were classified into the following major themes—patient satisfaction, transplant waitlist, surgery, medications, posttransplant complications, lifestyle and monitoring, knowledge acquisition, illusion of control, and life changes posttransplant. Knowledge gaps were identified in all areas of the transplantation process and were not exclusive to IS medications. Conclusion: Misconceptions regarding transplantation were identified by a group of high-functioning, stable adult recipients who were satisfied with their clinical care. Future educational strategies should aim to address the entire transplantation process and not be limited to medications.
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Affiliation(s)
- Nicola Rosaasen
- Saskatchewan Transplant Program, Saskatoon, Saskatchewan, Canada
| | - Rahul Mainra
- Saskatchewan Transplant Program, Saskatoon, Saskatchewan, Canada
- Division of Nephrology, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ahmed Shoker
- Saskatchewan Transplant Program, Saskatoon, Saskatchewan, Canada
- Division of Nephrology, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jay Wilson
- College of Education, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - David Blackburn
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Holly Mansell
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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11
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Lonargáin DÓ, Brannigan D, Murray C. The experience of receiving a kidney transplant from a deceased donor: Implications for renal services. Psychol Health 2016; 32:204-220. [DOI: 10.1080/08870446.2016.1254214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Jamieson NJ, Hanson CS, Josephson MA, Gordon EJ, Craig JC, Halleck F, Budde K, Tong A. Motivations, Challenges, and Attitudes to Self-management in Kidney Transplant Recipients: A Systematic Review of Qualitative Studies. Am J Kidney Dis 2016; 67:461-78. [DOI: 10.1053/j.ajkd.2015.07.030] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 07/19/2015] [Indexed: 12/20/2022]
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13
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Zelle DM, Corpeleijn E, Klaassen G, Schutte E, Navis G, Bakker SJL. Fear of Movement and Low Self-Efficacy Are Important Barriers in Physical Activity after Renal Transplantation. PLoS One 2016; 11:e0147609. [PMID: 26844883 PMCID: PMC4742485 DOI: 10.1371/journal.pone.0147609] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 01/06/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Physical activity (PA) and exercise are commonly used as preventive measures for cardiovascular disease in the general population, and could be effective in the management of post-transplantation cardiovascular risk. PA levels are low after renal transplantation and very few renal transplant recipients (RTR) meet the PA guidelines. Identification of barriers to regular PA is important to identify targets for intervention to improve PA levels after renal transplantation. We investigated fear of movement and physical self-efficacy as barriers to PA in RTR. METHODS RTR were investigated between 2001-2003. The Tampa Score of Kinesiophobia-Dutch Version (TSK-11) was used to assess fear of movement. Physical self-efficacy was measured with the LIVAS-scale. PA was assessed using validated questionnaires (Tecumseh Occupational Activity Questionnaire and the Minnesota Leisure Time Physical Activity Questionnaire). RESULTS A total of 487 RTR (age 51±12 years, 55% men) were studied. Median score [interquartile range] on TSK-11 was 22 [17-26]. Low physical self-efficacy (Exp B:0.41[0.31-0.54], p<0.001) and history of myocardial infarction, transient ischemic attack and cerebrovascular accident (Exp B:1.30[1.03-1.63],p = 0.03) were independent determinants for fear of movement. Fear of movement was associated with lower daily PA, occupational, sports and leisure time PA. Mediation-analysis showed that a large part (73%) of the effect of fear of movement on PA was explained by low physical self-efficacy. CONCLUSIONS This study was the first to examine fear of movement and self-efficacy in relation to PA in RTR. Fear of movement was associated with a low PA level, and the larger part of this relation was mediated by low physical self-efficacy. Both fear of movement and physical self-efficacy level are important targets for intervention during rehabilitation after renal transplantation.
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Affiliation(s)
- Dorien M. Zelle
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Eva Corpeleijn
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerald Klaassen
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elise Schutte
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerjan Navis
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stephan J. L. Bakker
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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14
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Zegarow P, Jankowska M, Sańko-Resmer J, Durlik M, Grzeszczyk M, Pączek L. Kidney transplantation does not increase the level of basic hope or life satisfaction compared with hemodialysis in patients with chronic kidney disease. Transplant Proc 2015; 46:2598-601. [PMID: 25380875 DOI: 10.1016/j.transproceed.2014.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Although renal replacement therapy can lead to improved health, it also can cause emotional disturbances in patients. It is believed that the success of renal replacement therapy hinges not only on medical parameters, but also on psychosocial factors, which is why modern medicine provides an ever-increasing role in the improvement of patients' quality of life. PURPOSE The purpose of this study was to compare the level of life satisfaction, purpose in life, and basic hope in patients who had received renal replacement due to chronic kidney disease. We also tested whether the specific type of renal replacement therapy and kidney function parameters were influential factors on the above variables. PATIENTS AND METHODS Sixty-one adult patients treated via renal replacement for chronic kidney disease took part in the study. Patients were divided into two groups: 31 hemodialysis patients (15 women and 16 men, ages 23-77 years, mean 51.19 years, SD 14.53 years) and 30 patients who had undergone kidney transplantation (14 women and 16 men, ages 22-69 years, mean 48.40 years, SD 12.64 years). The following research tools were used for analysis: Satisfaction With Life Scale (SWLS), Purpose in Life Test (PIL), and Basic Hope Inventory (BHI-12). RESULTS There were no statistical differences in the level of satisfaction with life between hemodialysis patients and postkidney transplant patients. The results for the SWLS obtained from both groups fell within the normal range. The average SWLS for hemodialysis patients remained 20.61, SD = 5.79; for postkidney transplant patients, it was 22.57, SD = 5.16. The PIL level in the group of hemodialysis patients (101.5, SD = 15.64) was significantly lower than in the group of postkidney transplant patients (109.7, SD = 15.54). The average BHI-12 level was similar in both groups. The average BHI-12 result for hemodialysis patients was 29.00 (SD = 5.06), and for postkidney transplant patients 29.93 (SD = 3.55). The correlations between the psychological variables and selected biochemical parameters are worthy of particular attention. Among hemodialysis patients, there was an additional correlation between SWLS and hematocrit; whereas for postkidney transplant patients, there was an additional correlation of PIL and eGFR. CONCLUSIONS Our data show that satisfaction with life and basic hope do not increase in patients after renal replacement therapy. The form of renal replacement therapy (hemodialysis or kidney transplantation) does not change the above variables. Patients treated via renal replacement require specialized psychological support to improve the efficacy of renal replacement therapy.
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Affiliation(s)
- P Zegarow
- Institute of Psychology, Cardinal Stefan Wyszynski University in Warsaw, Poland.
| | - M Jankowska
- Institute of Psychology, Cardinal Stefan Wyszynski University in Warsaw, Poland
| | - J Sańko-Resmer
- Immunology, Transplantation, and Internal Medicine Clinic, Infant Jesus Clinical Hospital, 59 Nowogrodzka, Warsaw, Poland
| | - M Durlik
- Transplantation Medicine and Nephrology Clinic, Infant Jesus Clinical Hospital, 59 Nowogrodzka, Warsaw, Poland
| | - M Grzeszczyk
- Transplantation Medicine and Nephrology Clinic, Infant Jesus Clinical Hospital, 59 Nowogrodzka, Warsaw, Poland
| | - L Pączek
- Immunology, Transplantation, and Internal Medicine Clinic, Infant Jesus Clinical Hospital, 59 Nowogrodzka, Warsaw, Poland
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15
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Forsberg A, Cavallini J, Fridh I, Lennerling A. The core of social function after solid organ transplantation. Scand J Caring Sci 2015; 30:458-65. [PMID: 26395270 DOI: 10.1111/scs.12264] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 06/16/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Social function is a key aspect of health-related quality of life after solid organ transplantation (SOT). The focus of this study was to report how solid organ-transplanted patients change their social function after transplantation. AIM To investigate the main concerns associated with social function after SOT and how solid organ transplant recipients (SOTRs) deal with these concerns. METHOD Twenty SOTRs, 13 men and 7 women, with a mean age of 54 years (range 22-75 years) and due for their first-year follow-up were included in this study. The informants had received various types of solid organs. Data were collected through in-depth interviews, which were recorded and transcribed verbatim for analysis by the method of grounded theory (GT) developed by Charmaz. RESULT The GT of this study describes the efforts by the 20 SOTRs to adapt socially in order to maintain their social functioning and leading a normal life. The efforts summaries a process wherein the generated GT is present through three main categories: deconstruction, restriction and reconstruction, showing various ways to socially adapt. Through this process, a clear path of transition through adaptation is evident, starting before transplantation and continues beyond the first year after transplantation. CONCLUSION Social functions improved through a process of adaptation during the first year after transplantation. Working and travelling were the two most important aspects of social function. All the informants emphasised the importance of regaining a normal life, which was the outcome of a successful adaptation.
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Affiliation(s)
- Anna Forsberg
- Department of Health Sciences at Lund University, Lund, Sweden.,Department of Transplantation and Cardiology, Skåne University Hospital, Lund, Sweden
| | - Josefine Cavallini
- The Transplant Center, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Isabell Fridh
- Faculty of Caring Science, Work Life and Social Welfare at University of Borås, Borås, Sweden
| | - Annette Lennerling
- The Transplant Center, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Health and Caring Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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16
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Cavallini J, Forsberg A, Lennerling A. Social function after solid organ transplantation: An integrative review. ACTA ACUST UNITED AC 2015. [DOI: 10.1177/0107408315592335] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The way organ transplant recipients depend on social interactions to develop and experience social health and well-being is similar to that of the general population. A transplant may result in a close to full recovery of health status, but the physical and social problems can persist in some patients. The focus on improving the recipients’ social participation has therefore become an important issue. The purpose of this integrative literature review was study social function after solid organ transplantation, that is, kidney, liver, lung or heart. An integrative review was performed on studies that matched the selection criteria and published in peer-reviewed journals from January 2000 to December 2014. The information from the text was extracted and patterns of social function were categorized into different subgroups that were further looked at, and five categories emerged: 1) work, 2) education, 3) daily activities and leisure, 4) social adaption and 5) barriers. The key aspects of social functioning involve five vital domains, that is, work, education, daily activities and leisure, social adaption and barriers. Returning to work appears to be the most important for the recipients independently of the transplanted organ.
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Affiliation(s)
| | - Anna Forsberg
- Department of Health Sciences, Lund University, Sweden
- Department of Transplantation and Cardiology, Skåne University Hospital, Sweden
| | - Annette Lennerling
- The Transplant Centre, Sahlgrenska University Hospital, Sweden
- The Sahlgrenska Academy Institute of Health and Care Sciences, University of Gothenburg, Sweden
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17
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Forsberg A, Lennerling A, Fridh I, Karlsson V, Nilsson M. Understanding the Perceived Threat of the Risk of Graft Rejections: A Middle-Range Theory. Glob Qual Nurs Res 2015; 2:2333393614563829. [PMID: 28462294 PMCID: PMC5342851 DOI: 10.1177/2333393614563829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 11/17/2014] [Indexed: 11/18/2022] Open
Abstract
From a clinical viewpoint, graft rejection is one of the greatest threats faced by an organ transplant recipient (OTR). We propose a middle-range theory (MRT) of Perceived Threat of the Risk of Graft Rejection (PTRGR) as a contribution to the practice of transplant nursing. It could also apply to the detection of risky protective behavior, that is, isolation, avoidance, or non-adherence. The proposed MRT covers the following concepts and the relationship between them: transplant care needs, threat reducing interventions, intervening variables, level of PTRGR, protective strategies, and evidence-based practice. Parts of this theory have been empirically tested and support the suggested relationship between some of the concepts. Further tests are needed to strengthen the theoretical links. The conceptual framework might serve as a guide for transplant nurses in their efforts to promote post-transplant health and reduce threat-induced emotions.
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Affiliation(s)
- Anna Forsberg
- Lund University, Lund, Sweden.,Skåne University Hospital, Lund, Sweden
| | - Annette Lennerling
- Sahlgrenska University Hospital, Gothenburg, Sweden.,University of Gothenburg, Göteborg, Sweden
| | - Isabell Fridh
- University of Gothenburg, Göteborg, Sweden.,University of Borås, Borås, Sweden
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18
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A Novel and Personalized Rehabilitation Program for Obese Kidney Transplant Recipients. Transplant Proc 2014; 46:3431-7. [DOI: 10.1016/j.transproceed.2014.05.085] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 05/27/2014] [Indexed: 11/15/2022]
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19
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Schmid-Mohler G, Schäfer-Keller P, Frei A, Fehr T, Spirig R. A Mixed-Method Study to Explore Patients' Perspective of Self-Management Tasks in the Early Phase after Kidney Transplant. Prog Transplant 2014; 24:8-18. [DOI: 10.7182/pit2014728] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Context Patients' perspectives of posttransplant self-management tasks have not been explored. Objective To explore the concept and the presence of self-management tasks mastered by patients in the early phase after kidney transplant. Design Mixed-method study using semistructured interviews and a structured questionnaire. Setting Outpatient Division of Nephrology at University Hospital Zurich, Switzerland Patients Twelve patients (median age, 52 years, interquartile range, 42.25–65.25 years; median time after kidney transplant, 6.5 months; interquartile range, 2.25–15.75 months) were included. Analysis Qualitative data were analyzed according to Corbin and Strauss' 3 self-management tasks with content analysis procedures. In the quantitative analysis, the presence of each self-management task is expressed as a frequency. Results The qualitative findings showed that patients were greatly challenged by the effort to manage the upcoming instability, which has a persistent broad impact on their lives. Managing emotions comprised dealing with uncertainty, disappointment, and frustration. Additionally, patients had to manage changes in self-perception. Managing life roles mainly involved an adaptation of relationships, occupational changes, and interactions with health care providers. Taking medications, managing symptoms, integrating new behaviors, and understanding one's course of disease were further tasks. Quantitatively, self-management tasks that were perceived as a challenge by at least half of the patients were primarily tasks from the questionnaire section “managing stressful emotions and self-perception.” The synthesis of qualitative and quantitative findings indicates that self-management programs for kidney transplant recipients should focus on strengthening patients' self-management of emotional tasks and on regaining stability in daily life.
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Affiliation(s)
- Gabriela Schmid-Mohler
- University Hospital Zurich (GS-M, AF, TF, RS), University of Applied Science and Arts Western Switzerland, Freiburg (PS-K), University of Basel (RS), Switzerland
| | - Petra Schäfer-Keller
- University Hospital Zurich (GS-M, AF, TF, RS), University of Applied Science and Arts Western Switzerland, Freiburg (PS-K), University of Basel (RS), Switzerland
| | - Anja Frei
- University Hospital Zurich (GS-M, AF, TF, RS), University of Applied Science and Arts Western Switzerland, Freiburg (PS-K), University of Basel (RS), Switzerland
| | - Thomas Fehr
- University Hospital Zurich (GS-M, AF, TF, RS), University of Applied Science and Arts Western Switzerland, Freiburg (PS-K), University of Basel (RS), Switzerland
| | - Rebecca Spirig
- University Hospital Zurich (GS-M, AF, TF, RS), University of Applied Science and Arts Western Switzerland, Freiburg (PS-K), University of Basel (RS), Switzerland
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20
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Urstad KH, Øyen O, Andersen MH, Moum T, Wahl AK. The effect of an educational intervention for renal recipients: a randomized controlled trial. Clin Transplant 2012; 26:E246-53. [PMID: 22686948 DOI: 10.1111/j.1399-0012.2012.01666.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The purpose of this randomized controlled trial was to test the efficacy of an educational intervention on renal recipient's knowledge, compliance, self-efficacy, and quality of life. METHODS In total, 159 renal recipients were randomized to the intervention (N = 77) or control group (N = 82). A total of 139 participants reached second measure point (7-8 wk post-Tx), and 120 participants reached third measure point (six months post-Tx). The intervention consisted of five tailored one-to-one sessions. Primary outcome was measured by a knowledge questionnaire. Secondary outcomes were measured by "The General- Self-efficacy Scale," SF-12 and by number of patient observations (Compliance). RESULTS Significantly higher levels of knowledge were found in the experimental group compared with the control group at both measure points (p = 0.002 and p = 0.004). Compliance was significantly higher in the experimental group at second measure point (p = 0.000). At third measure point, the experimental group reported significantly better scores on self-efficacy (p = 0.036) and mental score of quality of life (p = 0.001). CONCLUSIONS This structured, tailored educational intervention, applied in a 7-8 wk post-transplant period, increased renal recipients' levels of knowledge on both short and long terms. Furthermore, the intervention was beneficial for patients' compliance, self-efficacy, and mental quality of life.
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Affiliation(s)
- Kristin H Urstad
- Department of Health Studies, University of Stavanger, Stavanger, Norway.
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21
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Romano G, Lorenzon E, Montanaro D. Effects of exercise in renal transplant recipients. World J Transplant 2012; 2:46-50. [PMID: 24175196 PMCID: PMC3782234 DOI: 10.5500/wjt.v2.i4.46] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 04/02/2012] [Accepted: 06/30/2012] [Indexed: 02/05/2023] Open
Abstract
Even after a successful renal transplantation, the renal transplant recipients (RTRs) keeps on suffering the consequences of the uremic sickness. Cardiovascular risk, work capacity, and quality of life do not improve according to expectations since biological and psychological problems are not completely solved by pharmacological treatment. Furthermore, post-transplant treatment, per se, induces additional problems (i.e., side effects of drugs). It becomes, indeed, very important to insert “non-pharmacological” therapies able to reverse this trend. Exercise may represent an important contribution in the solution of this problem. In fact, many studies have demonstrated, in the last two decades, that physical training is able both, to improve graft function, work capacity and quality of life, and to reduce cardiovascular risk. In conclusion, if the analysis of the available data suggests that an appropriate dose of physical training represent a useful, safe and non-pharmacologic contribution to RTR treatment, it becomes a kidney transplantologist responsibility to introduce exercise in the current therapy of RTRs.
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Affiliation(s)
- Giulio Romano
- Giulio Romano, Eric Lorenzon, Domenico Montanaro, Department of Nephrology, S.M. Misericordia University Hospital, DISM, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
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22
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Urstad KH, Wahl AK, Andersen MH, Øyen O, Fagermoen MS. Renal recipients' educational experiences in the early post-operative phase--a qualitative study. Scand J Caring Sci 2012; 26:635-42. [PMID: 22417055 DOI: 10.1111/j.1471-6712.2012.00972.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Renal recipients need to acquire significant amount of knowledge for their life post-transplantation. More knowledge on kidney recipients' experiences after transplantation with regard to the patient education provided is needed. Sixteen renal recipients were interviewed 4-6 weeks post-transplantation about content and methods in the patient education programme. Data were analysed in the hermeneutic tradition. The patients experienced barriers towards learning in the early post-operative phase. Kidney transplantation was expressed as a 'turning point in life', causing learning difficulties because of both physical and mental stress. Survival knowledge was the label for topics concerning medication and rejection as they were experienced as essential for life. Situational knowledge, that is, knowledge related to recipients' individual life situations, requires further details in the main topics provided. The difference between knowing and practising what was taught was experienced as troublesome. The recipients expressed that a supportive learning atmosphere characterized by patience, respect, continuity and active participation was essential. This study revealed new knowledge about renal recipients' need for individual application of the educational content, as well as cognitive difficulties, and other factors impacting on learning in the early post-operative phase. The patients' perspective is an important and useful aid in creating effective interventions in this field.
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23
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McGee J, Jackson NR, Slakey DP. Disability and kidney transplantation in the United States. Clin Transplant 2012; 26:377-81. [PMID: 22376214 DOI: 10.1111/j.1399-0012.2012.01612.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2011] [Indexed: 11/29/2022]
Abstract
Transplantation is the treatment of choice for patients with end-stage renal disease. Despite complete or partial restoration of renal function, many recipients after transplant continue to self-identify as disabled. It is a designation required for federal healthcare assistance pre-transplant, but in some cases, post-transplantation, the designation is misapplied. When kidney recipients bear the label of disabled, regardless if the disability is real or perceived, they are less likely to participate in work and social activities. Although transplantation improves quality of life, for many recipients the designation of disability can extend an unintended, negative impact. It is well recognized that kidney recipients return to employment, education, and social activities after transplantation. However, there is a portion of the recipient population that can work but chooses not to engage. A large part of the phenomenon is related to disability status and the federal financing of kidney disease. This paper summarizes the history of the relationship between disability and kidney transplantation, the potential pitfalls associated with the relationship, and evidence-based strategies designed to mitigate or lead to mitigation of the unfavorable effects associated with misappropriated, perceived disability after kidney transplantation.
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Affiliation(s)
- Jennifer McGee
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112-2669, USA.
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24
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van der Mei SF, Kuiper D, Groothoff JW, van den Heuvel WJA, van Son WJ, Brouwer S. Long-term health and work outcomes of renal transplantation and patterns of work status during the end-stage renal disease trajectory. JOURNAL OF OCCUPATIONAL REHABILITATION 2011; 21:325-334. [PMID: 21656250 PMCID: PMC3173627 DOI: 10.1007/s10926-011-9317-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION The aim of this study was to examine the health- and work outcomes of renal transplant recipients long-term after transplantation as well as the pattern of work status, work ability and disability benefits during the end-stage renal disease (ESRD) trajectory that precedes transplantation. METHODS 34 transplant recipients completed interviews 3, 13 months and >6 years posttransplantation. Health status (SF-36), work ability (WAI), and fatigue (CIS) were assessed by questionnaires, clinical data were derived from medical charts, and data on functional limitations were extracted from the social security system database. The work status trajectory preceding transplantation was examined retrospectively. RESULTS Of the 34 third wave transplant recipients, 29% were severely fatigued. Compared with the general working population, recipients experienced worse general health and less vitality. Non-working recipients had worse renal function and general health, and more limitations in physical functioning compared to working recipients. The WAI score indicated moderate work ability for 60% of the employed recipients. Although 67% were employed (45% parttime), 30% of those working still received some disability benefits. Social insurance physicians found variable levels of functional limitations. The mean work status trajectory showed more sickness absence and less work ability during dialysis, but after transplantation, both work status and work ability generally improved. CONCLUSIONS Transplant recipients have a compromised health status which leads to functional limitations and disability. Although work status improved after transplantation, a substantial number of the transplant recipients received disability benefits. The negative health consequences of anti-rejection medications may play an important role in long-term work ability. These results indicate that a 'new' kidney has advantages over dialysis with respect to work, but does not necessarily leads to 'normal' work outcomes.
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Affiliation(s)
- Sijrike F van der Mei
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, P.O. Box 196, 9700 AD Groningen, The Netherlands.
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25
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Lin SY, Fetzer SJ, Lee PC, Chen CH. Predicting adherence to health care recommendations using health promotion behaviours in kidney transplant recipients within 1-5 years post-transplant. J Clin Nurs 2011; 20:3313-21. [DOI: 10.1111/j.1365-2702.2011.03757.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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26
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Stiavetti E, Matteucci R, Giannessi E, Ducci J, Baldoni L, De Simone P, Filipponi F. Patient satisfaction among liver transplant recipients: single-center survey. Transplant Proc 2011; 42:2233-7. [PMID: 20692452 DOI: 10.1016/j.transproceed.2010.05.135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A single-center survey using a semistructured questionnaire was conducted in liver transplantation recipients at discharge after the primary surgery. The objectives of the study were to assess patient satisfaction and to identify critical points that negatively affected their perception of the quality of care received, and to derive information to enable improvement in current standards of care. The questionnaire included 5 sections about quality and 1 section for suggestions. Patients were asked to provide answers on a 5-item Likert scale. Areas assessed included quality of staff, organization, boarding, privacy, and transfer of care. Among 51 recipients, satisfaction was high (>50%) in all areas. Lower satisfaction scores were given for room services, diet, and background music. The most frequently reported area of dissatisfaction (12%) was lack of availability of in-hospital physical rehabilitation programs. Despite overall satisfaction with quality of care, recipients reported lack of appropriate physical rehabilitation programs in the early posttransplantation period.
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Affiliation(s)
- E Stiavetti
- General Surgery and Liver Transplantation Unit, University of Pisa Medical School Hospital, Pisa, Italy.
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27
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Urstad KH, Andersen MH, Øyen O, Moum T, Wahl AK. Patients' level of knowledge measured five days after kidney transplantation. Clin Transplant 2010; 25:646-52. [PMID: 21077953 DOI: 10.1111/j.1399-0012.2010.01355.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Kidney recipients' knowledge is important in terms of coping with short-term problems posed by transplantation and the long-term outcome. Little attention has been given to the development of instruments for measuring patient's knowledge in this field. AIM The purpose of this study was to describe the development of a knowledge questionnaire for kidney recipients and to explore possible factors related to the knowledge level. METHODS The sample consisted of 159 kidney recipients at a Norwegian transplant center, answering the questionnaire five d post-transplantation. RESULTS The questionnaire was generated on the basis of literature review and clinical experience - and was pilot tested. Mean score of the questionnaire was 11, of 19 obtainable points. Longer duration of kidney disease was significantly correlated with an increased knowledge level, whereas the longer the time on dialysis prior to transplantation and post-operative complications were found to have significantly negative impact on total knowledge score. CONCLUSIONS The positive impact of disease duration may suggest that insight gained over time makes patients better prepared for the transplantation itself and for life post-transplant. However, the negative impact of dialysis duration could be attributed to impaired cognitive function imposed by chronic dialysis treatment. Further research is needed regarding the questionnaire's responsiveness to educational interventions.
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28
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Nilsson M, Forsberg A, Bäckman L, Lennerling A, Persson LO. The perceived threat of the risk for graft rejection and health-related quality of life among organ transplant recipients. J Clin Nurs 2010; 20:274-82. [PMID: 20964748 DOI: 10.1111/j.1365-2702.2010.03388.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS This study was primarily aimed for developing and testing a valid and reliable instrument that measures perceived threat of the risk for graft rejection after organ transplantation. A second aim was to report descriptive data regarding graft rejection and Health-Related Quality of Life. BACKGROUND The most serious risk connected with transplantations besides infection is graft rejection. DESIGN Non experimental, descriptive involving instrument development and psychometric assessment. METHOD Questionnaires about perceived threat of the risk for graft rejection and Health-Related Quality of Life were mailed to 229 OTRs between 19-65 years old. The items were formed from a previous interview study. Patients were transplanted with a kidney, a liver or a heart and/or a lung. All patients with follow-up time of one year ± three months and three years ± three months were included. RESULTS With an 81% response rate, the study comprised of 185 OTRs, who had received either a kidney (n = 117), a liver (n = 39) or heart or lung (n = 29). Three homogenous factors of perceived threat for graft rejection were revealed, labelled 'intrusive anxiety', 'graft-related threat' and 'lack of control'. Tests of internal consistency showed good item-scale convergent and discriminatory validity. A majority of the OTRs scored low levels for 'intrusive anxiety'. The kidney transplant recipients experienced more 'graft-related threat' by acute graft rejection than those transplanted with a liver, heart or lung. CONCLUSION In conclusion, this study suggests that it is possible to measure the perceived threat of the risk for graft rejection in three homogenous factors. Relevance to clinical practice. The instrument perceived threat of the risk for graft rejection, might be usable to measure the impact of fear of graft rejection, to predict needs of pedagogical intervention strategies to reduce fear and to improve Health-Related Quality of Life related to graft rejection.
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Affiliation(s)
- Madeleine Nilsson
- The Sahlgrenska Academy at University of Gothenburg, Institute of Health and Care Sciences and Sahlgrenska University Hospital, Gothenburg, Sweden.
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29
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White C, Gallagher P. Effect of patient coping preferences on quality of life following renal transplantation. J Adv Nurs 2010; 66:2550-9. [DOI: 10.1111/j.1365-2648.2010.05410.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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31
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Liu H, Feurer ID, Dwyer K, Shaffer D, Pinson CW. Effects of clinical factors on psychosocial variables in renal transplant recipients. J Adv Nurs 2009; 65:2585-96. [DOI: 10.1111/j.1365-2648.2009.05111.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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32
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van der Mei SF, van Sonderen ELP, van Son WJ, de Jong PE, Groothoff JW, van den Heuvel WJA. Social participation after successful kidney transplantation. Disabil Rehabil 2009; 29:473-83. [PMID: 17364802 DOI: 10.1080/09638280600841257] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To explore and describe the degree of social participation after kidney transplantation and to examine associated factors. METHOD A cross-sectional study on 239 adult patients 1-7.3 years after kidney transplantation was performed via in-home interviews on participation in obligatory activities (i.e., employment, education, household tasks) and leisure activities (volunteer work, assisting others, recreation, sports, clubs/associations, socializing, going out). RESULTS Kidney transplantation patients had a lower educational level, spent less time on obligatory activities, had part-time jobs more often, and participated less in sports compared to a control group from the general population. No difference was found in socializing, church attendance, volunteer work and going out. Multivariate regression analysis showed a negative association of age and a positive association of educational status and time since transplantation with obligatory participation. Multivariate logistic regression showed positive associations of education and time since transplantation with volunteer work; age was negatively and education positively associated with sports and going out, whereas living arrangement was also associated with going out. CONCLUSIONS Although kidney transplantation patients participate less in employment and sports, they do participate in household tasks, volunteer work, going out, socializing and other leisure activities. Participation is associated with factors as age, educational status and time since transplantation.
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Affiliation(s)
- Sijrike F van der Mei
- Department of Health Sciences, Northern Centre for Healthcare Research (NCH), University Medical Centre Groningen (UMCG), University of Groningen, The Netherlands.
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Nilsson M, Persson LO, Forsberg A. Perceptions of experiences of graft rejection among organ transplant recipients striving to control the uncontrollable. J Clin Nurs 2008; 17:2408-17. [PMID: 18705720 DOI: 10.1111/j.1365-2702.2008.02364.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To investigate perceptions of graft rejection and different methods to obtain knowledge about graft rejection among adult organ transplant recipients. BACKGROUND Rejection is the most common cause of graft loss and graft dysfunction in clinical transplantation. Little is known about the recipients' own explanation models related to graft rejection. DESIGN Phenomenography. METHOD A strategic selection included patients who had undergone a kidney, liver, heart or lung transplant. Sixteen patients, six males and 10 females, aged 21-63 years with a follow-up time of between three months and 10 years were interviewed. RESULTS The result comprised five domains of variations in perceptions of graft rejection: the abstract threat to life; the concrete threat to health; trust in the body; striving to control the threat; and one's identity. The inner perspective and personal explanation models involved threat, fear, trust, control and identity adjustment. Different approaches had the same purpose; 'striving to control the uncontrollable'. CONCLUSION Learning about graft rejection revealed security, lack of security and uncertainty. RELEVANCE TO CLINICAL PRACTICE The inner perspective of graft rejection in this result leads to several clinical implications in terms of patient education and recipients' differing ways of obtaining knowledge about graft rejection. We suggest that patient's education should be tailored in a different way, offering support and advice in line with their personal models of explanation of graft rejection as a complement to the explanation from the biomedical model of disease.
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Affiliation(s)
- Madeleine Nilsson
- Institute of Health and Care Sciences, The Sahlgrenska Academy at Göteborg University and Queen Silvia's Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Muehrer RJ, Becker BN. PSYCHOSOCIAL FACTORS IN PATIENTS WITH CHRONIC KIDNEY DISEASE: Life After Transplantation: New Transitions in Quality of Life and Psychological Distress. Semin Dial 2008; 18:124-31. [PMID: 15771656 DOI: 10.1111/j.1525-139x.2005.18214.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Individuals with kidney failure often elect to undergo kidney transplantation because they believe that they will be more active and return a sense of normality to their lives with a functioning transplant. Therefore it is important to assess whether these objectives are being met. To do so, we can examine health-related quality of life (HRQOL) in transplant recipients. A number of tools have been used for this purpose, including general HRQOL instruments such as the 36-item short-form health survey (SF-36) and transplant-specific surveys such as the Kidney Transplant Questionnaire. In general, HRQOL assessments improve with transplantation in functional and physical domains. However, many factors actually influence HRQOL in a negative way, including comorbid conditions, kidney function per se, rejection episodes and hospitalizations, employment status, and adverse effects of medications. Perceived physical appearance, issues related to sexuality, stress, anxiety, and even guilt complicate the emotional and psychological landscape after transplantation. This constellation of factors may be predictive of posttransplant life events, such as resumption of employment. Posttransplant HRQOL may be exceedingly important in understanding the issues related to adherence with treatment regimens, especially in the pediatric and adolescent transplant populations. HRQOL is now established as an important issue after transplantation. Nonetheless, shortcomings still exist in our ability to address HRQOL after transplantation. In particular, more study of patient-centered interventions is needed. The use of standardized methodologies for patient assessment could improve our ability to identify if such patient-centered interventions actually succeed across populations, and help us further address the panoply of factors encompassed within posttransplant HRQOL.
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Affiliation(s)
- Rebecca J Muehrer
- Section of Nephrology, Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA
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Leung SSH, Shiu ATY. Experience of Hong Kong patients awaiting kidney transplantation in mainland China. J Clin Nurs 2008; 16:341-9. [PMID: 17931326 DOI: 10.1111/j.1365-2702.2007.02070.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM This paper describes the experience of Hong Kong Chinese patients awaiting kidney transplantation in mainland China. BACKGROUND While travelling to mainland China for kidney transplantation is a controversial issue, there is an increasing trend of Hong Kong Chinese patients with chronic kidney disease seeking this treatment choice, which outnumbers that performed in Hong Kong. Although these patients seek pre- and post-transplantation care from Hong Kong public healthcare system, little is known about their experience during the waiting period. METHODS This experience is examined in an exploratory qualitative study. In-depth interviews were used to collect data from a purposive sample of 12 kidney recipients. RESULTS Three major findings are identified: (i) transplant waiting patients may travel to mainland China for transplantation in search of normal life, (ii) they need informational support from their continuing healthcare providers in Hong Kong to make the informed decision and (iii) they perceive a variation of attitudes of nurses and doctors in Hong Kong towards transplantation in mainland China. CONCLUSIONS This study contributes to the literature by researching patients' perspective. The findings highlight the importance and controversy of addressing these patients' informational needs. While the authors have no inclination for or against travelling to mainland China for transplantation, the findings reveal a tenacious clinical dilemma, which deserves debate in international transplant community and further research to inform the debate. Nurse and doctors in Hong Kong may contribute to the debate by articulating their experience of caring for these patients. RELEVANCE TO CLINICAL PRACTICE Health information that is readily available for patients scheduled for kidney transplantation in Hong Kong should be made accessible to the whole community of patients with chronic kidney disease. To address the complexity of patients travelling to elsewhere for transplantation and the needs of these patients, provider reticence may be counterproductive.
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Ameli J, Kachuee H, Assari S, Rasta VR, Khoddami-Vishte HR, Einollahi B, Lessan-Pezeshki M, Khedmat H. Does etiology of end-stage renal disease affect sleep quality in kidney transplant recipients? Transplant Proc 2007; 39:1091-4. [PMID: 17524900 DOI: 10.1016/j.transproceed.2007.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND That hypertension (HTN) as a leading cause of end-stage renal disease (ESRD) is linked to sleep disorders in the general population can be the basis of a hypothesis that HTN may be a contributing factor to the poor quality of sleep in some kidney transplant recipients. This study was designed to investigate the correlation between ESRD secondary to HTN and sleep quality among kidney transplant recipients. METHODS In this case control study, 201 kidney transplant recipients were divided into group I (ESRD) secondary to HTN, (n=82) and group II (ESRD secondary to other causes, n=119). The groups were matched for medical comorbidities, demographic and clinical data, and symptoms of anxiety and depression. Sleep quality assessed by means of the Pittsburgh Sleep Quality Index (PSQI) was compared between the study groups. RESULTS The mean (SD) of the total PSQI score was significantly high in group I compared with group II (7.42 +/- 2.36 vs 6.60 +/- 3.07, P=.042). Similar results were observed for the sleep duration scores in the groups (1.22 +/- 1.12 vs 0.86 +/- 1.12, P=.026). In group I, all the other PSQI components were higher than those in group II, difference that were statistically significant. CONCLUSION Sleep quality and duration was poorer among our kidney transplant recipients with ESRD secondary to HTN compared with the controls. Further studies, however, are required to investigate whether HTN is responsible for the reported poor quality of sleep in some kidney transplant recipients.
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Affiliation(s)
- J Ameli
- Nephrology/Urology Research Center (NURC), Baqiyatallah Medical Sciences University, Tehran, Iran
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Dobbels F, De Bleser L, De Geest S, Fine RN. Quality of life after kidney transplantation: the bright side of life? Adv Chronic Kidney Dis 2007; 14:370-8. [PMID: 17904505 DOI: 10.1053/j.ackd.2007.07.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This review describes the state-of-the-art on quality of life (QOL) in kidney transplant (KTx) recipients. More specifically, posttransplant QOL is compared with the pretransplant evaluation, with other chronically ill patient populations, and with healthy subjects. Determinants, consequences, and potential interventions to improve QOL are also summarized. However, because of the methodological diversity of published articles, this review starts with addressing some conceptual and methodological concerns surrounding research on QOL in general and in KTx recipients specifically. The ultimate goal of this review was to identify the gaps in the state-of-the-art evidence and to provide some guidelines for conduct of research in the future.
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Affiliation(s)
- Fabienne Dobbels
- Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium.
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van der Mei SF, van Son WJ, van Sonderen ELP, de Jong PE, Groothoff JW, van den Heuvel WJA. Factors Determining Social Participation in the First Year After Kidney Transplantation: A Prospective Study. Transplantation 2007; 84:729-37. [PMID: 17893606 DOI: 10.1097/01.tp.0000281409.35702.53] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study describes changes in social participation in the first year after kidney transplantation and examines the influence of clinical factors, health status, transplantation-related symptoms, and psychological characteristics on change in social participation. METHODS A prospective study was performed on a cohort of primary kidney transplant recipients, transplanted between March 2002 and March 2003. Data on participation in obligatory activities (i.e., employment, education, household tasks) and leisure activities (i.e., volunteer work, assisting others, sports, clubs/associations, recreation, socializing, going out) were collected by in-home interviews (n=61) at 3 months (T1) and 1 year posttransplantation (T2). Analysis of covariance was performed. RESULTS Data showed an increase in participation in obligatory activities and diversity of leisure participation between T1 and T2, although pre-end-stage renal disease level was not regained and differed from the general population. On T1, the majority of employed recipients were on sick leave, but returned to work on T2. Employment rate remained stable. An increase in obligatory participation was predicted by clinical factors (i.e., peritoneal dialysis, initial hospitalization), whereas change in leisure participation was related to serum albumin and cognitive capacity. No effects were found for type of donation, comorbidity, and renal function. CONCLUSIONS We found that mainly clinical factors were associated with an increase in participation in society. Although health-status related factors and the psychological attribute self-efficacy may be related to recovery of social participation, their effect was outweighed by the strength of clinical predictors in multivariate analysis.
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Affiliation(s)
- Sijrike F van der Mei
- Northern Center for Healthcare Research, University Medical Center Groningen, University of Groningen, the Netherlands.
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Abstract
PURPOSE To investigate the relationship between sense of coherence and spirituality and their association with perceptions of stress, and quality of life. METHODS Questionnaires mailed to nonhospitalized patients with chronic obstructive pulmonary disease. Data analyses included descriptive statistics, Pearson's correlations, multiple regressions, and ANOVA. RESULTS High sense of coherence (SOC) and spirituality were correlated with low stress and high quality of life (QoL). Neither SOC nor spirituality related significantly to objective symptom severity. In regression analyses 73.2% of the variance in QoL was explained by SOC, the FEV1/FVC ratio, and functional ability. CONCLUSIONS Psychosocial factors are important in patients' cognitive interpretations of illness. SOC and spirituality may buffer stress in the context of chronic illness.
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Affiliation(s)
- Cheryl Delgado
- School of Nursing, Cleveland State University, Cleveland, OH 44115, USA.
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Abstract
The previous article explored the role of the nurse pre-renal transplantation, which addressed the physical, psychological and educational support that the patient and family members require prior to this life-changing surgery. The following article explores the continual role of the nurse in caring for and educating the patient post-renal transplantation. Renal transplantation is considered the optimal treatment of choice for patients with end-stage renal failure (ESRF) and who are receiving dialysis. The nurse plays a pivotal role in assisting the patient in facing the many challenges that are associated post-renal transplantation, including the complications and the long-term physical and psychosocial implications.
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Affiliation(s)
- Fiona Murphy
- School of Nursing and Midwifery, Trinity College, Dublin
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Abstract
The following two articles explores the role of the nurse in caring for and educating the patient both pre- and post-renal transplantation. The nurse plays a pivotal role in assisting the patient facing the many challenges that are associated with transplantation. Renal transplantation is considered the optimal treatment of choice for patients with end stage renal failure (ESRF) and who are receiving dialysis. This first article will explore the role that nurses play regarding the care of the patient pre-transplant, including the physical, psychological and educational support required to assist the patient and family members deal with the many challenges associated with transplantation.
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Affiliation(s)
- Fiona Murphy
- School of Nursing and Midwifery, Trinity College, Dublin
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Noohi S, Khaghani-Zadeh M, Javadipour M, Assari S, Najafi M, Ebrahiminia M, Pourfarziani V. Anxiety and Depression Are Correlated With Higher Morbidity After Kidney Transplantation. Transplant Proc 2007; 39:1074-8. [PMID: 17524895 DOI: 10.1016/j.transproceed.2007.04.002] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Psychiatric comorbidities have been reported to be associated with low quality of life, but less attention has been paid to their impact on other morbidity measures. The aim of this study was to investigate the correlation of anxiety and depression with marital relation, sexual function, and sleep quality in kidney transplant recipients. METHODS In a cross-sectional study between 2005 and 2006, 88 kidney transplant recipients were divided into four groups according to their scores of anxiety and depression using Hospital Anxiety Depression Scale (HADS): group I(anx) (anxiety score <11; n=64); group II(anx) (anxiety score >or= 11; n=24); group I(dep) (depression score <11; n=68); and group II(dep) (depression score >or= 11; n=20). Morbidity measures including quality of life (Short Form-36), marital adjustment (Revised Dyadic Adjustment Scale), sexual relationship (Relationship and Sexuality Scale), and quality of sleep (Pittsburgh Sleep Quality Index) were separately compared between groups of anxious versus nonanxious and depressed versus nondepressed. RESULTS Group I(anx), compared with group II(anx), displayed a better state of mental health (48.80 +/- 7.14 vs. 44.45 +/- 7.80; P=.01), general health (49.36 +/- 12.77 vs. 42.91 +/- 16.67; P=.05), marital adjustment (55.13 +/- 8.01 vs. 48.35 +/- 16.62; P=.04), and lower sleep disturbance (1.36 +/- 0.62 vs. 1.66 +/- 0.63; P=.05). Group I(dep), compared with group II(dep), showed lower fatigue score (39.79 +/- 8.30 vs. 46.84 +/- 8.85; P=.002) and better sexual relationships (15.28 +/- 5.50 vs. 19.00 +/- 5.92; P=.03). CONCLUSIONS Screening for anxiety and depression in kidney transplant recipients is essential. Appropriate treatment of these prevalent psychiatric comorbidities may improve various aspects of patient well-being, including quality of life, sleep, marital relations, and sexual relationship.
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Affiliation(s)
- S Noohi
- Nephrology/Urology Research Center (NURC), Baqiyatallah Medical Sciences University, Tehran, Iran.
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Kugler C, Fischer S, Gottlieb J, Welte T, Simon A, Haverich A, Strueber M. Health-related quality of life in two hundred-eighty lung transplant recipients. J Heart Lung Transplant 2005; 24:2262-8. [PMID: 16364880 DOI: 10.1016/j.healun.2005.07.005] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2005] [Revised: 07/08/2005] [Accepted: 07/13/2005] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) has increasingly been accepted as a supplementary outcome measure for patients after lung transplantation (LTx). METHODS Using a retrospective cross-sectional study design, 280 LTx recipients (3 months to 14 years after LTx) were asked to assess their HRQoL using a generic (Quality of Life Profile for Chronic Diseases) questionnaire, which was previously validated for this specific population. In addition, the questionnaire was also performed by 155 healthy participants. RESULTS All sub-scale findings ranged from 2.40 to 3.08 (0 to 4) for all patients after LTx. A significantly reduced HRQoL was reported by the sub-cohort of patients living 5 to 6 years with the allograft for all sub-scales (p < 0.006), except for Social Functioning, and was associated with the incidence of bronchiolitis obliterans syndrome (BOS; p < 0.05). Cystic fibrosis patients (p < 0.05), single-lung transplant recipients (p < 0.05) and patients of older age (p < 0.05) showed significantly decreased physical ability ratings. Patients who remained free of infection and late acute rejection episodes scored themselves significantly higher with regard to their Relaxation Capabilities (p < 0.05 for rejection; p < 0.05 for infection) and Social Functioning (p < 0.01 for rejection; p < 0.05 for infection) vs patients who experienced infection or rejection episodes. Comparisons with a normative cohort showed similar HRQoL scales for LTx patients and the healthy population, except with regard to Social Functioning (p < 0.01). CONCLUSIONS Self-ratings for HRQoL were high for all dimensions for the entire sample, and remained relatively similar even for medium- and long-term survivors. HRQoL was dependent on incidence of infections, rejections and the onset of BOS. Despite differences in life expectancy of LTx patients compared with the healthy population, HRQoL self-ratings were within similar ranges.
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Affiliation(s)
- Christiane Kugler
- Hannover Thoracic Transplant Program, Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany.
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Gordon EJ, Prohaska T, Siminoff LA, Minich PJ, Sehgal AR. Needed: tailored exercise regimens for kidney transplant recipients. Am J Kidney Dis 2005; 45:769-74. [PMID: 15806481 PMCID: PMC1242115 DOI: 10.1053/j.ajkd.2005.01.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Elisa J. Gordon
- Address reprint requests to Elisa J. Gordon, PhD, Neiswanger Institute for Bioethics and Health Policy, Stritch School of Medicine, Loyola University Chicago, 2160 S. FirstAve., Maywood, IL60153. E-mail:
| | | | | | | | - Ashwini R. Sehgal
- Center for Reducing Health Disparities and Division of Nephrology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
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