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Uçgun T, Ercan Koyuncu İ, Koç E, Şahin Kılınç B, Kabakcı Sarıdağ KN. Identification of Psychosocial Issues in Pediatric Patients Undergoing or Waiting for Organ Transplant: A Systematic Review. EXP CLIN TRANSPLANT 2024; 22:132-138. [PMID: 39498934 DOI: 10.6002/ect.pedsymp2024.p10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2024]
Abstract
OBJECTIVES Despite increased rates of survival, pediatric organ transplant is characterized by clinical complexities and psychosocial challenges. Understanding and addressing the psychosocial issues inherent in this population are crucial for optimizing their overall well-being and transplant outcomes. In this systematic review, we thus aimed to provide a comprehensive analysis of the psychosocial issues encountered by pediatric patients undergoing or awaiting organ transplant. MATERIALS AND METHODS This systematic review was conducted by retrospectively searching PubMed, Scopus, ScienceDirect, and Cochrane electronic databases using the keywords "pediatric kidney transplantation" or "pediatric liver transplantation" or "pediatric heart transplantation" and "psychosocial problems" or "psychosocial issues" or "psychosocial outcomes" or "psychosocial needs." The literature review resulted in 3746 initial studies, with 6 studies included in this systematic review. RESULTS Examination of psychosocial problems experienced by pediatric organ transplant recipients in included studies showed factors such as depression, anxiety, quality of life, medication adherence, psychological distress, children's psychosocial characteristics, healthy behaviors, mental and somatic well-being, fear of rejection, fear of recurrence, fear of secondary diseases, sleep problems, sadness, and exhaustion. CONCLUSIONS Pediatric organ transplant intertwines complex medical procedures with intricate psychosocial dynamics, placing nurses at the forefront of care delivery for pediatric transplant recipients and their families. In embracing a holistic approach to care, nurses advocate for the integration of psychosocial support into standard practice protocols, recognizing that optimal health outcomes extend beyond physiological parameters.
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Affiliation(s)
- Tuğçe Uçgun
- From the Psychiatric and Mental Health Nursing Department, Başkent University Faculty of Health Sciences, Ankara, Turkey
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Langarizadeh M, Moghbeli F, Ahmadi S, Langarizadeh MH, Sayadi M, Sarpourian F, Fatemi Aghda SA. Design and evaluation of an educational mobile program for liver transplant patients. BMC Health Serv Res 2023; 23:974. [PMID: 37684647 PMCID: PMC10492268 DOI: 10.1186/s12913-023-09989-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Liver transplantation, the last treatment for advanced liver failure, necessitates patient education due to its wide range of complications and subsequent disabilities. The present study was development-applied research and aimed to design a mobile-based educational program to provide liver transplant patients with critical health information. METHODS In the first phase of the study, the crucial educational components were collected from the literature and organized in the form of a questionnaire using library studies and available global guidelines. The validity and reliability of this researcher-made questionnaire were confirmed by a panel of experts (n = 15), including gastroenterologists and liver specialists working in the Motahari liver clinic and AbuAli Sina Hospital in Shiraz. The application was designed followed by analyzing the data gathered from the first phase. To evaluate the mobile phone program's usability, to evaluate the application, 30 liver transplant patients were randomly selected. RESULTS Most educational components covered in the questionnaire were deemed necessary by experts in the first phase. As a result, the educational contents were classified under 10 categories. The application had a good level of usability since the participants' satisfaction score was 8.1 (out of 9 points). CONCLUSIONS Due to the increase in liver transplantation and the use of mobile phones, applications increase the patient's role in their health, and their awareness. It also leads to a better interaction and follow-up of the patient, the treatment staff of the medical centers.
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Affiliation(s)
- Mostafa Langarizadeh
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Fateme Moghbeli
- Department of Health Information Technology, Varastegan Institute for Medical Sciences, Mashhad, Iran
| | - Shamim Ahmadi
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mohammadjavad Sayadi
- Department of Computer Engineering, Technical and Vocational University (TVU), Tehran, Iran
| | - Fatemeh Sarpourian
- Department of Health Information Technology, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Ali Fatemi Aghda
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
- Research Center for Health Technology Assessment and Medical Informatics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Harju E, Speierer A, Jungo KT, Levati S, Baggio S, Tancredi S, Noor N, Rodondi PY, Cullati S, Imboden M, Keidel D, Witzig M, Frank I, Kohler P, Kahlert C, Crivelli L, Amati R, Albanese E, Kaufmann M, Frei A, von Wyl V, Puhan MA, Probst-Hensch N, Michel G, Rodondi N, Chocano-Bedoya P. Changes in Healthcare Utilization During the COVID-19 Pandemic and Potential Causes-A Cohort Study From Switzerland. Int J Public Health 2023; 68:1606010. [PMID: 37663371 PMCID: PMC10469983 DOI: 10.3389/ijph.2023.1606010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/05/2023] [Indexed: 09/05/2023] Open
Abstract
Objectives: To describe the frequency of and reasons for changes in healthcare utilization in those requiring ongoing treatment, and to assess characteristics associated with change, during the second wave of the pandemic. Methods: Corona Immunitas e-cohort study (age ≥20 years) participants completed monthly questionnaires. We compared participants reporting a change in healthcare utilization with those who did not using descriptive and bivariate statistics. We explored characteristics associated with the number of changes using negative binomial regression. Results: The study included 3,190 participants from nine research sites. One-fifth reported requiring regular treatment. Among these, 14% reported a change in healthcare utilization, defined as events in which participants reported that they changed their ongoing treatment, irrespective of the reason. Reasons for change were medication changes and side-effects, specifically for hypertension, or pulmonary embolism treatment. Females were more likely to report changes [Incidence Rate Ratio (IRR) = 2.15, p = 0.002]. Those with hypertension were least likely to report changes [IRR = 0.35, p = 0.019]. Conclusion: Few of those requiring regular treatment reported changes in healthcare utilization. Continuity of care for females and chronic diseases besides hypertension must be emphasized.
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Affiliation(s)
- Erika Harju
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- School of Health Sciences, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
- Clinical Trial Unit, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Alexandre Speierer
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | | | - Sara Levati
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Stéphanie Baggio
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Population Health Laboratory (#PopHealthLab), Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Stefano Tancredi
- Population Health Laboratory (#PopHealthLab), Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Nazihah Noor
- Population Health Laboratory (#PopHealthLab), Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | | | - Stéphane Cullati
- Population Health Laboratory (#PopHealthLab), Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
- Quality of Care Service, Geneva University Hospitals, Geneva, Switzerland
| | - Medea Imboden
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss TPH), Allschwil, Switzerland
- Department of Public Health, University of Basel, Basel, Switzerland
| | - Dirk Keidel
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss TPH), Allschwil, Switzerland
- Department of Public Health, University of Basel, Basel, Switzerland
| | - Melissa Witzig
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss TPH), Allschwil, Switzerland
- Department of Public Health, University of Basel, Basel, Switzerland
| | - Irène Frank
- Clinical Trial Unit, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Philipp Kohler
- Department of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Christian Kahlert
- Department of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Infectious Diseases and Hospital Epidemiology, Children’s Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Luca Crivelli
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Rebecca Amati
- Institute of Public Health, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Emiliano Albanese
- Institute of Public Health, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Marco Kaufmann
- Epidemiology, Biostatistics and Prevention Institute, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Anja Frei
- Epidemiology, Biostatistics and Prevention Institute, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Viktor von Wyl
- Epidemiology, Biostatistics and Prevention Institute, Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zürich, Switzerland
| | - Milo A. Puhan
- Epidemiology, Biostatistics and Prevention Institute, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Nicole Probst-Hensch
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss TPH), Allschwil, Switzerland
- Department of Public Health, University of Basel, Basel, Switzerland
| | - Gisela Michel
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patricia Chocano-Bedoya
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Population Health Laboratory (#PopHealthLab), Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
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Kuntz K, Engel K. Adherence in transplantation. Curr Opin Organ Transplant 2022; 27:530-534. [PMID: 36166274 DOI: 10.1097/mot.0000000000001025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Adequately managing a complex medical regimen is paramount to the success of organ transplants. When patients stray from their prescribed medical regimen posttransplant, graft rejection, and death can occur. Predictors of adherence have been studied for many years, and various factors have been identified as contributing to adequate or poor adherence. Both demographic and personal characteristics have been associated with adherence behavior. However, recent developments, such as the COVID-19 pandemic, increased use of mobile health interventions, and use of medical biomarkers have affected the way adherence is measured and applied. RECENT FINDINGS The COVID-19 pandemic affected patients' comfort with accessing outpatient care and created a wider use of telehealth services. Measurement of adherence through serum lab levels continues to be reviewed as a potential objective assessment of adherence. Psychosocial factors continue to be identified as major contributors to nonadherence. SUMMARY Adherence to antirejection medication, lab work, appointments, and exercise and dietary instructions remains critical to the health of the transplant patient. It is critical that providers involved in the selection process and posttransplant treatment of these patients remain well informed of potential new factors affecting adherence.
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Affiliation(s)
- Kristin Kuntz
- The Ohio State University Wexner Medical Center, Department of Psychiatry & Behavioral Health, Columbus, Ohio, USA
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Tacke F, Cornberg M, Sterneck M, Trebicka J, Settmacher U, Bechstein WO, Berg T. S1-Leitlinie zur Versorgung von Lebertransplantierten während der COVID-19-Pandemie – AWMF-Registernummer: 021-031 – Stand 15. Juni 2022. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2022; 60:1678-1698. [PMID: 36368659 DOI: 10.1055/a-1934-1989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Frank Tacke
- Charité - Universitätsmedizin Berlin, Medizinische Klinik m. S. Hepatologie und Gastroenterologie, Campus Charité Mitte/Campus Virchow-Klinikum, 13353 Berlin
| | - Markus Cornberg
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, 30625 Hannover; Centre for individualised infection Medicine (CiiM), Hannover; Deutsches Zentrum für Infektionsforschung (DZIF)
| | - Martina Sterneck
- Universitätsklinikum Hamburg-Eppendorf, I. Medizinische Klinik und Poliklinik, 20246 Hamburg
| | - Jonel Trebicka
- Universitätsklinikum Münster, Medizinische Klinik B, 48149 Münster
| | - Utz Settmacher
- Universitätsklinikum Jena, Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, 07747 Jena
| | - Wolf Otto Bechstein
- Universitätsklinikum Frankfurt, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, 60590 Frankfurt
| | - Thomas Berg
- Universitätsklinikum Leipzig AöR, Bereich Hepatologie, Klinik und Poliklinik für Onkologie, Gastroenterologie, Hepatologie, Pneumologie und Infektiologie, 04103 Leipzig
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Gyftopoulos A, Ziogas IA, Montenovo MI. Liver transplantation during COVID-19: Adaptive measures with future significance. World J Transplant 2022; 12:288-298. [PMID: 36187879 PMCID: PMC9516488 DOI: 10.5500/wjt.v12.i9.288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/08/2022] [Accepted: 08/26/2022] [Indexed: 02/05/2023] Open
Abstract
Following the outbreak of coronavirus disease 2019 (COVID-19), a disease caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the field of liver transplantation, along with many other aspects of healthcare, underwent drastic changes. Despite an initial increase in waitlist mortality and a decrease in both living and deceased donor liver transplantation rates, through the implementation of a series of new measures, the transplant community was able to recover by the summer of 2020. Changes in waitlist prioritization, the gradual implementation of telehealth, and immunosuppressive regimen alterations amidst concerns regarding more severe disease in immunocompromised patients, were among the changes implemented in an attempt by the transplant community to adapt to the pandemic. More recently, with the advent of the Pfizer BNT162b2 vaccine, a powerful new preventative tool against infection, the pandemic is slowly beginning to subside. The pandemic has certainly brought transplant centers around the world to their limits. Despite the unspeakable tragedy, COVID-19 constitutes a valuable lesson for health systems to be more prepared for potential future health crises and for life-saving transplantation not to fall behind.
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Affiliation(s)
- Argyrios Gyftopoulos
- School of Medicine, National Kapodistrian University of Athens, Athens 14564, Greece
| | - Ioannis A Ziogas
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Martin I Montenovo
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, United States
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Kakos CD, Ziogas IA, Tsoulfas G. Pediatric transplantation during the COVID-19 pandemic. World J Transplant 2022; 12:88-99. [PMID: 35663540 PMCID: PMC9136715 DOI: 10.5500/wjt.v12.i5.88] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/16/2022] [Accepted: 04/20/2022] [Indexed: 02/06/2023] Open
Abstract
Children infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seem to have a better prognosis than adults. Nevertheless, pediatric solid organ transplantation (SOT) has been significantly affected by the unprecedented coronavirus disease 2019 (COVID-19) pandemic during the pre-, peri-, and post-transplant period. Undoubtedly, immunosuppression constitutes a real challenge for transplant clinicians as increased immunosuppression may prolong disease recovery, while its decrease can contribute to more severe symptoms. To date, most pediatric SOT recipients infected by SARS-CoV-2 experience mild disease with only scarce reports of life-threatening complications. As a consequence, after an initial drop during the early phase of the pandemic, pediatric SOTs are now performed with the same frequency as during the pre-pandemic period. This review summarizes the currently available evidence regarding pediatric SOT during the COVID-19 pandemic.
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Affiliation(s)
| | - Ioannis A Ziogas
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Georgios Tsoulfas
- Department of Transplantation Surgery, Aristotle University School of Medicine, Thessaloniki 54622, Greece
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So M, Walti L. Challenges of Antimicrobial Resistance and Stewardship in Solid Organ Transplant Patients. Curr Infect Dis Rep 2022; 24:63-75. [PMID: 35535263 PMCID: PMC9055217 DOI: 10.1007/s11908-022-00778-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/29/2022]
Abstract
Purpose of Review Without effective antimicrobials, patients cannot undergo transplant surgery safely or sustain immunosuppressive therapy. This review examines the burden of antimicrobial resistance in solid organ transplant recipients and identifies opportunities for antimicrobial stewardship. Recent Findings Antimicrobial resistance has been identified to be the leading cause of death globally. Multidrug-resistant pathogens are associated with significant morbidity and mortality in transplant recipients. Methicillin-resistant S. aureus affects liver and lung recipients, causing bacteremia, pneumonia, and surgical site infections. Vancomycin-resistant enterococci is a nosocomial pathogen primarily causing bacteremia in liver recipients. Multidrug-resistant Gram-negative pathogens present urgent and serious threats to transplant recipients. Extended-spectrum beta-lactamase-producing E. coli and K. pneumoniae commonly cause bacteremia and intra-abdominal infections in liver and kidney recipients. Carbapenemase-producing Enterobacterales, mainly K. pneumoniae, are responsible for infections early-post transplant in liver, lung, kidney, and heart recipients. P. aeruginosa and A. baumannii continue to be critical threats. While there are new antimicrobial agents targeting resistant pathogens, judicious prescribing is crucial to minimize emerging resistance. The full implications of the COVID-19 global pandemic on antimicrobial resistance in transplant recipients remain to be understood. Currently, there are no established standards on the implementation of antimicrobial stewardship interventions, but strategies that leverage existing antimicrobial stewardship program structure while tailoring to the needs of transplant recipients may help to optimize antimicrobial use. Summary Clinicians caring for transplant recipients face unique challenges tackling emerging antimcirobial resistance. Coordinated antimicrobial stewardship interventions in collaboration with appropriate expertise in transplant and infectious diseases may mitigate against such threats.
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Affiliation(s)
- Miranda So
- Toronto General Hospital, University Health Network, 9th Floor Munk Building, Room 800, 585 University Avenue, Toronto, ON M5G 2N2 Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON Canada
| | - Laura Walti
- Toronto General Hospital, University Health Network, 9th Floor Munk Building, Room 800, 585 University Avenue, Toronto, ON M5G 2N2 Canada
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Kröncke S, Lund LK, Buchholz A, Lang M, Briem‐Richter A, Grabhorn EF, Sterneck M. Psychosocial situation, adherence, and utilization of video consultation in young adult long-term pediatric liver transplant recipients during COVID-19 pandemic. Pediatr Transplant 2021; 25:e14121. [PMID: 34428322 PMCID: PMC8646625 DOI: 10.1111/petr.14121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/13/2021] [Accepted: 08/04/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Young adults who underwent liver transplantation in childhood (YALTs) are highly vulnerable to non-adherent behavior and psychosocial problems. During the COVID-19 pandemic, special efforts may be necessary to maintain contact with these patients and offer support. This can be achieved through the use of telemedicine. The study's objective was to assess adherence and the psychosocial situation of YALTs during the COVID-19 pandemic in Germany and to evaluate the utilization of video consultations. METHODS In May 2020, a questionnaire was sent to YALTs treated at the Hamburg University Transplant Center, accompanied by the offer of video appointments with the attending physician. The questionnaire included the Generalized Anxiety Disorder Scale 7, the Patient Health Questionnaire 2, and questions compiled by the authors. RESULTS Of 98 YALTs, 12% used the video consultation, while 65% had an in-person appointment. The 56 patients who completed the questionnaire did not report reduced medication adherence during the pandemic, but 40% missed follow-up visits with their primary care physician or check-up laboratory tests. About 70% of YALTs were afraid to visit their physician and the transplant center, and 34% were afraid of a SARS-CoV-2 infection. Mental health and well-being were unimpaired. CONCLUSIONS During the COVID-19 pandemic, YALTs in our study did not show an increased need for psychosocial support, but a majority were afraid to attend medical appointments, and 40% reported lower appointment adherence. Acceptance of video consultations was lower than expected. The reasons for this need to be further investigated in order to optimize care.
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Affiliation(s)
- Sylvia Kröncke
- Department of Medical PsychologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Louisa Katharina Lund
- Department of GastroenterologyUniversity Transplant CenterUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Angela Buchholz
- Department of Medical PsychologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Melanie Lang
- Department of GastroenterologyUniversity Transplant CenterUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Andrea Briem‐Richter
- Department of PediatricsUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Enke Freya Grabhorn
- Department of PediatricsUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Martina Sterneck
- Department of GastroenterologyUniversity Transplant CenterUniversity Medical Center Hamburg‐EppendorfHamburgGermany
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