bluuebunny/crossref_metadata_2025_split huggingface dataset:
Families' Understanding of Brain Death
Authors: Siminoff Laura A. , Mercer Mary Beth , Arnold Robert 
Published: July 2017

Context Families' understanding of brain death may be a factor that contributes to decisions regarding organ donation. Objective To examine factors related to families' understanding of brain death and how those factors affect families' decisions about organ donation. Design Chart reviews were conducted on all deceased patients at 9 trauma hospitals. Interviews were then conducted with healthcare providers who spoke with families about organ donation and family decision makers. Setting Southwest Pennsylvania and Northeast Ohio. Participants The sample consisted of 403 families of organ donor–eligible patients who reported that someone at the hospital told them the patient was brain dead. Main Outcome Measures Families' awareness of brain-death testing procedures, understanding of brain death, and donation decision. Results Most families (96%) were told their family member was brain dead, but only 28.3% were able to provide a completely correct definition of brain death. No association between the definition of brain death and willingness to donate was found. Those who donated were less likely to agree with the statement that someone is dead only when the heart stops than those who did not donate. Respondents who accepted that their loved one was dead when informed the patient was brain dead were more likely to donate than those who did not consider the patient dead until mechanical support was turned off and the heart stopped.
Evaluation of an Immunosuppressant Side Effect Instrument
Authors: Winsett Rebecca P. , Arheart Kris , Stratta Robert J. , Alloway Rita , Wicks Mona N. , Gaber A. Osama , Hathaway Donna K. 
Published: July 2017

Background Clinicians continue to be compelled to evaluate the impact of immunosuppressive medication side effects on the quality of life of transplant recipients. We were asked to develop an instrument to measure side effects in immunosuppressed transplant recipients. Objective To construct an instrument that measures the impact and severity of side effects of immunosuppressive medications used in transplantation and to assess the reliability and validity of the newly developed instrument called the Memphis Survey. Design The instrument was constructed by a panel of physicians, nurses, and pharmacists with experience in treating transplant recipients. A small group of kidney transplant recipients (n=13) provided pilot data for refining and testing the instrument. A national sample of kidney, liver, and heart transplant recipients (n=505) provided data that were used to further develop the instrument. Analysis Factor analysis was used to determine the psychological dimensions underlying the instrument and to guide the construction of scales from the survey items. The instrument scales were then computed from the dataset of 505 transplant recipients to quantify the impact of immunosuppressant side effects on the quality of life of transplant recipients. Results and Conclusion Analyses showed the final instrument scales to be valid and reliable. Exploratory analysis suggests the need for further testing of the instrument to determine gender differences.
An Analysis of the Long-Term Complications of Intestine Transplant Recipients
Authors: Andersen Deborah A. , Horslen Simon 
Published: July 2017

Background One-year survival rates for intestine transplant recipients have increased to 70%, but it is believed that the complications following the procedure do not diminish after the first year as is seen in other forms of solid-organ transplantation. Objective To review the ongoing medical requirements of an increasing number of long-term survivors of intestinal transplantation. Method A retrospective medical chart review was completed on all patients who received intestinal transplantation at the University of Nebraska Medical Center from September 1990 through March 2003. One hundred forty-six transplantations were performed on 128 patients—53 intestinal, 70 liver/intestinal, and 23 intestinal with liver and pancreas or kidney. Results Seventy-six patients survived longer than 365 days and form the study group. Major reasons for readmissions were infections, gastrointestinal complications, dehydration, and rejection. The average number of rehospitalizations per patient per year remained constant. Death in patients with more than 365 days survival (N=23) was the result of sepsis (56%) and multiple other complications (44%). Conclusion The number of readmissions each year per patient remains constant and medical problems remain complex and life threatening. Patients with intestinal transplantation will continue to require regular expert follow-up care and careful attention to even the smallest medical problem even years following transplantation.
Relationships between Sex, Race, and Social Class and Social Support Networks in Kidney, Liver, and Pancreas Transplant Recipients
Authors: Cetingok Muammer , Winsett Rebecca P. , Russell Cynthia L. , Hathaway Donna K. 
Published: July 2017

Context The contribution of social support networks to the recovery of transplant recipients is an important assessment in measuring improved physical and psychosocial well-being. Social support networks are described by structure, type, and function. Objectives (1) To describe the levels of structure (size, formal and informal support), type (concrete, emotional, and informational), and function (criticalness, direction, closeness, frequency, and duration) of the social support network and (2) to examine the relationships between individual characteristics of sex, race, and social class and social support networks. Methods This exploratory-descriptive study was done in a Mid-south transplant center. A total of 258 kidney, liver, and pancreas transplant recipients participated, 61% of whom were less than 50 years old. Instruments included a demographic questionnaire, the social support network pie chart, and the social support network grid. Descriptive statistics and analysis of variance were used with a .05 significance level. Results The social support network comprised extended family (67%), with a mean of 13.68 members. Emotional support was the most prevalent type of support reported. The mean (SD) duration of support was 7.9 (4.9) years. Sex, race, and social class had no main relationships with structure and type of support. However, women had a main effect with closeness (F=4.98, P<.03) and African Americans had significantly higher levels of frequency of support (F=7.51, P<.01) and longer duration of support (F=9.07, P< .01) than did whites. Social and nursing intervention may improve the network closeness in males and may also augment support frequency and duration for whites.
Psychiatric Differences between Liver Transplant Candidates with Familial Amyloid Polyneuropathy and Those with Alcoholic Liver Disease
Authors: Telles-Correia Diogo , Barbosa A. , Mega Inês , Direitinho M. , Morbey A. , Monteiro E. 
Published: July 2017

Background Psychiatric diagnoses are very common in liver transplant candidates, and such diagnoses are predictive of a poor clinical evolution and quality of life after transplantation. Also, nonadherence before the transplant is predictive of nonadherence after the transplant. Methods We studied the psychiatric and psychosocial profiles of 85 liver transplant candidates, comprising consecutive patients attending outpatient clinics of a liver transplantation unit at a public hospital. Interviews and questionnaires were used to measure personality traits, symptoms of anxiety and depression, social support, and adherence. These patients were broken into 3 groups: patients with familial amyloid polyneuropathy (n=20), patients with alcoholic liver disease (n=33), and patients with other liver diseases (n=32). Results About 58% of patients had a current psychiatric diagnosis (24.8%, major depressive disorder, 22.3% generalized anxiety disorder, 8.3% adaptive disorder, 2.3% abuse of or dependence on substances other than alcohol). Current psychiatric diagnosis did not differ between patients with familial amyloid polyneuropathy and patients with alcoholic liver disease. Patients with alcoholic liver disease showed lower scores for 2 protective personality traits, social support and adherence to medication, than other patients. Patients with familial amyloid polyneuropathy showed higher scores for those traits. Conclusions All patients waiting for a liver transplant should undergo psychiatric and psychological assessment. Some psychological characteristics such as personality traits and social support differ between clinical groups, so it may be useful to design different approaches for each group. Patients with alcoholic liver disease may require a special approach to improve adherence to medication.
Health Care Professionals: What Do They Know about Organ Donation?
Authors: Castellana Teresa Pont , Burralló Núria Masnou , Gozalo Rosa Maria Gràcia , Barreto Marcelo , Guilera Enric Duque , Díez Júlia Portillo , Granè Natalia Vila , Barò Pere Salamero , Vilarnau Rosa Deulofeu 
Published: July 2017

Background Although donor detection is influenced by the legal system and family refusal, underreporting due to erroneous knowledge of donation criteria and a lack of familiarity with the procedure among medical professionals is also a contributing factor. Objective To investigate the outlook of critical health professionals participating in our postgraduate courses (2001 to 2006) about organ donation. Methods We administered an in-depth survey, evaluating attitudes, knowledge, roles, and experiences related to organ and tissue donation and transplantation, to 350 participants before and after the postgraduate courses. Results We collected 690 surveys from 350 attendees. In the first survey, 280 (80%) of them showed a positive attitude toward organ donation, 210 (60%) toward tissue donation, and 24 (7%) declared lack of knowledge about the subject. Only 175 (50%) had relatives who had donated organs. Sixty-three participants (18%) believed brain death is not equivalent to death, 176 (50%) claimed a lack of adequate training in this area, and 211 (60%) felt uncomfortable approaching families for donation. Only 88 (25%) were able to state the percentage of people receiving an organ in Spain, and 36 (10%) reported the correct number. After the course, the participants declared progress in attitudes toward and comfort levels with donation. Furthermore, family refusal in our hospital decreased from 33% to 8% to 11%. Conclusion Continuous training of health care professionals about transplant, the legal system, and communication skills are crucial for successful organ and tissue donation.
Importance of Depression and Active Coping in Liver Transplant Candidates' Quality of Life
Authors: Telles-Correia Diogo , Barbosa A. , Mega I. , Monteiro E. 
Published: July 2017

Objective To investigate the importance of psychiatric and psychological factors such as depression, anxiety, personality traits, and coping strategies in liver transplant candidates' quality of life. Methods A total of 131 consecutive liver transplant candidates attending outpatient clinics at a liver transplantation central unit were assessed by means of the Medical Outcomes Study Short Form quality-of-life questionnaire, psychiatric diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, a personality inventory (NEO Five-Factor Inventory), the Hospital Anxiety and Depression Scale, and the Brief COPE scale. Results and Conclusions Both physical and mental components of quality of life are far more correlated with depression and active coping strategy than with clinical and sociodemographic factors. Neuroticism was also strongly correlated with the mental component of quality of life, and employment was correlated with the physical component of quality of life.
Donor Factors That Affect the Number of Organs Transplanted per Donor
Authors: Olson Leslie , Cravero Lynn 
Published: July 2017

Background Demographic factors and factors from donors' medical and social history influence the number of organs transplanted per donor. The goal for organ procurement organizations is 4.30 organs transplanted per standard criteria donor. Objective To examine the influence of factors related to donors' demographics and donors' medical and social histories on the number of organs transplanted per donor. Methods The medical and social histories of 772 deceased donors were reviewed to assess demographic factors (eg, age, sex), diseases (eg, heart disease, hepatitis, diabetes, hypertension), and other factors (eg, body mass index, high-risk behavior, alcohol abuse). Statistics were calculated by using MarketSight software. Results Between 2003 and 2007, 2409 organs were recovered and transplanted from 772 donors (number of organs per donor, mean [SD], 3.12 [1.73]) in our designated service area. Some demographic factors (eg, age, sex) were associated with significantly fewer organs transplanted per donor. Other factors from donors' medical and social histories also played a major role, with each added factor significantly decreasing the number of organs transplanted per donor. The number of organs transplanted differed significantly between donors with 0 vs 1, 1 vs 2, and 2 vs 3 or more factors related to their medical and social histories. Conclusion Demographic factors and other factors in donors' medical and social histories significantly reduced the number of organs transplanted per donor. An algorithm that uses all potential demographic factors and factors related to medical and social history nested within each other could be developed to predict number of organs transplanted.
Effects of Administration of Intravenous Naloxone on Gas Exchange in Brain-Dead Lung Donors
Authors: Eagan Christina , Keller Cesar A. , Baz Maher A. , Thibault Michael 
Published: July 2017

Objective To observe the effect of naloxone on the lung function of potential lung transplant donors with neurogenic pulmonary edema. Design and Interventions Donors aged 16 to 55 years without any factors to contraindicate lung donation (pneumonia, pulmonary contusion, etc) were included. Ventilator settings were standardized to a tidal volume of 10 to 12 mL/kg, an FiO2 of 0.40, and a respiratory rate that kept PCO2 between 35 and 45 mm Hg. Chest physiotherapy, nebulizer treatments, and frequent suctioning were undertaken. Baseline arterial blood gas analysis and an oxygen challenge were performed. The patients were then given 8 to 10 mg of naloxone. Oxygen challenges and arterial blood gas analyses were repeated every 4 to 6 hours. The data were analyzed by using a paired t test, and each patient served as his or her own control. Setting These interventions were performed on the 19 LifeQuest donors who met the set criteria from July 2002 to July 2004. Results The PaO2 on the oxygen challenge immediately after administration of naloxone increased from 329 (SD 177) to 363 (SD 191) mm Hg, although the increase from baseline was not significant. The PaO2 from the second oxygen challenge (median time, 7 hours after administration of naloxone) increased to 413 (SD 177) mm Hg ( P < .01).
Ventricular Assist Device: Saving the Failing Heart
Authors: Kurien Sudha , Gallagher Colleen 
Published: July 2017

Background Improving the survival and quality of life of patients with end-stage heart failure is the primary goal of using a ventricular assist device, generally known as mechanical circulatory support. Ventricular assist devices are a practical long-term surgical option for a select group of patients with end-stage heart failure. Method A case study is used to demonstrate the process of selection and evaluation of patients with end-stage heart failure for ventricular assist device therapy. Also, a detailed description of all aspects of care of patients before, during, and after implantation of a ventricular assist device is presented. Conclusion A ventricular assist device is a superior therapeutic option for patients with end-stage heart failure who have become intolerant to medical therapy or in whom medical therapy has been unsuccessful. Advances in device technology through the development of nonpulsatile continuous flow devices are showing favorable long-term outcomes for patients with a ventricular assist device by minimizing complications and enhancing quality of life.
Newsletters and Adherence to a Weekly Home Spirometry Program after Lung Transplant
Authors: LaVelle Meghan B. , Finkelstein Stanley M. , Lindgren Bruce R. , Lindquist Ruth , Robiner William N. , MacMahon Kathleen , VanWormer Arin M. 
Published: July 2017

Context Newsletters are a common intervention for patients in clinical trials. However, it is not clear whether newsletters are associated with increased adherence to the health regimen, and if so, which aspects of the newsletter are reported as most helpful to patients. Objective To examine the association between patients' ratings of worthwhileness of a quarterly newsletter and adherence with a home spirometry regimen. Design Patients (n=48) were in a research-based spirometry program after lung transplant and had received at least 1 newsletter; 24 (50%) returned completed surveys via postal mail. Main Outcome Measures Adherence for forced vital pulmonary function tests for respondents versus nonrespondents, number of weeks they were adherent, ratings they gave the newsletter, and which components of the newsletters were helpful to the respondents. Results Respondents had more forced vital capacity pulmonary function tests (“blows”) overall, blew more times weekly, and blew more consistently from week to week than did nonrespondents. Although it was not statistically significant, a mild correlation was found between the number of weeks that the respondents were adherent and their ratings of the newsletter ( r = 0.36, P = .08). Most respondents reported that newsletter length was “about right,” and 86% reported that newsletters helped encourage regular spirometer use, maintain interest in the study, educate about general health, and alert readers to seasonal health risks. Implications for Practice High ratings for newsletters used to encourage participation among adults in our home spirometry study were associated with higher adherence.
Validity of 2 Sleep Quality Items to Be Used in a Large Cohort Study of Kidney Transplant Recipients
Authors: Burkhalter Hanna , Sereika Susan M. , Engberg Sandra , Wirz-Justice Anna , Steiger Jürg , De Geest Sabina 
Published: July 2017

Context Poor sleep quality and poor daytime functioning affect many kidney transplant patients. Objective To evaluate the validity of 2 items assessing sleep quality and daytime functioning using the Pittsburgh Sleep Quality Index as reference standard before use in a large cohort study, following the American Psychological Association's guidelines. Design A cross-sectional study using a psychosocial questionnaire developed for a large cohort study and the Pittsburgh Sleep Quality Index. Sample and Setting One hundred thirty-five home-dwelling kidney transplant patients aged 21 to 76 years (mean, 51.6 years; SD, 11.9 years). Main Outcome Measures Evidence on content, internal structure, and relation to other variables. Results The Pittsburgh Sleep Quality Index indicated a 47.4% prevalence of poor sleep quality; the sleep quality item in the psychosocial questionnaire showed a 30.7% prevalence of poor sleep quality and a 34.1% prevalence of poor daytime functioning. Content validity was good for the psychosocial questionnaire's sleep quality item but poor for its daytime functioning item. As hypothesized, the psychosocial questionnaire's sleep quality item was moderately correlated with its daytime functioning item (Spearman rho, ρs = 0.520, P< .001), indicating related but distinct concepts. When combined, the 2 items from the psychosocial questionnaire showed significant correlations with the total score on the Pittsburgh Sleep Quality Index (ρs = −0.784, P< .001), depressive symptoms (ρs = −0.680, P< .001), perceived health status (ρs = 0.619, P< .001), and subjective health status (ρs = 0.671, P< .001) in the expected directions. Conclusion For kidney transplant patients, validity is strong for the psychosocial questionnaire's sleep quality item, but the mixed findings regarding the validity of the daytime functioning item suggest that additional items are needed to measure daytime functioning.
Sleep and Daytime Sleepiness of Patients with Left Ventricular Assist Devices: A Longitudinal Pilot Study
Authors: Casida Jesus M. , Davis Jean E. , Brewer Robert J. , Smith Cheryl , Yarandi Hossein 
Published: July 2017

Context No empirical longitudinal data on sleep and daytime sleepiness patterns in patients with an implantable left ventricular assist device (LVAD) exist. Objective (1) To describe the sleep patterns (sleep onset latency, sleep efficiency, sleep fragmentation index, total sleep time, and wake after sleep onset), sleep quality, and daytime sleepiness variables and (2) to determine the change in the pattern of these variables before and up to 6 months after LVAD implantation. Design A longitudinal descriptive repeated-measures design was used. Patients wore wrist actigraphs (AW64 Actiwatch), which objectively measured sleep, for 3 consecutive days and nights before LVAD implant and at the first and second week and first, third, and sixth month after implantation. During these periods, patients also completed questionnaires on sleep quality and daytime sleepiness. Patients Twelve of 15 patients completed the 6-month data. Data were analyzed by using descriptive statistics and repeated-measures analysis of variance. Results We found long sleep onset latencies and low sleep efficiency across time periods. High sleep fragmentation index was noted at baseline and 1 week after LVAD. Short total sleep times, long wake-after-sleep-onset durations, and poor sleep quality were evident at baseline and persisted up to 6 months after LVAD implantation. Low alertness level, a manifestation of sleepiness, was common during late morning to early evening hours. However, only sleep efficiency and wake after sleep onset showed significant changes in pattern (P < .05). Conclusion Sleep disturbance and daytime sleepiness may be prevalent before and up to 6 months after LVAD implantation, warranting further investigation.
From Insiders' Perspectives: Adjusting to Caregiving for Patients with Left Ventricular Assist Devices
Authors: Marcuccilli Linda , Casida Jesus M. 
Published: July 2017

Context Caregivers for patients with a long-term implantable left ventricular assist device have a very important role in helping patients maintain their health and well-being and attain an improved quality of life. Although the caregiving tasks, burdens, and challenges of family caregivers have been described in the literature, we know little about how caregivers adjust to or accommodate the new role in their lives. Objective To explore and describe the lifestyle adjustments of caregivers for adults living with a left ventricular assist device as a bridge to heart transplant or destination therapy. Design A hermeneutic phenomenology was used as a guide for interviews and analysis of the data. Participants A purposive convenience sample of 5 women, aged 39 to 71 years, who had served as caregivers of a left ventricular assist device patient for at least 3 months. Setting Recruitment and data collection (interviews) were conducted in an outpatient clinic for the mechanical circulatory support program of a large academic medical center in the Midwest. Results Three main themes (caregiving: a “24/7” responsibility, coping strategies, and satisfaction) and 13 subthemes emerged from the data. Conclusions Lifestyle adjustments with caregiving may become easier over time, and with effective use of coping strategies, caregivers accept their new caregiving role as part of life.