bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Impact of a Change in Tacrolimus Monitoring Immunoassay Techniques on Clinical Decision Making
Authors: Cavanaugh Teresa M. , Parrish Nicholas , Neff Guy , Rudich Steven , Martin-Boone Jill 
Published: July 2017

Context Tacrolimus is an immunosuppressant that undergoes therapeutic drug monitoring. The laboratory at our institution changed its immunoassay techniques from the fluorescence polarization immunoassay to the cloned enzyme donation immunoassay. Objective To evaluate the relationship between the 2 assays and to determine the impact of the change on clinical decision making. Design A retrospective study of patients admitted to the hospital during the assay transition period. Tacrolimus values for the 2 assays were collected for 4 weeks and compared. Setting An academic health center. Patients Liver transplant patients hospitalized from February 18, 2008, to March 18, 2008. Main Outcome Measure The primary outcome was the agreement between the results of the 2 immunoassays. Secondary outcome was agreement of clinical decision making with established patient-specific therapeutic ranges or with a 30% difference in absolute values between the assays. Results Seventy-nine pairs of tacrolimus concentrations were collected from 21 liver transplant patients. The mean (SD) tacrolimus concentrations were 7.36 (4.21) μg/L for the fluorescence polarization immunoassay and 9.00 (5.30) μg/L for the cloned enzyme donation immunoassay ( P= .03). A clinically different decision would have been made if the fluorescence polarization immunoassay value had not been reported 51% of the time. A Bland-Altman plot indicated no relationship between the assay results. Conclusion A change in tacrolimus monitoring assay would have resulted in different clinical decisions 51% of the time. Awareness of changes in assay technology must be heightened to enhance clinical decision making and prevent potential impact on morbidity among liver transplant patients.
Barriers to Implementing Protocols for Kidney Paired Donation and Desensitization: Survey of US Transplant Programs
Authors: Clark Emma , Hanto Ruthanne , Rodrigue James R. 
Published: July 2017

Context Special types of kidney transplant exist for patients who have willing but incompatible donors. Two types of transplants that circumvent donor-recipient incompatibility are “kidney paired donation” and “desensitization.” Lack of access to these protocols limits living donations and shortens the life span of patients with willing but incompatible donors. Objective To understand potential barriers to implementing kidney paired donation and desensitization, as well as attitudes toward nondirected donation and compatible type O donation, which would maximize the number of kidney paired donation transplants performed via chains. Design We created a 56-question Web-based survey to elicit information from US transplant program directors about 24 potential barriers to implementing these protocols. Participants Of 166 programs contacted, 96 responded, including 88 complete and 8 partial responses. After pediatric-only programs and multiple responses from the same program were removed, 84 total (78 complete) remained. Main Outcome Measures Respondents were asked to designate each barrier as “major,” “minor,” or “not a barrier.” Results Availability of dedicated nurse coordinators and the United Network for Organ Sharing's variance request process (although kidney paired donation does not actually require a variance) were significant barriers to kidney paired donation. Most respondents (54%, 42/78) would prefer to participate in a regional rather than a national protocol for kidney paired donation. Risk of complications was the most significant barrier to desensitization. University affiliation, region, and training (nephrologist vs surgeon) had little effect on perception of barriers. Most (92%, 71/78) would evaluate nondirected donations; 53% (41/78) would encourage compatible type O donors to enter kidney paired donation.
Exploring the Information Needs of Adolescents and Their Parents Throughout the Kidney Transplant Continuum
Authors: Korus Moira , Stinson Jennifer N. , Pool Rita , Williams Angela , Kagan Susan 
Published: July 2017

Context Adolescents are at higher risk for organ loss than are all other age groups, but no studies have been conducted to examine the specific information needs of adolescents. A better understanding of adolescents' information needs is essential for developing programs tailored to their unique requirements. Objective To explore information needs of adolescents who have undergone kidney transplantation in order to inform development of an education program. Design A qualitative descriptive design was used. Focus groups (n = 2) were conducted by using a semistructured interview guide. Transcribed data were organized into categories that reflected emerging themes by using simple content analysis. Participants and Setting A convenience sample of 8 adolescents (50% female) who varied in age, donor type, and time since transplantation were recruited from a large Canadian tertiary care pediatric center. Results Adolescents articulated that the process of undergoing kidney transplant was very stressful and affected all aspects of their lives. In particular, adolescents identified 4 main stressors: changes in body image, wanting to be normal, pain, and breakdown in communication processes. The 2 strategies that assisted adolescents in coping with these stressors were (1) gaining knowledge about the transplantation process and (2) experiencing understanding through social support. They wanted information provided to them gradually throughout the transplant experience with choices given as to how they receive the information. Conclusion Adolescents were united in their call for information, self-management strategies, and meaningful social support to better manage their kidney transplant and prepare for transition to adult health care.
A Family-Centered Educational Program to Promote Independence in Pediatric Heart Transplant Recipients
Authors: Lawrence Kathy S. , Stilley Carol S. , Pollock John A. , Webber Steven A. , Quivers Eric S. 
Published: July 2017

Context Characteristic adolescent risk-taking behavior, including nonadherence with prescribed medications, can be life-threatening for transplant recipients. Suggestions for managing nonadherence in teen recipients include providing them and their parents with adequate information about medications, talking with and listening to pediatric recipients about problems with the comprehensive regimen, and encouraging age-appropriate responsibility for maintaining health. Objective The clinical goal of this project was to develop a structured age-appropriate educational program to prepare pediatric transplant recipients and their families for the patient's life as a responsible, independent individual. Our primary research goal was to assess patients' and parents' knowledge about critical aspects of heart transplantation and the treatment regimen with brief questionnaires before and after they received the educational materials from their primary nurse coordinator. Design, Setting, Participants This descriptive pre-post test study was done to assess the effectiveness of an innovative family-centered educational program among 20 pediatric heart transplant recipients and their parents at Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center. Main Outcome Measure, Results Percentage change in children's scores on questionnaires given before and after the educational intervention ranged from $8% to 300% (mean, 64.1%). Percentage change in scores from before to after for parents ranged from $19% to 53.8% (mean, 7.2%).
“It Has its Ups and Downs”: Adolescents' Quality of Life after Heart Transplantation
Authors: Green Angela , Meaux Julie , Huett Amy , Ainley Kathy 
Published: July 2017

Context Heart transplantation is not curative and results in a high-morbidity chronic illness. Despite this, little research has focused on adolescents' quality of life after heart transplant. Such research is critically needed because of the complex developmental changes experienced by adolescents and the need for transition to self-management during this vulnerable period. Objective To examine adolescents' perceptions of their quality of life and factors affecting it. Design Focused ethnography. Setting and Participants Fourteen adolescents (mean age, 17 years) who had received a heart transplant at least 6 months earlier were recruited from a large children's hospital. The ethnically diverse sample (7 black, 5 white, 1 Asian, and 1 Hispanic) included 8 females and 6 males. Data Collection and Analysis The adolescents participated in audio-taped qualitative interviews, which were transcribed verbatim and entered into Ethnograph to assist with data management. Thematic analysis was used to identify recurrent themes. Results Participants described life after transplant by saying, “It has its ups and downs.” Major themes included these: (1) I am normal and I am not normal, (2) I am grateful and I am resentful, and (3) I am managing and I am not managing. The themes reflect the dichotomous nature of the adolescents' experiences and provide insight into the complex needs of adolescents after heart transplant.
Transplant Cost-Report Tracking at Henry Ford Transplant Institute and other Centers Nationwide
Authors: Beach-Langlois Marianne , Yankasky Pamela 
Published: July 2017

Context The lack of uniformity in the reporting of direct and indirect costs by organ acquisition cost centers, diagnosis-related groups, and in physician reimbursement often results in Medicare overpayment and findings of unjustified charges in audits conducted by the Office of the Inspector General. Although it is true that organ transplantation costs vary widely, uniform cost-report accounting is needed. Objective Henry Ford Transplant Institute has developed systematic auditing protocols that result in acceptable compliance with Medicare. The differences between those protocols and the methods used elsewhere are illustrated by the results of a national survey of transplant centers. Design The survey addresses 10 crucial questions, drawn from the cost-reporting model used at Henry Ford Transplant Institute. Setting Surveys were distributed via the United Network for Organ Sharing list-serv, with replies from 43 centers. Patients or Other Participants The participants were transplant administrators. Results Several important practices that are audited by the Office of the Inspector General were not followed by a number of reporting institutions. About 30% did not account for pretransplant charges, 15% did not track pretransplant services, 40% do not use an external consultant, and the frequency of physician time studies varied. On the other hand, the vast majority of institutions perform frequent time studies and manually review pretransplant charges. These results suggest that most centers use accounting methods similar to those used at Henry Ford Transplant Institute, which will significantly improve recognition of pretransplantation costs.
Using Crisis Theory to Explain the Quality of Life of Organ Transplant Patients
Authors: Denny Bianca , Kienhuis Mandy 
Published: July 2017

Objectives To evaluate the literature on the stress, coping, and quality of life of organ transplant candidates and recipients, and to place previous research within a theoretical context. Data Sources CINAHL database, Proquest database, Google Scholar; references from articles were also reviewed to identify additional data. Study Selection Qualitative and quantitative research studies and meta-analyses pertinent to the stress, coping, and quality of life of transplant candidates and recipients were selected. Results Stressors associated with the transplantation process, coping strategies of transplant patients, and quality of life or transplant patients have been well researched for many years. Patients typically use problem-focused coping strategies in response to various stressors. Transplant recipients typically report a higher quality of life than do transplant candidates; however, posttransplant quality of life does not typically equal the quality of life of healthy nonpatients. Conclusions The relationship between stress, coping, and quality of life of transplant patients has not yet been systematically investigated from a theoretical perspective. Recommendations for further research are provided.
Is Model for End-Stage Liver Disease Score Associated with Quality of Life after Liver Transplantation?
Authors: Rodrigue James R. , Nelson David R. , Reed Alan I. , Hanto Douglas W. , Curry Michael P. 
Published: July 2017

Context The Model for End-Stage Liver Disease (MELD) is used to predict short-term mortality of patients on the liver transplant waiting list and to allocate deceased donor livers for transplantation. Objective To examine the relationship between MELD score before transplant and quality of life and other functional status indicators after transplant. Design, Setting, and Patients Two-hundred sixty-five adults from 2 transplant programs completed quality-of-life measures 1 year after transplantation. A subcohort (n = 115) also completed quality-of-life assessments before transplant. Clinical parameters at the time of transplantation were collected from their medical records. Main Outcome Measures Short Form-36 Health Survey, version 2; Transplant Symptom Frequency Questionnaire. Results Patients with MELD scores greater than 25 at transplantation had significantly higher scores on the Short Form-36 general health ( P = .004) and physical component summary ( P = .02) than did patients with MELD scores of 25 or less. However, scores on the Transplant Symptom Frequency Questionnaire did not vary significantly by MELD score. Child-Turcotte-Pugh (CTP) score, a measure of disease severity, was significantly associated with total symptom frequency after transplant ( P = .03) but was not correlated with any domains on the Short Form-36. In the subcohort of 115 patients, a MELD score greater than 25 at the time of transplantation was associated with greater improvement in physical functioning (11.3 vs 4.8, P = .02), role functioning-physical (10.7 vs 4.7, P = .04), general health (11.9 vs 5.5, P = .03), vitality (10.4 vs 5.2, P = .02), and physical component summary (12.3 vs 5.4, P = .01) relative to patients with MELD scores of 15 to 25. Conclusions The relationship between disease severity before transplant and quality of life after transplant is different depending on the index of disease severity used (MELD vs CTP) and whether the assessment of quality of life is general or specific to transplant-related symptoms.
Interventions Used by Health Care Professionals to Enhance Medication Adherence in Transplant Patients: A Survey of Current Clinical Practice
Authors: Berben Lut , Dobbels Fabienne , Kugler Christiane , Russell Cynthia L. , De Geest Sabina 
Published: July 2017

Context Although medication nonadherence is associated with severe complications including graft rejection and loss, its prevalence remains high among organ transplant recipients. Still, little information exists on clinical use of interventions to improve medication adherence. Objective To identify transplant health care professionals' methods of assessing medication adherence, classify the used interventions, and measure those interventions' perceived effectiveness. Design, Setting and Participants A 46-item questionnaire on adherence assessment and interventions was distributed at the 2010 International Transplant Nurses Society symposium in Germany. Data were analyzed by using descriptive statistics. Results Of 141 distributed questionnaires, 94 (67%) were returned. Respondents with no direct patient contact (9%, n = 8) were excluded. The most frequently used assessment strategy was patient self-reporting (60%, n = 52). On average, participants reported using 47% of the educational/cognitive, 44% of the counseling/behavioral, and 42% of the psychological/affective interventions listed. Training patients to self-administer medications and providing printed adherence information were the most frequently used interventions (79% each, n = 68), followed by providing printed medication instructions (69%, n = 59). Most respondents (90%, n = 77) reported combining interventions. The intervention perceived as most effective was medication self-administration training. Conclusion Although available alternatives are demonstrably more effective for enhancing medication adherence, this sample relied more on educational interventions.
Improving Transplant Discharge Education Using a Structured Teaching Approach
Authors: Frank-Bader Margaret , Beltran Karen , Dojlidko Dorothy 
Published: July 2017

Context Nonadherence to posttransplant regimens is common in transplant patients and has the potential for devastating consequences, including acute rejection, graft loss, decreased quality of life, and even death. Comprehensive education of patients and families that improves their understanding of posttransplant regimens and selfcare techniques can increase adherence and improve outcomes. Transplant recipients have to learn a vast amount of complex information in a short period as they recover from major surgery and cope with the emotional stress of transplantation. It is not surprising that many patients report that they do not feel ready for discharge. Objective To describe the development, implementation, and outcomes of a comprehensive interdisciplinary patient education program. Design A quality improvement project. Setting A solid organ transplant unit of a large academic medical center. Participants In-hospital transplant patients and their families and the interdisciplinary team. Interventions A comprehensive discharge education program that integrated written materials, patient and clinical pathways, and discharge instructions. Main Outcome Measure Improved patient satisfaction with readiness for discharge and medication teaching. Results A postimplementation patient discharge survey using a 5-point Likert scale showed an increase in patients' understanding of medication dosage (3.6 to 4.6) and side effects (3.6 to 4.7), and satisfaction with the discharge teaching process (3.4 to 5.0).
A Cognitive Systems Engineering Application for Interface Design
Authors: Klinger David W. , Gomes Marie E. 
Published: July 2017

Cognitive Systems Engineering (CSE) is primarily a blend of technological opportunities, findings from cognitive research, and Cognitive Task Analysis. Using CSE, we were able to produce an efficient and effective redesign of the AWACS Weapons Director (WD) station. The design effort was completed in a relatively short period of time. A Cognitive Task Analysis was performed using two interview techniques: Concept Mapping and the Critical Decision method (CDM). The information obtained using these methods pinpointed specific cognitive areas which any redesign of the WD interface must address. A revised interface was developed and evaluated. During the evaluation, the training of the participants on the revised interface was quite brief (4.5 hours). As a result, the WDs did not achieve the same degree of familiarity or automatization with the revised interface that they have with the current interface. Yet, when WDs were using the revised system their performance improved. This was indicated by an increase in performance for a number of process and outcome measures. Also, a skilled WD provided blind ratings of WD performance. These global ratings were significantly higher for the revised interface. The effectiveness of the revised interface suggests that it is possible to pinpoint cognitive task requirements and to make these the driving factors in a design effort. Moreover, these Cognitive Systems Engineering activities do not consume a great deal of time or effort. The use of CSE may be a feasible aspect of the design process, enabling system developers to achieve a much stronger effectiveness at relatively low cost.
The Effect of Peripheral Visual Cues on the Control of Self-Stabilization in Roll
Authors: James Melanie R. , Coldwell Jon N. , Belyavin Andrew J. 
Published: July 2017

This paper reports a programme of laboratory research to assess the potential of a new form of aircraft attitude indicator. The Ambient Attitude Indicator (AAI), designed to exploit the characteristics of the ambient visual system, provides a continuous source of world-stabilized orientation information to the pilot's ambient visual system. In laboratory experiments, the first of which is reported here, the effects of peripheral visual cues on subjects' control of continuous self-stabilization in roll are assessed. Subjects, seated on a roll turntable, were required to null a continuous quasi-random forcing function using a velocity-control joystick. Their objective was to maintain a stable upright orientation. Three visual conditions were studied: no visual cues, world-stabilized peripheral visual cues, and turntable-stabilized peripheral visual cues. Significant effects of visual condition were found for measures of joystick RMS displacement, turntable RMS error, and frequency of changes of direction of the turntable. World-stabilized conditions resulted in the highest joystick RMS displacement, the lowest turntable RMS error, and the highest frequency of changes of direction of the turntable. A linear transfer function, with autoregressive noise process to represent the remnant, was fitted to the data using maximum likelihood estimation. Details of subjects' frequency response are presented and the effects of practice on these measures are also considered.
Remote Conference Interpreting Using ISDN Videotelephone: A Requirements Analysis and Feasibility Study
Authors: Böcker Martin , Anderson Donald 
Published: July 2017

The introduction of videocommunications via the Integrated Services Digital Network (ISDN) offers the potential of significant changes in the working conditions of a variety of professions including conference interpreters. A study was conducted aiming at identifying the special videocommunications requirements of professional conference interpreters and establishing whether ISDN videotelephony offers a sufficient audio bandwidth and image resolution to support the interpreters in their work. To this aim, a requirements analysis was conducted and four videotelephony systems were set up each implementing a different ISDN combination of audio bandwidth and picture quality. Five professional interpreters took part in the study. Each performed a simultaneous interpretation task of 30 minutes under each of the four conditions (set-ups). Stimulus material to be interpreted consisted of videotapes of conference presentations and TV interviews. Data on the dependent variables (task difficulty, benefits of the picture, sound quality, Social Presence, performance, and acceptance) were collected by means of questionnaires. The most important conclusion is that remote interpreting using ISDN videotelephony is possible only at a cost in terms of both increased fatigue and less satisfaction of the interpreters with their work. Remote interpreting requires at least the image quality that can be provided by a 384 kbit/s transmission rate (until better coding algorithms are available for lower transmission rates) and an audio bandwidth of at least 7 kHz. It is further recommended to conduct a field study with standardized interpreting equipment using more realistic input material.