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Determination as a Sturdy Signal of Medication Adherence-Related Quality and Performance.
52, 95% confidence interval [CI] 1.01-2.29, P = .040). On additional analysis for mortality assessing each leukocytosis subgroup, the data were acute graft rejection (HR = 8.21, 95% CI 4.09-16.49, P less then .001), second surgery (HR = 2.05, 95% CI 1.08-3.90, P = .020), primary graft dysfunction (HR = 2.72, 95% CI 0.65-11.33, P = .169), other causes (HR = 1.30, 95% CI 0.47-3.62, P = .620), and unknown etiology (HR = 0.94, 95% CI 0.54-1.62, P = .800). CONCLUSIONS Delayed post-lung transplant leukocytosis is a poor prognostic sign, especially when attributed to acute graft rejection, infection, and multiple etiologies. In the absence of an identifiable etiology, it can be attributed to postoperative reactive stress, is not associated with increased mortality, and likely does not warrant further diagnostic investigation.The purpose of this article is to describe palliative care incorporation within the care of heart transplant patients. Palliative care is a holistic approach to care that includes symptom management and goal setting to improve patients' quality of life. Palliative care is designed to be used with patients who have chronic illness that impacts quality of life and should be incorporated early in the disease. All providers have a responsibility to be knowledgeable in palliative care approaches and to know when to refer a patient for specialty palliative care services. This article will describe palliative care, research study findings, and current professional guideline recommendations for patients. The article also describes challenges and barriers to the use of palliative care in heart transplant patients and strategies to address these challenges and barriers.CONTEXT Early tailored transplant education could help patients make informed transplant choices. OBJECTIVE We interviewed 40 patients with chronic kidney disease (CKD) stages 3 to 5, 13 support persons, and 10 providers at Kaiser Permanente Southern California to understand (1) barriers to transplant education and (2) transplant educational preferences and recommendations based on CKD stage and primary language spoken. DESIGN A grounded theory analysis identified central themes related to transplant education barriers, preferences, and recommendations. RESULTS Barriers included confusion about diagnosis and when transplant may be necessary, concerns about transplant risks, families' lack of transplant knowledge, financial burdens, transportation and scheduling, and the emotional overload of chronic illness. Hispanic and Spanish-speaking participants reported difficulty in understanding transplant education and medical mistrust. Recommendations included providing general education, earlier introduction to transplant, wait-listing information, transplant education for support persons, living donation education for patients and potential donors, opportunities to meet living donors and kidney recipients, information on the benefits of transplant, recovery, and available financial resources, flexible class scheduling, online and print resources, and more provider follow-up. Spanish-speaking and Hispanic participants recommended using bilingual educators, print, video, and online resources in Spanish, and culturally responsive education. Patients with CKD stages 3 to 4 wanted information on slowing disease progression and avoiding transplant. CONCLUSION Increasing access to culturally responsive transplant education in multiple languages, pairing appropriate content to the disease stage, and increasing system-wide follow-up as the disease progresses might help patients make more informed choices about transplant.Aim of the study With the development of emergency medicine and intensive care technology, the number of people who survive with disorders of consciousness (DOC) has dramatically increased. The diagnosis and treatment of such patients have attracted much attention from the medical community. From the latest evidence-based guidelines, non-invasive brain intervention (NIBI) techniques may be valuable and promising in the diagnosis and conscious rehabilitation of DOC patients.Methods This work reviews the studies on NIBI techniques for the assessment and intervention of DOC patients.Results A large number of studies have explored the application of NIBI techniques in DOC patients. The NIBI techniques include transcranial magnetic stimulation, transcranial electric stimulation, music stimulation, near-infrared laser stimulation, focused shock wave therapy, low-intensity focused ultrasound pulsation and transcutaneous auricular vagus nerve stimulation.Conclusions NIBI techniques present numerous advantages such as being painless, safe and inexpensive; having adjustable parameters and targets; and having broad development prospects in treating DOC patients.INTRODUCTION Depression and anxiety are common affective experiences during the first year following a solid organ transplant. This study examined the degree to which an evidenced-based clinical intervention implemented by social workers-Symptom Targeted Intervention-can alter self-reported depression and anxiety in heart, kidney, liver, and lung transplant recipients. Olaparib RESEARCH QUESTIONS This investigation explored 2 questions (1) Can symptom-targeted interventions significantly reduce posttransplant recipients' self-reported depression and anxiety at the conclusion of treatment and at 1-month follow-up? and (2) Does the response differ by gender? DESIGN A 1-group pretest-posttest design with a 1-month follow-up was used to test for changes in anxiety and depression after transplantation. Forty-eight patients at 2 US transplant centers were enrolled between January 2016 and May 2017. Data were collected using an online platform and analyzed to assess for differences over time and by gender. RESULTS Anxiety decreased significantly between pretest and posttest using the General Anxiety Disorder-2 (P less then .05). Comparisons by gender indicated that women had a significant decrease in anxiety between pretest and posttest (P less then .001); however, there was no significant decrease in anxiety for men. Analyses by gender and time yielded no significant differences for depression. Discussion Symptom-targeted interventions have the potential to reduce anxiety in solid organ transplant patients and enhance their psychosocial adjustment after surgery.
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