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Biomedical subjects

C E Skotzko

Publications and source records attributed to C E Skotzko.

7 recordsLinked to original sources
PubMed2001

Approaching a consensus: psychosocial support services for solid organ transplantation programs.

BACKGROUND: Solid organ transplantation has become an accepted treatment for individuals with end-stage organ dysfunction. Criteria are being developed in the United States to determine medical eligibility for transplant candidates and competencies for transplant centers and physicians. To date, similar criteria for psychosocial services have not been developed. DESIGN AND SETTING: We queried participants in a specialty psychosocial transplant meeting to determine their views of which psychosocial services are essential to the comprehensive care of transplant patients in the United States. RESULTS: There was broad based multidisciplinary support for proactive pretransplant screening to discern individual psychosocial needs; focused pretransplant interventions to improve candidacy and future compliance; and posttransplant programs that address psychosocial, rehabilitation, and financial issues. CONCLUSION: Among psychosocial providers of solid organ transplantation services, there is support for expanding routine screening and support services to individuals who are candidates for and undergo solid organ transplantation.

Community Health Services↗
PubMed2000

Depression is common and precludes accurate assessment of functional status in elderly patients with congestive heart failure.

BACKGROUND: Congestive heart failure (CHF) and depression are independently known to result in physical decline and diminished functional capacity in the general population. The prevalence and relationship of depressive symptoms in CHF to physical limitations has not been objectively examined. METHODS AND RESULTS: The Center for Epidemiological Studies Depression Scale (CES-D) was used to ascertain depressive symptoms in 33 elderly ambulatory individuals with CHF. Self-report assessment of functional status, cardiopulmonary exercise testing (CPX), and measurement of energy expenditure by doubly labeled water and Caltrac Accelerometer (Muscle Dynamics, Torrance, CA) were performed. Depressed and nondepressed groups were compared. Forty-two percent of the patients scored in the depressed range (CES-D score of 16 or greater). There were no differences in demographic variables or severity of illness between the depressed and nondepressed patients. Energy expenditure was comparable across groups. Although obtaining similar maximal heart rate and maximal oxygen consumption (VO2max) on CPX, the depressed group showed less exertion on exercise testing with a significantly lower respiratory quotient (P = .017). CONCLUSION: Depressive symptoms were common and unrelated to the severity of CHF. Although depressed individuals tended to report worse physical functioning than nondepressed individuals, objective assessment of energy expenditure was comparable. Depressed patients appear to underestimate their functional ability. Subsequently, inaccurate assessment of functional status may occur.

Activities of Daily Living↗
PubMed2000

Psychiatric assessment in transplantation.

The implementation of the presumptive donor law in Brazil is expected to increase the availability of organs for transplantation. As medical management of end-stage organ dysfunction continues to improve, increasing numbers of potential transplant recipients will be available to meet this supply. There is mounting evidence that supports the involvement of skilled psychiatric practitioners in the selection of transplant candidates. Data supporting the influence of psychosocial factors on compliance and therefore medical outcomes continues to grow. The literature review allows delineating the components and rationale for comprehensive psychosocial evaluations as a component of preoperative transplantation evaluation.

Brazil↗
PubMed1999

Psychiatric disorders and outcome following cardiac transplantation.

BACKGROUND: Psychosocial factors are frequently included in determining candidacy for cardiac transplantation. Although there are some data demonstrating a link between preoperative psychosocial status and postoperative outcome, a definitive answer has yet to be reached. METHODS: We studied 107 consecutive patients, transplanted from January 1990 to September 1991, with a retrospective review of pretransplant psychiatric evaluations to define a DSM III-R Axis I diagnosis. The medical outcome data included 1-year survival, rehospitalizations, infections, and rejection episodes, gathered from the transplant database. RESULTS: There were no discernable differences between the groups with (n = 25) and without (n = 82) a DSM III-R Axis I psychiatric disorder prior to transplant in the evaluation of demographic data and medical outcome variables. CONCLUSION: These data demonstrate that individuals with a history of psychiatric disorder who are carefully selected for compliance with medical care display no inherent difference from individuals without psychiatric disorder in medical outcome and survival at 1 year after cardiac transplantation.

Adult↗
PubMed1996

Delirium: acute confusional state.

Many clinicians do not realize the costs associated with delirium. Francis and Kapoor found that patients who had had delirium had higher two-year mortality rates and greater loss of independence than control patients. The investigators also reported a trend toward decline in cognitive performance among patients who had had delirium. Levkoff and coworkers found that delirium was associated with no change in mortality, but that it was associated with prolonged hospital stays and an increased risk of institutional placement among community dwelling elderly. Poor outcomes might be avoided, in part, with early diagnosis and appropriate management of delirium.

Aged↗
PubMedDate not supplied

Fluoxetine and cyclosporine in organ transplantation. Failure to detect significant drug interactions or adverse clinical events in depressed organ recipients.

Depression and anxiety disorders are common clinical problems in organ transplant recipients, but there is a paucity of clinical data to inform the selection of psychopharmacologic treatment. The authors retrospectively compared 13 depressed organ transplant recipients treated with fluoxetine with 13 nondepressed matched control recipients and 11 transplant recipients treated with tricyclic antidepressants (nortriptyline or desipramine). Blood level:dose ratios and dose-response relationships for cyclosporine were virtually identical in all three groups before and during treatment. No increase in adverse clinical events was detected in either active treatment group compared with the control subjects. Fluoxetine appeared to be well tolerated by this population of transplant patients, and the authors failed to detect significant alterations in cyclosporine levels or graft function.

Antidepressive Agents, Tricyclic↗