Biomedical subjects

Donna M Evon

Publications and source records attributed to Donna M Evon.

8 recordsLinked to original sources

PubMed2025

LIVE-SMART: A sequential, multiple assignment randomized trial to reduce falls in cirrhosis.

INTRODUCTION: Falls are a major threat to the well-being of patients with cirrhosis. We are performing a clinical trial to determine whether lactulose, TeleTai-Chi, or their combination will reduce falls in HE and improve health-related quality of life (HRQOL) among patients with cirrhosis. METHODS AND ANALYSIS: Patients with cirrhosis and portal hypertension without HE will be enrolled in 3 US states and followed participants for 24 weeks. In stage 1 (12 wk), participants will be randomized to receive either lactulose therapy or enhanced usual care. In stage 2 (12 wk), participants will be randomized to either TeleTai-Chi or usual care. The primary outcome is a hierarchical composite: Injurious falls, noninjurious falls, incident HE, and death/transplantation. Secondary outcomes include cognitive function, days-alive and out-of-hospital, and HRQOL. After completion of the interventions, participants will be followed for 48 weeks for health and financial outcomes. ETHICS AND DISSEMINATION: Our study has a central institutional review board with individual site IRB review. Dissemination includes the publication of study findings and patient-focused educational webinars.

Female↗

PubMed2006

Relationship between coping and depression in heart transplant candidates and their spouses.

CONTEXT: Survival rates for heart transplantation are encouraging, but the pretransplant period can be extremely stressful for patients and their spouses. Although a relationship between patients' depression levels and the coping strategies employed by their spouses has been demonstrated, this association has not been examined in heart transplant candidates and their spouses. Depression in this group of patients is important because heart transplant patients with preoperative depression have been found to have a higher mortality rate after transplantation. OBJECTIVE: To determine if a relationship exists between spousal coping strategies and heart transplant candidates' depression. METHODS: A descriptive, exploratory pilot study. PARTICIPANTS: Twenty-two individuals with end-stage heart disease who were undergoing an inpatient evaluation for heart transplantation, plus their spouses. Design-Heart transplant candidates were assessed via the Structured Interview Guide for the Hamilton Depression Scale. Spouses completed the COPE Inventory and the Center for Epidemiological Studies Depression Scale. RESULTS: Spousal behavioral disengagement was positively associated with heart transplant candidates' depression. CONCLUSIONS: Heart transplant candidate depression may follow spousal disengagement, or, conversely, a spouse may disengage in response to the patient becoming depressed. Identification during the pretransplant evaluation of those spouses who cope using behavioral disengagement might be a first step in the process of assessment and intervention. Clinical interventions may need to focus on the spouse as well as on the transplant candidate.

Adaptation, Psychological↗

PubMed2005

Religious and non-religious coping in lung transplant candidates: does adding god to the picture tell us more?

Individuals use many non-religious coping (NRC) and religious coping (RC) strategies to cope with stress. In previous studies with lung transplant candidates, we found that NRC and RC predicted depression, anxiety, and disability. The present study aimed to (a) assess whether RC and NRC contributed uniquely to the prediction of distress and disability, or whether they were redundant and offered no additional information, and (b) evaluate the unique contribution of each subscale to determine the strongest associations with outcomes. Participants were 81 patients with end-stage lung disease being evaluated for lung transplant. Our findings suggest that RC and NRC are not functionally redundant. The best RC predictor was reappraising the situation as a punishment from God, and the best NRC predictors were mental disengagement and denial. Our findings suggest that NRC and RC are independent components of psychological functioning, and measuring both coping styles provides more information than studying each alone.

Adaptation, Psychological↗

PubMed2005

Coping predicts depression and disability in heart transplant candidates.

OBJECTIVE: The aim of this study was to describe the coping strategies used by cardiac patients who are pursuing heart transplant and to determine which coping strategies are related to depression and self-reported disability. METHOD: This is a cross-sectional design with 50 cardiac patients (74% male) who were inpatients being evaluated for heart transplant at a large medical center. Coping styles were measured using the COPE Inventory (Carver CS, Scheier MF, Weintraub, JK. Assessing coping strategies: a theoretically based approach. J Pers Soc Psychol 1989;56:267-83). Depression was assessed with the Structured Interview Guide for the Hamilton Depression Rating Scale (HAM-SIGH-D; Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56-62), and disability was assessed using the Sickness Impact Profile (SIP; Bergner M, Bobbitt R, Carter W, Gilson B. The Sickness Impact Profile: development and final revision of a health status measure. Med Care 1981;19:787-805). RESULTS: Patients reported using a variety of adaptive coping strategies, but depression and disability were only significantly correlated with maladaptive coping strategies. Multiple regressions demonstrated that denial had the strongest association with depression, and focusing on and venting emotions had the strongest association with disability. CONCLUSIONS: Maladaptive coping styles, such as denial and focusing and venting of emotions, can serve as markers of emotional distress and disability that may identify patients who may benefit from psychologic and psychiatric interventions.

Adaptation, Psychological↗

PubMed2005

Tobacco and alcohol use in lung transplant candidates and recipients.

Tobacco and alcohol use among lung transplant candidates and recipients is unknown. Our first goal was to describe tobacco and alcohol use before and after lung transplant in patients with cystic fibrosis (CF) and other pulmonary diseases (non-CF). Our second goal was to determine whether demographic variables, depression, anxiety and social support predicted tobacco and alcohol use. Self-report data from transplant candidates and recipients, and transplant nurse coordinator ratings of post-transplant smoking and drinking were utilized. Data from two samples were analyzed. Sample 1 comprised 219 patients being evaluated for lung transplant, and sample 2 comprised 45 transplant recipients who were 1-7 yrs post-transplant. The results from analyzing sample 1 indicated that 72% of non-CF patients and 16% of CF patients had a history of smoking cigarettes, and the majority of patients in both groups had consumed alcohol in the past. For CF patients, past smoking was related to higher depression scores, and past drinking was related to higher education and lower social support. For non-CF patients, a history of smoking was associated with being Caucasian and older. For CF patients, a history of drinking was associated with being older and less depressed, and for non-CF patients a history of drinking was associated with higher education and lower social support. Post-transplant 100% of recipients reported abstinence from tobacco, and over 60% reported abstinence from alcohol. Transplant coordinator ratings corroborated that no transplant recipients were using tobacco products or consuming alcohol in an excessive or problematic manner. For both groups, consuming alcohol after transplant was related to lower levels of social support. In conclusion, lung recipients remain abstinent from tobacco, and although over 30% of patients consume alcohol after transplant, it is not at problematic levels. Smoking and drinking behaviors were related to demographic variables, depression, and low social support.

Adult↗

PubMed2005

Health locus of control predicts survival after lung transplant.

The purpose of this study was to assess whether health locus of control beliefs measured pre-transplant predicted survival after lung transplant. Participants were 100 patients who completed the Multidimensional Health Locus of Control scale before and after transplant. Cox proportional hazards regressions were used to investigate the relationship between each of the three subscales (IHLC, PHLC, CHLC) and survival time after transplant. After adjusting for age and medical diagnosis, participants with medium and high levels of IHLC had lower hazard ratios than those with low IHLC. Neither PHLC nor CHLC exhibited statistical differences in survival. Compared to patients with low IHLC, patients with medium and high levels of IHLC lived longer after lung transplant.

Adolescent↗

PubMed2004

Process and outcome in cardiac rehabilitation: an examination of cross-lagged effects.

Cardiac rehabilitation patients improve cardiorespiratory fitness and quality of life, yet therapeutic processes that produce these changes remain unknown. A cross-lagged panel design was used to determine whether early-treatment enhancement of self-efficacy regarding abilities to change diet and exercise habits and the quality of the patient-staff working alliance predicted late-treatment changes in a wide range of outcomes, but not vice versa. Eighty cardiac patients participating in a 12-week program completed measures at early, mid- and late treatment. Early-treatment changes in exercise self-efficacy predicted late-treatment changes in activity level, depression, and working alliance, but not vice versa. Diet self-efficacy changes correlated with concurrent changes in fat intake and body weight. Early-treatment changes in cardiorespiratory fitness and activity level predicted late-treatment changes in working alliance, but not vice versa. Findings suggest that increased exercise self-efficacy represents an important therapeutic mechanism by which rehabilitation gains are realized. ((c) 2004 APA, all rights reserved)

Angioplasty, Balloon, Coronary↗

PubMed2004

Appraisal and coping as predictors of psychological distress and self-reported physical disability before lung transplantation.

CONTEXT: Certain appraisals and coping strategies have been associated with increased levels of psychological distress and disability in other medical populations, but no study has examined this relationship with patients who are awaiting lung transplantation. OBJECTIVE: To describe the cognitive appraisal and coping strategies used by patients who are pursuing lung transplantation and to evaluate the extent to which these processes are associated with depression, anxiety, and disability. METHODS: This is a cross-sectional design with 160 participants (42.5% men) who have end-stage lung disease and were evaluated for lung transplantation at a large medical center. MEASURES: The outcome variables of depression, anxiety, and physical disability were assessed using the Beck Depression Inventory, Spielberger Trait Anxiety Inventory, and the Sickness Impact Profile, respectively. The predictor variables, coping and appraisal styles, were measured using the COPE and the Stress Threat Questionnaire, respectively. Demographic variables were also assessed. RESULTS: Patients used a variety of adaptive problem- and emotion-focused coping strategies. Hierarchical multiple regressions demonstrated that harm appraisals and the use of particular types of coping styles; namely, disengagement, avoidance, ruminating and venting emotions, low solicitation of emotional support, and suppressing other activities are maladaptive and were uniquely related to psychological distress and disability. CONCLUSIONS: Maladaptive appraisal and coping styles can serve as markers of emotional distress and disability that may help the transplant team identify patients who may benefit from counseling and psychological interventions.

Activities of Daily Living↗