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Biomedical subjects

S De Geest

Publications and source records attributed to S De Geest.

31 records · Page 2Linked to original sources
PubMed2000

Clinical risk associated with appointment noncompliance in heart transplant recipients.

This study examined the prevalence of appointment noncompliance in 101 heart transplant recipients and how appointment noncompliance is related to patient profile and clinical risk. Appointment noncompliance was defined as patients not showing up at 1 or more planned clinic appointments (at a minimal frequency of every 3 months) during the previous year. Clinical variables were collected from medical files. Psychosocial variables were measured using established instruments. Medication noncompliance was assessed using electronic event monitoring. Paired t test, Wilcoxon 2-sample test, chi-square test, or Fisher exact test were used for statistical analysis as appropriate. The prevalence of appointment noncompliance was 7%. Appointment noncompliers were significantly younger, were less likely to live in a stable relationship with a partner, were more depressed, perceived their health as poorer, experienced more symptom distress, and had significantly more drug holidays. Fifty-seven percent of the appointment noncompliers experienced 1 or more late acute rejection episodes, compared to 2% of the appointment compliers. Appointment noncompliance is a critical behavioral risk factor in the occurrence of late acute rejection episodes in heart transplant patients. Patient profiles allow the identification of patients at risk for appointment noncompliance.

Adult↗
PubMed1998

Compliance issues with the geriatric population: complexity with aging.

Nonadherence with the prescribed treatment regimen is a major issue in health care. This article focuses specifically on adherence issues in the geriatric population. The strengths and weaknesses of measurement methods to assess nonadherence with medication regimens are discussed. Determinants of noncompliance with special emphasis on risk factors for geriatric patients are described. Finally, an overview of preventative and restorative compliance interventions is given.

Aged↗
PubMed1998

Late acute rejection and subclinical noncompliance with cyclosporine therapy in heart transplant recipients.

BACKGROUND: Although noncompliance with immunosuppressive medication is recognized as a critical behavioral risk factor for late acute rejection episodes and graft loss after transplantation, little is known about the degree of subclinical cyclosporine noncompliance, its associated risk for acute late rejection episodes (>1 year after transplantation), and its determinants in heart transplant recipients. METHODS: The convenience sample of this longitudinal study included 101 European heart transplant recipients (87 men and 14 women), with a median age of 56 (Q1 = 50, Q3 = 61) and a median posttransplantation status of 3 (range 1 to 6) years. Subclinical cyclosporine noncompliance was measured during a 3-month period with electronic event monitoring. Selected sociodemographic, behavioral, cognitive, emotional, health, and treatment-related determinants of medication noncompliance were measured by using instruments with established psychometric properties or by patient interviews. With the use of iterative partitioning methods of cluster analysis, including nonstandardized electronic event monitoring compliance parameters, patients were categorized by degree of subclinical cyclosporine noncompliance into a 3-cluster solution. RESULTS: Overall compliance was high, with a median medication taking compliance of 99.4%. The 3 derived clusters, that is, excellent compliers (84%), minor subclinical noncompliers (7%), and moderate subclinical noncompliers (9%), differed significantly by degree of subclinical noncompliance (p < .0001) and showed a 1.19%, 14.28%, and 22.22% incidence of late acute rejections (p = .01), respectively. The 3 groups also differed in terms of former medication noncompliance (p = .02), appointment noncompliance (p = .03), and perceived self-efficacy with medication taking (p = .04). CONCLUSIONS: Although in absolute numbers cyclosporine compliance in this sample was high, minor deviations from dosing schedule were associated with an increased risk for acute late rejection episodes. This suggests a pivotal role of patient compliance in successful long-term outcome after transplantation.

Acute Disease↗
PubMed1996

Clinical and cost comparison of three postoperative skin preparation protocols in CABG patients.

This descriptive pilot study includes a clinical and cost comparison of three preoperative skin preparation protocols (razor, clipper, and depilatory cream, in combination with whole body disinfection) in 82 patients undergoing coronary artery bypass graft (CABG) surgery. The clinical research protocol included an evaluation of body surface area, index of body hair growth, depilatory effect, skin integrity after depilation, and side effects of body disinfection with chlorhexidine solution, as well as protocol-specific evaluation criteria. The cost comparison was performed by keeping a record of the materials used and the workload for each separate activity associated with the three preoperative skin preparation protocols. Material and labor costs were calculated for each of the different aspects of the protocols. Clinical evaluation revealed that the clipper protocol (if necessary, in combination with cream depilation) is most convenient for depilation of patients with heavy hair growth. The depilatory cream protocol is an appropriate method to depilate patients with slight or moderate hair growth. The razor method should be eliminated from clinical practice due to previous documented evidence of an associated increased risk of postoperative wound infection. Cost calculations revealed that the median hospital cost (standardized for differences in hair growth index, working hours and nurse qualification levels) of the razor, clipper, and cream protocols is $6.13, $9.84, and $8.16 (U.S. dollars), respectively. In 1995, yearly raw (i.e. non-standardized) hospital costs for the three procedures were $14,402, $16,114, and $16,765, respectively, with 708 CABG procedures performed. Although changing to a clipper and/or cream protocol may be associated with an initial, although moderate, increase in hospital costs, compared to the razor method, substantial cost savings could be expected long-term. The superiority of these protocols is primarily due to a decreased incidence of postoperative wound infections, as compared to that associated with the razor protocol.

Aged↗
PubMed1995

Incidence, determinants, and consequences of subclinical noncompliance with immunosuppressive therapy in renal transplant recipients.

In this descriptive cross-sectional study, we investigated the incidence, determinants, and consequences of subclinical noncompliance with immunosuppressive therapy in 150 adult renal transplant recipients with more than one year posttransplant status. Symptom frequency and symptom distress, and self-care agency were measured by the Transplant Symptom Frequency and Symptom Distress Scale, and the Appraisal for Self-Care Agency Scale, respectively. The Long-Term Medication Behavior Self-Efficacy Scale and a renal transplant knowledge questionnaire were developed as part of this study to measure perceived self-efficacy and knowledge of the therapeutic regimen. Demographic variables were also measured. The incidence of subclinical noncompliance with immunosuppressive therapy as assessed by interview was 22.3%. Compliers and noncompliers differed significantly on the variables of marital status (P = 0.03), situational-operational knowledge (P = 0.02), self-care agency (P = 0.03), and perceived self-efficacy related to long-term medication intake (P = 0.048). A logistic regression model using gender, marital status, perceived self-efficacy, self-care agency, knowledge about medication administration and signs of infection, and situational operational knowledge as predictor variables, revealed a 78.6% correct classification of compliers versus noncompliers and a sensitivity ratio of 95.9%. There were significantly more acute late rejection episodes (P = 0.003) in the noncompliant group. Graft survival at 5 years in this group was also significantly lower (P = 0.03) than the compliant patients. No significant difference was found in terms of the occurrence of chronic rejection episodes or in terms of patient survival at 5 years. Because noncompliance is a risk factor for negative clinical outcome in renal transplant recipients, it is of utmost importance to develop intervention strategies to enhance compliance in this population by using determinants identified in exploratory studies.

Adult↗
PubMed1995

Conditions, interventions, and outcomes in nursing research: a comparative analysis of North American and European/International journals. (1981-1990).

This study compared the conceptual foci and methodological characteristics of research projects which tested the effects of nursing interventions, published in four general nursing research journals with predominantly North American, and two with predominantly European/International authorship and readership. Dimensions and variables of comparison included: nature of subjects, design issues, statistical methodology, statistical power, and types of interventions and outcomes. Although some differences emerged, the most striking and consistent finding was that there were no statistically significant differences (and thus similarities) in the content foci and methodological parameters of the intervention studies published in both groups of journals. We conclude that European/International and North American nursing intervention studies, as reported in major general nursing research journals, are highly similar in the parameters studied, yet in need of overall improvement. Certainly, there is no empirical support for the common (explicit or implicit) ethnocentric American bias that leadership in nursing intervention research resides with and in the United States of America.

Adult↗
PubMed1994

Development of the long-term medication behaviour self-efficacy scale: qualitative study for item development.

There are no published instruments of patient self-efficacy related to medication behaviour, yet understanding and promoting medication compliance are central to nursing practice. The purpose of this quanlitative study was to explore patient perceptions, experiences and practices associated with long-term medication behaviour in order to establish an instrument measuring self-efficacy in medication behaviour. In-depth interviews were conducted with 14 patients with lifelong dependency on medicine. Using a phenomenological method of analysis the following themes emerged, all of which could be integrated within Bandura's conceptualization of dimensions of self-efficacy. The dimension of personal attributes comprised the themes of emotional distress, confidence in the physician, perceived health status, and normalcy. Environmental factors included the themes of routine, distraction, social support and cost of medication. The third dimension of self-efficacy, task-related and behavioural factors was composed of themes of side-effects, drug delivery system, medication aids, medication schedule, and knowledge. Based on these themes, items for the Long-Term Medication Behaviour Self-Efficacy Scale, were developed and integrated into a version that is currently being submitted to further psychometric work.

Adult↗
PubMedDate not supplied

Symptom experience associated with maintenance immunosuppression after heart transplantation: patients' appraisal of side effects.

OBJECTIVE: To evaluate symptom experience related to side effects of immunosuppressive therapy in heart transplant recipients. METHODS: This descriptive, cross-sectional study included 105 heart transplant recipients (90 men; 15 women) with a median age of 56 years. Maintenance immunosuppression consisted of triple therapy (cyclosporine, corticosteroids, azathioprine). Symptom frequency and symptom distress were assessed by an adapted version of the Transplant Symptom Frequency and Symptom Distress Scale, which includes 27 symptoms associated with side effects of immunosuppressive therapy. RESULTS: The most frequent symptom for both sexes was increased hair growth. Impotence and painful menstruation were experienced as the most distressing symptoms for men and women, respectively. Women reported a significantly higher level of symptom experience. The majority of the most frequent and most distressing symptoms were corticosteroid associated. CONCLUSIONS: Patients' perception of side effects completes the symptomatologic profile of immunosuppressive therapy. A gender-specific evaluation is indicated because symptom experience differs between the sexes.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Hospital costs of protective isolation procedures in heart transplant recipients.

BACKGROUND: This study details the hospital costs of strict reverse isolation procedures in heart transplant recipients. METHODS: In a prospective, descriptive design, a research protocol was developed, identifying all of the activities related to strict reverse isolation procedures in heart transplant recipients. For each separate activity, materials used and workload were registered, which allowed the calculation of the material and labor costs for each of the isolation procedures. RESULTS: The cost calculations show that the first day in isolation costs about $160 (for isolation procedures only) and about $65 for each consecutive isolation day. With a mean post-intensive care unit length of stay of 22 days, the mean cost of isolation procedures for heart transplant recipients amounts to $1535. Finally, a modified isolation protocol was developed, incorporating only those procedures with proven effectiveness. It was calculated that a switch to such a modified protocol would allow a savings of over 50% of the hospital resources devoted to isolation measures. CONCLUSIONS: Isolation procedures use a significant portion of hospital resources. Modifying isolation protocols in heart transplant recipients can be a source of considerable savings in a transplant program.

Belgium↗