The Course and Predictors of Health-Related Quality of Life in Living Kidney Donors: A Systematic Review and Meta-Analysis

Item does not contain fulltextA better understanding of the course and risk factors for impaired long-term health-related quality of life (HRQoL; ie, physical, psychological, and social-relational functioning) after kidney donation might help clinicians improve the care of live kidney donors. This systematic review and meta-analysis summarizes prospective studies about the course and predictors of HRQoL in living kidney donors. Studies indicate that shortly after donation, donors have lower HRQoL, with minor to moderate changes in psychological and social-relational functioning and major changes in physical functioning. At 3-12 months after donation, HRQoL returned to baseline or was slightly reduced, particularly for fatigue, but scores were still comparable to general population norms. Results were mainly robust across surgery techniques. A limited number of studies examined risk factors for impaired HRQoL, with low psychological functioning before donation as the most consistent predictor. Based on these results, clinicians can inform potential donors that, on average, kidney donors have high long-term HRQoL; however, donors with low psychological functioning at baseline are those most at risk of impaired long-term HRQoL. Future studies should focus on other potentially relevant predictors of postdonation HRQoL, including donor eligibility criteria and donor-recipient relationships, to optimize screening and interventions for donors at risk

Pre-hospital and acute management of traumatic spinal cord injury in the Netherlands: survey results urge the need for standardisation

Item does not contain fulltextSTUDY DESIGN: Questionnaire survey. OBJECTIVES: Although a range of novel therapeutic approaches for traumatic spinal cord injury (tSCI) are being trialled in highly standardised, pre-clinical research models, little has been published about the extent of standardisation in health service delivery for newly injured tSCI patients. SETTING: All Emergency Medical Services (EMSs) and 11 level-1 trauma centres (L1TCs) in the Netherlands. METHODS: A survey assessing the organisation of pre-hospital and acute tSCI management was developed and distributed across all 23 pre-hospital EMSs and 11 L1TCs based in the Netherlands. RESULTS: Response rates for EMSs and L1TCs were 82 and 100%, respectively. Thirteen EMSs (68%) transported all patients who are suspected of having tSCI to L1TCs. The decision to transfer tSCI patients to L1TCs was primarily made by paramedics at the scene of accident (79%). Nonetheless, no EMS reported the use of validated neurological assessments for determining the likelihood of tSCI. The International Standards for Neurological Classification of SCI were used to determine the level and severity of tSCI in four centres, and three centres performed magnetic resonance imaging in all tSCI patients. Three L1TCs had spinal cord perfusion support protocols in place, and two centres administered methylprednisolon to acute tSCI patients. CONCLUSION: We found a large variance in the delivery of pre-hospital and acute tSCI management in a well-defined geographical catchment area. This survey urges the need for implementing standardised assessments and developing best-practice guidelines, which should be endorsed by all pre-hospital and acute tSCI health-care providers.5 p

Development and feasibility of a guided and tailored internet-based cognitive-behavioural intervention for kidney donors and kidney donor candidates

Contains fulltext : 193524.pdf (publisher's version ) (Open Access)OBJECTIVES: Living donor kidney transplantation is currently the preferred treatment for patients with end-stage renal disease. A subgroup of the kidney donor population experiences adjustment problems during or after the donation procedure (eg, anxiety or fatigue). There is a need for evidence-based interventions that decrease donation-related difficulties before or after donation. In the current study, a guided and tailored internet-based cognitive-behavioural therapy (ICBT) intervention for donors and donor candidates was developed and the feasibility and perceived effectiveness were evaluated. DESIGN: Pilot study including qualitative and quantitative research methods for intervention development and evaluation. SETTING: Living kidney donor population of two Dutch transplantation centres. PARTICIPANTS: Donors and healthcare professionals participated in focus group interviews conducted to identify intervention themes and to map attitudes towards internet-based interventions. In a pilot feasibility study, 99 donors and donor candidates participated, of whom 38 completed the screening. Eight donors or donor candidates with a risk profile (ie, impaired mental health-related quality of life (HRQoL)) received and evaluated the intervention. INTERVENTIONS: A guided and tailored ICBT intervention for donors and donor candidates was developed. Donation-related treatment modules, assignments and psychoeducation were integrated within an existing disease-generic ICBT intervention. OUTCOME MEASURES: HRQoL, anxiety and depression were assessed before and after the ICBT intervention. Additional questionnaires were included to identify specific problem areas of donor functioning to tailor the ICBT intervention to the donor's needs. RESULTS: Different intervention themes were derived from the focus group interviews (eg, physical limitations, and donation-specific emotional and social-relational problems). Participants were satisfied about the intervention content (7.7+/-0.8 on a 0-10 scale) and the therapeutic relationship (4.4+/-0.6 on a 1-5 scale), and indicated an improvement on domains of their treatment goals (3.2+/-0.7 on a 1-4 scale). CONCLUSION: This study showed positive evaluations concerning both feasibility and perceived effectiveness of the tailored ICBT intervention in kidney donors and donor candidates, in line with previous studies using comparable ICBT treatment protocols in other populations. Future research should examine the possibilities of integrating the intervention into psychosocial care for kidney donors

Psychosocial consequences of living kidney donation: a prospective multicentre study on health-related quality of life, donor-recipient relationships and regret

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Pre-donation cognitions of potential living organ donors: the development of the Donation Cognition Instrument in potential kidney donors

Item does not contain fulltextBackground.: Cognitions surrounding living organ donation, including the motivation to donate, expectations of donation and worries about donation, are relevant themes during living donor evaluation. However, there is no reliable psychometric instrument assessing all these different cognitions. This study developed and validated a questionnaire to assess pre-donation motivations, expectations and worries regarding donation, entitled the Donation Cognition Instrument (DCI). Methods.: Psychometric properties of the DCI were examined using exploratory factor analysis for scale structure and associations with validated questionnaires for construct validity assessment. Results.: From seven Dutch transplantation centres, 719 potential living kidney donors were included. The DCI distinguishes cognitions about donor benefits, recipient benefits, idealistic incentives, gratitude and worries about donation (Cronbach's alpha 0.76-0.81). Scores on pre-donation cognitions differed with regard to gender, age, marital status, religion and donation type. With regard to construct validity, the DCI was moderately correlated with expectations regarding donor's personal well-being and slightly to moderately to health-related quality of life. Conclusions.: The DCI is found to be a reliable instrument assessing cognitions surrounding living organ donation, which might add to pre-donation quality of life measures in facilitating psychosocial donor evaluation by healthcare professionals

Combining transplant professional’s psychosocial donor evaluation and donor self-report measures to optimise the prediction of HRQoL after kidney donation: an observational prospective multicentre study

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