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Background: Little is known about living kidney donors' satisfaction with life (SWL) after donation. We compared donors' SWL to previously reported general population samples and investigated predictors of donors' SWL., Methods: Three transplant centers mailed questionnaires to assess SWL, physical health, optimism, retrospective evaluation of the donation experience, and demographic characteristics to living kidney donors' homes between 2010 and 2012. Two thousand four hundred fifty-five donors who were between 5 and 48 years from the time of their donor surgery completed the questionnaire., Results: Eighty-four percent of donors were satisfied with their lives (scores ≥ 20 on the Satisfaction With Life Scale). Donors were at least as satisfied with their lives as previously reported general population samples. After adjusting for physical health, optimism, and demographics, donors' SWL was significantly associated with donors' recalled experience of donation. Social support and positive effects of the donation on relationships predicted greater SWL. Financial difficulties associated with donation and longer recovery times predicted lower SWL. Recipient outcomes were not significantly related to donor SWL., Discussion: Limitations include the lack of predonation SWL data, potential bias in postdonation SWL because of the situational context of the questionnaire, and a sample that is not representative of all U.S. living kidney donors. Nonetheless, strategies focused on improving the donation experience, particularly related to recovery time, financial issues, and social support, may result in greater SWL after donation.

Objectives: To demonstrate the feasibility of a concentration-controlled approach to combination antiretroviral therapy, and to compare the virological responses and safety of this strategy versus conventional fixed-dose therapy., Design: A prospective, randomized, 52 week, open-label trial of concentration-controlled compared with conventional dose zidovudine, lamivudine, and indinavir therapy conduced in a university-based general clinical research center in the United States., Patients: Forty antiretroviral-naive individuals with plasma HIV-RNA levels > 5000 copies/ml., Interventions: Zidovudine, lamivudine, and indinavir plasma concentrations were measured in all participants. Doses were adjusted in those assigned to concentration-controlled therapy to achieve levels equal to or greater than target values., Main Outcome Measures: The proportion of patients who achieved the desired drug concentrations, the proportion of patients with HIV-RNA levels < 50 copies/ml at week 52, and safety and tolerance in the concentration-controlled versus conventional therapy arms., Results: Significantly more concentration-controlled recipients achieved the desired concentration targets for all three drugs: 15 of 16 concentration-controlled recipients compared with nine of 17 conventional recipients (P = 0.017) had HIV-RNA levels < 50 copies/ml at week 52. No difference was observed in the occurrence of drug-related clinical events or laboratory abnormalities between the two treatment arms., Conclusion: Concentration-controlled therapy implemented simultaneously for three antiretroviral agents was feasible, as well tolerated as conventional therapy, and resulted in a greater proportion of recipients with HIV-RNA levels < 50 copies/ml after 52 weeks. These findings provide a scientific basis to challenge the accepted practice of administering the same dose of antiretroviral agents to all adults, ignoring the concentrations actually achieved.

Background: Simultaneous pancreas/kidney transplant (SPK) is an effective therapy that enables people with insulin-dependent diabetes mellitus (IDDM) and renal failure to maintain a more normal lifestyle, without the burdens of dialysis and insulin therapy. However, SPK has been viewed as a higher cost and higher risk procedure than kidney transplant, and it is unclear if SPK offers better health and quality of life (QOL) outcomes than insulin therapy plus kidney transplant alone (KTA). The purpose of this study is to determine which procedure affords better health and QOL outcomes., Methods: This is a prospective observational study with assessments at pretransplant and 1 and 3 years posttransplant. Patients with IDDM and renal dysfunction who received either SPK or KTA from August 1990 to September 1993 at a university transplant center were enrolled. A convenience sample of patients with IDDM and complications not seeking transplants were enrolled during the same time interval. The main outcome measures were the SF-36 Short Form Health Survey and a Satisfaction with Diabetes Therapy Scale., Results: Most health status and QOL measures improved from baseline values within each transplant group. After adjustment for diabetes severity and other baseline variables, year 3 follow-up scores of the SPK cohort were better than those of the KTA cohort for several SF-36 scales: physical functioning (P=0.038); bodily pain (P=0.047), general health (P=0.014), and the physical component summary (P=0.003). SPK recipients also reported greater satisfaction with diabetes therapy (P=0.014) and perceived more benefits to secondary complications. The KTA patients, however, had higher adjusted scores for the role-emotional subscale (P=.037) and the mental component summary (P=.037). By year 3, the SPK cohort is at the 30th and 51st percentiles of the general adult US population in self-reported physical and mental health; the KTA cohort is at the 10th and 73rd percentile., Conclusions: At follow-up, both SPK and KTA patients report better health and quality of life but SPK patients report greater improvements than KTA patients in physical health and in areas that are diabetes specific. Although the improved physical outcomes of SPK patients are consistent with perceived benefits to secondary complications, the mental health differences cannot be explained by the study data and warrant further study.

Client satisfaction is considered an important outcome measure in a managed care environment faced with escalating health care costs, shortened lengths of hospital stay, and competition among acute care hospitals. With shortened lengths of stay in acute care hospitals, discharge planning has assumed increased importance, particularly for elders who have chronic conditions, such as heart failure, that require follow-up care. Consequently, understanding the predictors of client satisfaction with discharge planning can help hospitals and their nursing staff to tailor services to meet client needs. Previous studies have focused on patient satisfaction with hospital care, with little attention given specifically to satisfaction with discharge planning and to family caregiver satisfaction with discharge planning. The purpose of this study was to determine whether there is a difference between elder and family member satisfaction with discharge planning 2 weeks after hospitalization and what factors predict satisfaction with discharge planning 2 weeks after hospitalization for elders hospitalized with heart failure and their family caregivers. Telephone interviews were conducted with 134 elder/family caregiver dyads 2 weeks after hospitalization. The results indicated that there were no statistically significant differences in discharge planning satisfaction of elders and their family caregivers. Continuity of care and extent to which they felt prepared to manage care following hospitalization were the best predictors of elder's and family caregiver's satisfaction with discharge planning.

Objective: To assess complications of bronchoalveolar lavage in the intubated, mechanically ventilated patient., Design: A retrospective, consecutive case series., Setting: Medical, surgical, and bone marrow transplant critical care units at a university teaching hospital., Patients: Ninety-nine consecutive critically ill, mechanically ventilated patients undergoing bronchoalveolar lavage were included in the study., Interventions: All patients underwent bronchoalveolar lavage using a standard method designed to maximize the safety of the procedure., Measurements: Each patient's hospital chart was reviewed for immediate and delayed medical complications of the procedure, including cardiac arrhythmias, bleeding, and hemodynamic disturbances. Specific indices of lung mechanics (peak inspiratory airway pressure and static compliance) and oxygenation (alveolar to arterial oxygen tension gradient [P(A-a)O2] and the ratio of FIO2/PaO2) were measured before and 4 hrs after bronchoalveolar lavage to assess durable physiologic consequences of the procedure., Results: No complications occurred that required premature termination of bronchoalveolar lavage. Three patients exhibited adverse effects (hypotension in two and wheezing in one) immediately after the procedure, all of which resolved promptly with treatment. No statistically significant changes were observed in the variables of arterial oxygenation or pulmonary mechanics. Although the sample mean did not change significantly for any of the oxygen variables, 19% of the patients experienced widening of the P(A-a)O2 by greater than 100 torr (greater than 13.3 kPa). A systematic analysis indicated that there was no statistically significant relationship between readily available clinical variables (including duration of mechanical ventilation before bronchoalveolar lavage and prebronchoalveolar lavage P[A-a]O2), and deterioration in oxygenation after the procedure., Conclusions: We conclude that bronchoalveolar lavage is a well-tolerated procedure in critically ill, mechanically ventilated patients, provided that risk factors for complications are corrected before the procedure and one adheres to procedural guidelines focused on patient safety. Clinically important complications are uncommon. Some patients exhibit deterioration in oxygen after bronchoalveolar lavage; this occurrence cannot be predicted before the procedure.

This study has attempted to identify all persons from an area of southern Alabama who had a stroke in 1980 and were hospitalized. Data were gathered on disease onset, clinical course, laboratory results, history of risk factors, and outcome. The age-adjusted incidence rates for initial stroke were 109 per 100,000 for whites and 208 per 100,000 for blacks. Age-specific rates were higher in blacks than whites, and highest for black females. The distribution of cases by type of stroke was: atherothrombotic (6%), embolic (26%), lacunar (13%), infarction of unspecified origin (40%), parenchymatous hemorrhage (8%), subarachnoid hemorrhage (6%), and unidentified type (1%). Blacks had higher incidence rates for hemorrhages, and black females had the highest incidence rate for lacunar stroke. The overall stroke incidence rates in this series were not significantly higher than those from prior population studies, suggesting that southern Alabama is not part of the so-called "Stroke Belt" area of the southeastern United States.

Four university centers collaborated to contribute 1158 patients with acute episodes of cerebrovascular disease to the pilot Stroke Data Bank, initiated by NINCDS in 1978. During the pilot project a standard set of data collection forms were developed and used at each of the collaborating centers. Data on clinical course, laboratory findings, therapy and outcome were gathered prospectively throughout the patient's hospitalization and at specified follow-up intervals. Using operational definitions of stroke sub-types, consecutive cases were systematically allocated to specific categories of brain and vascular pathology. The definitions were based on clinical criteria as well as on laboratory data, including computerized tomography (CT), and angiography findings. This paper describes the pilot Stroke Data Bank and presents the distribution of cases by diagnostic and demographic categories. It represents one of the largest series of prospectively collected stroke cases studied by CT (90% of the cases) and angiography (42%). Based upon the methods and processes of this pilot study, a main phase of the Stroke Data Bank has been established to address a number of questions pertaining to stroke classification, evolution, diagnosis, and prognosis.

This study examined the inter-observer reliability and validity of the Center for Epidemiologic Studies Depression Scale (CES-D) as a measure of depressive symptomatology in stroke patients, and its utility as a screening tool for depression in this population. The CES-D Scale is a brief questionnaire originally designed for use in community surveys. Twenty-seven non-aphasic patients enrolled in the Stroke Data Bank at the University of Maryland were interviewed by a research nurse using the CES-D. On the same day, each patient was independently evaluated by a research assistant using a psychiatric battery for depression and measures of cognitive, physical, and social functioning. Forty-one percent (11/27) of the patients were depressed according to clinical criteria for major or minor depression. With a cutpoint corresponding to the upper (most severe) 20% in community surveys, the CES-D Scale picked up 73% (8/11) of the depressed patients. In this sample no nondepressed patient scored over 16 on the CES-D (no false positives). The CES-D Scale scores correlated significantly with the other depression measures (r = .57 to r = .82, p less than .002) and did not correlate with the measures of cognitive, physical, or social functioning. Based on 24 patients who received a CES-D Scale score from both the nurse and the research assistant, inter-rater reliability was high (r = .76, p less than .001). Thus, the CES-D was found to be reliable and valid as a screening tool for assessing depression in stroke patients.