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Context: Patients who have received solid organ transplants continue to experience a myriad of complex symptoms related to their underlying disease and to chronic immunosuppression that reduce the quality of life. Beneficial nonpharmacologic therapies to address these symptoms have not been established in the transplant population.Objective: Assess the efficacy of mindfulness-based stress reduction (MBSR) in reducing symptoms of anxiety, depression, and poor sleep in transplant patients.Design, Setting, and Patients: Controlled trial with a two-staged randomization. Recipients of kidney, kidney/pancreas, liver, heart, or lung transplants were randomized to MBSR (n=72) or health education (n=66) initially or after serving in a waitlist. Mean age was 54 years (range 21-75); 55% were men, and 91% were white.Interventions: MBSR, a mindfulness meditation training program consisting of eight weekly 2.5-hour classes; health education, a peer-led active control.Primary Outcome Measures: Anxiety (State-Trait Anxiety Inventory), depression (Center for Epidemiologic Studies Depression Scale), and sleep quality (Pittsburgh Sleep Quality Index) scales assessed by self-report at baseline, 8 weeks, 6 months, and 1 year.Results: Benefits of MBSR were above and beyond those afforded by the active control. MBSR reduced anxiety and sleep symptoms (P < .02), with medium treatment effects (.51 and .56) at 1 year compared to health education in intention-to-treat analyses. Within the MBSR group, anxiety, depression, and sleep symptoms decreased and quality-of-life measures improved by 8 weeks (P < .01, all), and benefits were retained at 1 year (P < .05, all). Initial symptom reductions in the health education group were smaller and not sustained. Comparisons to the waitlist confirmed the impact of MBSR on both symptoms and quality of life, whereas health education improvements were limited to quality-of-life ratings.Conclusions: MBSR reduced distressing symptoms of anxiety, depression, and poor sleep and improved quality of life. Benefits were sustained over 1 year. A health education program provided fewer benefits, and effects were not as durable. MBSR is a relatively inexpensive, safe, and effective community-based intervention. [ABSTRACT FROM AUTHOR]

Purpose: This article describes a factor analysis of a 22-item version of the Serenity Scale, a tool that measures spirituality and well-being. Method: A sample of 87 participants, enrolled in a National Institutes of Health-funded clinical trial examining the impact of mindfulness-based stress reduction on symptom management post-solid organ transplantation, completed the abbreviated instrument. Findings: Exploratory factor analysis yielded three subscales: acceptance, inner haven, and trust. The Serenity Scale was positively associated with positive affect and mindful awareness and inversely related to negative affect, anxiety, depression, health distress and transplant-related stress. Conclusions: Serenity, a dimension of spirituality that is secular and distinct from religious orientation or religiosity, shows promise as a tool that could be used to measure outcomes of nursing interventions that improve health and well-being. Implications: Spirituality is recognized as being an essential component of holistic nursing practice. As nurses expand their use of spiritual interventions, it is important to document outcomes related to nursing care. The Serenity Scale appears to capture a dimension of spirituality, a state of acceptance, inner haven and trust that is distinct from other spirituality instruments. [ABSTRACT FROM AUTHOR]

CONTEXT: Solid organ transplant patients require life-long immune suppression that can produce distressing side effects and complications. OBJECTIVE: To evaluate the potential of Mindfulness-Based Stress Reduction (MBSR) to reduce symptoms of depression, anxiety, and sleep disturbance and improve quality of life after solid organ transplantation. DESIGN: Longitudinal with evaluations at baseline, postcourse and 3-month follow-up. PARTICIPANTS AND SETTING: Kidney, lung, or pancreas transplant recipients (N=20), aged 35 to 59 years, living in the community. INTERVENTION: An MBSR class (2.5 hours weekly, for 8 weeks), modeled after the program of Jon Kabat-Zinn. Home practice (goal: 45 minutes, 5 days weekly) was monitored. MAIN OUTCOME MEASURES: Self-report scales for depression (CES-D), anxiety (STAI-Y1), and sleep dysfunction (PSQI). RESULTS: Nineteen participants completed the course. Findings suggest improvement from baseline symptom scores for depression (P=.006) and sleep (P=.011) at the completion of the MBSR program. At 3 months, improvement in sleep continued (P=.002), and a significant improvement in anxiety scores was seen (P=.043); scores for both symptoms demonstrated a linear trend and dose-response relationship with practice time. In contrast, depression scores showed a quadratic trend, and at 3 months were no longer different from baseline. A composite symptom measure was significantly improved at 3-month follow-up (P=.007). Global and health-related quality of life ratings were not improved. Effects of group support and instructor attention were not controlled, and sample size and follow-up time were limited. A randomized trial to overcome these shortcomings should be done, as symptom distress in transplant recipients appears responsive to MBSR. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The purpose of this article is to describe the development of a satisfaction instrument specifically designed for use with long-stay nursing home residents, present findings regarding the psychometric properties of the measure, and make suggestions for its use. DESIGN: Not given. SETTING: Three proprietary metropolitan nursing homes in Minnesota. POPULATION: The sample consisted of 79 females and 31 males residing in a nursing home. Their ages ranged from 42 to 100 with a mean age of 81.6 years. INTERVENTIONS: The Satisfaction with the Nursing Home Instrument (SNHI) was developed and tested as part of a larger study. The SNHI was administered to subjects at 2 months following admission and again at 6 months following admission by graduate students. MAIN OUTCOME MEASURE(S): Significant relationships were found between SNHI scores and measures of affect (negatively associated with depression and positively associated with morale), providing support for the construct validity of the scale. The correlation between the SNHI and the GDS was -.22, indicating that residents who were less depressed were more satisfied. Residents' dependence status as reflected by case mix was not significantly related to either the SNHI or the global quality of care item. Neither age nor MMSE scores were significantly related to either SNHI scores of the quality of care scores. There was a significant relationship between the SNHI scores and the global quality of care item. RESULTS/CONCLUSIONS: The psychometric findings provide support for the utility of the 29-item SNHI. The significant relationships between this measure of satisfaction and the measures of affect (depression and morale) demonstrate the construct validity of the SNHI. It is possible that the dependent status of most respondents and the lack of opportunity for arrangements for care other than in the nursing home may have contributed to an unwillingness to report dissatisfaction. Given the evidence in support of the reliability and the validity of the SNHI, we conclude that this instrument offers promise in measuring the resident satisfaction dimension of quality of care in nursing homes. [CINAHL abstract] [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess patient perceptions of the impact of pancreas transplantation on various aspects of life, as well as perceptions of the benefits of and concerns with the procedure. All surviving adult patients who had received a pancreas transplant at a midwestern hospital and were at least 1 year posttransplant at the time of the study (N = 138) were sent a self-report questionnaire that included demographic data, questions about life satisfaction, quality of life, symptoms, and health impact. Patients with pancreas graft function reported less pain with healthcare treatment, fewer episodes of feeling physically ill, fewer dietary restrictions, less interference with family life, fewer health limitations in interpersonal relationships and leisure activities, and feeling good about themselves compared with those without graft function. A majority of patients with functioning grafts cited the following benefits: freedom from insulin reactions, normal blood sugars, freedom from insulin injections, freedom from a specialized diet, decreased chance of amputation, feeling better physically, more feelings of hope for the future, and more freedom and control over life. Major concerns posttransplant included side effects and the expense of immunosuppressive medications. [ABSTRACT FROM AUTHOR]

Assessing affect in cognitively impaired elders is difficult. A number of instruments have been developed to measure single emotions or more broad aspects of well-being. The Apparent Emotion Rating (AER) scale is an observational instrument that measures the presence or absence of three positive (pleasure, interest, and tranquility) and three negative emotions (anger, anxiety, and sadness). Interrater percentage of agreement ranged from 82% for anxiety to 100% for interest. A weak, but statistically significant correlation (r = .303, p = .000) was found with the Philadelphia Geriatric Morale Scale (Lawton, 1975). Elders with greater cognitive impairment had lower AER scores than did persons with higher scores. The AER is a promising tool for providing reliable and valid observational data about mood state, particularly in persons unable to respond to a self-report measure. [ABSTRACT FROM AUTHOR]

Objective: The intra-aortic balloon pump (IABP) is widely used to rescue patients from complications following cardiac surgery. Given improvements in rescue strategies over the past decade, the appropriateness of IABP must be reexamined. This study assessed the risk factors, outcomes, and predictors of survival of rescue IABP placement., Methods: Patients receiving an isolated rescue IABP during or after cardiac surgery from 2012 to 2020 were studied. All adult patients undergoing cardiac surgery except transplantation and primary mechanical circulatory support (MCS) procedures were included., Results: Of 10,591 patients, 397 (3.7%) received a perioperative IABP, including 182 (45.8%) with rescue IABP placement. The indications for rescue IABP were postcardiotomy shock (n = 66; 36.3%), failure to wean off cardiopulmonary bypass (n = 58; 31.9%), myocardial ischemia (n = 30; 16.5%), cardiac arrest (n = 25; 13.7%), and ventricular arrhythmia (n = 3; 1.6%). The in-hospital failure to rescue rate was 17.6% (n = 32 of 182) with a 90-day survival of 80.8% and 1-year survival of 76.9%. The most common etiology of mortality was ongoing cardiogenic shock (61.9%; n = 26 of 42). IABP use for >4 days and cardiac arrest as an indication for IABP were risk factors for 1-year mortality (adjusted hazard ratio, 2.68 [95% confidence interval (CI), 1.31-5.50] and 2.69 [95% CI, 1.11-6.54], respectively)., Conclusions: Rescue IABP following cardiac surgery is associated with increased early and 1-year mortality. Prolonged IABP use beyond 4 days or cardiac arrest as an indication portended a significantly worse prognosis. Rescue IABP may not be the optimal first-line temporary MCS for all patients, as the level of support provided might not match the severity of cardiogenic shock. Alternative MCS strategies should be considered early., Competing Interests: Conflict of Interest Statement Dr Adams reports royalty agreements with Edwards Lifesciences and Medtronic regarding the following: Physio Flex annuloplasty ring, Physio II mitral annuloplasty ring, IMR ETlogix mitral annuloplasty ring, and TriAd tricuspid annuloplasty ring. He is also the national co-principal investigator for the Triluminate US Pivotal trial, Medtronic Apollo US Pivotal trial, ReChord US Pivotal trial, and Medtronic CoreValve US Pivotal trial. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest., (Copyright © 2024. Published by Elsevier Inc.)

Heart failure (HF) and pulmonary hypertension (PH) are increasingly prevalent comorbidities in patients presenting for noncardiac surgery. The unique pathophysiology and pharmacotherapies associated with these syndromes have important perioperative implications. As new medications for HF and PH emerge, it is imperative that anesthesiologists and other perioperative providers understand their mechanisms of action, pharmacokinetics, and potential adverse effects. We present an overview of the novel HF and PH pharmacotherapies and strategies for their perioperative management., Competing Interests: Disclosure The authors have no conflicts of interest to disclose., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Failure to rescue, defined as mortality after a surgical complication, is a widely accepted quality metric across many specialties and is becoming an important metric in cardiac surgery. The failure to rescue metric provides a target for improvements in patient outcomes after complications occur. To be used appropriately, the failure to rescue metric must be defined using a prespecified set of life-threatening and rescuable complications. Successful patient rescue requires a systematic approach of complication recognition, timely escalation of care, effective medical management, and mitigation of additional complications. This process requires contributions from cardiac surgeons, intensivists, and other specialists including cardiologists, neurologists, and anaesthesiologists. Factors that affect failure to rescue rates in cardiac surgery and cardiovascular critical care include nurse staffing ratios, intensivist coverage, advanced specialist support, hospital and surgical volume, the presence of trainees, and patient comorbidities. Strategies to improve patient rescue include working to understand the mechanisms of failure to rescue, anticipating postoperative complications, prioritizing microsystem factors, enhancing early escalation of care, and educating and empowering junior clinicians. When used appropriately, the failure to rescue quality metric can help institutions focus on improving processes of care that minimize morbidity and mortality from rescuable complications after cardiac surgery., (Copyright © 2023 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)

Originally intended for life-saving salvage therapy, the use of temporary mechanical circulatory support (MCS) devices has become increasingly widespread in a variety of clinical settings in the contemporary era. Their use as a short-term, prophylactic support vehicle has expanded to include procedures in the catheterization laboratory, electrophysiology suite, operating room and intensive care unit. Accordingly, MCS device design and technology continue to develop at a rapid pace. In this Review, we describe the functionality, indications, management and complications associated with temporary MCS, together with scenario-specific utilization, goal-directed development and bioengineering of future devices. We address various considerations for the use of temporary MCS devices in both prophylactic and rescue scenarios, with input from stakeholders from various cardiovascular specialties, including interventional and heart failure cardiology, electrophysiology, cardiothoracic anaesthesiology, critical care and cardiac surgery., (© 2022. Springer Nature Limited.)

Objectives: To describe the trend in plasma renin activity over time in patients undergoing cardiac surgery on cardiopulmonary bypass, and to investigate if increased plasma renin activity is associated with postcardiopulmonary bypass vasoplegia., Design: A prospective cohort study., Setting: Patients were enrolled from June 2020 to May 2021 at a tertiary cardiac surgical institution., Patients: A cohort of 100 adult patients undergoing cardiac surgery on cardiopulmonary bypass., Interventions: None., Measurements and Main Results: Plasma renin activity was measured at 5 time points: baseline, postoperatively, and at midnight on postoperative days 1, 2, and 3. Plasma renin activity and delta plasma renin activity were correlated with the incidence of vasoplegia and clinical outcomes. The median plasma renin activity increased approximately 3 times from baseline immediately after cardiac surgery, remained elevated on postoperative days 0, 1, and 2, and began to downtrend on postoperative day 3. Plasma renin activity was approximately 3 times higher at all measured time points in patients who developed vasoplegia versus those who did not., Conclusions: In patients undergoing cardiac surgery on cardiopulmonary bypass, plasma renin activity increased postoperatively and remained elevated through postoperative day 2. Additionally, patients with vasoplegic syndrome after cardiac surgery on cardiopulmonary bypass had more robust elevations in plasma renin activity than nonvasoplegic patients. These findings support the need for randomized controlled trials to determine if patients undergoing cardiac surgery with high plasma renin activity may benefit from targeted treatment with therapies such as synthetic angiotensin II., Competing Interests: Conflict of Interest Dr David H. Adams reports that the Icahn School of Medicine at Mount Sinai receives royalty payments from Edwards Lifesciences and Medtronic for intellectual property related to the development of valve repair rings. National Co-PI of the Medtronic APOLLO FDA Pivotal Trial, the NeoChord ReChord FDA Pivotal Trial, the Medtronic CoreValve United States Pivotal Trial and the Abbott TRILUMINATE Pivotal Trial. The other authors have no conflicts of interest to declare., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Purpose: Pain is a problem for individuals undergoing hemodialysis. Renal disease, comorbidities, concurrent symptoms, and dialysis procedures pose barriers to adequate pain management. The purpose of this study was to evaluate feasibility, examine construct validity of The Patient-Reported Outcomes Measurement Information System (PROMIS) computerized adaptive testing (CAT) instruments, and explore pain benefits of Reiki sessions conducted during hemodialysis., Design: A one group, repeated-measures design was used., Method: Fifteen participants received Reiki for 20 minutes, twice a week for 4 weeks. Pain, fatigue, and depression were evaluated using established symptom scales and PROMIS CAT instruments., Findings: Participants reported general relaxation feelings with Reiki and acceptability of using a touch-screen device to respond to web-based measures. Although staff were initially reluctant to engage patients for Reiki, they reported Reiki did not interfere with workflow and thought Reiki could be integrated into the practice setting. Significant, strong correlations with established symptom scales support construct validity of PROMIS CAT instruments. There was a significant decrease in mean symptom scores after four weeks of Reiki. Effect size values suggest a range of practical significance., Conclusions: Findings suggest Reiki provides symptom relief for individuals receiving hemodialysis, and randomized clinical trials to establish Reiki's pain benefits in this population are warranted.

Background: This study explored whether addition of culture-specific bolt-on dimensions, 'interpersonal relationships (IR)' and 'activities related to bending knees (AK)' improves the relevance and validity of the EQ-5D among Thai patients with diabetes., Methods: A cross-sectional study was conducted among 200 diabetic patients. Ceiling/floor effects, known-groups validity and test-retest reliability were evaluated. Hierarchical multiple regressions was performed to evaluate the incremental value of the EQ-5D+AK+IR over the EQ-5D-5L in predicting utility measured by visual analog scale (VAS)., Results: The EQ-5D+AK+IR reduced ceiling effects by 34%. For known-groups validity, women and lower educated patients reported more AK problems (p-value< 0.05); however, none of the IR dimension hypotheses were supported. Both IR and AK had the weighted kappa coefficients of 0.49, indicating good reliability. Hierarchical multiple regression found that adding AK (adjusted r 2 : 0.182 vs 0.156), but not IR (adjusted r 2 : 0.157 vs 0.156) significantly increased the explained variance in VAS score., Conclusion: Preliminary findings suggest that AK, but not IR, may be a useful addition to the EQ-5D questionnaire for use with Thai patients. Further studies in diverse populations are needed to examine the impacts of the proposed new dimensions and determine if these cultural adaptations are justified.

Purpose: As the EQ-5D was developed in western countries with only five dimensions, it might be insensitive to non-western populations including Thai. This study examined the impact of adding two candidate dimensions, "interpersonal relationships (IR)" and "activities related to bending knees (AK)," to the EQ-5D questionnaire, and evaluated their psychometric properties in a Thai population sample., Methods: Face-to-face interviews were conducted with 600 Thai. Ceiling effect for the EQ-5D and the EQ-5D-5L+AK+IR were compared. Spearman's rho correlation was used to determine whether the two new dimensions were redundant with the existing EQ-5D dimensions. Correlations between the two dimensions and similar dimensions of the SF-36v2 were also assessed. Hierarchical multiple regression was performed to evaluate the incremental value of the EQ-5D-5L+AK+IR over the EQ-5D in predicting VAS scores., Results: The two new dimensions were not redundant with the existing five dimensions of the EQ-5D. The highest correlation (0.371) was found between MO and AK. The overall ceiling effect decreased by 5% (50.5-45.5%) when using the EQ-5D-5L+AK+IR. Moderate correlations were found between the candidate dimensions and similar dimensions of the SF-36v2. Multiple regression indicated that adding AK (adjusted r 2 0.329 vs. 0.306) but not IR (adjusted r 2 0.307 vs. 0.306) significantly increased ability to predict VAS scores., Conclusions: Our preliminary results suggested that AK holds promise for making the EQ-5D more relevant to Thai while it is premature to conclude on the impact of IR. Nevertheless, more work is required to carefully assess the value of the new dimensions as well as the trade-off for the modification.

Background: Liver transplants account for a high number of procedures with major investments from all stakeholders involved; however, limited studies address liver transplant population heterogeneity pretransplant predictive of posttransplant survival., Objective: The aim of the study was to identify novel and meaningful patient clusters predictive of mortality that explains the heterogeneity of liver transplant population, taking a holistic approach., Methods: A retrospective cohort study of 344 adult patients who underwent liver transplantation between 2008 through 2014. Predictors were summarized severity scores for comorbidities and other suboptimal health states grouped into 11 body systems, the primary reason for transplantation, demographics/environmental factors, and Model for End Liver Disease score. Logistic regression was used to compute the severity scores, hierarchical clustering with weighted Euclidean distance for clustering, Lasso-penalized regression for characterizing the clusters, and Kaplan-Meier analysis to compare survival across the clusters., Results: Cluster 1 included patients with more severe circulatory problems. Cluster 2 represented older patients with more severe primary disease, whereas Cluster 3 contained healthiest patients. Clusters 4 and 5 represented patients with musculoskeletal (e.g., pain) and endocrine problems (e.g., malnutrition), respectively. There was a statistically significant difference for mortality between clusters (p < .001)., Conclusions: This study developed a novel methodology to address heterogeneous and high-dimensional liver transplant population characteristics in a single study predictive of survival. A holistic approach for data modeling and additional psychosocial risk factors has the potential to address holistically nursing challenges on liver transplant care and research.

The primary objective of this study was to assess feasibility and gather preliminary outcome data on Mindfulness-Based Resilience Training (MBRT) for law enforcement officers. Participants (n = 61) were randomized to either an 8-week MBRT course or a no intervention control group. Self-report and physiological data were collected at baseline, post-training, and three months following intervention completion. Attendance, adherence, post-training participant feedback, and interventionist fidelity to protocol all demonstrated feasibility of MBRT for law enforcement officers. Compared to no intervention controls, MBRT participants experienced greater reductions in salivary cortisol, self-reported aggression, organizational stress, burnout, sleep disturbance, and reported increases in psychological flexibility and non-reactivity at post-training; however, group differences were not maintained at three-month follow-up. This initial randomized trial suggests MBRT is a feasible intervention. Outcome data suggest MBRT targets key physiological, psychological, and health risk factors in law enforcement officers, consistent with the potential to improve officer health and public safety. However, follow-up training or "booster" sessions may be needed to maintain training gains. A fully powered longitudinal randomized trial is warranted., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objectives: To assess the usability and clinical effectiveness of diabetes mobile applications (diabetes apps) developed for adults with type 2 diabetes., Method: A systematic review of the usability and effectiveness of diabetes apps was conducted. Searches were performed using MEDLINE, EMBASE, COMPENDEX, and IEEE XPLORE for articles published from January 1, 2011, to January 17, 2017. Search terms included: diabetes, mobile apps, and mobile health (mHealth)., Results: The search yielded 723 abstracts of which seven usability studies and ten clinical effectiveness studies met the inclusion criteria from 20 publications. Usability, as measured by satisfaction ratings from experts and patients, ranged from 38% to 80%. Usability problem ratings ranged from moderate to catastrophic. Top usability problems are multi-steps task, limited functionality and interaction, and difficult system navigation. Clinical effectiveness, measured by reductions in HbA1c, ranged from 0.15% to 1.9%., Conclusion: Despite meager satisfaction ratings and major usability problems, there is some limited evidence supporting the effectiveness of diabetes apps to improve glycemic control for adults with type 2 diabetes. Findings strongly suggest that efforts to improve user satisfaction, incorporate established principles of health behavior change, and match apps to user characteristics will increase the therapeutic impact of diabetes apps., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: Patients with progressive kidney disease experience increasing physiologic and psychosocial stressors and declining health-related quality of life (HRQOL)., Methods: We conducted a randomized, active-controlled, open-label trial to test whether a Mindfulness-based Stress Reduction (MBSR) program delivered in a novel workshop-teleconference format would reduce symptoms and improve HRQOL in patients awaiting kidney transplantation. Sixty-three transplant candidates were randomized to one of two arms: i) telephone-adapted MBSR (tMBSR, an 8-week program of meditation and yoga); or ii) a telephone-based support group (tSupport). Participants completed self-report questionnaires at baseline, post-intervention, and after 6-months. Anxiety, measured by the State-Trait Anxiety Inventory (STAI) post-intervention served as the primary outcome. Secondary outcomes included: depression, sleep quality, pain, fatigue, and HRQOL assessed by SF-12 Physical and Mental Component Summaries (PCS, MCS)., Results: 55 patients (age 54±12yrs) attended their assigned program (tMBSR, n=27; tSupport, n=28). 49% of patients had elevated anxiety at baseline. Changes in anxiety were small and did not differ by treatment group post-intervention or at follow-up. However, tMBSR significantly improved mental HRQOL at follow-up: +6.2 points on the MCS - twice the minimum clinically important difference (95% CI: 1.66 to 10.8, P=0.01). A large percentage of tMBSR participants (≥90%) practiced mindfulness and reported it helpful for stress management., Conclusions: Neither mindfulness training nor a support group resulted in clinically meaningful reductions in anxiety. In contrast, finding that tMBSR was more effective than tSupport for bolstering mental HRQOL during the wait for a kidney transplant is encouraging and warrants further investigation. ClinicalTrials.govNCT01254214., (Copyright © 2017. Published by Elsevier Inc.)

Objective: Liver transplantation is a costly and risky procedure, representing 25 050 procedures worldwide in 2013, with 6729 procedures performed in the United States in 2014. Considering the scarcity of organs and uncertainty regarding prognosis, limited studies address the variety of risk factors before transplantation that might contribute to predicting patient's survival and therefore developing better models that address a holistic view of transplant patients. This critical review aimed to identify predictors of liver transplant patient survival included in large-scale studies and assess the gap in risk factors from a holistic approach using the Wellbeing Model and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement., Data Source: Search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, and PubMed from the 1980s to July 2014., Study Selection: Original longitudinal large-scale studies, of 500 or more subjects, published in English, Spanish, or Portuguese, which described predictors of patient survival after deceased donor liver transplantation., Data Extraction: Predictors were extracted from 26 studies that met the inclusion criteria., Data Synthesis: Each article was reviewed and predictors were categorized using a holistic framework, the Wellbeing Model (health, community, environment, relationship, purpose, and security dimensions)., Conclusions: The majority (69.7%) of the predictors represented the Wellbeing Model Health dimension. There were no predictors representing the Wellbeing Dimensions for purpose and relationship nor emotional, mental, and spiritual health. This review showed that there is rigorously conducted research of predictors of liver transplant survival; however, the reported significant results were inconsistent across studies, and further research is needed to examine liver transplantation from a whole-person perspective.

Context: Sleep issues are prevalent and affect health and well-being. The aspects of well-being that are impacted by sleep interventions have not been well studied., Objectives: To investigate the impact of lavender and sleep hygiene (LSH) compared to sleep hygiene (SH) alone on well-being as measured by the Self-assessment of Change questionnaire (SAC) at post-intervention and two-week follow-up, and secondarily to compare the SAC sleep item to results from standardized sleep surveys., Design: Secondary analysis of a randomized controlled trial (RCT) where one group received a lavender inhalation patch and practiced sleep hygiene (LSH) and the other group received a placebo inhalation patch and practiced sleep hygiene (SH) for five consecutive nights., Setting: Usual sleep setting., Participants: Seventy-nine college students with self-reported sleep issues., Main Outcome Measures: The SAC was completed at post-intervention and follow-up., Results: Exploratory analysis showed significantly improved well-being for the LSH group at post-intervention for well-being domains of sleep, energy, and vibrancy (P = .01, .03, and .05, respectively) and an overall trend of improved well-being in comparison to the SH group at post-intervention and follow-up. The SAC sleep item showed a similar pattern of change to the standardized sleep surveys with a statistically significant improvement in sleep for the LSH group at follow-up (P = .02)., Conclusions: Findings demonstrate the positive impact of the lavender intervention on three domains of self-assessed well-being are energy, vibrancy, and sleep. SAC results extend and complement prior findings of improved sleep quality., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background and Objectives: Most kidney donors view their experience positively, but some may experience psychosocial and financial burdens. We hypothesized that certain donor characteristics, poor outcome of the recipient, negative perceptions of care, and lack of support may be associated with poor psychosocial outcomes for donors., Design, Setting, Participants, & Measurements: The Renal and Lung Living Donors Evaluation Study (RELIVE) examined long-term medical and psychosocial outcomes for kidney donors (at three U.S. transplant centers) who donated between 1963 and 2005. Standardized questionnaires evaluated donor perspectives, recovery time, social support, motivation, financial impact, insurability after donation, and current psychological status. Questionnaires were mailed to 6909 donors., Results: Questionnaires were returned by 2455 donors, who had donated 17 ± 10 years earlier (range, 5-48 years), a response rate of 36%. Most (95%) rated their overall donation experience as good to excellent. Rating the overall donor experience more negatively was associated with donor complications, psychological difficulties, recipient graft failure, and longer time since donation. Nine percent (n=231) reported one or more of the following poor psychosocial outcomes: fair or poor overall donor experience, financial burden, regret or discomfort with decision to donate, or psychological difficulties since donation. Recipient graft failure was the only predictor for reporting one or more of these poor psychosocial outcomes (odds ratio, 1.77; 95% confidence interval, 1.33 to 2.34). Donors with lower educational attainment experienced greater financial burden. One of five employed donors took unpaid leave; 2% reported health and life insurability concerns., Conclusions: Although the majority of donors viewed their overall donation experience positively, almost 1 in 10 donors reported at least one negative consequence related to donation. Recipient graft failure was associated with poor psychosocial outcome, defined as one or more of these negative consequences. Some donors were financially disadvantaged, and some experienced insurance difficulties. Interventions to avoid negative psychosocial and financial consequences are warranted., (Copyright © 2015 by the American Society of Nephrology.)

Background: Adverse drug events (ADEs) cause significant morbidity and mortality to patients. A brief questionnaire asking patients how they coped with such problems could be a useful tool for providing timely interventions., Objective: The aim of this study was to develop an adverse-event coping scale (AECS) to measure patients' coping responses to their ADE., Methods: Data were collected from subjects recruited from community pharmacies. Psychometric analyses based on item response theory (IRT) were performed to calibrate items and assess reliability. Convergent validity was evaluated by testing a priori formulated hypotheses about expected correlations between the coping scores and other related scales., Results: A total of 140 patients participated in this study by answering the developed items. Confirmatory factor analysis supported a one-dimensional item bank with 11 items. The developed scale was reliable with the reliability coefficient of 0.82. Coping scores were positively correlated with seriousness of the ADE and health literacy, but not coping self-efficacy. Overall, results suggest that the score reflects problem magnitude and coping effort rather than coping efficacy., Conclusion: A high score on the AECS indicates an ADE serious enough to prompt a patient to invest substantial efforts to cope with it. The final AECS item bank and its short-form can help clinicians better understand their patients' ADE-coping efforts., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Mindfulness-based stress reduction (MBSR) has demonstrated benefits for stress-related symptoms; however, for patients with burdensome treatment regimens, multiple co-morbidities and mobility impairment, time and travel requirements pose barriers to MBSR training., Purpose: To describe the design, rationale and feasibility results of Journeys to Wellness, a clinical trial of mindfulness training delivered in a novel workshop and teleconference format. The trial aim is to reduce symptoms and improve quality of life in people waiting for a kidney transplant., Methods: The standard 8-week MBSR program was reconfigured for delivery as two in-person workshops separated in time by six weekly teleconferences (tMBSR). A time and attention comparison condition (tSupport) was created using the workshop-telephone format., Feasibility Results: Kidney transplant candidates (N = 63) were randomly assigned to tMBSR or tSupport: 87% (n = 55) attended ≥ 1 class, and for these, attendance was high (6.6 ± 1.8 tMBSR and 7.0 ± 1.4 tSupport sessions). Fidelity monitoring found that all treatment elements were delivered as planned and few technical problems occurred. Patients in both groups reported high treatment satisfaction, but more tMBSR (83%) than tSupport (43%) participants expected their intervention to be quite a bit or extremely useful for managing their health. Symptoms and quality of life outcomes collected before (baseline, 8 weeks and 6 months) and after kidney transplantation (2, 6 and 12 months) will be analyzed for efficacy., Conclusions: tMBSR is an accessible intervention that may be useful to people with a wide spectrum of health conditions. Clinicaltrials.gov: NCT01254214., (Copyright © 2015 Elsevier Inc. All rights reserved.)

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.

Following kidney donation, short-term quality of life outcomes compare favorably to US normative data but long-term effects on mood are not known. In the Renal and Lung Living Donors Evaluation Study (RELIVE), records from donations performed 1963-2005 were reviewed for depression and antidepressant use predonation. Postdonation, in a cross-sectional cohort design 2010-2012, donors completed the Patient Health Questionnaire (PHQ-9) depression screening instrument, the Life Orientation Test-Revised, 36-Item Short Form Health Survey and donation experience questions. Of 6909 eligible donors, 3470 were contacted and 2455 participated (71%). The percent with depressive symptoms (8%; PHQ-9>10) was similar to National Health and Nutrition Examination Survey participants (7%, p=0.30). Predonation psychiatric disorders were more common in unrelated than related donors (p=0.05). Postdonation predictors of depressive symptoms included nonwhite race OR=2.00, p=0.020), younger age at donation (OR=1.33 per 10 years, p=0.002), longer recovery time from donation (OR=1.74, p=0.0009), greater financial burden (OR=1.32, p=0.013) and feeling morally obligated to donate (OR=1.23, p=0.003). While cross-sectional prevalence of depression is comparable to population normative data, some factors identifiable around time of donation, including longer recovery, financial stressors, younger age and moral obligation to donate may identify donors more likely to develop future depression, providing an opportunity for intervention., (© Copyright 2014 The American Society of Transplantation and the American Society of Transplant Surgeons.)

Objectives: To evaluate quality of life (QOL) in kidney transplant recipients aged 65 and older, identify predictors of impaired physical and mental QOL cross-sectionally and compare QOL over time with that of younger transplant recipients and general population controls., Design: Comparison of serial Medical Outcomes Study 36-item Short-Form Survey (SF-36) QOL scores in transplant recipients aged 65 and older with those of transplant recipients younger than 65 and with those of general population controls from the National Health Measurement Study (NHMS)., Setting: University of Minnesota., Participants: Individuals aged 65 and older (n = 150) and younger than 65 (n = 1,544) who received a primary kidney transplant between 1963 and 2009., Measurements: Two-sample t-tests and logistic regression were used to assess the risk of significant impairment in physical and mental QOL, defined as 1 standard deviation below the general population norms (<40 points) for the SF-36 Physical (PCS) and Mental Component Subscale (MCS) scores., Results: PCS scores were 39.3 for transplant recipients aged 65 and older, 43.5 for recipients younger than 65, and 49.2 for NHMS controls (P < .005 for each pairwise comparison). MCS scores were 54.6 for transplant recipients aged 65 and older, 51.0 for recipients younger than 65, and 53.8 for NHMS controls (P < .005 for ≥ 65 vs <65 and NHMS vs <65). These scores did not change significantly from the first (3.6 years after transplant) to the last (6.2 years after transplant) survey. Longer time since transplantation in elderly participants was associated with having significantly impaired physical QOL, but no predictors were associated with significantly impaired mental QOL. In younger recipients, rejection, diabetes mellitus, delayed graft function, coronary artery disease, and longer time on dialysis were associated with impaired physical QOL. Rejection, smoking, diabetes mellitus, and longer time on dialysis were predictors of impaired mental QOL., Conclusion: Physical QOL is lower in elderly recipients but mental QOL is maintained and is higher than in younger recipients., (© 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.)

Obesity and being overweight are associated with many comorbid conditions and are major contributing factors to cardiovascular disease. The increased proportion of overweight and obese people in Western societies has been attributed largely to behaviors that include sedentary lifestyle and dietary excess. Women are at particular risk during perimenopause, when hormones change and metabolism slows. The purpose of this review was to examine published studies of weight loss programs for perimenopausal women using behavioral change strategies of diet alone, regular physical activity alone, or both in combination to determine the range of potential outcomes and reduction of cardiovascular risks. Based on the findings from this review, practice applications and recommendations for future research are proposed.

Objectives: To describe change in balance confidence, and to identify associated factors and disabling consequences., Method: Secondary analysis of 2 years of data collected from 272 older women enrolled in a randomized clinical trial of fall prevention. Balance confidence and disability measures were assessed at baseline, after the 12 week intervention, and at 1 and 2 years follow-up. Associated factors were measured at baseline., Results: Balance confidence varied at baseline and decreased 5% over 2 years, but no variables predicted this decline. Baseline balance confidence was associated with poor physical function and mental health. Decreasing balance confidence was associated with increasing impairments in balance and hip flexion strength, increasing functional limitations in mobility and chair rises, reduced physical activity levels, increased activity restrictions, and decreasing social networks., Discussion: Decreasing balance confidence plays an important role in disablement. More research is needed to identify predictors of decreasing balance confidence., (© The Author(s) 2014.)

Objectives: To better understand the direct costs of insomnia. Our study aimed to compare healthcare costs and utilization of patients diagnosed with insomnia who received care in a managed care organization with a set of matched controls., Design: Our observational, retrospective cohort study compared 7647 adults with an insomnia diagnosis with an equally sized matched cohort of health plan members without an insomnia diagnosis between 2003 and 2006. We also compared a subset of patients diagnosed with and treated for insomnia with those diagnosed with insomnia but not treated., Setting: A large Midwestern health plan with more than 600,000 members., Results: Multivariate analysis was used to estimate the association between insomnia diagnosis and costs, controlling for covariates, in the baseline and follow-up periods. Although we cannot conclude a causal relationship between insomnia and healthcare costs, our analysis found that insomnia diagnosis was associated with 26% higher costs in the baseline and 46% in the 12 months after diagnosis. When comorbidities were recognized, the insomnia cohort had 80% higher costs, on average, than the matched control cohort., Conclusions: These outcomes suggest the need to look beyond the direct cost of insomnia to how its interaction with comorbid conditions drives healthcare cost and utilization.

Background: Chronic insomnia is a major public health problem affecting approximately 10% of adults. Use of meditation and yoga to develop mindful awareness ('mindfulness training') may be an effective approach to treat chronic insomnia, with sleep outcomes comparable to nightly use of prescription sedatives, but more durable and with minimal or no side effects. The purpose of this study was to understand mindfulness training as experienced by patients with chronic insomnia, and suggest procedures that may be useful in optimizing sleep benefits., Methods: Adults (N = 18) who completed an 8-week mindfulness-based stress reduction (MBSR) program as part of a randomized, controlled clinical trial to evaluate MBSR as a treatment for chronic insomnia were invited to participate in post-trial focus groups. Two groups were held. Participants (n = 9) described how their sleep routine, thoughts and emotions were affected by MBSR and about utility (or not) of various mindfulness techniques. Groups were audio-recorded, transcribed and analyzed using content analysis., Results: Four themes were identified: the impact of mindfulness on sleep and motivation to adopt a healthy sleep lifestyle; benefits of mindfulness on aspects of life beyond sleep; challenges and successes in adopting mindfulness-based practices; and the importance of group sharing and support. Participants said they were not sleeping more, but sleeping better, waking more refreshed, feeling less distressed about insomnia, and better able to cope when it occurred. Some participants experienced the course as a call to action, and for them, practicing meditation and following sleep hygiene guidelines became priorities. Motivation to sustain behavioral changes was reinforced by feeling physically better and more emotionally stable, and seeing others in the MBSR class improve. The body scan was identified as an effective tool to enable falling asleep faster. Participants described needing to continue practicing mindfulness to maintain benefits., Conclusions: First-person accounts are consistent with published trial results of positive impacts of MBSR on sleep measured by sleep diary, actigraphy, and self-report sleep scales. Findings indicate that mindfulness training in a group format, combined with sleep hygiene education, is important for effective application of MBSR as a treatment for chronic insomnia.

Purpose: Mindfulness has emerged as an important health concept based on evidence that mindfulness interventions reduce symptoms and improve health-related quality of life. The objectives of this study were to systematically assess and compare the properties of instruments to measure self-reported mindfulness., Methods: Ovid Medline(®), CINAHL(®), and PsycINFO(®) were searched through May 2012, and articles were selected if their primary purpose was development or evaluation of the measurement properties (validity, reliability, responsiveness) of a self-report mindfulness scale. Two reviewers independently evaluated the methodological quality of the selected studies using the COnsensus-based Standards for the selection of health status Measurement INstruments checklist. Discrepancies were discussed with a third reviewer and scored by consensus. Finally, a level of evidence approach was used to synthesize the results and study quality., Results: Our search strategy identified a total of 2,588 articles. Forty-six articles, reporting 79 unique studies, met inclusion criteria. Ten instruments quantifying mindfulness as a unidimensional scale (n = 5) or as a set of 2-5 subscales (n = 5) were reviewed. The Mindful Attention Awareness Scale was evaluated by the most studies (n = 27) and had positive overall quality ratings for most of the psychometric properties reviewed. The Five Facet Mindfulness Questionnaire received the highest possible rating ("consistent findings in multiple studies of good methodological quality") for two properties, internal consistency and construct validation by hypothesis testing. However, none of the instruments had sufficient evidence of content validity. Comprehensiveness of construct coverage had not been assessed; qualitative methods to confirm understanding and relevance were absent. In addition, estimates of test-retest reliability, responsiveness, or measurement error to guide users in protocol development or interpretation of scores were lacking., Conclusions: Current mindfulness scales have important conceptual differences, and none can be strongly recommended based solely on superior psychometric properties. Important limitations in the field are the absence of qualitative evaluations and accepted external referents to support construct validity. Investigators need to proceed cautiously before optimizing any mindfulness intervention based on the existing scales.