Journal Article Annotations
2017, 1st Quarter
Annotations by Paula Zimbrean, MD, FAPM, and Frank Vinitius, MD
Also of interest:
This study detected a high percentage of ongoing alcohol consumption in a selected group of patients before listing for liver transplantation. One weakness of the study is the cross-sectional design.
The study promotes the discussion how to use hETG in clinical routine. In a further approach, the comparison between the whole group (n=233) and the selected group regarding positive hETG values would be helpful to assess the quality of clinical interview regarding underreporting and denying of alcohol consumption.
The finding: This is a validation study for the Japanese version of PACT (Psychosocial Assessment of Candidates for Transplantation), one of the most frequently used instruments to assess the psychosocial risk of transplant candidates. The study was done retrospectively. The investigators evaluated the interrater reliability as well as the correlations between PACT and mood status.
Strengths and weaknesses: Three clinicians were involved in the translation and retrospective application of the scale. Seventy cases were assessed. The most important strength of this study was that no cases were rejected from transplantation; therefore, the validity of PACT was assessed in patients with all ranges of psychosocial risks.
Relevance: This study is important in the context of the ongoing debate about what is the optimal measure for pretransplant psychosocial risk.
The finding: Two sessions of cognitive behavioral therapy centered around the behavior of taking medications had a positive effect on improving medication adherence after kidney transplantation.
Strengths and weaknesses: The study is a prospective randomized trial of a brief psychotherapeutic intervention. The main limitations of the study are described by the authors and consists in being localized to one single centre, limited psychological evaluation of subjects, and limited consideration of other psychosocial factors that may interfere with adherence. In addition, the objective measure of adherence was medication levels and there was no discussion about biological factors that can influence those levels (genetic factors or pharmacodynamic interactions).
Relevance: With poor adherence being a main risk factor for posttransplant complications, this study suggests that a short behavioral intervention can have a positive impact.