Journal Article Annotations
2017, 3rd Quarter
Annotations by Paula Zimbrean, MD, FAPM
- A prospective study of the reliability and validity of the Live Donor Assessment Tool
- Prevalence and predictors of patient-reported long-term mental and physical health after donation in the Adult to Adult Living Donor Liver Transplantation Cohort Study (A2ALL)
- Prospective computerized monitoring of cognitive functioning before and after blood and marrow transplantation
Also of interest:
PUBLICATION #1 — Transplant Psychiatry
A prospective study of the reliability and validity of the Live Donor Assessment Tool
Iacoviello BM, Shenoy A, Hunt J, Filipovic-Jewell Z, Haydel B, LaPointe Rudow D
Psychosomatics 2017; 58(5):519-526
Background: The psychosocial evaluation is an important part of the live organ donor evaluation process, yet this is not standardized across institutions.
Objective: This study was designed to prospectively test the reliability and validity of a semistructured psychosocial evaluation tool that was recently developed and reported in the literature (the Live Donor Assessment Tool [LDAT]).
Methods: A total of 248 live donor candidates who presented for evaluation were invited to participate in a study that involved the LDAT being scored as part of the standard psychosocial evaluation process; 222 provided informed consent. Evaluations were conducted by staff experienced with psychosocial evaluation of living donors and trained in the use of the LDAT. Furthermore, 123 donor candidates were evaluated twice, as per routine standard of care, and had 2 LDATs administered. Reliability of the LDAT was assessed by calculating the internal consistency of the LDAT items and inter-rater reliability. Validity was assessed by comparing LDAT scores across the risk-group categories (the traditional outcome designation of the psychosocial evaluation) and in 86 eventual donors, associations between LDAT scores, and indicators of psychosocial outcomes post-donation.
Results: The LDAT was found to have good internal consistency, strong inter-rater reliability, and showed signs of validity: LDAT scores differentiated the traditional risk-group categories, and a significant association between LDAT score and treatment adherence post-donation was revealed.
Conclusions: The LDAT demonstrated good reliability and validity, but future research on the LDAT and the ability to implement the LDAT across institutions is warranted.
On PubMed: Psychosomatics 2017; 58(5):519-526
The finding: The Live Donor Assessment Tool (LDAT) is a structured assessment tool created with the goal to standardize the evaluation of the living organ donors and to assess the psychosocial risk of candidates to living donation. This is the first prospective study evaluating their validity and reliability of this instrument.
Strength and weaknesses: This is a prospective study that involved over 200 liver living donors, the biggest study to-date to look at a structured psychosocial assessment in this population. A significant number of donor candidates were assessed twice, which allowed the evaluation of internal consistency and inter-rater validity of this instrument. The study did not assess the predictive value of LDAT in regards to post living donation psychosocial outcomes. Since this was a single center study, it is not clear if the population study is representative for all the organ liver donors.
Relevance: This study suggests that the LDAT can be considered as a useful measure in assessing liver organ donor candidates. As pointed out by the authors, further research is needed to address the generalizability of the findings in terms of implementation and validity.
PUBLICATION #2 — Transplant Psychiatry
Prevalence and predictors of patient-reported long-term mental and physical health after donation in the Adult to Adult Living Donor Liver Transplantation Cohort Study (A2ALL)
Dew MA, Butt Z, Liu Q, et al
Transplantation 2017 Sep 6 (Epub ahead of print)
Background: Prospective and longitudinal studies have examined liver donors’ medical outcomes beyond the first 1-2 years postdonation. There is no analogous longitudinal evidence on long-term psychosocial outcomes, including patient-reported clinically significant mental health problems and perceptions of physical well-being. We examined prevalence, descriptive characteristics, and predictors of diagnosable mental health conditions and self-reported physical health problems, including fatigue and pain, in the long-term years after liver donation.
Methods: Donors from 9 centers who initially completed telephone interviews at 3-10 years postdonation (M=5.8 years, SD=1.9) were reinterviewed annually for 2 years using validated measures. Outcomes were examined descriptively. Repeated measures regression analyses evaluated potential predictors and correlates of outcomes.
Results: Of 517 donors initially interviewed (66% of those eligible), 424 (82%) were reassessed at least once. Prevalence rates of major depression and clinically significant pain were like general population norms; average fatigue levels were better than norms. All donors showed little temporal change. Anxiety and alcohol use disorder rates exceeded normative rates at 1 or more assessments. Longer postdonation hospitalization, female sex, higher body mass index (BMI), concerns about donation-related health effects, and burdensome donation-related financial costs were associated with increased risk for most outcomes (p’s<.05). Men were at higher risk for alcohol use disorder (p<.001).
Conclusions: Anxiety and alcohol use disorders were more common than would be expected; they may warrant increased research attention and clinical surveillance. Surveillance for long-term problems in the areas assessed may be optimized by targeting donors at higher risk based on identified predictors and correlates.
On PubMed: Transplantation 2017 Sep 6 [Epub ahead of print]
The finding: Negative psychosocial outcomes after living liver donation had the following predictive factors: longer post donation hospitalization, female sex, higher body mass index (BMI), concerns about donation-related health effects, and donation-related financial costs.
Strength and weaknesses: As discussed previously in the APM quarterly annotations, this was the biggest prospective longitudinal study looking at psychosocial status pre- and post- living liver donation. It is important to note that even if the study was prospective, donors were involved only after transplantation, and follow prospectively from that time on. Therefore, there were no available pretransplant structured assessments. The study implemented validated measures administered via the phone.
Relevance: As stated above, this is the biggest systematic psychosocial assessment of liver living donors to date. The findings suggest that men who donate part of the liver should be considered at risk for developing alcohol use disorders, while donors in general can be at risk for developing anxiety. This information is crucial in designing wellness programs or clinic follow-up programs for living donors.
PUBLICATION #3 — Transplant Psychiatry
Prospective computerized monitoring of cognitive functioning before and after blood and marrow transplantation
Votruba KL, Hoodin F, Giordani B, Kentor R, Couriel DR, Kitko CL
Bone Marrow Transplant 2017; 52(8):1215-1217
(Abstract edited by P. Zimbrean based on the paper. The authors did not provide an abstract for this article).
The primary aim of this pilot study was to document the feasibility of implementing repeated neurocognitive screenings using a brief computerized assessment (CogState) via test completion rates and patient and provider reports. Secondary aims were to delineate cognitive performance relative to normative data, explore cognitive changes over time and compare cognitive performance of patients receiving allogeneic versus autologous transplants. The sample consisted of 13 autologous and 17 allogeneic transplant recipients. CogState4 is a brief electronic battery assessing processing speed, attention, visual learning, working memory (that is, temporary storage and manipulation of information to be encoded), executive function (that is, problem-solving) and visual memory. This battery took ~17 min to complete on a laptop computer, allowing for administration in inpatient and outpatient settings. Of the 28 HCT patients, 23 (82%) completed the T2 and 22 (79%) completed the T3 assessments. Twenty-one patients (75%) completed all three evaluations. On a scale from 0 (not at all) to 7 (definitely), providers reported that cognitive screening did not take a significant amount of time (m=0.56) and did not negatively impact clinic procedures (m=0.56). Patients reported the evaluation did not increase their fatigue (m=0.74) or emotional distress (m=0.47). Before transplant, severe cognitive deficits were noted in problem-solving (13%), with moderate deficits in visual learning (13%) and memory (10%). In contrast, at T2, severe deficits were in processing speed (10%), visual learning (10%) and working memory (20%), with mild deficits evident in nearly 25% of the sample in these domains. Thirteen to 20% of the sample continued to exhibit moderate to severe deficits in processing speed, visual learning and working memory at T3. Few impairments in visual memory or problem-solving were observed after transplant.
On PubMed: Bone Marrow Transplant 2017; 52(8):1215-1217
The finding: This study reports on the feasibility of administering cOGsTATE4, a computerized cognitive assessment, to bone marrow transplant patients. The study showed that the battery took 17 minutes to complete, and did not lead to increased stress, nor did it impact with the general clinical care. Cognitive deficits were observed in 20% of the sample, however the study did not include enough patients to allow conclusions about the prevalence of cognitive deficits in this population.
Strength and weaknesses: This was a small pilot study that included a total of 30 transplant recipients. The main strength of the study was to assess cognitive battery that was administered via an electronic device.
Relevance: Using computerized psychometric assessment can open the field for improved research methods and clinical care. Computerized psychometric assessment can be more acceptable to the patients and may allow faster data collection and analysis, providing new information that clinicians can implement in the ongoing clinical care.