Journal Article Annotations
2017, 3rd Quarter
Annotations by Paula Zimbrean, MD, FAPM
Also of interest:
This article reviews the most important aspects of the clinical care of transplant patients in the critical care setting. The paper is an update of a previous version written by Andrea DiMartini and Catherine Crone. This review was conceived for medical professionals from various medical specialties involved in the care of transplantation patients and provides a quick reference to the most important aspect of psychiatric assessment and care of this clinical population.
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.
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.
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.