Search

Background Cooperation between patients and physicians in chronic treatment is an important factor in the patients' adaptation to difficult circumstances. The search is ongoing for factors important to the physician–patient relationship, with the goal of identifying deficits and psychological resources of the patients and medical soft skills of the physicians that can affect the quality of cooperation. The aim of this study was to analyze the psychological mechanisms of patient cooperation with physicians in the area of treatment after kidney transplantation. Methods The study group consisted of 105 patients (62 male patients and 43 female patients) aged 25 to 82 years (mean age, 50.91 years) after kidney transplantation who remained in the follow-up protocol of the Outpatient Transplant Clinic. A questionnaire was used to examine the compatibility of ratings as expressed by the patients and their physicians in 10 areas of cooperation in treatment. The tests for a sense of self-efficacy (General Self-Efficacy Scale), optimism (Life Orientation Test–Revised), and the control of emotions (Courtauld Emotional Control Scale) in Juczyński's adaptation were used in the study of psychological factors. Results Only 1 case reached total congruity by the patients and their physicians in all 10 areas of cooperation. In 3 areas, compliance was achieved in 70%, 72%, and 76%, respectively; in 6 areas, 50% to 66%; and in 1 sphere, 37%. We found no significant impact of psychological factors on patient compliance. A comparison was made of 2 groups of patients (1 of which was characterized by a high compatibility between the physician and patient assessments, and the second which was characterized by the lack of conformity). Moreover, assessment of the functioning of the transplanted kidneys was rated higher in those patients who achieved a high compliance with the opinions of medical cooperation in the treatment. Conclusions The quality of cooperation measured by using compliance assessments of the patients and physicians in health behaviors is satisfactory. This finding translated into a favorable assessment of the functioning of the transplanted kidney expressed by the patients. Qualitative information provides guidance for targeted increasing collaboration. [ABSTRACT FROM AUTHOR]

Background Immunosuppressive medications often cause posttransplant hyperlipidemia. The effects of cyclosporine (CsA) and tacrolimus (Tac) on lipid profile is well-known; however, there are very few studies related to the effect of these immunosuppressants on fatty acids (FA) of phosholipids fraction (PL) in renal transplant recipients (RTR). We sought to analyze the FA profile in PL fraction of RTR treated with Tac or CsA. Methods The study included 65 renal transplant patients on CsA (n = 24, group I) or Tac (n = 41, group II), and 14 healthy controls. Individual serum FA concentrations were measured by gas chromatography. Chemstation software was used to analyze the data. Results No differences between studied groups and controls were noted for monounsaturated FA, polyunsaturated n-3 FA (PUFA n-3), PUFA n-6, or the ratio of PUFA n-6 to PUFA n-3. The following mean values of FA were significantly higher in the CsA-RTR and Tac-RTR as compared with controls: total FA ( P < .01 in both cases), saturated FA (SFA; P < .02 in both cases), C12 ( P < .003 in both cases), C18 ( P < .003 in both cases), and C18:2 ( P < .01 for CsA RTR; P < .02 for Tac RTR). No differences between the measurements in patients on CsA and in patients on Tac were noticed. Significant correlation between SFA and eGFR was observed only in the CsA RTR group ( P < .05). A negative relationship between PUFA n-6 and the estimated glomerular filtration rate was seen, but the correlation was not significant. Conclusions Immunosuppressive drugs may affect FA metabolism, but the FA profile does not depend on the type of immunosuppressive drug administered. [ABSTRACT FROM AUTHOR]

Background Patients who are receiving immunosuppressive treatment after kidney transplantation are at greater risk of developing new-onset diabetes after transplantation (NODAT). New biochemical markers that may contribute to a better assessment of the prognosis of renal failure for patients diagnosed with diabetes mellitus (DM) are needed. The aim of this study was to assess selected proinflammatory markers in patients after kidney transplantation depending on the prevalence of DM and to evaluate the predictive value of these cytokines. Methods A total of 82 patients were divided into 3 groups after kidney transplantation and were included in the analysis: group I, no DM; group II, DM diagnosed before transplantation; and group III, NODAT. Selected marker levels (platelet-derived growth factor, transforming growth factor β 1 , tumor necrosis factor receptor II [TNF-RII], and high-sensitivity interleukin-6 [IL-6 HS]) were assessed by using enzyme-linked immunosorbent assays. For summary endpoint, a return to dialysis treatment and/or death of the patient was adopted. Results Patients with NODAT were characterized by higher levels of IL-6 HS and body mass index. There were no statistically significant differences in the levels of other assessed markers among the 3 analyzed groups. The summary endpoint was observed in 16 cases (19.5%). Patients with summary endpoint during the observation time at baseline had higher levels of TNF-RII (7180 vs 4632 pg/mL; P = .0002) and IL-6 HS (4.58 vs 2.72 pg/mL; P = .033). Conclusions Levels of inflammatory markers in patients after kidney transplantation did not differ between groups with and without DM. In the study population, DM was not a significant risk factor for graft loss or death. Patients who experienced these complications at baseline were characterized by higher values of TNF-RII and IL-6 HS. [ABSTRACT FROM AUTHOR]

Introduction A patient who complies with doctor recommendations is an indicator of proper cooperation in treatment. It is affected by environmental factors, soft competences of the doctors, and properties of the human personality. We investigated the psychological characteristics of patients that may facilitate human contact and promote healthy behaviors. The aim of the study was to analyze the importance of psychological factors for the occurrence of health-related behaviors necessary for cooperation in treatment. Material and Methods The study was conducted in a group of 105 patients (62 males and 43 females) aged from 25 years to 82 years old (mean, 50.4 years) after kidney transplantation who remained in follow-up at the Outpatient Transplant Clinic. We used two questionnaires: one for the patients and one for their doctors, including an assessment of healthy behaviors listed in 10 categories. The patients also completed the tests exploring the sense of self-efficacy (generalized self-efficacy scale), optimism (life orientation test – revised) and the control of emotions (Courtauld emotional control scale) in a Polish adaptation by Zygfryd Juczynski. In the statistical analysis, the Spearman rank correlation coefficient and the Kanonicza analysis were used, adopting the significance level of P < .05. Results We found significant correlations between psychological factors and behaviors of the patients. The patients controlling the expression of anxiety often concentrated on cleanliness and hygiene ( P = .013). The patients controlling the expression of anger ( P = .008) and anxiety ( P = .049) were less likely to perform self-observation, being of the opinion that the role of the physicians was to evaluate the development of the disease and advances in treatment. The patients with higher levels of optimism were perceived by the physicians as better cooperating in conducting self-observation ( P = .024) and adherence to hygiene ( P = .047); they were also less frequently struggling with ophthalmic problems ( P = .004). The relationship between the factors associated with the disease and treatment (pressure, the efficiency of the transplanted kidney, and duration of treatment) and psychological factors (optimism, emotional control, and self-efficacy) has been confirmed. The emerged factors significantly affected each other, which indicated the matching of the model ( P = .08). Conclusions The analysis of the results shows that psychological and somatic functioning of patients has a strong relationship with certain pro-health behaviors that determine the collaboration in treatment. This can serve as a basis for modifying the rules of managing the patients. [ABSTRACT FROM AUTHOR]