Patient perceptions of benefits and concerns following pancreas transplantation.

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.

Comparison of a needleless system with conventional heparin locks.

BACKGROUND: Despite the improvements in needle disposal systems, needlesticks to health care workers continue to occur at unacceptably high rates. Needleless systems have been shown to reduce the risk of needlesticks. METHODS: This pilot study examined the safety of such a system for patients by comparing the rates of intravenous infection-related indicators between a conventional heparin lock and a needleless system. Patients (n = 97) were categorized on the basis of the duration of intravenous placement into 24-, 48-, and 72-hour groups. Within each group, half of the patients received conventional heparin locks and half received the needleless system. Intravenous infection-related indicators included catheter tip culture, adaptor fluid culture, intravenous site erythema, induration and tenderness, and elevated oral temperature. RESULTS: Prevalence of one or more indicators was 48% for the conventional and 40% for the needleless system, a difference that was not statistically significant. CONCLUSIONS: The needleless system appeared to pose no greater risk of infection to patients and nurses preferred it for its reduced risk of potential needlesticks.

Health-related quality of life outcomes of pancreas transplant recipients.

The health status and quality of life outcomes of 131 patients who were 1 to 11 years post-pancreas transplant were studied. Patients were compared based on the current status of their pancreas graft, i.e. whether or not their grafts were successful in maintaining an insulin-independent state, and according to recipient category (pancreas alone vs kidney and pancreas). For this study, quality of life was defined as patients' perceptions of their well-being and ability to function in six areas: physical and mental health, social functioning, role (work and home) functioning, overall health perceptions, and physical pain. Patient self-report questions from the Medical Outcome Study were used to provide a score scaled from 0 to 100, for each area. Health status was assessed by sick days, hospitalizations, and emergency room visits. Patients with a successful pancreas graft (N = 65) reported significantly more positive health perceptions (51.9 vs 28.9), less pain (33.9 vs 45.3), and greater ability to function socially (84.9 vs 71.3) than did patients whose pancreas grafts were not successful. In addition, patients with successful pancreas grafts rated their ability to perform routine activities as nearer to normal on the Karnofsky Index (2.82 vs 3.63) and were more likely to view themselves as healthier since the pancreas transplant than were patients whose pancreas grafts were not successful. These effects persisted after statistical adjustment for recipient category and case-mix factors of age, sex, education, and length of time since pancreas transplant.(ABSTRACT TRUNCATED AT 250 WORDS)

Quality of life of pancreas transplant recipients.

The quality of life outcome of 131 pancreas transplant recipients who were 1 to 11 years post-transplant were studied. Patients with a functioning pancreas graft (n = 65) described their current quality of life and rated their health significantly more favourably than those with non-functioning grafts (n = 66). For example, of those patients with a functioning pancreas graft, 68% expressed overall satisfaction with their life, 89% felt healthier since their transplant, and 78% reported that they could care for themselves and their routine daily activities. In contrast, of those patients without a functioning graft, only 48% expressed overall satisfaction with life (p less than 0.01), only 25% felt healthier since their transplant (p less than 0.001), and only 56% indicated they could care for themselves and their daily activities (p less than 0.001). Regardless of graft function, the majority of patients were comfortable with their decision to have the transplant, and most of the patients with pancreas graft function reported that they would have another transplant if their graft failed. While successful pancreas transplantation may not elevate all diabetic patients to the level of health and function of the general population, these patients report a significantly better quality of life than do those patients who remain diabetic.