Example 1
BACKGROUND: Detailed information regarding the work history of heart transplant patients is limited. Therefore, the work history and factors associated with return to work at 1 year after heart transplantation were examined in 237 heart transplant patients as part of a longitudinal quality-of-life study at two university medical centers. Patient characteristics were as follows: 81% male; 89% white; mean age 54 years (range 24 to 71); mean level of education 13 years; and 84% were married.
METHODS: Data were collected using the following instruments: Work History tool; Rating Question Form; Heart Transplant Stressor Scale; Quality of Life Index; Sickness Impact Profile; Jalowiec Coping Scale; Social Support Index; Heart Transplant Symptom Checklist; and Chart Review Form. Frequency distributions, chi-square, t-tests and stepwise regression were used to examine the work history of patients.
RESULTS: Pre-transplant, only 17% of patients were working as compared with 26% (61 of 237) working by 1 year after transplant (p = 0.003). Pre-transplant non-working patients (n = 197) were hospitalized more frequently, were more physically disabled, had more symptom distress, and rated their health as poorer. After heart transplant non-working patients (n = 176) had more rejection, infection and medical complications and more hospital days. Patients who were working either pre- or post-transplant were more likely to hold jobs that were less physically demanding. Factors significantly associated with return to work by 1 year after heart transplant were better functional ability, higher education, fewer endocrine problems, fewer acute rejection episodes and shorter heart transplant waiting time.
CONCLUSIONS: Clinical and demographic variables influence return to work after heart transplantation. Knowledge of these variables provides the health-care team with information to assist patients in securing gainful employment.
From: White-Williams, C., Jalowiec, A., & Grady, K. (2005). Who returns to work after heart transplantation? The Journal of Heart and Lung Transplantation 24, 2255-2261.
Example 2
BACKGROUND: Current practice recommends that immunosuppressed patients (pts) receive yearly influenza (flu) vaccinations. However, disparity exists between current recommendations and clinical practice regarding the decision to administer flu vaccinations to heart transplant (Tx) pts. The purpose of this study was to examine the common clinical practices and outcome characteristics in Tx pts in a multi-institutional database. We assess the incidence of rejection, infection and flu in the months after administration of flu vaccinations.
METHODS: Between 1990 and 2001, 5,581 pts underwent Tx at 28 institutions. Pts who were >1 year post-Tx as of January 1, 2002 (N = 3,601) constituted the study group.
RESULTS: During the years 2002 and 2003, 89% of the institutions administered flu vaccines, with 7 institutions requiring pts to be >3 months (N = 1), 6 months (N = 1) and 12 months (N = 5) post-Tx. All 25 centers that vaccinated pts used trivalent inactivated vaccines during the months of October through January. Three centers did not vaccinate Tx pts due to a purported association with increased allograft rejection. There were no significant differences in the total number of rejection episodes (0.4% vs 0.3%, p = 0.7), rejection episodes by month (January: 0.4% vs 0%, p = 0.2; February: 0.5% vs 1.5%, p = 0.08; March: 0.5% vs 0%, p = 0.14), all infections (0.7% vs 0.6%, p = 0.6) and viral infections (0.1% vs 0%, p = 0.17) between centers that administered flu vaccines and those that did not, respectively. The incidence of flu was low in both groups.
CONCLUSIONS: Flu vaccinations can be given safely to heart transplant pts without an increased incidence of rejection or infection. This information provides clinicians with data to improve clinical practice.
From: White-Williams, C., Brown, R., Kirklin, J., St Clair, K., Keck, S., O'Donnell, J.,...Van Bakel, A. (2006). Improving clinical practice: should we give influenza vaccinations to heart transplant patients? The Journal of Heart and Lung Transplantation 25, 320-323.
