Renal Transplantation: Relationship between Hospital/Surgeon Volume and Postoperative Severe Sepsis/Graft-Failure. A Nationwide Population-Based Study

Background and objects: We explored the relationship between hospital/surgeon volume and postoperative severe sepsis/graft-failure (including death).Methods: The Taiwan National Health Insurance Research Database claims data for all patients with end-stage renal disease patients who underwent kidney transplantation between January 1, 1999, and December 31, 2007, were reviewed. Surgeons and hospitals were categorized into two groups based on their patient volume. The two primary outcomes were severe sepsis and graft failure (including death). The logistical regressions were done to compute the Odds ratios (OR) of outcomes after adjusting for possible confounding factors. Kaplan-Meier analysis was used to calculate the cumulative survival rates of graft failure after kidney transplantation during follow-up (1999-2008).Results: The risk of developing severe sepsis in a hospital in which surgeons do little renal transplantation was significant (odds ratio [OR]; p = 0.0115): 1.65 times (95% CI: 1.12-2.42) higher than for a hospital in which surgeons do many. The same trend was true for hospitals with a low volume of renal transplantations (OR = 2.39; 95% CI: 1.62-3.52; p < 0.0001). The likelihood of a graft failure (including death) within one year for the low-volume surgeon group was 3.1 times higher than for the high-volume surgeon group (p < 0.0001); the trend was similar for hospital volume. Female patients had a lower risk than did male patients, and patients ≥ 55 years old and those with a higher Charlson comorbidity index score, had a higher risk of severe sepsis.Conclusions: We conclude that the risk of severe sepsis and graft failure (including death) is higher for patients treated in hospitals and by surgeons with a low volume of renal transplantations. Therefore, the health authorities should consider exporting best practices through educational outreach and regulation and then providing transparent information for public best interest.     

Adaptation of the Youth Connectedness to Provider scale to assess the relationship between health professionals and adolescent and young adult patients

ObjectiveThe aim was to adapt an instrument that evaluates the relationship between young individuals and health professionals to the Brazilian population, which will be called the Escala de Avaliação de Vínculo entre Jovens e Profissionais de Saúde (Youth Connectedness to Provider scale).MethodThe questionnaire known as the Youth Connectedness to Provider scale consists of seven Likert-like questions. The translation, back-translation, evaluation by ten specialists, and pre-test with 43 adolescents and young adults aged between 10 and 24 years were performed to assess the clarity and reliability of meanings. The content validity index was calculated for each question. Subsequently, the clinical validation was performed with 83 patients aged 10–24 years old and Cronbach's alpha coefficient was calculated.ResultsA content validity index >0.8 (considered satisfactory) was obtained for all items analyzed by experts and adolescents. At the clinical validation, it showed a high internal consistency (Cronbach’s alpha = 0.76). The questions showed a good correlation, except for the question about judgment (Spearman’s rho = 0.03–0.19).ConclusionsThe scale adaptation showed an adequate agreement rate at the translation evaluation and a good reliability index in the questions. This instrument provides information on strengths and topics that require more attention from professionals to improve the relationship with their patients; it can be a valuable parameter in assessing the medical consultation quality.     

Caregiver-Care Recipient Relationship Closeness is Associated With Neuropsychiatric Symptoms in Dementia

Objective

Closer caregiver-care recipient (CG-CR) relationships are associated with better cognitive and functional abilities, activities of daily living (in persons with dementia), and lower informal care costs.

Rebuilding trust

Lack of trust is a major problem in our current health care system and is increasingly becoming a focus in the literature and in national discussions on how to better understand, address, and resolve. In this narrative essay, I share how I wrestled with rebuilding trust after my own adverse experiences with medical error, surgery complications, and communication challenges. This perspective highlights the critical importance of physician communication and trust in the patient-physician relationship.     

Parent-adolescent relationship quality as a predictor of leaving home

IntroductionLeaving home is a significant life transition that effects both emerging adults and their families. The age of leaving home has been increasing across industrialized societies, and children remain dependent on their parents for a longer time. The present study investigated the association between parent-adolescent relationships and timing of leaving home over a timespan of six years: From middle adolescence to emerging adulthood.MethodsData came from three cohorts of two longitudinal studies in the Netherlands (N = 1100). At the start of the study, participants had a mean age of 16.41 (SD=.71), and approximately half of them (n = 547) were male. Adolescents completed questionnaires on parent-adolescent relationship quality. The impact of positive and negative relationship characteristics on timing of leaving home were examined separately for mothers and fathers.ResultsSurvival analysis results showed that higher levels of mother's and father's warmth, and higher levels of power attributed to father, but not mother, predicted later timing of leaving home. Higher levels of parental autonomy support predicted earlier timing of leaving home. Conflict with parents was not associated with timing of leaving home, except in the father-daughter relationship. Only, the effect of parental warmth on timing of leaving home remained robust when controlling for age, gender, education level, and SES.ConclusionsOur findings indicate that certain parent-adolescent relationship characteristics contribute to the increase in age of leaving home. Parents may be able to prepare their children for a self-sufficient living by balancing warmth and autonomy support they provide during adolescence.