Summary:Using a prospective, repeated measures design, this study investigated the psychosocial functioning of patients and a close relative pre-and post-allogeneic and autologous bone marrow transplantation (BMT). All patients (n = 28) undergoing BMT in a 1 year period, and their relatives, were interviewed 1 week pre-transplant and at 3, 6 and 12 months post-BMT, using quantitative and qualitative measures. Pre-transplant data revealed a high level of anxiety (61% with moderate to severe anxiety), and a low level of depression (14% with moderate to severe depression). Twelve patients died in the study period. For the surviving patients there was a statistically significant improvement in physical, psychological and social functioning. Most relatives (88%) reported considerable psychological distress pretransplant and at 3 months post-transplant, but this was largely resolved by 12 months post-transplant. Significant correlations between the relative's distress and patient's physical and psychological wellbeing were observed at 3 months post-transplant, but not at the other assessment points. The findings from this study will help in counselling patients and their relatives as to what to expect in the year following BMT. Keywords: psychosocial; outcome; BMT; families It has been well documented that bone marrow transplantation (BMT) is physically and psychologically demanding for patients. [1][2][3][4][5][6][7] The effects of BMT on donors 8 and on other family members has received less attention, 9 although evidence suggests considerable disruption to families. 10 Prospective longitudinal research that includes baseline assessments is required, 11 with greater emphasis on the process of psychosocial adjustment in both patients and families. 9,11 One of the first prospective studies of psychosocial functioning in BMT showed that functioning was most impaired at 90 days post-transplant, with most aspects of physical and psychosocial functioning restored after 1 year. 12 A further prospective study reported similar findings, with little difference in physical and psychosocial status when assessed at pre-BMT and 1 year post-BMT. 13 While mean differences on pre-BMT and 1 year scores were not sig- nificant, the use of means obscures possible significant changes that individual patients may experience. 13 An analysis of change scores between pre-and post-transplant for individual patients suggests many experience substantial changes between these two assessments, 13 although detailed longitudinal studies of individual adaptation are scarce. 11 Qualitative research methods have rarely been used when studying BMT patients, particularly in a prospective longitudinal manner. Qualitative research is often viewed as the antithesis of quantitative research, 14 being somehow 'unscientific' and unreliable. 15 However, quantitative and qualitative methods are better viewed as complementary, 14 especially when health and illness issues are being examined in small numbers of patients, 16 and offer a useful addition to the usual...
Due to the consistently high levels of agreement reached on competency statements and their associated descriptors, this competency framework should be used to direct education for undergraduate healthcare professionals, and those working in new clinical roles to support healthcare delivery where an understanding of, and engagement with, AMS is important. Although the competencies target basic education, they can also be used for continuing education.
Tamoxifen and prior surgery, fracture, or immobilization were associated with a significantly increased risk of developing a VTE. Factor V Leiden and prothrombin mutations were not associated with thrombosis in this population.
Enquirers and an independent expert panel both determined that MI services provided useful patient-specific advice that impacted positively on patients. Reduction of risk was central to this impact. MI pharmacists frequently identified and advised on issues that clinicians using the service had not recognised themselves, this generally had a positive impact on patients.
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