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Self-Management of Infection Control Behavior of Adult Recipients of Living-Donor Liver Transplantation Within 5 Years After Transplantation
Self-Management of Infection Control Behavior of Adult Recipients of Living-Donor Liver Transplantation Within 5 Years After Transplantation C. Arakawa, S. Teraguchi, C. Akazawa, T. Nishizono, and M. Yamamoto ABSTRACT This study determines the present condition of self-management of infection control behavior of adult recipients who underwent living-donor liver transplantation (LDLT). The design was a qualitative study using a semistructured interview. The subjects were recipients who underwent LDLT at Kyoto University Hospital within 5 years to March 2011 and gave their consents to participate in this study. The subjects were 10 recipients (4 male and 6 female), and their average age was 56.7 years. Of 502 sentences about self-management behavior extracted from the verbatim records of all subjects, 61 sentences were about infection control behavior. Cluster analysis was used to classify these sentences into 5 groups: basic preventive behavior, application preventive behavior, active preventive behavior, change of preventive behavior depending on physical condition, and establishment of preventive behavior.
I
T HAS been 20 years since organ transplantation started in Japan. Transplant recipients have to live facing health-related problems including rejection, infection, and recurrence even after they are discharged. After discharge, they monitor their progress through self-care notebooks or other means. However, some recipients can not continue practicing self-care, such as adherence to medication, infection prophylaxis, and medical examination, which may lead to readmission and retransplantation. For long-term survival, it is important to practice self-care robustly and continuously to improve and maintain quality of life (QOL). Earlier studies have focused on the operation technique, immediate postsurgical management, and medication, such as immunosuppressive drugs; in contrast, studies are fewer regarding recipients’ self-management at 1, 5, and 10 years after the operation and their return to daily lifestyle, especially looking at increasing their QOL, and the detailed picture of the problems encountered after discharge from hospital is not clear [1e3]. This study sought to determine the present condition of selfmanagement of infection control behavior of adult recipients who underwent living-donor liver transplantation (LDLT). METHODS The design was a qualitative study using a semi-structured interview. The subjects are recipients who underwent LDLT at Kyoto 0041-1345/14/$esee front matter http://dx.doi.org/10.1016/j.transproceed.2013.12.044 838
University Hospital within 5 years to March 2011 and gave their consents to participate in this study. Recipients who were <18 years old were excluded from the study. The contents of the interview were recorded digitally and transcribed verbatim. The sentences were created such that one Table 1. Demographic Data of the Study Participants No
Gender
1 2 3 4 5 6 7 8 9 10
F M F M F F F M F M
Range of transplanted age
50 50 60 60 50 40 60 40 50 50
Disease
PBC HBV PBC HCV HCV PBC PBC HC PBC HBV
Years after transplantation
Donor
2 2 3 2 2 3 3 1 2 1
Daughter Wife Husband Son Husband Husband Daughter Sister Daughter Wife
Abbreviations: PBC, primary biliary cirrhosis; HBV, hepatitis B virus; HCV, hepatitis C virus.
From the University of Shiga Prefecture (C. Arakawa), Tenri Health Care University (S.T.), Kyoto University (C. Akazawa), Osaka Medical College (T.N.), and Sonoda Womens University (M.Y.), Japan. Address reprint requests to C. Arakawa, The University of Shiga, Prefecture Human Nursing, 2500 Hassaka-cho, Hikoneshi, Shiga 5228533, Japan. E-mail: [email protected] ª 2014 Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710 Transplantation Proceedings, 46, 838e840 (2014)
SELF-MANAGEMENT OF INFECTION IN LIVER RECIPIENTS Table 2. Categories and Subcategories Category
Basic preventive behavior (23 sentences) Application preventive behavior (12 sentences) Active preventive behavior (14 sentences)
Change of preventive behavior depending on physical condition (7 sentences) Establishment of preventive behavior (5 sentences)
Subcategory
Hand-washing Gargling Surgical mask wearing Precautions for using a bus or train Nutrition Precautions for vaccination (e.g., influenza) Gardening Animal companions The ways to treat a common cold or poor physical condition Comprised preventive behaviors added or modified according to season or climate
sentence indicated one meaning. The content analysis was performed using the qualitative-analysis software Word Miner (Japan Information Processing Service Co). Text mining is an approach to analyze an association of word-based common frequency. Word Miner is a set of correspondence analysis and cluster analysis. This study was approved by the Ethical Committee of Kyoto University. During the interview, as far as possible, we tried to protect the privacy of the recipients. Caution was taken to avoid imposing any burden on the recipients.
839
RESULTS
The subjects were 10 recipients (4 male and 6 female), and their average age was 56.7 years (Table 1). Of 502 sentences about self-management behavior extracted from the verbatim records of all subjects, 61 sentences were about infection control behavior. Cluster analysis was used to classify these sentences into 5 groups (Table 2; Fig. 1). 1. 2. 3. 4.
Basic preventive behavior (23 sentences) Application preventive behavior (12 sentences) Active preventive behavior (14 sentences) Change of preventive behavior depending on physical condition (7 sentences) 5. Establishment of preventive behavior (5 sentences). DISCUSSION
The sentences under basic preventive behavior involved hand washing, gargling, and surgical mask wearing. The sentences under application preventive behavior included precautions for using a bus or train and for transplant nutrition, and those under active preventive behavior included precautions for vaccination (eg, influenza), gardening, or animal companions. In the sentences under change of preventive behavior depending on physical condition, the ways to treat a common cold or poor physical condition were included. The sentences of establishment of preventive behavior comprised preventive behaviors added or modified according to season or climate.
Fig 1. Cluster analysis map.
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ARAKAWA, TERAGUCHI, AKAZAWA ET AL
CONCLUSION
REFERENCES
In recipients who underwent LDLT within 5 years, basic preventive behavior, such as hand washing, was realized. Additionally, they were able to practice application preventive behavior according to expanded life space. It was suggested that they practice active preventive behavior and change of preventive behavior depending on physical condition, because this may subsequently translate to establishment of preventive behavior.
[1] Desai R, Jamieson VN, Gimson EA, Watson JC, Bradley J, Praseedom KR. Quality of life up to 30 years following liver transplantation. Liver Transpl 2008;14:1473e9. [2] Bona DM, Ponton P, Ermani M, Iemmolo MR, Fetrin A, Boccagni P, et al. The impact of liver disease and medical complications on quality of life and psychological distress before and after liver transplantation. J Hepatol 2000;33:609e15. [3] Bravata MD, Olkin I, Barnato EA, Keeffe BE, Owens KD. Health-related quality of after liver transplantation [a metaanalysis]. Liver Transplant Surg 1999;5:318e31.
I
T HAS been 20 years since organ transplantation started in Japan. Transplant recipients have to live facing health-related problems including rejection, infection, and recurrence even after they are discharged. After discharge, they monitor their progress through self-care notebooks or other means. However, some recipients can not continue practicing self-care, such as adherence to medication, infection prophylaxis, and medical examination, which may lead to readmission and retransplantation. For long-term survival, it is important to practice self-care robustly and continuously to improve and maintain quality of life (QOL). Earlier studies have focused on the operation technique, immediate postsurgical management, and medication, such as immunosuppressive drugs; in contrast, studies are fewer regarding recipients’ self-management at 1, 5, and 10 years after the operation and their return to daily lifestyle, especially looking at increasing their QOL, and the detailed picture of the problems encountered after discharge from hospital is not clear [1e3]. This study sought to determine the present condition of selfmanagement of infection control behavior of adult recipients who underwent living-donor liver transplantation (LDLT). METHODS The design was a qualitative study using a semi-structured interview. The subjects are recipients who underwent LDLT at Kyoto 0041-1345/14/$esee front matter http://dx.doi.org/10.1016/j.transproceed.2013.12.044 838
University Hospital within 5 years to March 2011 and gave their consents to participate in this study. Recipients who were <18 years old were excluded from the study. The contents of the interview were recorded digitally and transcribed verbatim. The sentences were created such that one Table 1. Demographic Data of the Study Participants No
Gender
1 2 3 4 5 6 7 8 9 10
F M F M F F F M F M
Range of transplanted age
50 50 60 60 50 40 60 40 50 50
Disease
PBC HBV PBC HCV HCV PBC PBC HC PBC HBV
Years after transplantation
Donor
2 2 3 2 2 3 3 1 2 1
Daughter Wife Husband Son Husband Husband Daughter Sister Daughter Wife
Abbreviations: PBC, primary biliary cirrhosis; HBV, hepatitis B virus; HCV, hepatitis C virus.
From the University of Shiga Prefecture (C. Arakawa), Tenri Health Care University (S.T.), Kyoto University (C. Akazawa), Osaka Medical College (T.N.), and Sonoda Womens University (M.Y.), Japan. Address reprint requests to C. Arakawa, The University of Shiga, Prefecture Human Nursing, 2500 Hassaka-cho, Hikoneshi, Shiga 5228533, Japan. E-mail: [email protected] ª 2014 Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710 Transplantation Proceedings, 46, 838e840 (2014)
SELF-MANAGEMENT OF INFECTION IN LIVER RECIPIENTS Table 2. Categories and Subcategories Category
Basic preventive behavior (23 sentences) Application preventive behavior (12 sentences) Active preventive behavior (14 sentences)
Change of preventive behavior depending on physical condition (7 sentences) Establishment of preventive behavior (5 sentences)
Subcategory
Hand-washing Gargling Surgical mask wearing Precautions for using a bus or train Nutrition Precautions for vaccination (e.g., influenza) Gardening Animal companions The ways to treat a common cold or poor physical condition Comprised preventive behaviors added or modified according to season or climate
sentence indicated one meaning. The content analysis was performed using the qualitative-analysis software Word Miner (Japan Information Processing Service Co). Text mining is an approach to analyze an association of word-based common frequency. Word Miner is a set of correspondence analysis and cluster analysis. This study was approved by the Ethical Committee of Kyoto University. During the interview, as far as possible, we tried to protect the privacy of the recipients. Caution was taken to avoid imposing any burden on the recipients.
839
RESULTS
The subjects were 10 recipients (4 male and 6 female), and their average age was 56.7 years (Table 1). Of 502 sentences about self-management behavior extracted from the verbatim records of all subjects, 61 sentences were about infection control behavior. Cluster analysis was used to classify these sentences into 5 groups (Table 2; Fig. 1). 1. 2. 3. 4.
Basic preventive behavior (23 sentences) Application preventive behavior (12 sentences) Active preventive behavior (14 sentences) Change of preventive behavior depending on physical condition (7 sentences) 5. Establishment of preventive behavior (5 sentences). DISCUSSION
The sentences under basic preventive behavior involved hand washing, gargling, and surgical mask wearing. The sentences under application preventive behavior included precautions for using a bus or train and for transplant nutrition, and those under active preventive behavior included precautions for vaccination (eg, influenza), gardening, or animal companions. In the sentences under change of preventive behavior depending on physical condition, the ways to treat a common cold or poor physical condition were included. The sentences of establishment of preventive behavior comprised preventive behaviors added or modified according to season or climate.
Fig 1. Cluster analysis map.
840
ARAKAWA, TERAGUCHI, AKAZAWA ET AL
CONCLUSION
REFERENCES
In recipients who underwent LDLT within 5 years, basic preventive behavior, such as hand washing, was realized. Additionally, they were able to practice application preventive behavior according to expanded life space. It was suggested that they practice active preventive behavior and change of preventive behavior depending on physical condition, because this may subsequently translate to establishment of preventive behavior.
[1] Desai R, Jamieson VN, Gimson EA, Watson JC, Bradley J, Praseedom KR. Quality of life up to 30 years following liver transplantation. Liver Transpl 2008;14:1473e9. [2] Bona DM, Ponton P, Ermani M, Iemmolo MR, Fetrin A, Boccagni P, et al. The impact of liver disease and medical complications on quality of life and psychological distress before and after liver transplantation. J Hepatol 2000;33:609e15. [3] Bravata MD, Olkin I, Barnato EA, Keeffe BE, Owens KD. Health-related quality of after liver transplantation [a metaanalysis]. Liver Transplant Surg 1999;5:318e31.