Psychological aspects of patients in germ-free isolation: a review of child, adult, and patient management literature.
ABSTRACT Life-threatening medical conditions such as severe combined immunodeficiency disease, leukemia, severe aplastic anemia, radiation injury, burns, organ transplantation, and aggressive administration of chemotherapy often necessitate the isolation of the patient in a protected germ-free environment for weeks or months. This treatment milieu has the effect of extensive psychological and physical isolation from family and staff. A review of the literature was undertaken to investigate the psychological implications of such treatment and to question the possibility that this isolation therapy might produce a unique type of psychological stress. Most authors agree that patients are able to withstand the emotional stress of germ-free isolation and that behavioral changes relate more to the severity of the illness rather than to the isolation. However, there may be inherent stresses related to isolator therapy that can be alleviated by environmental manipulation. Case vignettes are included and patient management in such an environment is outlined.
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ABSTRACT: En el Servicio de Hematología del Hospital Universitario Virgen de las Nieves de Granada se ha puesto en marcha un programa psicológico para pacientes candidatos a trasplante de progenitores hematopoyéticos (TPH). Con dicho programa se pretende favorecer la adaptación, amortiguar el impacto psicológico y el sufrimiento asociado. Se potencian los recursos para disminuir, en lo posible, los efectos negativos como son la ansiedad y la depresión, en base a las diferencias individuales, el nivel de información a cerca del proceso y a sus propios recursos de afrontamiento. El programa psicológico consiste en cuatro sesiones que incluyen: 1. Análisis y manejo de la información, 2. Habilidades de afrontamiento, 3. Manejo del estrés y 4. Preparación para el aislamiento a nivel familiar. Se midieron las variables de ansiedad, depresión con la Escala de Ansiedad y Depresión (HAD) y el nivel de información con una escala categorial diseñada específicamente para este estudio. Los momentos de medida se realizan al diagnóstico, al ingreso en cámara de aislamiento, a los cien días, a los seis meses, al año y a los dos años después del trasplante. Se contemplan dos grupos principales. un grupo intervención, que recibe el programa de intervención psicológica y un grupo control al cual no se aplica el programa debido a la mecánica de ingreso. En este trabajo se muestra como los pacientes que reciben la intervención psicológica antes del trasplante, obtienen niveles menores en ansiedad y depresión, mostrando un nivel de información más elevado que los que no reciben dicha intervención. Se concluye con la importancia de la intervención psicológica especializada y adaptada en un proceso agresivo como es el trasplante de progenitores hematopoyéticos. At the department of Haematology on the University Hospital Virgen de las Nieves, Granada, it is applied a psychological program for patient bone marrow transplantation (BMT) candidates. With this program it is tried to favour the adjustment, to muffle the psychological impact and to determine the associated suffering. The resources are promoted to diminish the negative effects such as anxiety and depression, on the basis of the individual differences, the level of information to near the process and to it own resources of confrontation. The psychological program consists of four meetings which include: 1. Analysis and information management, 2. Confrontation skills, 3. Stress management and 4. Preparation for the isolation to family level. It is measured anxiety and depression by The Hospital Anxiety and Depression Scale (HADS), and the level information about the disease process and transplantation by a categorical scale designed for this research. The assessments are realized at following phases: the moment of diagnosis, at the revenue in chamber of isolation, at hundred days, at six months, one year and two years after BMT. Two principal groups were studied: an intervention group, which received the psychological intervention program and a control group for which did not apply the program due to the mechanics of revenue. In this work it appears as the patients who receive the psychological intervention before the transplant, they obtain minor levels in anxiety and depression. showing a level of information higher than it the patients did not receive the above mentioned intervention. These results stress the importance of psychological intervention for BMT patients.Psicooncología, 2007.
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ABSTRACT: This study analyzed the relationship between some psychosocial variables (depression, anxiety, stress, coping strategies, social support, optimism, rationality, and need for harmony) and clinical parameters indicative of immunological response after bone marrow transplantation (BMT; day of engraftment, number of infections and hemoglobin level) while controlling for demographic variables (age, educative level, civil state, and time from cancer diagnosis). Thirty-one post BMT hematological cancer patients were evaluated. Results show that higher educative levels are associated to lower number of infections, while age is associated with a delay in the time of engraftment; coping strategies, specially redefinition of the situation, relaxation, stoicism and passivity, are positively associated with the three clinical indices; depression is positively associated to number of infections during the hospitalization period; and rationality is associated with lower hemoglobin levels. These results suggest that psychosocial variables, especially coping strategies, play an important role in determining the immunological response after BMT.Behavioral Medicine 01/2012; 38(1):12-8. · 1.03 Impact Factor
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ABSTRACT: Contact isolation of infected or colonised hospitalised patients is instrumental to interrupting multidrug-resistant organism (MDRO) cross-transmission. Many studies suggest an increased rate of adverse events associated with isolation. We aimed to compare isolated to non-isolated patients in intensive care units (ICUs) for the occurrence of adverse events and medical errors. We used the large database of the Iatroref III study that included consecutive patients from three ICUs to compare the occurrence of pre-defined medical errors and adverse events among isolated vs. non-isolated patients. A subdistribution hazard regression model with careful adjustment on confounding factors was used to assess the effect of patient isolation on the occurrence of medical errors and adverse events. Two centres of the Iatroref III study were eligible, an 18-bed and a 10-bed ICU (nurse-to-bed ratio 2.8 and 2.5, respectively), with a total of 1,221 patients. After exclusion of the neutropenic and graft transplant patients, a total of 170 isolated patients were compared to 980 non-isolated patients. Errors in insulin administration and anticoagulant prescription were more frequent in isolated patients. Adverse events such as hypo- or hyperglycaemia, thromboembolic events, haemorrhage, and MDRO ventilator-associated pneumonia (VAP) were also more frequent with isolation. After careful adjustment of confounders, errors in anticoagulant prescription [subdistribution hazard ratio (sHR) = 1.7, p = 0.04], hypoglycaemia (sHR = 1.5, p = 0.01), hyperglycaemia (sHR = 1.5, p = 0.004), and MDRO VAP (sHR = 2.1, p = 0.001) remain more frequent in isolated patients. Contact isolation of ICU patients is associated with an increased rate of some medical errors and adverse events, including non-infectious ones.European Journal of Intensive Care Medicine 08/2013; · 5.17 Impact Factor