Publication: Calidad de vida relacionada con la salud en trasplantados pulmonares
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2017-02-09
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Universidad Complutense de Madrid
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Abstract
El objetivo del trasplante no es sólo aumentar la supervivencia de los pacientes con enfermedad terminal sino el plantearse como objetivo el poder llegar a ofrecer a los pacientes el grado de salud más aproximado posible al que ellos disfrutaban antes de la enfermedad, consiguiendo el equilibrio entre la funcionalidad del injerto tras la intervención y la integridad física y psicológica del paciente tras la cirugía. La medida de la CV es utilizada para evaluar los dominios de salud física y psicológica como áreas que son influenciadas por la experiencia previa de cada persona, sus expectativas y percepciones. El aumento del número de pacientes trasplantados ha generado una comunidad de pacientes caracterizadas no solo por su situación clínica sino también por características propias psicopatológicas específicas de este grupo. Los receptores de trasplante presentan cambios en su relación con la familia y el equipo médico como consecuencia de la larga duración de la enfermedad crónica y asociada a la experiencia de la cirugía del trasplante que es vivida como un ritual de muerte y renacimiento a una nueva vida. La recuperación de la integridad corporal suele ser compleja, en ocasiones con dificultades en el retorno a la actividad física, las relaciones sociales y laborales que tras el trasplante pueden verse comprometidas por situaciones de distress psicológico. Entre los determinantes más importantes para el resultado en CVRS postrasplante se encuentra el síndrome de bronquiolitis obliterante (BOS), el tipo de trasplante y el diagnóstico pretrasplante, los efectos adversos de inmunosupresores, disnea, disfunción función del injerto, dolor y rechazo agudo. Los estudios observaron que la disfunción crónica del injerto, antiguamente denominada síndrome de bronquiolitis obliterante (BOS) se asocia de forma fuerte y consistente con peor CVRS cuando se analiza con los instrumentos de medida de CVRS incluyen cuestionarios específicos respiratorios SGRQ y genéricos SF-12 o EQ5D. El impacto del BOS fue mayor en los dominios de la CVRS relacionados con el funcionamiento físico, la energía y la movilidad...
Lung transplantation (LT) aims not merely to extend recipients survival, but also to improve health-related quality of life (HRQL). Patients with advanced lung disease awaiting LT have poor HRQL but it is a key patient-centered outcome (PCOs). At the moment, analyses of HRQL outcomes following LT are relatively infrequent. The question to consider is not just how many years of life provides patients but also how LT improve HRQL. In transplantation medicine, as in other fields of medicine, the traditional "biomedical model" of health based on molecular genetics, physiology and biochemistry, is being integrated into the "model of social science" of health based on psychosocial and economic aspects. The high cost of transplantation in times when health spending is subjected to severe scrutiny, forced to defend the strength of the arguments of "lives saved" and "quality of life gained." HRQL measurement is used to assess the domains of physical and psychological as areas that are influenced by previous experience of each person, their expectations and perceptions. The increase in the number of transplant patients has generated a community of patients characterized not only by their clinical condition but also by specific psychopathological characteristics. Transplant recipients have changes in their relationship with the family and the medical team because of the long duration of chronic disease and associated with the experience of transplant surgery, lived as a ritual of death and rebirth to new life. The recovery of bodily integrity is often complex. The return to physical activity, social and labor relations after the transplant may be compromised by situations of psychological distress. A better understanding of the importance of the measure of HRQOL in LT has important clinical and research implications. The study of HRQOL in LT can provide to patients and physicians the information on the magnitude and duration of the improvements that can be expected with LT and identify the determinants of HRQOL that can be subjected to clinical intervention, in this way we can help to incorporate the HRQOL in clinical decision-making bases. Between the most important determinants of HRQL are the psychosocial determinants, bronchiolitis obliterans syndrome (BOS), the type of transplant, pretransplant diagnosis, the adverse effects of immunosuppressive, dyspnea, graft function, pain and rejection sharp. The studies found that chronic graft dysfunction, formerly called bronchiolitis obliterans syndrome (BOS) is associated with strong and consistent poorer HRQOL when analyzed with instruments measuring HRQOL including both specific questionnaires respiratory SGRQ and SF-12 EQ5D. The impact of BOS was higher in the domains of HRQL related to physical functioning, energy and mobility...
Lung transplantation (LT) aims not merely to extend recipients survival, but also to improve health-related quality of life (HRQL). Patients with advanced lung disease awaiting LT have poor HRQL but it is a key patient-centered outcome (PCOs). At the moment, analyses of HRQL outcomes following LT are relatively infrequent. The question to consider is not just how many years of life provides patients but also how LT improve HRQL. In transplantation medicine, as in other fields of medicine, the traditional "biomedical model" of health based on molecular genetics, physiology and biochemistry, is being integrated into the "model of social science" of health based on psychosocial and economic aspects. The high cost of transplantation in times when health spending is subjected to severe scrutiny, forced to defend the strength of the arguments of "lives saved" and "quality of life gained." HRQL measurement is used to assess the domains of physical and psychological as areas that are influenced by previous experience of each person, their expectations and perceptions. The increase in the number of transplant patients has generated a community of patients characterized not only by their clinical condition but also by specific psychopathological characteristics. Transplant recipients have changes in their relationship with the family and the medical team because of the long duration of chronic disease and associated with the experience of transplant surgery, lived as a ritual of death and rebirth to new life. The recovery of bodily integrity is often complex. The return to physical activity, social and labor relations after the transplant may be compromised by situations of psychological distress. A better understanding of the importance of the measure of HRQOL in LT has important clinical and research implications. The study of HRQOL in LT can provide to patients and physicians the information on the magnitude and duration of the improvements that can be expected with LT and identify the determinants of HRQOL that can be subjected to clinical intervention, in this way we can help to incorporate the HRQOL in clinical decision-making bases. Between the most important determinants of HRQL are the psychosocial determinants, bronchiolitis obliterans syndrome (BOS), the type of transplant, pretransplant diagnosis, the adverse effects of immunosuppressive, dyspnea, graft function, pain and rejection sharp. The studies found that chronic graft dysfunction, formerly called bronchiolitis obliterans syndrome (BOS) is associated with strong and consistent poorer HRQOL when analyzed with instruments measuring HRQOL including both specific questionnaires respiratory SGRQ and SF-12 EQ5D. The impact of BOS was higher in the domains of HRQL related to physical functioning, energy and mobility...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina Física y Rehabilitación (Hidrología Médica), leída el 22/01/2016