Journal of Consulting and Clinical Psychology, Jul 1, 1991
Research on the association between health locus of control and depression in chronic illness has... more Research on the association between health locus of control and depression in chronic illness has produced contradictory findings, perhaps because of a failure to consider contextual variables. In this study of 96 hemodialysis patients, the belief that one's health is controllable was associated with less depression among Ss who had not previously experienced a failed renal transplant. This belief was associated with greater depression for Ss who had returned to dialysis following an unsuccessful transplant. This interactive effect occurred among severely ill Ss, but health locus of control was unrelated to depression among Ss with less severe disease. This pattern occurred both when control perceptions reflected a belief in the Ss' own or powerful others' (i.e., health care providers) ability to influence health outcomes. Results underscore the adaptive value of congruence between control beliefs and objective circumstances in chronic illness.
... For these students, it seemed to be the case that their general enjoyment of what they did in... more ... For these students, it seemed to be the case that their general enjoyment of what they did in science lessons did not affect their view ... Key (1998) looked at how the perceptions of the chemical industry varied during the two years of their Advanced Chemistry course in England. ...
Purpose: The focus on acute care, time pressure, and lack of resources hamper the delivery of smo... more Purpose: The focus on acute care, time pressure, and lack of resources hamper the delivery of smoking cessation guidelines in the emergency department (ED). One strategy to improve the delivery of smoking cessation services in the ED is to involve non-physician staff. As clinicians’ attitudes are important determinants of delivery of preventive care, the aim of this study is to characterize the attitudes of emergency nurses (ENs) toward smoking cessation counseling and to identify factors associated with these attitudes. Method: We administered a written questionnaire to ENs during the pre-intervention phase of a guideline implementation trial in one University ED and one community ED. The questionnaire included an adapted 20-item decisional balance measure that elicits clinicians’ attitudes ("pros" and "cons") toward smoking cessation counseling [Park, 2001]. We also collected background information (e.g., age, gender, prior training, smoking status), perceived ...
Compliance with complex immunosuppressant drug therapies in transplant recipients might be improv... more Compliance with complex immunosuppressant drug therapies in transplant recipients might be improved with regimens that require less frequent dosing. A once-daily extended release (XL) formulation of tacrolimus has been developed that allows a 1:1 conversion from the twice-a-day tacrolimus (TAC) formulation and has a good exposure to trough concentration correlation. In an open-label, multicenter study, stable liver transplant recipients (n=69) were converted from twice-a-day TAC to XL once-daily in the morning, and were maintained for at least 2 years postconversion using the same therapeutic monitoring and patient care techniques employed with TAC. Two years after conversion, the incidence of biopsy-confirmed acute rejection was 5.8% (4 of 69); patient and graft survival was 98.6% (68 of 69). The safety profile of XL was consistent with that previously reported for TAC. Liver transplant recipients can be converted from twice-a-day TAC to once-daily XL and maintained for at least 2 ...
To assess the effect of basiliximab (BAS) induction therapy on acute rejection rates and overall ... more To assess the effect of basiliximab (BAS) induction therapy on acute rejection rates and overall costs in adult living related donor (LRD) renal transplant recipients. Design. Retrospective chart review and cost-effectiveness analysis of the first 12 months after transplantation. University hospital and outpatient renal transplant clinic. Sixty consecutive adult LRD renal transplant recipients. The treatment group received BAS 20 mg intravenously on postoperative days 0 and 4. The control group received no induction agents. Both groups received cyclosporine microemulsion, azathioprine, and corticosteroids for maintenance immunosuppression. Six patients (three in each group) were excluded; three had received muromonab-CD3 as an induction agent and three were lost to follow-up. At 12-months, the frequency of acute rejection episodes was 15% (4/27) in the control group and 22% (6/27) in the BAS group (NS). Renal function, as measured by average serum creatinine level, was similar at mo...
Immunosuppressive agents taken by pregnant organ transplant recipients readily cross the placenta... more Immunosuppressive agents taken by pregnant organ transplant recipients readily cross the placenta during development of the fetal immune system. There are few data on the long-term implications for the progeny, but evidence from animal studies suggest that second and third generations of organ transplant patients may be at risk for autoimmune disorders and reproductive problems. We present the 23-year-old daughter of a renal allograft recipient exposed to azathioprine 75 mg/day and prednisone 5 mg/day throughout her mother's pregnancy. During the daughter's first pregnancy, she developed multiple autoantibodies, Raynaud's phenomenon, and fetal death occurred at 20 weeks gestation. The second pregnancy was complicated by systemic lupus erythematosus, preeclampsia, and the birth of a preterm male infant. It is uncertain whether the autoimmune manifestations and obstetric complications in this patient were related to fetal exposure to immunosuppressive drugs. Nevertheless, further studies on the health and pregnancies of adult offspring of transplant patients are warranted.
This report characterizes acute rejection and rejection outcomes in subjects randomized to contin... more This report characterizes acute rejection and rejection outcomes in subjects randomized to continuous corticosteroid therapy (CCS) or early corticosteroid withdrawal (CSWD; 7 days after transplantation) in the Astellas Blinded CSWD Trial. The Astellas Blinded CSWD Trial was a 5-year, prospective, multicenter, randomized, double-blind trial of early CCS withdrawal in 386 kidney transplant recipients (195 CCS and 191 CSWD). Tacrolimus and mycophenolate mofetil were required as well as either rabbit antithymocyte globulin or interleukin-2 receptor antibody induction. Biopsy-confirmed acute rejection (BCAR) was grade 1A or higher by Banff criteria. This report also provides borderline changes (BL) that did not meet Banff grade 1A included with BCAR (BCAR+BL). BCAR+BL was 25 (12.8%) in CCS group and 42 (22.0%) in CSWD group (P=0.022). Early BCAR+BL (first 90 days after transplantation) was less frequent in CCS (n=5 [2.6%]) than in CSWD (n=22 [11.5%]; P<0.001). Among non-African-American subjects, early BCAR+BL occurred more often in CSWD (n=20 [12.7%]) versus CCS (n=2 [1.3%]; P<0.001). Late acute rejection (>2 years) occurred more often in African-American subjects in CCS (n=5 [13.9%]) than in CSWD (n=0; P=0.056). Risk factors were CSWD (hazard ratio [HR], 4.72; P<0.002) and human leukocyte antigen mismatch (HR, 1.48; P<0.005) for early BCAR+BL and CSWD (HR, 1.9; P<0.02), human leukocyte antigen mismatch (HR, 1.2; P<0.01), and age (HR, 0.97; P<0.002) for 5-year rejection. The HR for graft loss associated with BCAR+BL was 8.8. BCAR+BL may occur more frequently during the early period after transplantation under an early CSWD regimen with tacrolimus plus induction compared with CCS, particularly among non-African-Americans.
Journal of Consulting and Clinical Psychology, Jul 1, 1991
Research on the association between health locus of control and depression in chronic illness has... more Research on the association between health locus of control and depression in chronic illness has produced contradictory findings, perhaps because of a failure to consider contextual variables. In this study of 96 hemodialysis patients, the belief that one's health is controllable was associated with less depression among Ss who had not previously experienced a failed renal transplant. This belief was associated with greater depression for Ss who had returned to dialysis following an unsuccessful transplant. This interactive effect occurred among severely ill Ss, but health locus of control was unrelated to depression among Ss with less severe disease. This pattern occurred both when control perceptions reflected a belief in the Ss' own or powerful others' (i.e., health care providers) ability to influence health outcomes. Results underscore the adaptive value of congruence between control beliefs and objective circumstances in chronic illness.
... For these students, it seemed to be the case that their general enjoyment of what they did in... more ... For these students, it seemed to be the case that their general enjoyment of what they did in science lessons did not affect their view ... Key (1998) looked at how the perceptions of the chemical industry varied during the two years of their Advanced Chemistry course in England. ...
Purpose: The focus on acute care, time pressure, and lack of resources hamper the delivery of smo... more Purpose: The focus on acute care, time pressure, and lack of resources hamper the delivery of smoking cessation guidelines in the emergency department (ED). One strategy to improve the delivery of smoking cessation services in the ED is to involve non-physician staff. As clinicians’ attitudes are important determinants of delivery of preventive care, the aim of this study is to characterize the attitudes of emergency nurses (ENs) toward smoking cessation counseling and to identify factors associated with these attitudes. Method: We administered a written questionnaire to ENs during the pre-intervention phase of a guideline implementation trial in one University ED and one community ED. The questionnaire included an adapted 20-item decisional balance measure that elicits clinicians’ attitudes ("pros" and "cons") toward smoking cessation counseling [Park, 2001]. We also collected background information (e.g., age, gender, prior training, smoking status), perceived ...
Compliance with complex immunosuppressant drug therapies in transplant recipients might be improv... more Compliance with complex immunosuppressant drug therapies in transplant recipients might be improved with regimens that require less frequent dosing. A once-daily extended release (XL) formulation of tacrolimus has been developed that allows a 1:1 conversion from the twice-a-day tacrolimus (TAC) formulation and has a good exposure to trough concentration correlation. In an open-label, multicenter study, stable liver transplant recipients (n=69) were converted from twice-a-day TAC to XL once-daily in the morning, and were maintained for at least 2 years postconversion using the same therapeutic monitoring and patient care techniques employed with TAC. Two years after conversion, the incidence of biopsy-confirmed acute rejection was 5.8% (4 of 69); patient and graft survival was 98.6% (68 of 69). The safety profile of XL was consistent with that previously reported for TAC. Liver transplant recipients can be converted from twice-a-day TAC to once-daily XL and maintained for at least 2 ...
To assess the effect of basiliximab (BAS) induction therapy on acute rejection rates and overall ... more To assess the effect of basiliximab (BAS) induction therapy on acute rejection rates and overall costs in adult living related donor (LRD) renal transplant recipients. Design. Retrospective chart review and cost-effectiveness analysis of the first 12 months after transplantation. University hospital and outpatient renal transplant clinic. Sixty consecutive adult LRD renal transplant recipients. The treatment group received BAS 20 mg intravenously on postoperative days 0 and 4. The control group received no induction agents. Both groups received cyclosporine microemulsion, azathioprine, and corticosteroids for maintenance immunosuppression. Six patients (three in each group) were excluded; three had received muromonab-CD3 as an induction agent and three were lost to follow-up. At 12-months, the frequency of acute rejection episodes was 15% (4/27) in the control group and 22% (6/27) in the BAS group (NS). Renal function, as measured by average serum creatinine level, was similar at mo...
Immunosuppressive agents taken by pregnant organ transplant recipients readily cross the placenta... more Immunosuppressive agents taken by pregnant organ transplant recipients readily cross the placenta during development of the fetal immune system. There are few data on the long-term implications for the progeny, but evidence from animal studies suggest that second and third generations of organ transplant patients may be at risk for autoimmune disorders and reproductive problems. We present the 23-year-old daughter of a renal allograft recipient exposed to azathioprine 75 mg/day and prednisone 5 mg/day throughout her mother's pregnancy. During the daughter's first pregnancy, she developed multiple autoantibodies, Raynaud's phenomenon, and fetal death occurred at 20 weeks gestation. The second pregnancy was complicated by systemic lupus erythematosus, preeclampsia, and the birth of a preterm male infant. It is uncertain whether the autoimmune manifestations and obstetric complications in this patient were related to fetal exposure to immunosuppressive drugs. Nevertheless, further studies on the health and pregnancies of adult offspring of transplant patients are warranted.
This report characterizes acute rejection and rejection outcomes in subjects randomized to contin... more This report characterizes acute rejection and rejection outcomes in subjects randomized to continuous corticosteroid therapy (CCS) or early corticosteroid withdrawal (CSWD; 7 days after transplantation) in the Astellas Blinded CSWD Trial. The Astellas Blinded CSWD Trial was a 5-year, prospective, multicenter, randomized, double-blind trial of early CCS withdrawal in 386 kidney transplant recipients (195 CCS and 191 CSWD). Tacrolimus and mycophenolate mofetil were required as well as either rabbit antithymocyte globulin or interleukin-2 receptor antibody induction. Biopsy-confirmed acute rejection (BCAR) was grade 1A or higher by Banff criteria. This report also provides borderline changes (BL) that did not meet Banff grade 1A included with BCAR (BCAR+BL). BCAR+BL was 25 (12.8%) in CCS group and 42 (22.0%) in CSWD group (P=0.022). Early BCAR+BL (first 90 days after transplantation) was less frequent in CCS (n=5 [2.6%]) than in CSWD (n=22 [11.5%]; P<0.001). Among non-African-American subjects, early BCAR+BL occurred more often in CSWD (n=20 [12.7%]) versus CCS (n=2 [1.3%]; P<0.001). Late acute rejection (>2 years) occurred more often in African-American subjects in CCS (n=5 [13.9%]) than in CSWD (n=0; P=0.056). Risk factors were CSWD (hazard ratio [HR], 4.72; P<0.002) and human leukocyte antigen mismatch (HR, 1.48; P<0.005) for early BCAR+BL and CSWD (HR, 1.9; P<0.02), human leukocyte antigen mismatch (HR, 1.2; P<0.01), and age (HR, 0.97; P<0.002) for 5-year rejection. The HR for graft loss associated with BCAR+BL was 8.8. BCAR+BL may occur more frequently during the early period after transplantation under an early CSWD regimen with tacrolimus plus induction compared with CCS, particularly among non-African-Americans.
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Papers by John Holman