Depression, Anxiety, and Acute Stress Disorder Among Patients Hospitalized With COVID-19: A Prospective Cohort Study.

BACKGROUND: The epidemiology of psychiatric symptoms among patients with coronavirus disease 2019 is poorly characterized. OBJECTIVE: This article sought to identify the prevalence of anxiety, depression, and acute stress disorder among hospitalized patients with coronavirus disease 2019. METHODS: Adult patients recently admitted to nonintensive care unit medical ward settings with coronavirus disease 2019 were eligible for enrollment. Enrolled patients were screened for depression, anxiety, and delirium. Subsequently, patients were followed up by phone after 2 weeks and rescreened for depression, anxiety, and acute stress disorder symptoms. Subjects' medical records were abstracted for clinical data. RESULTS: A total of 58 subjects were enrolled; of whom, 44 completed the study. Initially, 36% of subjects had elevated anxiety symptoms and 29% had elevated depression symptoms. At 2-week follow-up, 9% had elevated anxiety symptoms, 20% had elevated depression symptoms, and 25% had mild-to-moderate acute stress disorder symptoms. Discharge to home was not associated with improvement in psychiatric symptoms. CONCLUSIONS: A significant number of patients hospitalized with coronavirus disease 2019 experienced symptoms of depression and anxiety. While anxiety improved after index admission, depression remained fairly stable. Furthermore, a significant minority of patients experienced acute stress disorder symptoms, though these were largely mild to moderate.

The altruistic unbalanced paired kidney exchange: proof of concept and survey of potential donor and recipient attitudes.

BACKGROUND: Altruistic unbalanced paired kidney exchanges (AUPKE) use compatible live donor/recipient pairs to facilitate transplants for individuals with incompatible live donors. We report a three donor/recipient pair complex AUPKE. Little is known of the circumstances under which individuals are likely to trade away a compatible live donor or the overall impact that AUPKE could have on the organ supply. METHODS: (1) A retrospective analysis of live donor renal transplants was performed using United Network for Organ Sharing data and our own center experience to determine the potential impact of AUPKE. (2) At initial evaluation, potential donors and recipients were administered a survey regarding attitudes toward AUPKE using a 5-point Likert Scale. RESULTS: (1) One thousand three hundred ninety-six (22.8%) ABO compatible but nonidentical live donor transplants were performed in the United States in 2005. Ninety-one percent of donors were blood group O. (2) Recipient survey respondents were more likely than donors (P=0.002) to favor participation in AUPKE with no advantage to themselves. A number of circumstances increased the propensity to view AUPKE favorably (P<0.05). CONCLUSIONS: (1) AUPKE can have a profound impact on the kidney supply. (2) By using ABO compatible but nonidentical donors, AUPKE can be performed at individual centers without requiring large sharing networks. (3) O recipients with incompatible donors are likely to be the primary beneficiary of AUPKE. (4) Attitudes are not static and can be influenced in favor of participation if there is a perceived benefit to the recipient. (5) Both donors and recipients are more willing to participate if their intended recipient or donor is enthusiastic about participating. (6) AUPKE reflects a paradigm shift for live donation, converting a private resource (the donor) to a shared one.