The role of preoperative psychosocial counseling on the improvement of the recipient compliance and speed of recovery after liver transplantation - A systematic review of the literature and expert panel recommendations.

BACKGROUND: Psychosocial disorders ranging from anxiety to severe psychiatric diseases and active alcohol/substance abuse are frequent in liver transplant candidates and potentially associated with worse post- transplant outcomes. Therefore, psychosocial evaluation is mandatory to optimize success after liver transplantation. However, how to carry out this evaluation, the type of intervention needed and its potential impact on patient outcome remain unclear. OBJECTIVES: To investigate whether psychosocial assessment may help in predicting risks of poor outcome; and to investigate whether psychosocial interventions may mitigate these risks and improve posttransplant outcomes, in particular compliance and speed of recovery. DATA SOURCES: Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central. METHODS: Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. The protocol was registered on PROSPERO CRD42021238361. Main outcomes assessed were mortality, alcohol relapse, rejection, and medication compliance. RESULTS: Fifteen studies were analyzed including five observational comparative and ten observational noncomparative studies. Preoperative psychosocial evaluation of LT candidates was associated with higher concordance with the treatment plan (i.e., higher adherence to treatment and lower alcohol relapse) and lower rates of rejection. Psychosocial assessment tools were used in some studies to guide the evaluation, but their predictive ability remains debated, and they should not be used in isolation. Most of the interventions were studied in patients with alcohol related issues. In this context, support by specialized teams was associated with better posttransplant outcome, especially through a decrease in post-transplant alcohol relapse. CONCLUSIONS: Preoperative psychosocial assessment should be provided in order to detect patients at increased risk of poorer post-transplant outcome, in particular in terms of concordance to the treatment plan (Quality of Evidence; Low | Grade of Recommendation; Strong/For). The experts suggest that, when possible, provision of preoperative psychological assessment and concomitant interventions aimed at improving the concordance to treatment plans will positively impact the success of liver transplantation. (Quality of Evidence; Very Low | Grade of Recommendation; Strong/For].

How Is a Label of Borderline Personality Disorder Constructed on Twitter: A Critical Discourse Analysis.

This research took a social constructionist stance and explored how Borderline Personality Disorder (BPD) is constructed by Twitter users who identify with this diagnostic label. Consistent with this position, a critical discourse analysis (CDA) methodology was employed. The data comprised two-hundred and twenty-five tweets. Tweets from professionals, or links to blogs, were excluded, in an attempt to ensure only personal tweets were used. Two interpretative repertoires were produced from the analysis: BPD as an existence of tension and BPD as a different existence. The findings indicated that authors were involved in a negotiation between themselves and BPD, which had an impact upon their felt sense of agency/control over BPD. Likewise, authors constructed themselves in opposition to individuals who did not identify with the diagnosis of BPD. Whilst this provided more favourable positions, it potentially limited access to healthcare professionals and services. The research highlights the importance of the terminology and language clinicians employ when working with clients and other professionals, as they may inadvertently disempower or stigmatise. As CDA does not assume equivalence between individuals' accounts and their internal experiences, future research may need to explore the experience of stigmatisation through social networking sites.