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Öğe Effect of Acceptance and Commitment Therapy on Motivation and Adherence to Immunosuppressive Medication in Liver Transplant Recipients: A Randomized Controlled Trial(Wiley, 2025) Saritas, Serdar; Okutan, Serafettin; Saritas, Hasan; Bulbuloglu, SemraBackground: After liver transplantation, recipients continue to receive immunosuppressive drug regimens at varying doses for years to ensure graft function and survival. Although liver transplant recipients are aware of the importance of immunosuppressive drug regimens, treatment compliance may decrease over time due to low motivation, putting recipients at risk of organ rejection. Acceptance and commitment therapy (ACT) appears to be an ideal solution for increasing motivation and, indirectly, treatment compliance. Objective: The aim of this study was to investigate the effect of ACT on adherence to immunosuppressive medication and motivation in liver transplant recipients. Methods: This study was conducted at an organ transplant hospital with the participation of recipients who had completed at least 6 months post-liver transplant. The sample included n = 140 liver transplant recipients (n = 70 experimental, n = 70 control). The study was randomized and controlled. The control group received no intervention, while the experimental group underwent an eight-session ACT program administered by a psychologist. Data collection utilized a personal characteristics form, the Adherence to Immunosuppressive Drug Regimen Scale (AIDRS), the Mindfulness Scale (MS), and the Adult Motivation Scale (AMS). Data analysis was performed using descriptive statistical methods and tests of significance for differences between variables. Findings: According to the homogeneity tests of this study, there was no statistically significant difference between the control and experimental groups in terms of individual characteristics (age, time since transplantation, immunosuppressive drugs, comorbidities, etc.). In the experimental group, the level of adherence to the immunosuppressive drug regimen after ACT was very close to the maximum AIDRS score. In the control group, the level of compliance with the immunosuppressive drug regimen was close to the mean value of the AIDRS. The differences mentioned in both groups were statistically significant (p < 0.05). In addition, the scores obtained from the MS and YMS were higher than those in the pretest. When the experimental and control groups were compared, the experimental group's final test YMS score was almost twice that of the control group, and this difference was statistically significant (p < 0.05). Conclusion: The importance of full compliance with the immunosuppressive drug regimen in improving graft function after liver transplantation is well known. The results of this study showed that liver transplant recipients who underwent ACT demonstrated higher adherence to the immunosuppressive drug regimen due to increased motivation and conscious awareness. We recommend the use of ACT to increase adherence to the immunosuppressive medication due to its effectiveness.Öğe Relation between monocyte to high-density lipoprotein cholesterol ratio and prognosis in recipients after liver transplantation(Elsevier, 2025) Okutan, Serafettin; Saritas, Hasan; Saritas, Serdar; Bulbuloglu, Semra; Gunes, HuseyinBackground The end-stage liver diseases require liver transplantation as the life-saving solution. It is known that monocytes/macrophages and high-density lipoprotein cholesterol (HDLC) have important contributions to the development of hepatic inflammation and oxidative stress before liver transplantation. However, the effect of monocyte/HDL-C ratio (MHR) on clinical progression and outcome in the post-transplant period are not fully understood. Our hypothesis is that the MHR value may be associated with poor vs. good outcomes after liver transplantation. Methods In our retrospective study, we included 464 liver transplant recipients. Patients' data were extracted from electronic and other paper records in our teaching/research hospital. The MHR values and other blood parameters (creatinine, total protein, albumin, etc.) were expressed as a mean and standard deviation, which were analyzed by the Pearson correlation test. The relationship between graft dysfunction and MHR was determined by ROC curve analysis. Results The mean age of liver transplant recipients was 45.8 +/- 13.7 years. Nineteen percent of patients had liver failure due to Alcoholic Fatty Liver Disease (AFLD) and 34.5 % had liver failure due to hepatitis B virus. At the end of 3 months after liver transplantation, 84.5 % of liver transplant recipients were alive, 5.8 % experienced graft rejection and 5.17 % had an infection. There was a statistically significant improvement in total protein, albumin, liver function tests, and serum creatinine values of the survivors (all p < 0.05). The MHR levels were significantly higher in patients who died after transplantation in comparison to those who survived before and after liver transplantation and these differences were statistically significant (p < 0.01). Conclusion The increased MHR values of recipients after liver transplantation correlated with their risk of survival. Furthermore, the MHR value increased with increased MELD score and the number of days of hospitalization and was not affected by gender and age. MHR was higher in patients with chronic diseases. Patients with high MHR before and after transplantation should be monitored more closely in the perioperative period.Öğe The effect of nurses' attitudes towards evidence-based nursing on the level of compliance with isolation measures in nurses caring for liver transplant patients(Wiley, 2025) Gurkan, Kapikiran; Okutan, Serafettin; Aktura, Seher Cevik; Cici, RemziyeObjectiveLiver transplant recipients are at a high risk of infection during the first month. Therefore, it is crucial to implement isolation measures correctly to prevent the spread of nosocomial infections. Evidence-based practices and proper implementation of isolation measures can significantly reduce morbidity and mortality. The study aimed to investigate the impact of nurses' attitudes towards evidence-based nursing on their compliance with isolation measures.MethodsThis is a descriptive study conducted between October 2023 and January 2024, with the participation of 137 nurses working in the organ transplant clinics of a university hospital in Turkey. Data was collected using a participant introduction form, the attitudes towards evidence-based nursing scale, and the compliance with isolation measures scale.ResultsThe mean total score for the scale of attitudes towards evidence-based nursing among nurses was 55.95 +/- 10.43 (15-75). Similarly, the mean total score for the scale of compliance with isolation measures was 71.44 +/- 13.53 (18-90). Both scores were above the middle level. The study found a moderately significant positive correlation between attitudes towards evidence-based nursing and compliance with isolation measures (r: 0.670, p: 0.000). The regression model showed that the attitude towards evidence-based nursing explained 44.9% of the positivity towards isolation measures (R2 = 0.449).ConclusionsThe study found a positive correlation between nurses' positive attitudes towards evidence-based nursing and their compliance with isolation precautions when caring for liver transplant patients. This highlights the significance of evidence-based nursing in patient care and the importance of adhering to isolation measures to prevent nosocomial infections.Öğe The Effect of Virtual Reality Practice and Music on Patients' Pain, Comfort, and Vital Signs After Laparoscopic Abdominal Surgery(Lippincott Williams & Wilkins, 2024) Okutan, Serafettin; Saritas, SerdarAim: This research was conducted to identify the effect of virtual reality and music on patients' pain, comfort, and vital signs after laparoscopic abdominal surgery. Methods: This study was designed as a prospective randomized controlled single-blind clinical trial. The research population consisted of adult patients who underwent laparoscopic abdominal surgery in surgery clinics. The research sample comprised 225 patients who had laparoscopic abdominal surgery. Experimental groups watched virtual reality videos and listened to music, whereas no intervention was administered to the control group. The research data were evaluated with descriptive statistics, the chi 2 test, the Friedman test, the one-way analysis of variance, the Kruskal-Wallis test, and Tukey's and Dunn's post hoc tests. Findings: In the post-test phase after the 2 interventions, the virtual reality and music groups had lower pain and comfort levels than the control group, and this intergroup difference was statistically significant (P<0.05). Results for vital signs in successively repeated post-test measurements after interventions were in general different, and these differences were statistically significant. Patients in the virtual reality group generally had higher pulse rate, diastolic blood pressure, respiratory rate, and body temperature values in successively repeated post-test measurements than patients in other groups (P<0.05). Patients in the control group generally had higher systolic blood pressure and saturation values in successively repeated post-test measurements than patients in other groups (P<0.05). Conclusion: It was discerned that music and the virtual reality practice reduced patients' pain and comfort levels and had positive effects on their vital signs after laparoscopic abdominal surgery.
