Rebecca Spirig

Stable partnership and progression to AIDS or death in HIV infected patients receiving highly active antiretroviral therapy: Swiss HIV cohort study

Abstract Objectives To explore the association between a stable partnership and clinical outcome in HIV infected patients receiving highly active antiretroviral therapy (HAART). Design Prospective cohort study of adults with HIV (Swiss HIV cohort study). Setting Seven outpatient clinics throughout Switzerland. Participants The 3736 patients in the cohort who started HAART before 2002 (median age 36 years, 29% female, median follow up 3.6 years). Main outcome measures Time to AIDS or death (primary endpoint), death alone, increases in CD4 cell count of at least 50 and 100 above baseline, optimal viral suppression (a viral load below 400 copies/ml), and viral rebound. Results During follow up 2985 (80%) participants reported a stable partnership on at least one occasion. When starting HAART, 52% (545/1042) of participants reported a stable partnership; after five years of follow up 46% (190/412) of participants reported a stable partnership. In an analysis stratified by previous antiretroviral therapy and clinical stage when starting HAART (US Centers for Disease Control and Prevention group A, B, or C), the adjusted hazard ratio for progression to AIDS or death was 0.79 (95% confidence interval 0.63 to 0.98) for participants with a stable partnership compared with those without. Adjusted hazards ratios for other endpoints were 0.59 (0.44 to 0.79) for progression to death, 1.15 (1.06 to 1.24) for an increase in CD4 cells of 100 counts/μl or more, and 1.06 (0.98 to 1.14) for optimal viral suppression. Conclusions A stable partnership is associated with a slower rate of progression to AIDS or death in HIV infected patients receiving HAART.

Symptom Management in HIV/AIDS: Advancing the Conceptualization

For people living with HIV, symptoms related to the disease, comorbidities, and treatment side effects make symptom management essential. Poorly managed symptoms result in reduced medication adherence, disease progression, and lower quality of life. The Self-regulatory HIV/AIDS Symptom Management Model is a conceptual model that describes how persons living with HIV/AIDS manage their symptoms. The model links symptom experience, symptom management, social support, adherence, and health-related quality of life. It can assist nurses, through a multidimensional approach to illness management, to enhance symptom assessment, better understand factors influencing symptom experience, and to improve symptom management among people living with HIV/AIDS.

Outcomes of elderly hip fracture patients in the Swiss healthcare system : a survey prior to the implementation of DRGs and prior to the implementation ofa Geriatric Fracture Centre

UNLABELLED PROBLEM AND QUESTIONS: The consequences for elderly patients with hip fractures are well known. In Switzerland, the introduction of diagnosis related groups (DRG) will bring additional challenges. New models of care, such as Geriatric Fracture Centres (GFC), may be the key to minimising negative outcomes. This study documents outcomes of hip fracture patients in the Swiss healthcare system, for use as baseline data prior to DRG- and GFC-implementation, and compares them to results reported in the literature, for example by Cooper (1997). METHODS This was a prospective cohort quality assurance survey with a one-year follow-up. Outcomes were mortality, living situation, required support and mobility. All patients 65 years of age or older with a proximal femoral fracture were included. Data were analysed by descriptive and interferential statistics. RESULTS From 272 patients, 70% were community dwelling pre-fracture. Overall, one-year mortality was 22%. Pre-fracture community dwelling patients had better outcomes than nursing home patients with a one-year mortality rate of 12%. A total of 83% of pre-fracture community dwelling patients still lived in the community after one year but more needed help with activities of daily living (ADL) or mobility. Patients with dementia, ADL- and mobility dependency pre-fracture were significantly more at risk for being newly admitted to a nursing home. CONCLUSIONS Our results reflect the clinical reality of the hip fracture population in Switzerland. Results one year after fracture were comparable to study findings in different health care systems. Our findings provide important baseline data prior to the implementation of DRG and GFC.

The unspoken disease: symptom experience in women with vulval neoplasia and surgical treatment : a qualitative study

Women with vulval neoplasia often experience severe post-surgical complications. This study focuses on symptom experience of women during the first 6 months following surgical treatment for vulval neoplasia considering their socio-cultural context. In this qualitative study using a critical hermeneutic approach, narrative interviews were conducted. A purposeful sample of 20 patients was recruited from one Swiss and two German university hospitals. Content analysis was employed to analyse the transcribed interviews considering womens experiences and social perceptions. Narratives showed eight interrelated themes: delayed diagnosis, disclosed disease, disturbed self-image, changed vulva care, experienced wound-related symptoms, evoked emotions, affected interpersonal interactions and feared illness progression. The women experienced a general lack of information pertaining to above themes and all described strategies used to handle their situation, which affected their distress. The communication, assessment and treatment of symptoms were hampered by the societys and the health systems tendency to overlook these symptoms and leave them in the realm of the unspeakable. Health professionals need new strategies to support these women to recognise, assess and evaluate the seriousness of symptoms, and to communicate their symptom experience so that timely medical treatment is sought. This support may minimise potentially preventable complications and symptom-related distress.

Moral distress in nurses at an acute care hospital in Switzerland: Results of a pilot study

Background: In the context of new reimbursement systems like diagnosis-related groups, moral distress is becoming a growing problem for healthcare providers. Moral distress can trigger emotional and physical reactions in nurses and can cause them to withdraw emotionally from patients or can cause them to change their work place. Objective: The aim of this pilot study was to develop an instrument to measure moral distress among acute care nurses in the German-speaking context, to test its applicability, and to obtain initial indications of the instrument’s validity. Method: The study was designed in 2011 as a cross-sectional pilot survey. Conducted on eight units of one university hospital in German-speaking Switzerland, 294 registered nurses were asked to fill out a web-based questionnaire on moral distress. Ethical considerations: The study proposal was approved by the cantonal ethics committee. All participating nurses provided informed consent and were assured of data confidentiality. Results: The survey had a response rate of 55%. The results show the prevalence of statements on the questionnaire indicating situations with the potential to trigger moral distress. The entire range of answers was used in the responses. Most participants found the questionnaire comprehensible, while some criticized the phraseology of certain statements. Many more found the registration process prior to online access to be too time consuming. Nurses confirmed that the results reflect their subjective assessment of their situation and their experience of moral distress. Conclusion: The newly developed moral distress questionnaire appears to produce face validity and is sufficiently applicable for use in our study. The results indicate that moral distress appears to be a relevant phenomenon also in Swiss hospitals and that nurses were experiencing it prior to the introduction of Swiss diagnosis-related groups.

Prinzipien und Methoden einer wissenschaftlich akkuraten Übersetzungspraxis von Instrumenten für Forschung und direkte Pflege

Kulturubergreifende, gultige und zuverlassige Instrumente wie Fragebogen oder Messinstrumente, die auch in der Pflege zunehmend gebraucht werden, sind aufwandig aufzubereiten. Die Ubersetzung von bereits bestehenden, validierten Instrumenten aus einem Sprach- und Kulturraum in einen anderen ist die am haufigsten verwendete Methode um transkulturelle Instrumente zu entwickeln. Diese Vorgehensweise ist jedoch mit vielen Herausforderungen verbunden, da die Ubersetzung und kulturelle Anpassung eines Instruments eine Vertrautheit mit den grundlegenden Problemen linguistischer Adaptation, den kulturellen Konzepten und den psychometrischen Veranderungen aufgrund des Ubersetzungsprozesses verlangt. Die Qualitat der Daten aus ubersetzten Instrumenten ist jedoch von einem akkuraten Ubersetzungsprozess abhangig. Der vorliegende Artikel hat zum Ziel, verschiedene Methoden, die fur Ubersetzungsprozesse von Instrumenten in andere Kultur- und Sprachraume verwendet werden, vorzustellen und anhand eines Anwendungsbeispiel...

A before and after study of a nurse led comprehensive delirium management programme (DemDel) for older acute care inpatients with cognitive impairment

BACKGROUND Studies estimate that approximately one-third of episodes of delirium are preventable and that delirium prevention and management are often suboptimal in practice. While there is no doubt that prevention is desirable, the evidence of the benefits of early intervention and treatment for older hospitalised patients with dementia is unclear. AIM To determine the effects of DemDel, a comprehensive delirium management programme, in inpatient acute care elders with cognitive impairment. DESIGN AND METHODS This paper reports the quantitative part of a mixed methods study, comparing an intervention with treatment as usual using validated outcome measures. After training, ward nurses and physicians administered the intervention based on the DemDel algorithm that focused on delirium prevention, including an intensive systematic screening schedule for cognitive impairment and delirium, as well as comprehensive delirium management. The delirium management regimen included timely administration of pro re nata medication. SETTINGS The study was conducted within four medical wards of an acute care university hospital in urban Switzerland. PARTICIPANTS A total of 268 patients with cognitive impairment participated in the pre/post comparison study. The intervention and treatment as usual groups consisted of 138 and 130 patients, respectively. RESULTS Eighty-seven (32.5%) out of 268 patients developed delirium, of whom 51 (58.6%) were of mixed, 10 (11.5%) hyperactive and 26 (29.9%) hypoactive delirium subtypes. Delirium appeared within the first five days after admission in 81.6% of cases. The 44 (31.9%) patients with delirium in the intervention group with systematic delirium management had less severe episodes of delirium and required medication for management than the 43 (33.1%) delirious patients in the control group. Intervention compliance was good on three of the four units. CONCLUSIONS The DemDel programme was effective with regard to improvement of outcomes associated with delirium in patients with cognitive impairment. The intervention was feasible and possible to be embedded within routine practice on four busy general medical wards.

Übersetzungsverfahren eines klinischen Assessmentinstrumentes am Beispiel der Richmond Agitation-Sedation Scale (RASS)

In intensive care units, patients are sedated to reduce the stress caused by illness and/or treatments such as artificial respiration. Regular assessment of the degree of sedation as part of the goal-directed therapy has been recommended as a standard of care. The Swiss Society of Intensive Care Medicine requires all accredited Swiss intensive care units to periodically document the degree of sedation by means of a sedation scale as part of the minimal data set (MDSi). The ten-level Richmond Agitation-Sedation Scale (RASS) is one of two proposed scales for the assessment of the degree of sedation. Because validated versions of the recommended sedation scales exist in English only, the RASS was translated by a systematic iterative procedure in six steps. The iterative translation of the RASS for use in Swiss intensive care units described in this article is an example of interdisciplinary teamwork. Translation of clinical assessment tools for clinical use should be carried out as carefully and stringently as the development of research tools. Based on the experience gained in the described project we recommend the following points to consider when translating clinical assessment tools: a) referring to literature not only on the subject of translation but also on the process of translation itself, b) involving professional translators as language experts, and c) consulting the author(s) of the original version.

Screening, Assessment und Diagnostik von Delirien

Ein Delir ist eine akute Verschlechterung der Aufmerksamkeit und Kognition. Fur die Diagnosestellung stehen zwei Klassifikationssysteme zur Verfugung: Das Diagnostische und Statistische Manual Psychischer Storungen (DSM) (American Psychiatric Association, 2000) und die Internationale Klassifikation der Krankheiten (ICD) (World Health Organization, 2006). Wahrend sich die Kernsymptome beider Klassifikationssysteme ahneln, bedarf es fur die Diagnose des Delirs nach ICD-10 zusatzlicher Kriterien: Psychomotorischer Storungen, Storungen des Schlaf-Wach-Zyklus und affektiver Storungen. Daher gilt die Diagnosestellung nach ICD als strengeres Verfahren. In Abhangigkeit der untersuchten Population werden bis zu 60% der Delirien, die mittels DSM-IV Kriterien festgestellt wurden, verpasst. Fur die klinische Praxis stehen zahlreiche Screening- und Assessmentinstrumente zur Verfugung. In der Regel basieren diese auf den DSM-Kriterien. In diesem Beitrag werden zwei Instrumente vorgestellt, welche Pflegefachpersonen im ...

Professionelle Pflege – Entwicklung und Inhalte einer Definition

Die hier vorgestellte Definition professioneller Pflege wurde von Mitarbeiterinnen des Instituts fur Pflegewissenschaft der Universitat Basel in Zusammenarbeit mit der Expertengruppe des Projektes «Zukunft Medizin Schweiz» der Schweizerischen Akademie der Medizinischen Wissenschaften entwickelt. Ausgangspunkt waren bestehende Definitionen und eine Liste erwunschter Inhalte. Mittels Ansatzen der Grounded Theory wurden mogliche Inhalte bearbeitet und ein erster Entwurf geschrieben. In mehreren Feedback-Runden wurde dieser zur jetzt vorliegenden Definition verfeinert. Professionelle Pflege wird in zwei Kernsatzen definiert. Inhaltlich geht es um das Fordern und Erhalten von Gesundheit, das Vorbeugen von gesundheitlichen Schaden und das Unterstutzen von Menschen in der Behandlung und im Umgang mit Auswirkungen von Krankheiten und deren Therapien. Ziel sind bestmogliche Behandlungs- und Betreuungsergebnisse sowie eine bestmogliche Lebensqualitat in allen Phasen des Lebens bis zum Tod fur die betreuten Menschen...