A model for managing quality control for a network of clinical chemistry instruments measuring the same analyte.

OBJECTIVES: Monitoring quality control for a laboratory or network with multiple instruments measuring the same analyte is challenging. We present a retrospective assessment of a method to detect medically significant out-of-control error conditions across a group of instruments measuring the same analyte. The purpose of the model was to ensure that results from any of several instruments measuring the same analytes in a laboratory or a network of laboratories provide comparable results and reduce patient risk. Limited literature has described how to manage QC in these very common situations. METHODS: Single Levey-Jennings control charts were designed using peer group target mean and control limits for five common clinical chemistry analytes in a network of eight analyzers in two different geographical sites. The QC rules used were 13s/22s/R4s, with the mean being a peer group mean derived from a large population of the same instrument and the same QC batch mean and a group CV. The peer group data used to set the target means and limits were from a quality assurance program supplied by the instrument supplier. Both statistical and clinical assessments of significance were used to evaluate QC failure. Instrument bias was continually monitored. RESULTS: It was demonstrated that the biases of each instrument were not statistically or clinically different compared to the peer group's average over six months from February 2023 until July 2023. Over this period, the error rate determined by the QC model was consistent with statistical expectations for the 13s/22s/R4s rule. There were no external quality assurance failures, and no detected error exceeded the TEa (medical impact). Thus, the combined statistical/clinical assessment reduced unnecessary recalibrations and the need to amend results. CONCLUSIONS: This paper describes the successful implementation of a quality control model for monitoring a network of instruments, measuring the same analytes and using externally provided quality control targets. The model continually assesses individual instrument bias and imprecision while ensuring all instruments in the network meet clinical goals for quality. The focus of this approach is on detecting medically significant out-of-control error conditions.

'Thank you for loving me': A qualitative study on perceptions of gratitude and their effects in palliative care patients and relatives.

BACKGROUND: Empirical studies suggest that gratitude positively influence the quality of life of palliative patients and relatives. However, the literature is marked by a lack of conceptual clarity about what gratitude is and whether it can bring about individual and social benefits. AIM: This paper explores how palliative care patients and relatives understand gratitude, how discursive representations of gratitude may affect their positions, perceptions and relations, and how to conceptualise gratitude in the palliative context. DESIGN: We examine 33 gratitude letters written by patients and relatives and 25 semi-structured interviews conducted as part of a pilot gratitude intervention study. We use a qualitative approach, thematic analysis, within a conceptual framework of discourse analysis. SETTINGS/PARTICIPANTS: Data were collected from 23 patients and 13 relatives recruited through three hospital palliative care services in French-speaking Switzerland. RESULTS: Participants articulate gratitude in five ways: (1) appreciating others; (2) love; (3) need to reciprocate; (4) appreciating the little things; (5) solace amid serious illness. While some of these representations are sources of positive emotions and outlook, wellbeing and hope, others may confirm self-perceptions of powerlessness and burden. These results support a tridimensional conceptualisation of gratitude in palliative care as source of individual benefits, valuing closest relationships and moral obligation. CONCLUSION: Our study suggests that gratitude is a key to a good (end of) life, whilst highlighting potential negative effects. It could help healthcare professionals to better understand what gratitude means to patients and relatives, which may facilitate awareness and fostering of gratitude in palliative care.

Patient altruism at the end of life: A scoping review.

OBJECTIVES: The concept of altruism is evidenced in various disciplines but remains understudied in end-of-life (EOL) contexts. Patients at the EOL are often seen as passive recipients of care, whereas the altruism of professionals and families receives more research and clinical attention. Our aim was to summarize the state of the scientific literature concerning the concept of patient altruism in EOL contexts. METHODS: In May 2023, we searched 11 databases for scientific literature on patient altruism in EOL contexts in consultation with a health information specialist. The scoping review is reported using the PRISMA checklist for scoping reviews. We used a data charting form to deductively extract data from the selected articles and then mapped data into 4 themes related to our research questions: how authors describe and employ the concept of patient altruism; expressions of patient altruism; consequences of patients' altruistic acts; and possible interventions fostering patient altruism. RESULTS: Excluding duplicates, 2893 articles were retrieved; 33 were included in the final review. Altruism was generally considered as an act or intention oriented toward the benefit of a specific (known) or non-specific (generic) recipient. Patients expressed altruism through care and support, decisions to withhold treatment or actively hasten death, and engagement in advance care planning. Consequences of altruism were categorized in patient-centered (contribution to meaning in life and quality of life), non-patient-centered (leaving a positive impact and saving money), and negative consequences (generating feelings of guilt, exposing individuals with low self-esteem). Interventions to encourage altruism comprised specific interventions, providing opportunities to plan for future care, and recognizing and respecting the patients' altruistic motivations. SIGNIFICANCE OF RESULTS: We identified heterogeneous and limited research conceptualization of patient altruism and its operationalization in palliative care settings. A deeper conceptual, empirical, and theoretical exploration of patient altruism in EOL is necessary.

Giving and receiving thanks: a mixed methods pilot study of a gratitude intervention for palliative patients and their carers.

BACKGROUND: Psychological research examining the nature and workings of gratitude has burgeoned over the past two decades. However, few studies have considered gratitude in the palliative care context. Based on an exploratory study which found that gratitude was correlated with better quality of life and less psychological distress in palliative patients, we designed and piloted a gratitude intervention where palliative patients and a carer of their choice wrote and shared a gratitude letter with each other. The aims of this study are to establish the feasibility and acceptability of our gratitude intervention and provide a preliminary assessment of its effects. METHODS: This pilot intervention study adopted a mixed-methods, concurrent nested, pre-post evaluation design. To assess the intervention's effects, we employed quantitative questionnaires on quality of life, quality of relationship, psychological distress, and subjective burden, as well as semi-structured interviews. To assess feasibility, we considered patients and carers' eligibility, participation and attrition rates, reasons for refusal to participate, appropriateness of intervention timeframe, modalities of participation, and barriers and facilitators. Acceptability was assessed through post-intervention satisfaction questionnaires. RESULTS: Thirty-nine participants completed the intervention and twenty-nine participated in interviews. We did not find any statistically significant pre/post intervention changes for patients, but found significant decrease in psychological distress for carers in terms of depression (median = 3 at T0, 1.5 at T1, p = .034) and total score (median = 13 at T0, 7.5 at T1, p = .041). Thematic analysis of interviews indicates that overall, the intervention had: (1) multiple positive outcomes for over a third of interviewees, in the form of positive emotional, cognitive, and relational effects; (2) single positive outcomes for nearly half of interviewees, who experienced emotional or cognitive effects; (3) no effect on two patients; and (4) negative emotional effects on two patients. Feasibility and acceptability indicators suggest that the intervention was well received by participants, and that it should adopt flexible modalities (e.g. writing or dictating a gratitude message) to ensure that it is feasible and adapted to individual needs and preferences. CONCLUSIONS: Larger scale deployment and evaluation of the gratitude intervention, including a control group, is warranted in order to have a more reliable evaluation of its effectiveness in palliative care.

"Life goes on": Perspectives on the will to live from residents of Swiss long-term care facilities.

OBJECTIVES: While there is a growing body of literature on the wish to die in older patients, there is little research about their will to live. Exploring the subjective will to live (WTL) offers valuable insights into the patients' resources and motivations, which could help improving geriatric palliative care. The aim of this study was to examine, in long-term care facilities (LTCF), residents' definitions of and factors influencing their WTL. METHODS: Twenty residents (mean age 85.8 ± 10.3 years, 70% women) of 3 Swiss LTCFs gave informed consent and participated in semi-structured interviews about their WTL. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was conducted to identify recurrent themes (40% double coded). RESULTS: The majority of residents reported that they had not thought about the WTL. Nevertheless, they had no difficulty in describing it as innate in their lives. They spontaneously mentioned factors that contributed to their WTL, classified into 5 themes: (1) relationships - primarily with family and health professionals, secondarily with other residents; (2) living situation - the LTCF as a necessary place providing care, constant professional presence, and security, yet necessitates inconveniences such as loss of independence; (3) personality factors - positive outlook on life or spirituality; (4) engagement in routines - organized activities and individual daily routines; and (5) health status - primarily related to functional health. SIGNIFICANCE OF RESULTS: Examining WTL provides important insights into elements that are essential to take into account in planning care and promoting well-being in LTCF residents. The themes identified provide important starting points for improving life in LTCFs.

Shennong: A Python toolbox for audio speech features extraction.

We introduce Shennong, a Python toolbox and command-line utility for audio speech features extraction. It implements a wide range of well-established state-of-the-art algorithms: spectro-temporal filters such as Mel-Frequency Cepstral Filterbank or Predictive Linear Filters, pre-trained neural networks, pitch estimators, speaker normalization methods, and post-processing algorithms. Shennong is an open source, reliable and extensible framework built on top of the popular Kaldi speech processing library. The Python implementation makes it easy to use by non-technical users and integrates with third-party speech modeling and machine learning tools from the Python ecosystem. This paper describes the Shennong software architecture, its core components, and implemented algorithms. Then, three applications illustrate its use. We first present a benchmark of speech features extraction algorithms available in Shennong on a phone discrimination task. We then analyze the performances of a speaker normalization model as a function of the speech duration used for training. We finally compare pitch estimation algorithms on speech under various noise conditions.

Pain Interventions for people with dementia: a quasi-experimental study.

BACKGROUND: Due to the complexity of the provision of care for people with dementia, pain assessment and management is still considered to be lacking. An optimal way to support frontline staff in providing pain assessment and management for people with dementia living in nursing homes has not yet been identified. The success of supporting interventions seems dependent on contextual factors in the nursing homes. This study, therefore, analyzes the feasibility of a nurse-led training intervention, using repeated on-site case studies, in modifying pain intensity and frequency in people with dementia. METHODS: Using a quasi-experimental design, we undertook a multi-center study of nurse-led training in pain management, with subsequent on-site case studies. Healthcare workers from 3 nursing homes assessed pain in 164 residents with dementia over 147 days. We used mixed-effect growth curve models with spline regression to analyze the data. RESULTS: We found that on-site case studies support frontline staff with pain management and assessment. Repeated reflection in case studies led to significantly longer pain free intervals (from 4.7 at baseline to 37.1 days at second follow-up) and decreased frequency of pain events (OR 0.54 at first follow-up and 0.43 at second follow-up). However no trends regarding pain intensity could be found. Therefore, on-site case studies may be valuable for improving pain frequency and pain-free intervals over time. CONCLUSION: This feasibility study shows the potential of on-site support for frontline nursing home staff. On-site case studies may also affect health outcomes in people with dementia. However, the complexity of dementia care necessitates the management of a broader range of needs. TRIAL REGISTRATION: The study was retrospectively registered on the tenth of January 2017 with the German registry of clinical trials (DRKS00009726).

Posttraumatic growth in palliative care patients and its associations with psychological distress and quality of life.

OBJECTIVES: Posttraumatic growth (PTG) refers to positive psychological changes resulting from individuals' inner struggles with traumatic events such as life-threatening illness. Although palliative care patients are confronted with their own mortality, little is known about their PTG experience. This study investigates whether PTG is an empirically relevant concept for palliative patients by assessing the prevalence and areas of growth, and examining associations with psychological distress and quality of life. METHODS: Participants were recruited in Switzerland. Using validated questionnaires, we assessed PTG (Posttraumatic Growth Inventory, PTGI), psychological distress (Hospital Anxiety and Depression Scale), and quality of life (McGill-Quality of Life Questionnaire - Revised). We performed descriptive analyses, Spearman correlations, and linear regressions. RESULTS: Fifty-five patients completed the PTGI, 44% of whom experienced no/low growth, 47% moderate growth, and 9% high/very high growth. Participants experienced the greatest positive changes in terms of appreciating life and relating to others. We found significant negative bivariate correlations between PTG and psychological distress (r = -0.33) and between PTG and depression (r = -0.47). Linear regressions showed that PTG is associated with depression (ß = -0.468; p = 0.000), but not with anxiety or quality of life (adjusted R2 = 0.219). SIGNIFICANCE OF RESULTS: Over half of our patients experienced moderate to very high growth, indicating that PTG is an empirically relevant psychological process in palliative care. PTG is associated with lower levels of depression, possibly as those experiencing growth are more able to process past traumas and build a more positive outlook on one's life and self. By contrast, the relative independence of anxiety and PTG points to the likely coexistence of positive and negative psychological responses to trauma. The lack of association between PTG and quality of life points to the uniqueness of the PTG concept in capturing how people access deeper meaning and greater appreciation of life along the path toward posttraumatic self-reconstruction.

[Identifying patients in need of general or specialised palliative care with ID-PALL]. / Identifier les patients nécessitant des soins palliatifs généraux ou spécialisés grâce à ID-PALL.

Palliative care is frequently associated with end of life and cancer, both in the general population and among healthcare professionals. ID-PALL is a new, short, easy-to-use instrument to help professionals to identify general or specialized palliative care needs in adult inpatients in different care settings. ID-PALL has already been validated in internal medicine units. ID-PALL should help professionals to discuss a suitable palliative care project, in order to maintain the best quality of life for patients and their relatives, and to involve palliative care specialists at the appropriate time. Recommendations for clinical practice are also proposed to guide professionals after the identification phase.

Que ce soit dans la population ou chez les professionnels de la santé, les soins palliatifs sont fréquemment associés à la fin de vie et au cancer. ID-PALL est un nouvel instrument court, facile d'utilisation, pour aider les professionnels à identifier les besoins de soins palliatifs généraux ou spécialisés chez les patients adultes hospitalisés dans les différents milieux de soins et déjà validé en médecine interne. ID-PALL devrait aider les professionnels à se mettre en discussion autour d'un projet de soins palliatifs adapté, afin de maintenir la meilleure qualité de vie possible pour les patients et leurs proches et également permettre d'appeler les spécialistes de soins palliatifs au moment opportun. Des recommandations pour la pratique clinique sont également proposées pour orienter les professionnels après la phase d'identification.

Characterisation of vaccine breakthrough infections of SARS-CoV-2 Delta and Alpha variants and within-host viral load dynamics in the community, France, June to July 2021.

We compared PCR results from SARS-CoV-2-positive patients tested in the community in France from 14 June to 30 July 2021. In asymptomatic individuals, Cq values were significantly higher in fully vaccinated than non-fully vaccinated individuals (effect size: 1.7; 95% CI: 1-2.3; p < 10-6). In symptomatic individuals and controlling for time since symptoms, the difference vanished (p = 0.26). Infections with the Delta variant had lower Cq values at symptom onset than with Alpha (effect size: -3.32; 95% CI: -4.38 to -2.25; p < 10-6).

Life worth living: cross-sectional study on the prevalence and determinants of the wish to die in elderly patients hospitalized in an internal medicine ward.

BACKGROUND: Elderly people frequently express the wish to die: this ranges from a simple wish for a natural death to a more explicit request for death. The frequency of the wish to die and its associated factors have not been assessed in acute hospitalization settings. This study aimed to investigate the prevalence and determinants of the wish to die in elderly (≥65 years) patients hospitalized in an internal medicine ward. METHODS: This cross-sectional study was conducted between 1 May, 2018, and 30 April, 2019, in an acute care internal medicine ward in a Swiss university hospital. Participants were a consecutive sample of 232 patients (44.8% women, 79.3 ± 8.1 years) with no cognitive impairment. Wish to die was assessed using the Schedule of Attitudes toward Hastened Death-senior and the Categories of Attitudes toward Death Occurrence scales. RESULTS: Prevalence of the wish to die was 8.6% (95% confidence interval [CI]: 5.3-13.0). Bivariate analysis showed that patients expressing the wish to die were older (P = .014), had a lower quality of life (P < .001), and showed more depressive symptoms (P = .044). Multivariable analysis showed that increased age was positively (odds ratio [OR] for a 5-year increase: 1.43, 95% CI 0.99-2.04, P = .048) and quality of life negatively (OR: 0.54, 95% CI 0.39-0.75, P < 0.001) associated with the likelihood of wishing to die. Participants did not experience stress during the interview. CONCLUSIONS: Prevalence of the wish to die among elderly patients admitted to an acute hospital setting is low, but highly relevant for clinical practice. Older age increases and better quality of life decreases the likelihood of wishing to die. Discussion of death appears to be well tolerated by patients.

IDentification of patients in need of general and specialised PALLiative care (ID-PALL©): item generation, content and face validity of a new interprofessional screening instrument.

BACKGROUND: Early identification of patients requiring palliative care is a major public health concern. A growing number of instruments exist to help professionals to identify these patients, however, thus far, none have been thoroughly assessed for criterion validity. In addition, no currently available instruments differentiate between patients in need of general vs. specialised palliative care, and most are primarily intended for use by physicians. This study aims to develop and rigorously validate a new interprofessional instrument allowing identification of patients in need of general vs specialised palliative care. METHODS: The instrument development involved four steps: i) literature review to determine the concept to measure; ii) generation of a set of items; iii) review of the initial set of items by experts to establish the content validity; iv) administration of the items to a sample of the target population to establish face validity. We conducted a Delphi process with experts in palliative care to accomplish step 3 and sent a questionnaire to nurses and physicians non-specialised in palliative care to complete step 4. The study was conducted in the French and Italian-speaking regions of Switzerland. An interdisciplinary committee of clinical experts supervised all steps. RESULTS: The literature review confirmed the necessity of distinguishing between general and specialised palliative care needs and of adapting clinical recommendations to these different needs. Thirty-six nurses and physicians participated in the Delphi process and 28 were involved in the face validity assessment. The Delphi process resulted in two lists: a 7-item list to identify patients in need of general PC and an 8-item list to identify specialised PC needs. The content and face validity were deemed to be acceptable by both the expert and target populations. CONCLUSION: This instrument makes a significant contribution to the identification of patients with palliative care needs as it has been designed to differentiate between general and specialised palliative care needs. Moreover, diagnostic data is not fundamental to the use of the instrument, thus facilitating its use by healthcare professionals other than physicians, in particular nurses. Internal and criterion validity assessments are ongoing and essential before wider dissemination of the instrument.

WordSeg: Standardizing unsupervised word form segmentation from text.

A basic task in first language acquisition likely involves discovering the boundaries between words or morphemes in input where these basic units are not overtly segmented. A number of unsupervised learning algorithms have been proposed in the last 20 years for these purposes, some of which have been implemented computationally, but whose results remain difficult to compare across papers. We created a tool that is open source, enables reproducible results, and encourages cumulative science in this domain. WordSeg has a modular architecture: It combines a set of corpora description routines, multiple algorithms varying in complexity and cognitive assumptions (including several that were not publicly available, or insufficiently documented), and a rich evaluation package. In the paper, we illustrate the use of this package by analyzing a corpus of child-directed speech in various ways, which further allows us to make recommendations for experimental design of follow-up work. Supplementary materials allow readers to reproduce every result in this paper, and detailed online instructions further enable them to go beyond what we have done. Moreover, the system can be installed within container software that ensures a stable and reliable environment. Finally, by virtue of its modular architecture and transparency, WordSeg can work as an open-source platform, to which other researchers can add their own segmentation algorithms.

Challenges in a six-phase process of questionnaire adaptation: findings from the French translation of the Integrated Palliative care Outcome Scale.

BACKGROUND: The Integrated Palliative care Outcome Scale (IPOS) was developed for evaluating essential outcomes for palliative care patients. Our objectives here are to describe the process of a six-phase cross-cultural adaptation of IPOS to French (IPOS-Fr), highlight the difficulties encountered and strategies to solve them, and discuss the implications that adaptation may have on the validity and reliability of a questionnaire. METHODS: The adaptation of IPOS consisted of six phases: (i) literature review and interviews with target population; (ii) forward translation to French; (iii) backward translation to English; (iv) Expert Review; (v) cognitive interviews with target population; (vi) final review. RESULTS: Translation, cognitive interviews, and exchanges with Expert Review members allowed to make changes adapted to the target language regarding item 5 ("vomiting") and 8 ("sore or dry mouth"), and to identify and address, in the original version of IPOS, syntactic inconsistencies in language used in items 11 to 15 and methodological problems with items 11 ("anxiety about treatment and illness"), 15 ("share … as much as you wanted") and 17 ("problems addressed"). The adaptation also indicated that patients might have difficulties in interpreting items 8 ("sore or dry mouth"), 10 ("poor mobility"), 11 ("anxiety"), 12 (projected feelings of family and friends), and 14 ("feeling at peace"), thus indicating the need of monitoring during the psychometric validation. CONCLUSIONS: Following this process, IPOS-Fr has proved content and face validity. In our case, the adaptation allowed adjustments to be made to the questionnaire and, when this was not possible, highlighted potential biases and inconsistencies during the validation. The result relied on an intertwined and iterative process of seeking and reaching semantic, conceptual, and normative equivalence. We are now assessing the psychometrical properties of IPOS-Fr.

Probing Electron-Phonon Interaction through Two-Photon Interference in Resonantly Driven Semiconductor Quantum Dots.

We investigate the temperature dependence of photon coherence properties through two-photon interference (TPI) measurements from a single quantum dot (QD) under resonant excitation. We show that the loss of indistinguishability is related only to the electron-phonon coupling and is not affected by spectral diffusion. Through these measurements and a complementary microscopic theory, we identify two independent separate decoherence processes, both of which are associated with phonons. Below 10 K, we find that the relaxation of the vibrational lattice is the dominant contribution to the loss of TPI visibility. This process is non-Markovian in nature and corresponds to real phonon transitions resulting in a broad phonon sideband in the QD emission spectra. Above 10 K, virtual phonon transitions to higher lying excited states in the QD become the dominant dephasing mechanism, this leads to a broadening of the zero phonon line, and a corresponding rapid decay in the visibility. The microscopic theory we develop provides analytic expressions for the dephasing rates for both virtual phonon scattering and non-Markovian lattice relaxation.

[Identification of palliative care patients :issues and screening tools]. / Identification des patients palliatifs : enjeux et outils de dépistage.

From a health care perspective, and in order to improve the quality of care, early identification of palliative patients is a necessary step for the development of palliative care. Unfortunately, this early identification is still sub-optimal, resulting in a delayed introduction of palliative care in the patients' health care pathway. Although several tools exist to support health care professionals in this endeavour, their level of validity is incomplete, and they do not distinguish between patients in need of general versus specialised palliative care. A new tool which strives to better answer these criteria is presently being developed and validated at the CHUV.

Dans une perspective de santé publique et dans le but d'améliorer la qualité des soins, le développement des soins palliatifs passe par l'identification précoce des patients nécessitant ce type d'accompagnement. Celle-ci reste pourtant encore suboptimale, avec comme conséquence une mise en œuvre trop tardive des soins palliatifs dans la trajectoire de maladie des personnes. Différents outils existent pour soutenir les professionnels dans cette pratique même si ceux-ci ont encore un niveau de validité incomplet et ne permettent pas de distinguer les patients nécessitant des soins palliatifs généraux versus spécialisés. Un outil qui répond mieux à ces critères est en phase de développement et de validation au CHUV.

[Text messaging and self-care support of hypertensive patients : first achievements]. / Text messaging et accompagnement des patients hypertendus : premiers acquis.

Text messaging applied to self-care support of hypertensive patients is a new e-health tool available via mobile phones and computers. First validated programs are just emerging. Without being a panacea intended to replace the doctors by machines they could be provide a significant reinforcement of the patient's empowerment for self-monitoring. It is now time to begin their evaluation in real life and in primary care setting.

La technique du text messaging appliquée au suivi des patients hypertendus est un nouvel outil de prise en charge accessible aux patients et consommateurs de soins via les téléphones portables et les ordinateurs. Les premiers programmes validés se font jour. Sans être une panacée destinée à remplacer les médecins par des machines, cette technique pourrait être à l'origine d'un renforcement notable de l'autonomie des patients souhaitant assurer activement leur propre suivi. Il est temps de débuter l'évaluation du text messaging en vie réelle et notamment en pratique de soins primaires.

[Assessment of the impact of a palliative care support team in a tertiary hospital]. / Evaluation de l'impact d'une équipe mobile palliative intrahospitalière dans un hôpital tertiaire.

This study aimed to measure the effectiveness of the interventions of a palliative care support team in a tertiary hospital. It used a pre-post design and included 41 patients. The results show a significant improvement of the quality of palliative care as well as a significant reduction in the intensity and in the number of moderate to severe symptoms. The importance of a palliative care support team in a tertiary hospital is confirmed by our results. Its interventions appear to respond to the growing need for specialized palliative care, particularly in patients with complex clinical problems.

Cette étude avait pour objectif de mesurer l'efficacité des interventions d'une équipe palliative intrahospitalière d'un hôpital tertiaire. Elle a été menée selon un design pré-post-intervention auprès de 41 patients. Elle a montré une amélioration significative de la qualité de la prise en charge palliative et une diminution significative de l'intensité ainsi que du nombre de symptômes moyens à sévères. Nos résultats démontrent la pertinence des interventions d'une équipe palliative intrahospitalière dans un hôpital tertiaire. Ces interventions semblent ainsi répondre aux besoins croissants de soins palliatifs spécifiques s'adressant principalement à des patients présentant des problématiques cliniques complexes.

Meaning in life and perceived quality of life in Switzerland: results of a representative survey in the German, French and Italian regions.

BACKGROUND: The concept of meaning in life (MIL) has become a central one in recent years, particularly in psycho-oncology and palliative care. The Schedule for Meaning in Life Evaluation (SMILE) has been developed to allow individuals to choose the life areas that they consider to be important for their own MIL. This approach relates to the "World Health Organisation" definition of quality of life (QOL) as an individual's perception of his own position. The aims of this study were (i) to assess MIL in a representative sample of the Swiss population according to the three linguistic regions and (ii) to evaluate whether MIL constitutes a significant determinant of the perceived QOL. METHODS: A telephone survey of the Swiss population, performed by a professional survey company, was conducted between November and December 2013. The interview included the SMILE, perceived QOL (0-10) and health status (1-5), and various sociodemographic variables. In the SMILE, an index of weighting (IOW, 20-100), an index of satisfaction (IOS, 0-100), and a total SMILE index (IOWS, 0-100) are calculated from the areas mentioned by the participants as providing MIL. RESULTS: Among the 6671 telephonic contacts realized, 1015 (15%) participants completed the survey: 405 French, 400 German and 210 Italian participants. "Family" (80.2%), "occupation/work" (51%), and "social relations" (43.3%) were the most cited MIL-relevant categories. Italian participants listed "health" more frequently than German and French participants (50.4% vs 31.5% and 24.8% respectively, χ(2) = 12.229, p = .002). Age, gender, education, employment, and marital status significantly influenced either the MIL scores or the MIL-relevant categories. Linear regression analyses indicate that 24.3% of the QOL variance (p = .000) is explained by health status (B = .609, IC = .490-.728, p = .000), MIL (B = .034, IC = .028-.041, p = .000) and socioeconomic status (F = 11.01, p = .000). CONCLUSION: The major finding of our analysis highlights the positive and significant influence of MIL on the perceived QOL in a representative sample of a general, multilingual and multicultural population. This result indicates that the existential dimension is not only determinant for QOL in some critical life events, as shown e.g. in psycho-oncology and palliative care, but also in everyday life.