Risk of non-AIDS-defining events among HIV-infected patients not yet on antiretroviral therapy.

OBJECTIVES: Certain non-AIDS-related diseases have been associated with immunodeficiency and HIV RNA levels in HIV-infected patients on combination antiretroviral therapy (cART). We aimed to investigate these associations in patients not yet on cART, when potential antiretroviral-drug-related effects are absent and variation in RNA levels is greater. METHODS: Associations between, on the one hand, time-updated CD4 counts and plasma HIV RNA and, on the other hand, a composite non-AIDS-related endpoint, including major cardiovascular diseases, liver fibrosis/cirrhosis, and non-AIDS-related malignancies, were studied with multivariate Poisson regression models in 12 800 patients diagnosed with HIV infection from 1998 onwards while not yet treated with cART. RESULTS: During 18 646 person-years of follow-up, 203 non-AIDS-related events occurred. Compared with a CD4 count ≥ 500 cells/µL, adjusted relative risks (RRs) for the composite endpoint were 4.71 [95% confidence interval (CI) 2.98-7.45] for a CD4 count < 200 cells/µL, 2.06 (95% CI 1.38-3.06) for a CD4 count of 200-349 cells/µL, and 1.19 (95% CI 0.82-1.74) for a CD4 count of 350-499 cells/µL. There was no evidence for an independent association with HIV RNA. Other important covariates were age [RR 1.40 (95% CI 1.31-1.49) per 5 years older], hepatitis B virus coinfection [RR 5.66 (95% CI 3.87-8.28)] and hepatitis C virus coinfection [RR 9.26 (95% CI 6.04-14.2)]. CONCLUSIONS: In persons not yet receiving cART, a more severe degree of immunodeficiency rather than higher HIV RNA levels appears to be associated with an increased risk of our composite non-AIDS-related endpoint. Larger studies are needed to address these associations for individual non-AIDS-related events.

Fighting a losing battle: eating-related distress of men with advanced cancer and their female partners. A mixed-methods study.

BACKGROUND: Anorexia/cachexia is a frequent complication of advanced cancer with poorly understood psychosocial impact or eating-related distress (ERD) on both patients and family members. To assist palliative care practitioners manage this important psychosocial aspect of care, we aimed to discover and describe elements of ERD, focusing on male patients with advanced cancer and their female partners. METHODS: Nineteen male patients and their partners were systematically investigated by (1) focus group interviews and data analysis inspired by Grounded Theory, and (2) a comparative survey with categorical questions. RESULTS: For patients, eating-related distress was characterised by obstruction to eating, poor and capricious appetite, a disconnection of oral intake and ability to gain weight, and continuous efforts to eat. Partners expressed feelings of deep concern, frustration, and insufficiency in their loving and innovative efforts to prepare appealing food. Partners were more concerned about patients' weight loss than patients themselves (P =0.002). Patients felt more pressure to eat from partners than they estimated (P =0.007). CONCLUSION: Anorexia/cachexia of male cancer patients affects the cooking at home, a couple's daily eating routines, and their spousal relationship. Identification of ERD may trigger targeted psychosocial interventions.

Traumatic memories of relatives regarding brain death, request for organ donation and interactions with professionals in the ICU.

Little is known about the memories of relatives after they have been confronted with the brain death of a loved one and the request for organ donation. We conducted this study, guided by Grounded Theory, to explore relatives' experiences, their interactions with health care providers and what influenced their memories. We interviewed 40 relatives (31 consenting to and 9 refusing organ donation) of 33 brain-dead individuals. Relatives described their experiences as a difficult process composed of several stages spanning from the initial encounter to the final decision about donation. Long-term memories of bereaved relatives were influenced by the characteristics of their decision-making style (clear vs. ambivalent) and the perceived quality of the interaction with professionals on the intensive care unit. Organ-focused behavior of professionals and an ambivalent decision-making style of relatives appear to be risk factors for traumatic memories.

[Nursing science courses at the University of Basel/Switzerland. Concept, guidelines, curriculum and evaluation of study results]. / Das Pflegestudium an der Universität Basel/Schweiz. Konzeption, Leitlinien, Curriculum und Evaluationsergebnisse.

Since 2000 the University of Basel offers the first Bachelor-Master's education in nursing science in Switzerland. The structure, content, faculty and students of this BSN-MSN curriculum are described. An evaluation study on the basis of quantitative and qualitative data drawn from students (n = 50) and alumni, respectively (n = 15), assesses strengths and weaknesses of this new education.

[Developing and establishing an expanded and more comprehensive HIV/AIDS nursing practice]. / Entwicklung und Etablierung einer erweiterten und vertieften HIV/Aids-Pflegepraxis.

Developing and establishing an advanced nursing practice is an essential step toward future-oriented nursing care. An action research process was initiated to establish advanced nursing practice at the HIV clinic of the outpatient department at the University Hospital Basel with the goal to offer advanced nursing care to patients. Participatory action research allows generating knowledge about a social system while at the same time tempts to promote social change. The most important goal is to constantly analyse, improve, and evaluate nursing care for patients and family caregivers. Advanced nursing practice in HIV/AIDS is based on solid knowledge regarding the illness and current therapies. Central concepts are caring, clinical experiences, evidence based practice, and patient preferences. Through a systematic step-by-step process, the nurses at the HIV clinic are being better educated and more experienced in these concepts. An essential aspect of advanced nursing practice is the specialization of each nurse in a self selected topic within HIV/AIDS care. These nurses now offer new services such as medication management and adherence support, health maintenance and prevention, and symptom management. This ongoing process of learning while establishing advanced nursing practice in HIV/AIDS, enables the nurses to face future changes in health care in a proactive way.

Emotional and physical demands on caregivers in home care to the elderly in Switzerland and their relationship to nursing home admission.

BACKGROUND: Planning the home care of growing numbers of old, dependent people must include the caregivers' burden. METHODS: A convenience sample of 129 caregivers of elderly patients with multiple diagnoses was interviewed about the caregiving context, burden, caregivers' tolerance of patients' troublesome behaviours and physical symptoms, mutuality and feelings of closeness between caregiver and patient. Continued maintenance of home care was assessed by a follow-up telephone call. RESULTS: Caregivers were mainly spouses (67%) and female (73%), and the mean duration of care was 5.5 years. In five activities of daily living (ADL) 50-69% of the patients needed full help. Caregivers reported predominantly negative effects of caregiving on their physical and mental health, rest and sleep, leisure time and social life, problems with patients' symptoms and behaviours and little or no conversing (51%) or exchanging feelings with patients (71%). PREDICTIVE MODELS: Contributors to variance were for burden (35%), impact of care on caregivers' mental health, social relations and leisure time, patients' gender, accumulation of patients' symptoms and behaviours; for caregivers' tolerance toward patients' symptoms and behaviours (17%) caregivers' physical health, patients' level of confusion, feelings of mutuality; for mutuality (22%) and for closeness (19%) caregivers' mental health, patients' accumulation of symptoms and behaviours. Within 23 months 19% of the patients had been institutionalized. Factors giving a higher likelihood of institutionalization were: being male, caregiver was not a partner, and less closeness between caregiver and patient. CONCLUSION: Caregiving of older persons has bio-psychosocial ramifications for caregivers. Closeness between caregiver and patient seems to be a key factor in determination of the long-term outcome.

[Visions for the future--nursing as a profession in German-speaking Swiss health care]. / Visionen für die Zukunft--Die Pflege als Beruf im Gesundheitswesen der Deutschschweiz.

Social, scholarly, and technical changes and changes in health politics have a lasting influence on the nursing profession. The development of nursing science programs can be seen in this context and institutions, which offer educational programs for nurses, have to orient them toward the new demands of the profession. Up to now in the German-speaking realm, published data, which describe the changes the nursing profession can expect, have not been available, nor have possible future fields of activity of nursing been examined. In order to close this gap, a group of opinion leaders and experts in nursing in German-speaking Switzerland were studied. Eighty-one people were surveyed by means of a questionnaire, and ten people were interviewed in-depth. The results reflect the visions and perspectives of the nursing profession of the future in German-speaking Switzerland. The expectation is that nursing should deal increasingly with sociopolitical changes and that the main issues of nursing with regard to type of client and locations where care is given will change. A re-orientation toward strengthening professional identity is called for in the following areas: involvement in determining and shaping decisions in politics and health politics; taking entrepreneurial initiatives; building clinical practice on caring, patient preferences, and evidence; making professional training and continuing education clinically-oriented as well as the development and the establishment of nursing science. Through a re-orientation, nursing should be better able to meet the challenges, which it faces because of health and social problems in the population. A great discrepancy exists between the expectations for nursing in the future and present reality. The challenge will be to see whether it will be possible to close the gap between visions and reality by means of training, continuing education, and changes in clinical practice.

A randomized trial of in-home visits for disability prevention in community-dwelling older people at low and high risk for nursing home admission.

BACKGROUND: In-home preventive visits with multidimensional geriatric assessments can delay the onset of disabilities in older people. METHODS: This was a stratified randomized trial. There were 791 participants, community-dwelling people in Bern, Switzerland, older than 75 years. The participants' risk status was based on 6 baseline predictors of functional deterioration. The intervention consisted of annual multidimensional assessments and quarterly follow-up in-home visits by 3 public health nurses (nurses A, B, and C), who, in collaboration with geriatricians, evaluated problems, gave recommendations, facilitated adherence with recommendations, and provided health education. Each nurse was responsible for conducting the home visits in 1 ZIP code area. RESULTS: After 3 years, surviving participants at low baseline risk in the intervention group were less dependent in instrumental activities of daily living (ADL) compared with controls (odds ratio, 0.6; 95% confidence interval, 0.3-1.0; P = .04). Among subjects at high baseline risk, there were no favorable intervention effects on ADL and an unfavorable increase in nursing home admissions (P= .02). Despite the similar health status of subjects, nurse C identified fewer problems in the subjects who were visited compared with those assessed by nurses A and B. Subgroup analysis revealed that among low-risk subjects visited by nurses A and B, the intervention had favorable effects on instrumental ADL (P = .005) and basic ADL (P = .009), reduced nursing home admissions (P = .004), and resulted in net cost savings in the third year (US $1403 per person per year). Among low-risk subjects visited by nurse C, the intervention had no favorable effects. CONCLUSIONS: These data suggest that this intervention can reduce disabilities among elderly people at low risk but not among those at high risk for functional impairment, and that these effects are likely related to the home visitor's performance in conducting the visits.

[Psychosocial nursing diagnosis: an interpretative-phenomenological perspective]. / Psychosoziale Pflegediagnostik: Eine interpretativ-phänomenologische Perspektive.

Nursing diagnoses and other nomenclatures of this kind belong to the category of technological knowledge, developed for the sake of domination (Scheler 1974-1928). Nomenclatures can be used as base for the recording of nursing services. However, the body of knowledge represented by nursing diagnoses cannot serve the profession as a foundation for clinical decision making nor as inspiration for professional conversations with patients. Selected psycho-social nursing diagnoses are critiqued by comparing them with the description of a patient's illness experiences.

[Foot reflexology massage: a clinical study]. / Fussreflexzonenmassage: eine Interventionsstudie.

The aim of the study was to investigate the possible usefulness of foot reflexology on the recovery after a surgical intervention. 130 patients participated in the study. They underwent abdominal surgery under full anesthesia for different, but exclusively gynecological reasons. Foot reflexology investigated in this study was applied only for a few days for each patient. The following parameters were recorded: the subjective, self-assessed, general condition, pain intensity, movement of the bowels, micturition and sleep, beginning on the day before operation until day 10. Two other treatments served as controls, a simple massage of the foot or a personal conversation. The simple massage turned out to be a relaxing, positive experience, whereas foot reflexology had various effects, some of them were even negative. The conclusion was that foot reflexology is not recommended for acute, abdominal postsurgical situations in gynecology because it can occasionally trigger abdominal pain. This project is one of the few studies planned, conducted and performed by the nursing staff.

[Foot reflexology: an intervention study]. / Fussreflexzonenmassage. Eine Interventionsstudie.

The study's goal was to test if foot reflexology (FR) affects well-being, voiding, bowel movements, pain and/or sleep in women who underwent an abdominal operation. 130 subjects were randomized into three groups. For five days they were exposed to 15 minutes of FR, foot/leg massage (FM) or talking respectively. Results show that women in the FR group were more able to void without problems, after the indwelling catheter had been removed, than did women in the comparison groups. There was also a tendency in the FR-group for the indwelling catheter to be removed earlier than in the other groups. In comparison, the FR-subjects slept worse than the others. FM showed significant results in subjective measurements of well-being, pain and sleep.