Effect of a Bladder Control Self-Management Program Delivered Through a Health Kiosk.

PURPOSE: The purpose of this study was to examine the feasibility of delivering a bladder control self-management program through a multiuser health kiosk and to evaluate the program's effect on urinary incontinence (UI) and incontinence-specific quality of life (QoL). DESIGN: Secondary analysis of data collected during participants' interactions with the Bladder Control Module (BCM) from the parent study. SUBJECTS AND SETTING: One hundred eleven participants from the parent study were eligible to be included in this secondary analysis. Their mean age was 72.8 years, and most were female (n = 95, 85.6%); 81 (75.7%) identified themselves as Caucasian. Each participant could access the BCM at a health kiosk situated at one of several sites: senior centers, subsidized senior housing, retirement communities, and a public library. METHODS: The BCM comprised 6 sessions self-administered at least 1 week apart. The content focused on lifestyle modification, pelvic floor muscle training, and bladder (habit) retraining, with encouragement of behavioral self-monitoring between sessions. The feasibility of delivering the intervention was measured by the proportion of participants completing each session. The effect of the BCM on incontinence episodes and incontinence-specific QoL was measured, respectively, by a 7-day bladder diary and the Incontinence Impact Questionnaire Short Form. RESULTS: Sixty-one of the 111 eligible participants accessed the BCM. Participants recording incontinence episodes in their baseline bladder diary and completing at least 3 BCM sessions experienced significant decreases in median total UI (P = .01), urge UI (P < .001), and stress UI (P = .02) episodes per day. Incontinence-related QoL significantly improved (P = .03). CONCLUSIONS: Our findings support the potential effectiveness of providing community-based, kiosk-enabled access to a conservative behavioral intervention designed to improve incontinence-related outcomes among older adults with UI. Additional research with a larger sample is warranted.

Impact of lifestyle-based interventions on absolute cardiovascular disease risk: a systematic review and meta-analysis.

OBJECTIVE: The objective of the review was to synthesize the evidence of the effectiveness of lifestyle-based interventions for mitigating absolute cardiovascular disease (CVD) risk. INTRODUCTION: Evidence-based guidelines recommend employing an absolute CVD risk score to inform the selection and intensity of preventive interventions. However, studies employing this strategy have reported mixed results, hence the need for a systematic review of the current evidence. INCLUSION CRITERIA: Studies published in English that included a lifestyle-based intervention to mitigate CVD risk were considered. Studies were eligible if they enrolled individuals aged ≥18 years, with no history of CVD at baseline. The primary outcome was change in absolute CVD risk score post-intervention. METHODS: PubMed, Embase, and CINAHL searches were conducted from database inception to February 2022. The trial registers searched included Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov. Searches for unpublished studies/gray literature were conducted in ProQuest Dissertations and Theses Global, GreyLit Report, and OCLC First Search Proceedings. Two independent reviewers selected the studies and critically appraised them for methodological quality using JBI tools. Data extraction was performed for main outcome variables. Data were presented using separate pooled statistical meta-analysis for quasi-experimental and randomized clinical trials. Random effects models were employed in the analyses. Effect sizes (Cohen's d) were expressed as standardized mean difference at 95% CI. Heterogeneity was assessed via Cochran's Q statistic, and the inconsistency index ( I2 ) was used to describe variability in effect estimates due to heterogeneity rather than sampling error. RESULTS: Twenty-nine studies with a total sample of 5490 adults with no CVD at baseline were included. Fifteen were randomized controlled trials (RCTs; n=3605) and 14 were quasi-experimental studies (n=1885). The studies were conducted in Europe (n=18), the United States (n = 5), Asia (n=3), Mexico (n=1), Canada (n = 1), and Australia (n=1) and included the following lifestyle interventions: diet, physical activity, motivational interviewing, problem-solving, psychological counseling, cardiovascular risk assessment and feedback, health self-management education, and peer support. Six validated absolute CVD risk assessment tools were used to measure the study outcomes, including Framingham, SCORE, Heart Health Risk Assessment Score, Dundee, ASSIGN, and The UK Prospective Diabetes Study risk score. Overall, the methodological rigor of the RCTs and quasi-experimental studies was high. Of the 15 RCTs included in the meta-analysis, lifestyle intervention was favored over control in reducing absolute CVD risk score (Cohen's d = -0.39; P =0.032; Z= -2.14; I2 = 96). Similarly, in the 14 quasi-experimental studies, the absolute CVD risk score after lifestyle intervention was significantly lower compared to baseline (Cohen's d = -0.39; P <0.001; Z= -3.54; I2= 88). RCTs that combined diet and physical activity reported no significant impact on absolute CVD risk score, but those that used either intervention independently reported significant improvement in the absolute CVD risk score. CONCLUSIONS: There is evidence supporting the positive impact of lifestyle modification on absolute CVD risk score in adult populations without CVD. Our analysis further suggests that diet and physical activity had significant impact on absolute CVD risk, and a variety of validated screening tools can be used to monitor, evaluate, and communicate changes in absolute risk score after lifestyle modification. SUPPLEMENTAL DIGITAL CONTENT: A Spanish-language version of the abstract of this review is available [ http://links.lww.com/SRX/A29 ].

Exploring group differences in the response to a sexual risk reduction intervention to prevent hepatitis C virus reinfection in HIV-infected MSM: a mixed-methods study.

To prevent hepatitis C virus (HCV) reinfection, within the Swiss HCVree Trial, a preventive risk reduction intervention was implemented alongside curative treatment. Formative qualitative research identified three response patterns to the intervention. This mixed-methods study's aim was to cross-validate group differences in (a) the content of sexual risk reduction goals set during intervention and (b) the extent of their behavioural change in condomless anal intercourse with non-steady partners (nsCAI), sexualised and intravenous drug use at start and six-month post-intervention. Qualitative thematic analysis was used to summarise goal setting domains. Quantitative descriptive analysis was used to evaluate group differences based on assumptions of the group descriptions. Results largely confirmed assumptions on inter-group response differences in goal setting and behaviour: as expected group 1 Avoid risks showed the lowest HCV risk profile with changes in nsCAI. Group 2 Minimize-risks and Group 3 Accept-risks showed unchanged nsCAI. Group 3 had the highest HCV risk profile. Differences in their goal preferences (1: condom use; 2 reduction blood exposure; 3 safer dating) highlight diversity in attitudes to behavioural change. Our results improve understanding of variability in intervention responses such as changes in attitudes and behaviour. This provides evidence for intervention tailoring and outcome measurement.

A Scoping Literature Review on Patient Education in Intermittent Catheterization.

PURPOSE: To summarize evidence related to (1) research studies examining patient/caregiver educational interventions related to intermittent self/caregiver catheterization (ISC), (2) studies examining issues related to teaching ISC, and (3) evidence-based clinical practice guidelines addressing ISC. PROBLEM: Avoiding lower urinary tract trauma during catheter insertion, adequate frequency of catheterization, and complete emptying of the bladder are essential to prevent and reduce complications associated with ISC. Consequently, proper patient/caregiver education is essential to achieving good outcomes. METHODS: Scoping review of literature. SEARCH STRATEGY: We searched PubMed, EMBASE, and CINAHL databases, and the reference lists of background and included studies for quantitative and qualitative research studies and professional and healthcare organization-generated evidence-based clinical practice guidelines published between 2005 and September 2021. Eleven studies and 2 clinical practice guidelines met our eligibility criteria and are included in the review. FINDINGS: Research conducted in the United States examining the effectiveness of educational interventions for patients needing ongoing ISC is extremely limited. The single study identified was a small pilot feasibility study. Eight studies examining issues potentially related to patient/caregiver ISC education were identified, suggesting that catheter characteristics, patient barriers, and complications, particularly urinary tract infections, adherence, and upper extremity function, are important considerations when developing education interventions. The small number of studies and limitations in the methodologies limit the current evidence base to support patient/caregiver education about ISC. We also identified 2 evidence-based guidelines generated by European professional organizations that included recommendations related to ISC education. CONCLUSIONS: Additional research is needed to support the development of patient/caregiver educational interventions and to examine their effectiveness.

Patient Education in Intermittent Catheterization: A Consensus Conference.

Despite recent advances in intermittent catheter features, evidence guiding how to best educate patients when beginning and continuing a program of intermittent catheterization remains sparse. To address this gap and guide best practice, a scoping review was conducted and a consensus panel of clinicians and researchers with expertise in intermittent catheterization was convened in person during December 2022 in Austin, Texas, to develop evidence and consensus-based statements guiding instruction of patients beginning intermittent self or assisted catheterization. This article describes the 15 consensus-based statements that can be used to guide best practice in patient education on intermittent catheterization.

Shift work organization on nurse injuries: A scoping review.

BACKGROUND: Extended work hours and shift work can result in mistimed sleep, excessive sleepiness, and fatigue, which affects concentration and cognition. Impaired concentration and cognition negatively affect employee safety. OBJECTIVE: To examine the evidence of the impact of shift work organization, specifically work hours and scheduling, on nurse injuries including needlestick and sharps injuries, drowsy driving and motor vehicle crashes, and work-related accidents causing a near miss or actual injury to the nurse. METHODS: A scoping review was conducted using search results from five bibliographic databases. RESULTS: Through database searching, 7788 articles were identified. During the title and abstract screening, 5475 articles were excluded. Full text screening eliminated 1971 articles. During the data extraction phase, 206 articles were excluded leaving 34 articles from 14 countries in the scoping review. The results of the review suggest a strong association in nurses between long work hours and overtime and an increased risk for needlestick and sharps injuries, drowsy driving and motor vehicle crashes, and other work-related accidents. Rotating shifts increase the risk for needlestick and sharps injuries and other work-related accidents while night and rotating shifts increase the risk for drowsy driving and motor vehicle crashes. CONCLUSIONS: Proper management of work hours and scheduling is essential to maximize recovery time and reduce or prevent nurse injuries. Nurse leaders, administrators, and managers, have a responsibility to create a culture of safety. This begins with safe scheduling practices, closely monitoring for near miss and actual nurse injuries, and implementing evidence-based practice strategies to reduce these occurrences.

Response to a sexual risk reduction intervention provided in combination with hepatitis C treatment by HIV/HCV co-infected men who have sex with men: a reflexive thematic analysis.

BACKGROUND: Hepatitis C virus reinfections in HIV-positive men-who-have-sex-with-men (MSM) challenge the effectiveness of antiviral treatment. To fight this problem, an adapted sexual risk reduction intervention was implemented within a hepatitis C treatment trial. Following this, the current study had two aims and describes 1) how the program was received by participants; and 2) their responses to the program regarding sexual risk taking. Based on the participants' input, we hoped to judge the intervention's potential for scale-up. METHODS: Seventeen participants who received the sexual risk reduction intervention in addition to hepatitis C treatment were recruited for semi-structured interviews six to 12 months post-intervention. We evaluated the responses via reflexive thematic analysis and applied the concept of sense-making. RESULTS: Giving hepatitis C a place and living without it again illustrates how participants received the program and how their experiences were altered by the impact of sense-making. Based on their responses, we allocated participants to three groups: 1. Avoid risks: get rid of hepatitis C for life. For these men, hepatitis C remained a life-threatening disease: they actively modified their risk behavior and felt supported by the intervention in maintaining their behavioral changes. 2. Minimize risks: live as long as possible without hepatitis C. In contrast to group 1, these men saw hepatitis C as a manageable disease. The intervention facilitated reflection on risks and how to develop behavioral changes that suited them individually. 3. Accept risks; live with the risk of hepatitis C. These men perceived behavioral changes as much more difficult than "easy" medical treatment. They expected to either undergo repeated rounds of treatment or stay HCV re-infected. CONCLUSION: These results illustrate the diversity of men's responses and their decisions regarding sexual risk behavior after participating in a combination of antiviral treatment and a sexual risk reduction intervention. Two major aspects were identified: 1) Teachable moments, particularly at the time of diagnosis/treatment, could offer an opportunity to develop openness for behavioral change; 2) adapting sexual risk reduction interventions to sense-making patterns could help to improve its effectiveness. Support for reducing infection risk and raising awareness of preventative measures are additional benefits. TRIAL REGISTRATION: Clinical Trial Number: NCT02785666 , 30.05.2016.

Develop and validate family nurse practitioner transition program in Taiwan by using modified Delphi method.

BACKGROUND: Previous studies have shown that family nurse practitioners (FNPs) provide an important contribution to health promotion and disease management in primary care. Nevertheless, the position of FNP does not exist in Taiwan. In Taiwan, the leading cause of most disability and death is diabetes, for which an FNP has great potential to fulfill healthcare needs. Therefore, establishing how to cultivate competent FNPs is an important issue. It is feasible to train current acute care nurse practitioners (NPs) to become FNPs through enrollment in a transition program. OBJECTIVES: The purpose of this study is to develop an FNP transition program, including the necessary competencies and curriculum. DESIGN: A modified Delphi method (use of an expert panel) is used to validate the preliminary curriculum of an FNP transition program. SETTINGS: The Delph method conducted through email and physical meetings. PARTICIPANTS: Four expert panel groups involve in this project with different group has its own mission. Totally, there were 14 experts completed the transition program. METHODS: A modified Delphi method was used to validate the competencies and curriculum. Descriptive data analysis was used to evaluate the target consensus of 80%. RESULTS: This study provided the first FNP transition program design in Taiwan, based on the global literature and a local gap analysis. CONCLUSIONS: Nursing faculty, healthcare delivery system administration leaders, and policymakers can use the curriculum to train current NPs to become competent FNPs to provide optimal quality of care in the community.

Effect of a QI Intervention on Nursing Assistants' Pain Knowledge and Reporting Behavior.

BACKGROUND: Pain among long-term care residents is often underdiagnosed and inadequately treated. We examined the effect of a multimodal intervention on certified nursing assistants' pain recognition knowledge and verbal reporting behavior. Secondarily, we examined pain documentation in a newly established pain log compared with pain verbally reported to nurses and documented in the electronic health record (EHR). DESIGN: Quality improvement project using a pretest-posttest design. SETTING: A skilled nursing and rehabilitation facility in Southwestern Pennsylvania including two long-term care units and one transitional rehabilitation unit. PARTICIPANTS/SUBJECTS: Fifty-six nursing assistants. METHODS: The intervention was a face-to-face educational session with a training video and introduction of a new pain log used to document residents' pain. Pain knowledge was measured before and after the educational intervention. Multiple measures were used to examine nursing assistants' pain reporting. RESULTS: Nursing assistants' pain knowledge improved (p < .001). There was no change in verbal pain reporting behaviors. The percent of pain episodes documented in the electronic health record that were reported to nurses varied by unit type (45% on the long-term care units vs. 100% on the rehabilitation unit) but remained unchanged postintervention. Pain logs were used more often on the rehabilitation than the long-term care units; use was low overall. Nursing assistant reports that nurses provided feedback on their reports of resident pain increased from 45% in week 1 to 75% in week 4. CONCLUSIONS: Although the multimodal intervention improved nursing assistants' pain knowledge and their perceptions of the feedback they received from nurses when they reported pain, it had no effect on certified nursing assistants reporting of pain to nurses (per nurse report).

Interventions Post Catheter Removal (iPCaRe) in the Acute Care Setting: An Evidence- and Consensus-Based Algorithm.

Despite advances in the prevention of catheter-acquired urinary tract infections achieved by programs that include removal of the indwelling urinary catheter at the earliest possible time, evidence guiding bladder and incontinence management strategies following discontinuation of a catheter is sparse. To address this gap and guide best practice, the WOCN Society appointed a Task Force to develop an evidence- and consensus-based algorithm guiding clinical decision-making for effective bladder and incontinence management strategies after indwelling urinary catheter removal. This article describes the design and development of the algorithm, consensus-based statements used to guide best practice in this area, and its content validation.

Current Evidence Related to Intermittent Catheterization: A Scoping Review.

PURPOSE: The purpose was to summarize evidence related to adherence to intermittent catheterization (IC), complication rates, satisfaction with IC, and its effect on health-related quality of life. PROBLEM: Intermittent catheterization is frequently used to manage lower urinary tract dysfunctions including urinary retention and urinary incontinence, but research suggests that care for patients using IC may not always be based on evidence. METHODS: Scoping review. SEARCH STRATEGY: We searched the PubMed, EMBASE, CINAHL databases, and the Cochrane Database for Systematic Reviews to identify studies published between January 2009 and March 2019. Seventy studies met inclusion criteria and were evaluated for adherence, complication rates, satisfaction, and health-related quality in adults and children using IC for bladder management. FINDINGS: Recent research was variable in both quantity and quality. The evidence suggests that (1) most patients can successfully master IC and that functional status is likely the most important predictor of success; (2) adherence to IC probably decreases over time; (3) urinary tract infections (UTIs) are the most common complication of IC and that prophylactic antibiotic therapy may reduce the risk of recurrent UTIs; (4) urinary incontinence is also a common complication; and (5) other complications such as urethral strictures, bladder stones, hematuria, and urethral false passage do occur but are less prevalent than UTIs and incontinence between catheterizations. Our review also revealed multiple gaps in the evidence to support care for patients using IC. CONCLUSIONS: Research priorities include a need for prospective studies of the epidemiology and risk factors for IC-related complications, along with intervention studies to determine how to improve outcomes for patients using IC to manage bladder function.

Screening HIV-positive men who have sex with men for hepatitis C re-infection risk: is a single question on condom-use enough? A sensitivity analysis.

BACKGROUND: Hepatitis C virus (HCV) is common in men who have sex with men (MSM) with HIV. The Swiss HCVree Trial targeted a micro-elimination by using a treat and counsel strategy. Self-reported condomless anal intercourse with non-steady partners was used as the selection criterion for participation in a counselling intervention designed to prevent HCV re-infection. The purpose of this study was to assess the ability of this criterion to identify men who engaged in other sexual risk behaviours associated with HCV re-infection. METHODS: Men who disclosed their sexual and drug- use behaviours during the prior 6 months, at study baseline, were included in the current study. Using a descriptive comparative study design, we explored self-reported sexual and drug-use risk behaviours, compared the odds of reporting each behaviour in men who reported and denied condomless anal intercourse with non-steady partners during the prior year and calculated the sensitivity/specificity (95% CI) of the screening question in relation to the other at-risk behaviours. RESULTS: Seventy-two (61%) of the 118 men meeting eligibity criteria reported condomless anal intercourse with non-steady partners during the prior year. Many also engaged in other potential HCV transmission risk behaviours, e.g., 52 (44%) had used drugs. In participants disclosing drug use, 44 (37%) reported sexualised drug use and 17 (14%) injected drugs. Unadjusted odds ratios (95% CI) for two well-known risk behaviours were 2.02 (0.80, 5.62) for fisting and 5.66 (1.49, 37.12) for injecting drug use. The odds ratio for sexualised drug use - a potential mediator for increased sexual risk taking - was 5.90 (2.44, 16.05). Condomless anal intercourse with non-steady partners showed varying sensitivity in relation to the other risk behaviours examined (66.7-88.2%). CONCLUSIONS: Although condomless anal intercourse with non-steady partners was fairly sensitive in detecting other HCV relevant risk behaviours, using it as the only screening criterion could lead to missing a proportion of HIV-positive men at risk for HCV re-infection due to other behaviours. This work also points to the importance of providing access to behavioral interventions addressing other sexual and drug use practices as part of HCV treatment. TRIAL REGISTRATION: Clinical Trial Number: NCT02785666 , 30.05.2016.

Impact of lifestyle modification on absolute cardiovascular disease risk: a systematic review protocol.

OBJECTIVE: The objective of this review is to synthesize the available evidence on the effectiveness of lifestyle-based interventions for reducing absolute cardiovascular disease (CVD). INTRODUCTION: Cardiovascular disease prevention guidelines recommend tailoring the choice and intensity of preventive interventions based on absolute CVD risk score. Several studies employing lifestyle-based interventions to mitigate CVD risk have reported heterogeneous outcomes, necessitating a systematic review to provide an exhaustive summary of current evidence. INCLUSION CRITERIA: Eligible studies will include individuals at high-risk of CVD who are at least 18 years of age, with no history of CVD at baseline, regardless of sex, ethnicity and socio-economic status. Studies that compare lifestyle-based intervention to no intervention or usual care will be included. The outcome of interest is change in absolute CVD risk from baseline to post-intervention. Experimental and quasi-experimental study designs will be included. METHODS: Searches will be conducted in PubMed, EMBASE and CINAHL from the inception of each database. The search for gray literature will include ProQuest Dissertations and Theses Global, Grey Literature Report, Web of Science, BIOSIS Previews and the Proceedings database. Selected studies will be critically appraised by two independent reviewers at the study level for methodological quality. Extracted data will include details about the interventions, populations, study methods and outcomes of significance to the review question and objectives. Where possible, papers will be pooled in statistical meta-analysis. Effect sizes will be expressed as either odds ratios or standardized mean differences, and their 95% confidence intervals will be calculated for analysis. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42017073543.

Correlates and outcomes of alcohol use after single solid organ transplantation: A systematic review and meta-analysis.

BACKGROUND: Reviews on alcohol use in transplant recipients focus on liver recipients and their risk of post-transplant rejection, but do not assess alcohol use in kidney, heart, or lung transplant recipients. This systematic review and meta-analysis aims to synthesize the evidence on correlates and outcomes of any alcohol use and at-risk drinking after solid organ transplantation (Tx). METHODS: We searched 4 databases for quantitative studies in adult heart, liver, kidney and lung Tx recipients, investigating associations between post-Tx alcohol use and correlates and/or clinical, economic or quality of life outcomes. Paper selection, data extraction and quality assessment were performed by 2 reviewers independently. A pooled odds ratio (OR) was computed for each correlate/outcome reported ≥5 times. RESULTS: Of the 5331 studies identified, 76 were included in this systematic review (93.3% on liver Tx; mean sample size 148.9 (SD = 160.2); 71.9% male; mean age 48.9 years (SD = 6.5); mean time post-Tx 57.7 months (SD = 23.1)). On average, 23.6% of patients studied used alcohol post-transplant. Ninety-three correlates of any post-Tx alcohol use were identified, and 9 of the 19 pooled ORs were significantly associated with a higher odds for any post-Tx alcohol use: male gender, being employed post-transplant, smoking pre-transplant, smoking post-transplant, a history of illicit drug use, having first-degree relatives who have alcohol-related problems, sobriety <6 months prior to transplant, a history of psychiatric illness, and having received treatment for alcohol-related problems pre-transplant. On average 15.1% of patients had at-risk drinking. A pooled OR was calculated for 6 of the 47 correlates of post-Tx at risk drinking investigated, of which pre-transplant smoking was the only correlate being significantly associated with this behavior. None of the outcomes investigated were significantly associated with any use or at-risk drinking. CONCLUSION: Correlates of alcohol use remain under-investigated in solid organ transplant recipients other than liver transplantation. Further research is needed to determine whether any alcohol use or at-risk drinking is associated with poorer post-transplant outcomes. Our meta-analysis highlights avenues for future research of higher methodological quality and improved clinical care. PROTOCOL REGISTRATION: PROSPERO protocol CRD42015003333.

Correlates and Outcomes of Low Physical Activity Posttransplant: A Systematic Review and Meta-Analysis.

BACKGROUND: Little is known about associations between low physical activity (PA) and its correlates and outcomes in solid organ transplant recipients. This systematic review with meta-analysis examined correlates and outcomes associated with low PA (ie, not meeting individual study's definition of being physically active) following solid organ transplantation. METHODS: We searched PubMed, CINAHL, PsycINFO, and EMBASE from inception to February 2016 to identify peer-reviewed data-based articles. Articles published in English, German, Spanish, French, Italian, Portuguese, or Dutch that examined correlates or outcomes associated with low PA in adult single, solid organ transplant recipients were included. Studies' quality was assessed using a 14-item checklist. Pooled odds ratios and 95% confidence intervals were computed for correlates and outcomes examined in ≥5 studies. RESULTS: Of 7401 publications screened, 34 studies met inclusion criteria and were included in the overall synthesis with 15 included in the meta-analysis. Most focused on renal transplantation (n = 18, 53%) and used cross-sectional designs (n = 26, 77%). Of 30 correlates examined, [condition-related (n = 11), social/economic-related (n = 9), patient-related (n = 4), healthcare system-related (n = 3), and treatment-related (n = 3)], only 4 were examined ≥5 times and included in meta-analyses. None were significantly related to low PA. Of 19 outcomes assessed, only physical health-related quality of life was examined ≥5 times. Low PA was significantly associated with low physical health-related quality of life (odds ratio = 0.172, 95% confidence interval = 0.08-0.37). CONCLUSIONS: We found few studies examining most correlates and outcomes related to low PA despite growing evidence that improving PA might be an effective intervention in improving posttransplant outcomes.

Patterns of paediatric end-of-life care: a chart review across different care settings in Switzerland.

BACKGROUND: Paediatric end-of-life care is challenging and requires a high level of professional expertise. It is important that healthcare teams have a thorough understanding of paediatric subspecialties and related knowledge of disease-specific aspects of paediatric end-of-life care. The aim of this study was to comprehensively describe, explore and compare current practices in paediatric end-of-life care in four distinct diagnostic groups across healthcare settings including all relevant levels of healthcare providers in Switzerland. METHODS: In this nationwide retrospective chart review study, data from paediatric patients who died in the years 2011 or 2012 due to a cardiac, neurological or oncological condition, or during the neonatal period were collected in 13 hospitals, two long-term institutions and 10 community-based healthcare service providers throughout Switzerland. RESULTS: Ninety-three (62%) of the 149 reviewed patients died in intensive care units, 78 (84%) of them following withdrawal of life-sustaining treatment. Reliance on invasive medical interventions was prevalent, and the use of medication was high, with a median count of 12 different drugs during the last week of life. Patients experienced an average number of 6.42 symptoms. The prevalence of various types of symptoms differed significantly among the four diagnostic groups. Overall, our study patients stayed in the hospital for a median of six days during their last four weeks of life. Seventy-two patients (48%) stayed at home for at least one day and only half of those received community-based healthcare. CONCLUSIONS: The study provides a wide-ranging overview of current end-of-life care practices in a real-life setting of different healthcare providers. The inclusion of patients with all major diagnoses leading to disease- and prematurity-related childhood deaths, as well as comparisons across the diagnostic groups, provides additional insight and understanding for healthcare professionals. The provision of specialised palliative and end-of-life care services in Switzerland, including the capacity of community healthcare services, need to be expanded to meet the specific needs of seriously ill children and their families.

Handle with care: A systematic review on frailty in cardiac care and its usefulness in heart transplantation.

BACKGROUND: There is growing consensus that frailty, a state of vulnerability and a decline in functioning across multiple physiological body systems, is a valuable criterion to guide clinicians' risk prediction for poor outcomes in adult transplant candidates. In its 2016 listing criteria for heart transplantation the International Society for Heart Lung Transplantation recommends frailty assessment. We aimed to summarize the usefulness of frailty assessment in heart transplant candidates or recipients reported throughout the literature. METHODS: We performed a systematic literature search in PubMed to identify papers reporting on frailty in transplantation, chronic heart failure, and ventricualr assist device implantation published over the last 10 years in English. Additionally, a hand search was conducted, including manually searching the reference lists and a citation search of relevant papers. RESULTS: Eleven primary research articles were included in this systematic review. Frailty is a risk factor for morbidity, hospitalization, and mortality in patients with advanced heart failure and individuals being considered for ventricualr assist device implantation. Of the patients being considered for transplantation, 33% are frail. The Frailty Phenotype by Fried is a particularly useful tool to quickly identify higher risk patients for adverse outcomes. CONCLUSION: A lack of standardization and limited evidence on frailty in transplantation limit its use as a definitive listing criterion. Future research efforts should focus on systematic integration of frailty measures in transplant practice.

ExplorinG frailty and mild cognitive impairmEnt in kidney tRansplantation to predict biomedicAl, psychosocial and health cost outcomeS (GERAS): protocol of a nationwide prospective cohort study.

AIM: To present the rationale, design and methodology of the GERAS project, which examines whether assessment of frailty and mild cognitive impairment could enhance risk prediction for biomedical, psychosocial outcomes and foster efficient resource allocation in kidney transplantation. BACKGROUND: For the burgeoning cohort of older patients considered for kidney transplantation, evidence gaps regarding frailty and mild cognitive impairment limit clinical decision-making and medical management. As known risk factors for 'hard' clinical outcomes in chronic illness, both require further study in transplantation. Integrating these and other bio-psychosocial factors into a comprehensive pre-transplant patient assessment will provide insights regarding economic implications and may improve risk prediction. DESIGN: A nation-wide multi-centre prospective cohort study nested in the Swiss Transplant Cohort Study. METHODS: Our nationally representative convenience sample includes 250 adult kidney transplant recipients. Data sources include the Swiss Transplant Cohort Study and primary data collected at time of transplantation, 6 months, 1 and 2 years post-transplant via established measures (the Montreal Cognitive Assessment, Psychosocial Questionnaire, Fried Frailty Instrument and a blood analysis), investigator-developed instruments and datasets compiled by hospitals' management control units, sickness funds, the Swiss Federal Statistical Office and the European Renal Association. Descriptive, competing risk survival and mixed effects analyses will be performed. Research Ethics Committee approval was obtained in January 2016. DISCUSSION: This pioneering project jointly examines frailty and mild cognitive impairment from bio-psychosocial and health economic perspectives. Results may significantly inform risk prediction, care tailoring and resource optimization to improve health outcomes in the ageing kidney transplant cohort.

Correlates and Outcomes of Posttransplant Smoking in Solid Organ Transplant Recipients: A Systematic Literature Review and Meta-Analysis.

BACKGROUND: Despite smoking being an absolute or relative contraindication for transplantation, about 11% to 40% of all patients continue or resume smoking posttransplant. This systematic review with meta-analysis investigated the correlates and outcomes associated with smoking after solid organ transplantation. METHODS: We searched PubMed, EMBASE, CINAHL, and PsycINFO from inception until January 2016, using state-of-the art methodology. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were computed for correlates/outcomes investigated 5 times or more. RESULTS: Seventy-three studies (43 in kidney, 17 in heart, 12 in liver, 1 in lung transplantation) investigated 95 correlates and 24 outcomes, of which 6 correlates and 4 outcomes could be included in the meta-analysis. The odds of smoking posttransplant were 1.33 times higher in men (95% CI, 1.12-1.57). Older individuals were significantly less likely to smoke (OR, 0.48; 95% CI, 0.38-0.62), as were patients with a higher body mass index (OR, 0.68; 95% CI, 0.52-0.89). Hypertension (OR, 1.16; 95% CI, 0.77-1.75), diabetes mellitus (OR, 0.52; 95% CI, 0.15-1.78), and having a history of cardiovascular disease (OR, 0.92; 95% CI, 0.77-1.09) were not significant correlates. Posttransplant smokers had higher odds of newly developed posttransplant cardiovascular disease (OR, 1.41; 95% CI, 1.02-1.95), nonskin malignancies (OR, 2.58; 95% CI, 1.26-5.29), a shorter patient survival time (OR, 0.59; 95% CI, 0.44-0.79), and higher odds of mortality (OR, 1.74; 95% CI, 1.21-2.48). CONCLUSIONS: Posttransplant smoking is associated with poor outcomes. Our results might help clinicians to understand which patients are more likely to smoke posttransplant, guide interventional approaches, and provide recommendations for future research.