RESUMO
BACKGROUND: We aimed to evaluate the accuracy and acceptability of a short screening test battery for mild neurocognitive deficits. METHODS: HIV-infected individuals with a suppressed viral load were examined at the University Hospital Basel with a screening test consisting of a questionnaire and selected cognitive tests, administered by trained nurses, followed by an in-depth neuropsychological examination. Test acceptance was evaluated with a questionnaire. RESULTS: 30 patients were included in this study (median age of 52.5 years (interquartile range (IQR) 47-64), prior AIDS-defining condition in 37%, median CD4 cell count 658 (IQR 497-814) cells/µl). Overall, 25 (83%) patients were diagnosed with HIV-associated neurocognitive disorders (HAND) on in-depth neuropsychological assessment (16 patients had asymptomatic neurocognitive impairment (ANI), 8 a mild neurocognitive disorder (MND) and 1 patient HIV-associated dementia (HAD). Among 25 patients with HAND, only 9 patients (36%) were complaining of memory loss. The screening battery revealed neurocognitive deficits in 17 (57%) patients (sensitivity 64%, specificity 80%, positive predictive value 94% and negative predictive value 31%). Most patients (83%) estimated the screening test as valuable and not worrisome. CONCLUSIONS: A questionnaire combined with selected neuropsychological tests is a short, easy-to-perform very well accepted screening tool for mild neurocognitive disorders in asymptomatic HIV-infected individuals.
RESUMO
To offer advanced nursing care for people living with HIV, a participatory action research project was initiated that enabled constant learning and change at the levels of (a) the culture and organization of an outpatient department, (b) clinical leadership and interdisciplinary collaboration, and (c) development of new services. In this project, the development of the Advanced Nursing Practice (ANP) Team not only affected the practice of individual nurses with advanced degrees but also created a team of nurses educated at different levels. Through a systematic process, the nurses on the team became more educated and refined their clinical expertise. An essential aspect of the ANP Team was the specialization of each nurse in a self-selected topic within HIV/AIDS care. As members of the ANP Team, the nurses offer state-of-the-art nursing care including patient assessment, medication management and adherence support, symptom management, health maintenance and prevention, and family support for persons living with HIV.
