Mapping advanced practice nurses' scope of practice, satisfaction, and drivers of role performance.

Background: Advanced Practice Nurse (APN) roles in Switzerland include Clinical Nurse Specialist (CNS), Nurse Practitioner (NP) and blended roles. The variety contributes to unclear profiles and scope of practice. Aim: To describe a) the performance of APN tasks according to Hamric's competencies, b) job satisfaction, and c) barriers and facilitators to role performance. Methods: Nationwide cross-sectional survey among clinically working APNs. Inclusion criteria: academic degree, role with advanced nursing competency. Analysis of quantitative and qualitative data using inferential statistics and content analysis. Results: Of the 222 APNs, 49% (n = 108) described themselves as CNSs, 37% (n = 81) as working in a blended role, and 15% (n = 33) as NP. APNs provided the greatest proportion of their tasks in the competency direct clinical practice and the least in ethical decision-making. Group comparisons between roles revealed significant differences in the competencies: direct clinical practice, guidance and coaching, leadership, and evidence-based practice. Job satisfaction was high (76%, n = 165), most often described by the category work content/role (e.g., defined scope of practice). The most frequent barrier to role performance was the category scope of practice (e.g., unclear responsibilities); the most frequent facilitator was the category professional recognition (e.g., respect). Conclusion: The study highlights current APN scope of practice and can support the advancement of the role through clinical practice, educational institutions, and research.

Validation of the newly developed Advanced Practice Nurse Task Questionnaire: A national survey.

AIM: To describe psychometric validation of the newly developed Advanced Practice Nurse Task Questionnaire. DESIGN: Cross-sectional quantitative study. METHODS: The development of the questionnaire followed an adapted version of the seven steps described in the guide by the Association for Medical Education in Europe. A nationwide online survey tested the construct and structural validity and internal consistency using an exploratory factor analysis, Cronbach's alpha coefficient and a Kruskal-Wallis test to compare the hypotheses. RESULTS: We received 222 questionnaires between January and September 2020. The factor analysis produced a seven-factor solution as suggested in Hamric's model. However, not all item loadings aligned with the framework's competencies. Cronbach's alpha of factors ranged between .795 and .879. The analysis confirmed the construct validity of the Advanced Practice Nurse Task Questionnaire. The tool was able to discriminate the competencies of guidance and coaching, direct clinical practice and leadership across the three advanced practice nurse roles clinical nurse specialist, nurse practitioner or blended role. CONCLUSION: A precise assessment of advanced practice nurse tasks is crucial in clinical practice and in research as it may be a basis for further refinement, implementation and evaluation of roles. IMPACT: The Advanced Practice Nurse Task Questionnaire is the first valid tool to assess tasks according to Hamric's model of competencies independently of the role or the setting. Additionally, it distinguishes the most common advanced practice nurse roles according to the degree of tasks in direct clinical practice and leadership. The tool may be applied in various countries, independent of the degree of implementation and understanding of advanced nursing practice. REPORTING METHOD: The STARD 2015 guideline was used to report the study. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

A qualitative study of the sources of chronic obstructive pulmonary disease-related emotional distress.

OBJECTIVE: The aim of this study is to identify the sources of illness-related emotional distress from the perspective of individuals living with mild to severe chronic obstructive pulmonary disease (COPD). METHODS: A qualitative study design with purposive sampling was applied at a Swiss University Hospital. Eleven interviews were conducted with individuals who suffered from COPD. To analyze data, framework analysis was used, guided by the recently presented model of illness-related emotional distress. RESULTS: Six main sources for COPD-related emotional distress were identified: physical symptoms, treatment, restricted mobility, restricted social participation, unpredictability of disease course and COPD as stigmatizing disease. Additionally, life events, multimorbidity and living situation were found to be sources of non-COPD-related distress. Negative emotions ranged from anger, sadness, and frustration to desperation giving rise to the desire to die. Although most patients experience emotional distress regardless of the severity of COPD, the sources of distress appear to have an individual manifestation. DISCUSSION: There is a need for a careful assessment of emotional distress among patients with COPD at all stages of the disease to provide patient-tailored interventions.

[Toward a safe home: Experiencing the transition to an outpatient setting with home mechanical ventilation. A thematic analysis]. / Auf dem Weg in ein sicheres Daheim: Erleben des Übergangs in ein ambulantes Setting mit Heimbeatmung.

Toward a safe home: Experiencing the transition to an outpatient setting with home mechanical ventilation. A thematic analysis Abstract. Background: With the progress in medical options, the need for home mechanical ventilation increases. The transition from long-term ventilation in an institution to home mechanical ventilation in an outpatient setting is a difficult phase in terms of setting up the network of care, coordination of care for those with the ventilatory insufficiency and the financing. Aim: The study describes how patients with ventilatory insufficiency and family caregivers experience the transition from an institution to an ambulatory setting with invasive or non-invasive home mechanical ventilation. Methods: A qualitative research design with a social-constructivist approach was adopted using thematic analysis according to Braun and Clarke. We included seven German-speaking patients (≥ 18 years old) with ventilatory insufficiency and home mechanical ventilation (> 6 h/day) from the German part of Switzerland, with discharge from an institution to home, and five family caregivers who care for patients with the described criteria. Results: The institution was seen as a safe place. Affected persons and their family caregivers had to create a safe environment at home. Three themes were formed inductively: To gradually build trust with each other, to become experts as family caregivers, to align their own network with the new care needs.Conclusions: The transition home succeeds in the interplay of gaining trust, building expertise, and creating sustainable networks. Professionals can use this knowledge to provide targeted support to patients with home mechanical ventilation and their family caregivers.

Patients' Experiences of a Nurse-Led Self-Management Intervention After Kidney Transplantation.

Self-management after kidney transplantation is challenging. Therefore, current guidelines recommend education programs, but little is known about patients' experiences of such programs. With a qualitative design, we explored patients' experiences of either multiple behavioral interventions or a single educational intervention in the firstyear post-transplant. Patients were struggling to master changes before reassuming normal life post-transplant. They learned to have confidence in their new situation and resumed their social roles. In a therapeutic sense, they were open to information, wanted to recover normal weight, and engaged in physical activity and consistent medication intake. Those who had undergone the behavioral interventions tackled these challenges with more consistency and vigor. Individualized behavioral self-management interventions were well accepted and have the potential to guide patients towards better outcomes.

[Differences in epaAC© in heart failure patients with or without readmission: a retrospective case-control study]. / Unterschiede im epaAC© bei Patient_innen mit Herzinsuffizienz mit oder ohne Rehospitalisation.

Differences in epaAC© in heart failure patients with or without readmission: A retrospective case-control study Abstract. Background: Heart failure is one of the most frequent reasons for hospitalization in elderly people. In heart failure, approximately 22.8 % of hospitalised patients are rehospitalised within 30 days. The nursing assessment tool epaAC could provide information on risk factors for readmission. Aim: The aim of this study was to identify possible group differences in the items and scores of the epaAC discharge assessment with regard to the endpoint of unplanned readmissions within 30 days after discharge from index-hospitalisation. Methods: Using a retrospective case-control design, differences in the epaAC variables were investigated by descriptive and comparative statistics. Chi-square test, Wilcoxon test and t-test were performed with two-sided alpha level α < 0.05. Alpha error accumulation was accounted for by Benjamini & Hochberg correction. Results: No significant group differences were found in all items and scores of the discharge epaAC. There is only weak evidence that the presence of acute respiratory impairment at time of discharge is higher in the patient with rehospitalisation than in those without rehospitalisation. Conclusions: The items and scores of the nursing assessment instrument epaAC did not significantly differ between patients with or without 30-days readmission. Further exploration to assess the epaAC's potential to predict rehospitalisation in heart failure is needed.

Psychometric evaluation of the German version of the instrument: Families' Importance in Nursing Care - Nurses' Attitudes (FINC-NA).

BACKGROUND: The involvement of families in care has long been advocated for acute and critical care settings to improve quality and safety of care. Nurses' attitudes towards families influence the way they involve and partner with families in the planning and delivery of care. Therefore, instruments with proven psychometric properties are necessary to assess the attitudes of nurses towards involving families in nursing care. AIMS: To cross-culturally adapt and psychometrically test the German version of the Families' Importance in Nursing Care - Nurses' Attitudes (FINC-NA) scale with acute and critical care nurses. METHODS: A cross-sectional study was carried out with 316 acute-critical care nurses, who filled in the FINC-NA between December 2016 and May 2018. Exploratory factor analysis was performed to assess structural validity. Internal consistency and homogeneity were determined using Cronbach's alpha. RESULTS: The four-factor structure of the FINC-NA - family as partner in care, family as resource in nursing care, family as their own resource and family as burden - was confirmed in the German version. Due to low primary and multiple loadings, seven items were removed. Moreover, five items loaded on different factors than the original version. Cronbach's alpha of factors ranged between 0.68 and 0.86. CONCLUSION: The cross-cultural adaptation and psychometric testing of the German version of the FINC-NA resulted in a 19-item scale that measure nurses' attitudes towards the importance of families in nursing care. Further testing is needed to refine the structural validity and establish construct validity of the FINC-NA German version.

Translation and Psychometric Validation of the German Version of the Family Nursing Practice Scale (FNPS).

This article describes the cross-cultural adaption and psychometric testing of the Family Nursing Practice Scale (FNPS) German version. The FNPS aims to examine self-reported family nursing practice skills and reciprocity in the nurse-family relationship. Using a cross-sectional design, 583 acute and critical care nurses were invited to complete the FNPS German version. Exploratory factor analysis was used to assess the structural validity. Internal consistency was determined using Cronbach's alpha. A total of 317 nurses returned a completed online questionnaire. Principal axis factor analysis suggests a one-factor solution in which all 10 items are retained, accounting for 36% of the variance. Cronbach's alpha was .84. In contrast to the original version, our findings indicate the unidimensionality of the construct. The FNPS German version appears to be a valid and reliable scale to assess nurses' perception of their family nursing practice proficiency. Further testing is needed to confirm the unidimensionality and to establish test-retest reliability.

Gesundheitsverhalten und Bedürfnisse von Menschen mit COPD während der COVID-19-Pandemie - Eine Dokumentenanalyse.

Health behaviours and needs of people with COPD during COVID-19 pandemic: a document analysis Abstract. Background: The government's guidelines affected people with COPD on different levels during the COVID-19 pandemic. In addition to belonging to a group of particularly vulnerable persons, they had to adapt their health behaviours, in particular physical activity, to recommendations provided in order to prevent negative effects on disease progression. There is little knowledge regarding how this group of patients coped with these challenges during the COVID-19 pandemic. OBJECTIVE: To describe the health behaviours and needs people with COPD convey during nursing phone consultations and which nursing interventions have been carried out. METHODS: A document analysis of 50 nursing phone consultations was performed. The data were summarised descriptively and analysed thematically. RESULTS: The main topics were the adaptation of physical activity, the implementation of the recommendations to the individual life situation, the detection of a COVID-19 infection and questions concerning the planning of medical appointments. CONCLUSION: The COVID-19 pandemic poses additional challenges to the disease management of people with COPD. The increased need for care brought on by the pandemic was able to be met by the knowledge provided in the nursing phone consultations. What remains to be established is what role the consultations play in a sustainable change in behaviour and in dealing with negative emotions.

Introducing a model for emotional distress in respiratory disease: A systematic review and synthesis of symptom management models.

AIM: To undertake a theoretical systematic review to develop a conceptual model of illness-related emotional distress in the context of symptom management in chronic respiratory disease. DESIGN: We performed a systematic search to identify conceptual models. DATA SOURCES: Electronic databases MEDLINE, CINAHL, EMBASE and PsycINFO were searched and papers included from inception of the search term until June 2017. REVIEW METHODS: The review was conducted following Pound and Campbell's and Turner's theory synthesis. Conceptual models were appraised using Kaplan's criteria. Models were excluded if they referred to a specific condition and/or lacked clarity. RESULTS: This synthesis, which includes five models and additional evidence, yielded a new conceptual model describing the processes of regulation and symptom self-management in chronic respiratory disease. Identified sources of illness-related emotional distress are new or increased symptoms, additional treatment, new restrictions in performance of daily life roles and increased unpredictability. People goals and self-efficacy were identified as further drivers of symptom self-management. The regulation process is embedded in contextual factors. CONCLUSION: Theory synthesis provided transparent guidance in developing a model to understand of the factors driving self-management decisions. Therefore, the model has the potential to guide development of interventions that support symptom self-management in chronic respiratory disease. IMPACT: This newly presented conceptual model of illness-related emotional distress provides an understanding of the factors that drive self-management decisions when peoples experience new or increased symptoms. Such understanding is critical for nursing practice to developing appropriate interventions, especially in support of people decision-making.

"Thrust out of normality"-How adults living with cystic fibrosis experience pulmonary exacerbations: A qualitative study.

AIM AND OBJECTIVES: To explore the experience of pulmonary exacerbation from the perspective of adults with cystic fibrosis. BACKGROUND: While management of pulmonary exacerbations is a pillar of cystic fibrosis care, little is known of patients' perspectives. Understanding the patient's experience is essential for developing and evaluating interventions in support of patient self-management. DESIGN: Qualitative study with longitudinal study in a subsample. METHODS: The study took place from 2015-2016 in a university hospital. Eighteen patients with cystic fibrosis were included who were ≥18 years of age and had no solid organ transplant. Patients' experiences were explored through semistructured interviews and analysed using framework analysis. They each participated in one interview, with a subsample (N = 7) being interviewed twice during and once after antibiotic therapy. RESULTS: Patients (11 men and 7 women; median age 29.5 years, range 19-55 years; median FEV1 45%, range FEV1 23%-105%) experienced pulmonary exacerbations as disruptions of their normality, which led to a substantial increase in their emotional distress. Exacerbations represented a period of threat and domination by CF; that is, symptoms and treatment consumed energy, restricted physical activity and daily life roles. "Noting change," "waiting until antibiotics help," "returning to normality" and "establishing a new normality" characterised their descriptions of the pulmonary exacerbation trajectory. Emotional distress was the major driver for patients' self-management, and personal goals and illness beliefs influenced also patients' self-management decisions. CONCLUSION: The experienced degree and source of emotional distress are drivers for self-management decisions in patients with cystic fibrosis who experience a pulmonary exacerbation. RELEVANCE TO CLINICAL PRACTICE: Our data provide new understanding that will be essential to informing clinical practice, future patient-reported outcomes measures and intervention development.

[Easy come, easy go? Current strategies for maintaining the effects of pulmonary rehabilitation in COPD patients]. / Wie gewonnen, so zerronnen?

Easy come, easy go? Current strategies for maintaining the effects of pulmonary rehabilitation in COPD patients Abstract. Pulmonary rehabilitation (PR) is a comprehensive treatment method in the non-drug management of chronic respiratory diseases. Most evident data exists for COPD patients. However, the effect of PR is no longer detectable after 6 to 12 months, unless the patient participates in a kind of maintenance program following PR. But the contents of such a maintenance program are still unclear in terms of duration, location, methods and intensity. They are still subject of current research. Therefore concrete recommendations are still missing and further studies are necessary. This review aims to give an overview of the existing results in this field.

A mixed-method study to explore patients' perspective of self-management tasks in the early phase after kidney transplant.

CONTEXT: Patients' perspectives of posttransplant self-management tasks have not been explored.OBJECTIVE-To explore the concept and the presence of self-management tasks mastered by patients in the early phase after kidney transplant. DESIGN: Mixed-method study using semistructured interviews and a structured questionnaire.Setting-Outpatient Division of Nephrology at University Hospital Zurich, Switzerland. PATIENTS: Twelve patients (median age, 52 years, interquartile range, 42.25-65.25 years; median time after kidney transplant, 6.5 months; interquartile range, 2.25-15.75 months) were included.Analysis-Qualitative data were analyzed according to Corbin and Strauss' 3 self-management tasks with content analysis procedures. In the quantitative analysis, the presence of each self-management task is expressed as a frequency. RESULTS: -The qualitative findings showed that patients were greatly challenged by the effort to manage the upcoming instability, which has a persistent broad impact on their lives. Managing emotions comprised dealing with uncertainty, disappointment, and frustration. Additionally, patients had to manage changes in self-perception. Managing life roles mainly involved an adaptation of relationships, occupational changes, and interactions with health care providers. Taking medications, managing symptoms, integrating new behaviors, and understanding one's course of disease were further tasks. Quantitatively, self-management tasks that were perceived as a challenge by at least half of the patients were primarily tasks from the questionnaire section "managing stressful emotions and self-perception." The synthesis of qualitative and quantitative findings indicates that self-management programs for kidney transplant recipients should focus on strengthening patients' self-management of emotional tasks and on regaining stability in daily life.

Medication adherence in adults after hospitalization for heart failure: A cross-sectional study.

Background: Medication non-adherence in heart failure (HF) leads to increased mortality, morbidity and healthcare costs. However, no study has investigated HF patients' post-hospitalization medication non-adherence in Switzerland. Objectives: Our primary aim was to assess the prevalence of post-discharge medication non-adherence in patients with HF. A secondary objective was to identify differences between fully and partially adherent patients regarding selected unplanned therapy-related inpatient/outpatient cardiology visits. Methods: A non-experimental cross-sectional study was applied. The prevalence of medication adherence was assessed with a German-translated version of the Medication Adherence Report Scale (MARS-5) and analyzed descriptively. Differences between adherent and partially adherent patients' numbers of medications, dosing per day and 180-day unplanned inpatient stays or cardiology outpatient visits were explored. Results: Of 153 recruited patients, 72 participated in the survey. Of these, 26.4 % were not fully adherent. Their most common reason was forgetfulness (23.7 %). There were no significant group differences regarding therapy-related variables or 180-day unplanned cardiology stays/visits. Conclusions: Considering that over one-quarter of surveyed HF patients were not fully medication adherent, Swiss cardiology nurses need to be sensitized to this issue and trained in adherence-enhancing interventions. Reaching acceptable adherence levels in patients with HF will require further research and action.

[Development of an evidence-based self-management programme for patients in the first year after renal transplantation with a focus on prevention of weight gain, physical exercise and drug adherence]. / Entwicklung eines evidenzbasierten Selbstmanagementprogramms für Patient(inn)en im ersten Jahr nach Nierentransplantation mit Fokus auf die Prävention von Gewichtzunahme, Bewegung und Medikamentenadhärenz.

In the first year after kidney transplantation patients are challenged with incorporating new behaviour patterns into their daily lives. Due to the higher risk of cardiovascular disease amongst kidney transplant recipients, behaviours such as preventing undesired weight gain, exercising, avoiding smoking, and managing medications take on crucial importance. The aim of the project was to develop a programme based on prevailing evidence to promote self-management skills in this patient population. To this end a participatory action research approach was chosen. The programme was developed with inter-professional collaboration under the direction of an advanced practice nurse. As theoretical framework for the development of the intervention models of behaviour change and self-management were chosen. The content is based on current literature and includes the viewpoints of both patients and nursing experts. The programme consists of three elements: 1) Educational brochures developed through inter-professional collaboration and evaluated in a pilot survey. These brochures provide a framework for appointments with nursing professionals. 2) The appointments are a forum in which the patient can gain access to relevant information and can be supported in putting sustainable health-related behaviours into practice in daily life. 3) A peer programme that uses treatment plans to encourage patients deviating from preferred health-related behaviours to make changes in their behaviour. The programme evaluation started in May of 2012. Results of the pilot study are expected in 2014.

Acceptability, Appropriateness and Feasibility of a Nurse-Led Integrated Care Intervention for Patients with Severe Exacerbation of COPD from the Healthcare Professional's Perspective - A Mixed Method Study.

Purpose: To improve inpatient care and self-management in patients with severe acute exacerbations of COPD, we implemented a nurse-led behavioral intervention. This study aimed to assess implementation outcomes from the perspective of the healthcare professionals (HCP) who delivered it. Methods: Using an explanatory sequential mixed method approach, we conducted an online questionnaire and two small group interviews. We applied descriptive statistics for quantitative data, a framework analysis for qualitative data, and a mixed methods matrix to integrate the results. Results: A total of 19 of 27 invited participants answered the online questionnaire; 9 of 19 participated in the group interviews. The intervention's overall acceptability, appropriateness, and feasibility was rated high to very high (median 5/5; 4/5 and 4/5). Enablers to implementation included general recognition of the need for specialized care, sufficient knowledge of the intervention by HCP, and strong interprofessional collaboration. Main barriers included the lack of resident physician's resources and difficulties in adaptability. Conclusion: While the acceptance of the intervention was very high, the perceived appropriateness and feasibility were affected by its complexity. The availability of a knowledgeable interprofessional core team is a strategy that supports the implementation of complex interventions.

Criterion Validity and Test-Retest Reliability of a Modified Version of the International Physical Activity Questionnaire-Short Form (IPAQ-SF) in Kidney Transplant Recipients.

Introduction: Accelerometry, the clinically valued standard of physical activity monitoring, has limited acceptance in transplantation rehabilitation; therefore, the International Physical Activity Questionnaire (IPAQ) self-report instrument is widely used. However, while the IPAQ's repeatability is good, its criterion validity is unsatisfactory. We hypothesized that adding a concise oral introduction would help overcome this shortfall. Materials and Methods: This is a secondary analysis of a RCT in a sample of kidney transplant recipients that underwent observational follow-up. We assessed criterion validity of our modified version of the four-item IPAQ-Short Form (mIPAQ-SF) via Pearson, and test-retest reliability via intraclass correlation coefficients. The main difference in the new version is an oral pre-measurement introduction to the questionnaire's concepts. We compared our results with those of published studies. Results: Post-kidney-transplantation data of 92 patients were analyzed. Across the four IPAQ-SF/mIPAQ-SF items, values of correlations between mIPAQ-SF responses and accelerometry records ranged from 0.07 (min in vigorous activity) to 0.35 (min in moderate activity) for criterion validity, and from 0.19 (days with moderate activity) to 0.58 (min in moderate activity) for test-retest reliability. Discussion: Regarding moderate-to-vigorous physical activity, mIPAQ-SF self-reports' correlations to accelerometry records improved considerably on those of the IPAQ-SF (r = 0.18 vs. r = 0.33), i.e., improved criterion validity. We therefore conclude that a pre-measurement oral explanation of key IPAQ-SF/mIPAQ concepts enhances criterion validity regarding self-reported moderate-to-vigorous physical activity.

Variable Selection for Assessing Risk Factors for Weight and Body fat Gain During the First Year After Kidney Transplantation.

Background: Body fat and overall weight gain are common after kidney transplantation and are associated with poor clinical outcomes. Therefore, identification of at-risk patients is relevant for preventive interventions. Clinical Question: What variables influence weight and fat gain in patients in the first year after kidney transplantation? Literature Search Prospective and retrospective cohort studies published in or after 2001 naming fat and/or overall weight gain during the first year after kidney transplantation as outcome variable(s) were systematically searched in Medline/Pubmed in November 2018 and March 2022. Clinical Appraisal: We identified 16 studies examining a wide variety of potential factors influencing weight and fat gain over the first posttransplant years. These included genetic, socio-demographic, behavioral, biomedical, psychological and environmental factors. For a number of variables, study results were contradictory: some studies indicated preventive impacts on weight or fat gain; others concluded that the same factors increased it. Cases were discussed with 2 clinical experts. We eventually agreed on 13 potentially relevant risk factors for post-transplant weight/fat gain: age, gender, genes, income, ethnicity, education, eating habits, physical activity, smoking cessation, baseline BMI, baseline fat, depression and perceived overall wellbeing. Integration into Practice Before integration into clinical practice, a critical evaluation of all potential risk factors' suitability for assessment will be necessary. In addition to feasibility, operational definitions and measurement methods must also be considered. Evaluation: To reduce the list of risk factors to the most relevant, a first testing within a prospectively collected data set is planned.

Supporting Behavior Change After AECOPD - Development of a Hospital-Initiated Intervention Using the Behavior Change Wheel.

After hospitalization due to acute COPD exacerbations, patient-manageable behaviors influence rehospitalization frequency. This study's aim was to develop a hospital-ward-initiated Behaviour-Change-Wheel (BCW)-based intervention targeting patients' key health behaviors, with the aim to increase quality of life and reduce rehospitalization frequency. Intervention development was performed by University Hospital Zurich working groups and followed the three BCW stages for each of the three key literature-identified problems: insufficient exacerbation management, lack of physical activity and ongoing smoking. In stage one, by analyzing published evidence - including but not limited to patients' perspective - and health professionals' perspectives regarding these problems, we identified six target behaviors. In stage two, we identified six corresponding intervention functions. As our policy category, we chose developing guidelines and service provision. For stage three, we defined eighteen basic intervention packages using 46 Behaviour Change Techniques in our basic intervention. The delivery modes will be face-to-face and telephone contact. In the inpatient setting, this behavioral intervention will be delivered by a multi-professional team. For at least 3 months following discharge, an advanced nursing practice team will continue and coordinate the necessary care package via telephone. The intervention is embedded in a broader self-management intervention complemented by integrated care components. The BCW is a promising foundation upon which to develop our COPD intervention. In future, the interaction between the therapeutic care team-patient relationships and the delivery of the behavioral intervention will also be evaluated.

First Testing of Literature-Based Models for Predicting Increase in Body Weight and Adipose Tissue Mass After Kidney Transplantation.

Introduction: Weight gain is a risk factor for poor clinical outcomes following kidney transplantation. Research Question: This study's aim was a first testing of 2 models to identify patients early after kidney transplantation who are at risk for weight gain and increase in adipose tissue mass in the first year after kidney transplantation. Design: The literature-based models were evaluated on longitudinal data of 88, respectively 79 kidney transplant recipients via ordinary and Firth regression, using gains ≥ 5% in weight and adipose tissue mass respectively as primary and secondary endpoints. Results: The models included physical activity, smoking cessation at time of kidney transplantation, self-reported health status, depressive symptomatology, gender, age, education, baseline body mass index and baseline trunk fat as predictors. Area under the curve was 0.797 (95%-CI 0.702 to 0.893) for the weight model and 0.767 (95%-CI 0.656 to 0.878) for the adipose tissue mass model-showing good, respectively fair discriminative ability. For weight gain ≥ 5%, main risk factors were smoking cessation at time of transplantation (OR 16.425, 95%-CI 1.737-155.288) and better self-reported baseline health state (OR 1.068 for each 1-unit increase, 95%-CI 1.012-1.128). For the adipose tissue mass gain ≥ 5%, main risk factor was overweight/obesity (BMI ≥ 25) at baseline (odds ratio 7.659, 95%-CI 1.789-32.789). Conclusions: The models have potential to assess patients' risk for weight or adipose tissue mass gain during the year after transplantation, but further testing is needed before implementation in clinical practice.