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Background: The DV-QoL is a 17-item questionnaire measuring health-related quality of life in patients affected by symptomatic diverticular disease, covering four domains: physical symptoms, concerns, feelings, and behavioral changes. Given the lack of a diverticulitis-specific questionnaire to be used for German-speaking patients, we prospectively validated the German version of the DV-QoL. Methods: German-speaking patients with CT-confirmed history of recurrent diverticular disease admitted to a Swiss surgical department completed the German version of the DV-QoL, along with short form-36 (SF-36) and the Gastrointestinal Quality of Life Index (GIQLI). Reliability was examined using exploratory and confirmatory factor analysis, a Martin-Loef test, and Cronbach's alpha. For convergent validity testing, correlations were calculated with the GIQLI and SF-36. Discriminant validity tests included age and gender. Results: We included 121 patients, of whom 77 were admissions for elective surgery and 44 presented with acute diverticulitis treated conservatively. The DV-QoL's total score showed good correlations with the GIQLI (r = − 0.77) and its subscales (r = − 0.76 to − 0.45), as well as with the SF-36's subscales (r = − 0.30 to − 0.57). No relationships were found with age or gender (p < 0.05). The Cronbach's alpha coefficient was 0.89 over all items and 0.69, 0.90, 0.78, and 0.77 for the four separated domains (physical symptoms, cognitions/concerns, feelings, and behavioral changes, respectively). A nonsignificant Martin-Loef test indicated unidimensionality (p = 1), further supported by the exploratory factor analysis, which showed an item information sharing of 65%. Conclusion: The German DV-QoL questionnaire can be used as a valid and reliable disease-specific measure for quality of life in patients with recurrent diverticular disease. [ABSTRACT FROM AUTHOR]

Background: Literature review suggests that adherence to immunosuppressive drugs may be lower in recipients of living than of deceased donor kidney grafts, possibly because of profile differences. Objective: To compare the level of immunosuppressive adherence levels between patients with deceased and living (-related; -unrelated) donor grafts in Switzerland. Methods: Using data from two similar cross-sectional studies at two transplant centers in Switzerland, the level of adherence between the two groups was compared. Medication adherence was assessed by self-report or electronic monitoring. Possible explanatory factors included age, beliefs regarding immunosuppressive drugs, depressive symptomatology, pre-emptive transplantation, and the number of transplants received, were also considered. Data were analyzed using logistic regression analysis. Results: Unadjusted non-adherence odds were 2 to 3 times higher in living-related than deceased donor transplantation (ORs: 2.09-3.05; p<0.05). Adjustment for confounders showed that these differences were associated most with the younger age of living-related subjects and the belief that immunosuppressive drugs are less important for living-related donations. Conclusion: There is a lower immunosuppressive adherence in recipients of living-related donor kidneys, possibly owing to differences in patient profile (ie, health beliefs regarding their immunosuppressive needs), knowledge of which may enhance adherence if addressed. [ABSTRACT FROM AUTHOR]

Background Evidence indicates that medical and demographic contextual factors ( cFs) impact pain responses in preterm neonates, but the existing evidence is very heterogeneous. Aim To explore the effect of cFs on pain responses to heel-stick procedures of preterm infants. Methods This study was a secondary analysis of data collected during a randomized controlled trial examining pain response to non-pharmacological interventions across repeated heel sticks. Five heel sticks across the first 14 days of life were videotaped. Pain response was rated with the Bernese Pain Scale for Neonates ( BPSN) by four raters blinded to the heel-stick phases (baseline, heel stick, recovery). Demographic and medical cFs were extracted from medical charts. Mixed single and multiple regression analyses were performed controlling for the intervention group, site and heel-stick phase. Results Apgar scores at 1 min were negatively associated with behavioural ( p = 0.002) BPSN scores, while Apgar scores at 5 min after birth were positively associated with behavioural ( p = 0.006) scores. Accumulated number of painful procedures ( p = 0.002) and gender ( p = 0.02) were positively associated with physiological scores while continuous positive airway pressure CPAP ( p = 0.009) and mechanical ventilation ( p = 0.005) were negatively associated. Conclusion Higher exposure to painful procedures, male infants and having CPAP or mechanical ventilation were cFs associated with physiological response. The only variables significantly associated with behavioural BPSN scores were Apgar scores but these relationships were inconsistent. [ABSTRACT FROM AUTHOR]

. Arenja N, Reichlin T, Drexler B, Oshima S, Denhaerynck K, Haaf P, Potocki M, Breidthardt T, Noveanu M, Stelzig C, Heinisch C, Twerenbold R, Reiter M, Socrates T, Mueller C (University Hospital, Basel). Sensitive cardiac troponin in the diagnosis and risk stratification of acute heart failure. J Intern Med 2012; 271: 598-607. Background. The aim of our study was to investigate the diagnostic and prognostic value of a sensitive cardiac troponin I (s-cTnI) assay in patients with acute heart failure (AHF). Methods. Sensitive cardiac troponin I was measured in 667 consecutive patients at presentation to the emergency department with acute dyspnoea. Three s-cTnI strata were predefined: below the limit of detection (<0.01 μg L−1, undetectable), detectable but still within the normal range (0.01-0.027 μg L−1) and increased (≥0.028 μg L−1, ≥99th percentile). The final diagnosis was adjudicated by two independent cardiologists blinded to the s-cTnI levels. Median follow-up in patients with AHF was 371 days. Results. Levels of s-cTnI were higher in patients with AHF ( n = 377, 57%) compared to patients with noncardiac causes of acute dyspnoea (median 0.02 vs. <0.01 μg L−1, P < 0.001). In patients with AHF, in-hospital mortality increased with increasing s-cTnI in the three strata (2%, 5% and 14%, P < 0.001). One-year mortality also increased with increasing s-cTnI (21%, 33% and 47%, P < 0.001). s-cTnI remained an independent predictor of 1-year mortality [adjusted odds ratio 1.03 for each increase of 0.1 μg L−1, 95% confidence interval (CI) 1.02-1.05, P < 0.001] after adjustment for other risk factors including B-type natriuretic peptide. The net reclassification improvement was 68% ( P < 0.001), and absolute integrated discrimination improvement was 0.18 ( P < 0.001). The diagnostic accuracy of s-cTnI for the diagnosis of AHF as quantified by the area under the receiver operating characteristic curve was 0.78 (95% CI, 0.75-0.82). Conclusions. Sensitive cardiac troponin I is a strong predictor of short- and long-term prognosis in AHF that helps to reclassify patients in terms of mortality risk. Detectable levels of s-cTnI, even within the normal range, are independently associated with mortality. [ABSTRACT FROM AUTHOR]

Aim: To explore the variability in pain response in preterm infants across time who received sucrose during routine heel stick. Method: Single group, exploratory repeated measures design. Setting: Two tertiary level neonatal intensive care units (NICU) in Switzerland. Subjects: Nine preterm infants born between 28 2/7 and 31 4/7 weeks of gestation during their first 14 days of life. Measurements: Pain was assessed by the Bernese Pain Scale for Neonates (BPSN), the Premature Infant Pain Profile (PIPP) and the Visual Analogue Scale (VAS). Salivary cortisol was analysed. Results: 72–94% of the variability was within-subject variability, indicating inconsistency of pain responses across the 5 heel sticks. Interrater agreement was highest during heel sticks 1–3 and decreased during heel stick 4 and 5, indicating a possible alteration of pain patterns. No significant differences in the amount of cortisol could be detected before and after the heel sticks (p = 0.55), indicating no stress-induced peak after the painful intervention. However, a general gradual decrease of cortisol levels across time could be detected. Conclusion: A high variability in pain response among preterm neonates across time could be described. Consistency of cortisol levels before and after the heel sticks could indicate the effectiveness of sucrose across time. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although the focus of health care for people seeking asylum in Western European countries is usually on communicable diseases, there is little data about the general health care need of this population. In this study, we investigated the actual burden of disease among asylum seekers. METHODS: Data were collected from a Swiss Health Maintenance Organisation (HMO; a type of managed care organization in which physicians act as gate keepers) that was set up specifically to provide health care for asylum seekers. The data included socio-demographic characteristics, international classification of diseases (ICD-10) diagnoses and number of clinic visits. Descriptive statistics were used to assess the types of health problems and the number of clinic visits. Logistic regression analysis was used to determine whether age, gender or country or region of origin was predictive in terms of incidence of disease as diagnosed by using ICD classifications. RESULTS: The total number of asylum seekers (mean age 22 years; 38% women) enrolled in the HMO from 2000 through 2003 was 979. Half of this group came from the former country of Yugoslavia. The remainder came primarily from sub-Saharan Africa, Turkey, Iraq and Sri Lanka. The most common health problems encountered in the population included musculoskeletal diseases, respiratory diseases, depression and post-traumatic stress disorder. The prevalence of all disease clusters was significantly associated with age. One-fifth of the population did not request health care at all during the time they were enrolled in the HMO. It is not known whether those who did not visit the medical clinic did not require health care or just chose not to request clinic services. CONCLUSIONS: The most frequent health problems encountered in the study population were chronic medical conditions, not communicable acute diseases. Although health care services provided to asylum seekers usually focus on episodic acute care, what this group actually needs is continuity of care. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to explore nurses' responses to ethical dilemmas in daily nursing practice. Background. Concern about nurses' ethical competence is growing. Most nurses perceived that there were barriers in their work environment to ethical practice, compromising their ability to perform ethically. Since most research focuses on contextual barriers to nurses' ethical practice, little is known about how nurses involve themselves in ethical decision-making and action in daily care. Method. A meta-analysis of nurses' ethical behaviour was conducted using data from nine studies in four countries (n = 1592 registered nurses). In all studies, the Ethical Behaviour Test was used to measure nurses' ethical responses, based on an adapted version of Kohlberg's theory of moral development. Data were analysed using random-intercept regression analysis. Findings. All groups, except the expert group, displayed a uniform pattern of conventional ethical reasoning and practice. When nurses were faced with ethical dilemmas, they tended to use conventions as their predominant decision-guiding criteria rather than patients' personal needs and well-being. Conclusion. Conformist practice (following conventions rather than pursuing good for the patient) constitutes a major barrier for nurses to take the appropriate ethical actions, as creativity and critical reflection are absent. There is an urgent need to find ways to promote nurses' ethical development from conventional to postconventional ethical practice. More research is needed to strengthen existing empirical evidence. [ABSTRACT FROM AUTHOR]

Adherence to fluid restrictions and dietary and medication guidelines as well as attendance at prescribed hemodialysis sessions of a hemodialysis regimen are essential for adequate management of end-stage renal disease. A literature review was conducted to determine the prevalence and consequences of nonadherence to the different aspects of a hemodialysis regimen and the methodological obstacles in research on nonadherence. Nonadherence to the prescribed regimen is a common problem in hemodialysis and is associated with increased morbidity and mortality. Research on nonadherence is associated with 2 major obstacles: inconsistencies in definitions and invalid measurement methods. Further research is needed to validate measurement methods and to establish clinically relevant operational definitions of nonadherence. [ABSTRACT FROM AUTHOR]

Background: Electronic monitoring (EM) is used increasingly to measure medication non-adherence. Unbiased EM assessment requires fulfillment of assumptions. The purpose of this study was to determine assumptions needed for internal and external validity of EM measurement. To test internal validity, we examined if (1) EM equipment functioned correctly, (2) if all EM bottle openings corresponded to actual drug intake, and (3) if EM did not influence a patient's normal adherence behavior. To assess external validity, we examined if there were indications that using EM affected the sample representativeness.Methods: We used data from the Supporting Medication Adherence in Renal Transplantation (SMART) study, which included 250 adult renal transplant patients whose adherence to immunosuppressive drugs was measured during 3 months with the Medication Event Monitoring System (MEMS). Internal validity was determined by assessing the prevalence of nonfunctioning EM systems, the prevalence of patient-reported discrepancies between cap openings and actual intakes (using contemporaneous notes and interview at the end of the study), and by exploring whether adherence was initially uncharacteristically high and decreased over time (an indication of a possible EM intervention effect). Sample representativeness was examined by screening for differences between participants and non-participants or drop outs on non-adherence.Results: Our analysis revealed that some assumptions were not fulfilled: 1) one cap malfunctioned (0.4%), 2) self-reported mismatches between bottle openings and actual drug intake occurred in 62% of the patients (n = 155), and 3) adherence decreased over the first 5 weeks of the monitoring, indicating that EM had a waning intervention effect.Conclusion: The validity assumptions presented in this article should be checked in future studies using EM as a measure of medication non-adherence. [ABSTRACT FROM AUTHOR]

Objective: Nonadherence with immunosuppressive regimen (NAH) is a major risk factor for poor outcome after renal transplantation (RTX). The aim of this study was to test the effectiveness of a 3 months educational-behavioral intervention aimed at remediating non-adherence in non-adherent RTX as assessed by electronic event monitoring. Methods: This randomized controlled trial (RCT) included 18 non-adherent renal transplant recipients (21.4% f. - age 45.6 ± 1.2 y) identified during a 3 months run-in period measuring NAH using Electronic Event Monitoring (EEM) and using an algorithm to classify patient as NA. NAH patients were randomly assigned to either intervention (IG, N = 6) or enhanced usual care group (EUC, N = 12). NAH was assessed by EEM in both the IG and EUC groups. After the 3 months intervention period, a 6 months follow-up was done. EUC implied usual care and notification of treating physician about NAH as well as severe depression or suicidal ideation if applicable. The 3 months intervention included one home visit and 3 follow-up telephone calls on a monthly basis by a nurse who used behavioral, educational and social support interventions for remediation of NAH. EEM out-prints allowed detailed feedback to patients concerning their individual medication taking dynamics in the IG. Results: EEM parameters improved from baseline until after 3 months intervention in the IG (N = 5) compared to EUC (N = 9) (see figure 1 and 2). The figures only show taking and timing adherence, and indicate the level of NA for being at risk. A generalized estimating equation type logistic regression using a binary sequence of daily EEM events (dose taken or not) showed that at the end of the 3 months intervention period the IG showed 36% lower non-adherence compared with the enhanced usual care group (β = -0.4512, p = 0.0836, two-tailed). At 9 months (after 6 months follow-up) no significant difference between the groups (β = 0.0253, p = 0.95, two-tailed) was found indicating a wean out effect when the intervention was stopped. Conclusions: The findings of this RCT suggest that it was feasible to remediate non-adherence with the immunosuppressive regimen, providing a possible pathway to improve clinical outcome in RTX. [ABSTRACT FROM AUTHOR]

Objective: Even though light to moderate alcohol use might have beneficial effects on health, severe alcohol use is recognized as a major public health concern. Alcohol use has been studied to some extent in solid organ transplant populations, yet, very limited evidence has bee published on alcohol use and its correlates in the renal transplant population. The aim of this study was therefore to determine the prevalence and correlates of alcohol use in renal transplant recipients. Methods: This cross-sectional study is a secondary analysis of the Supporting Medication Adherence in Renal Transplantation (SMART) study. 284 patients were included in this analysis, 58.1% male, mean age: 54.02 y. (SD: 13.34); median years post transplantation 7 (IQR 3-11). The prevalence and frequency of alcohol use as well as the quantity of alcohol consumed were assessed by patient self-report using structured questionnaires. Patients were classified as being at low risk, moderate risk or severe risk based on WHO criteria. Selected psychosocial and behavioral correlates of alcohol use were explored to compare those patients consuming alcohol and those not given the small proportion of patients at risk. Results: 52.8% of the study participants reported to use alcohol. Of the 284 patients included in the analysis, 280 were drinking at low and 3 at moderate risk. However, 1 of the participants drinking at low risk according to WHO criteria was identified as binge drinker. Statistically significant correlates of alcohol use found in univariate analysis were, among others, male gender, current smoking, employment and higher education. In logistic regression analysis, male gender and paid work were found to increase the likelihood of consuming alcohol. Conclusions: Patterns of alcohol use and correlates are comparable to the general population. Severe alcohol use is less prevalent in renal transplant recipients compared to heart and liver transplantation (9% and 6%, respectively), where alcohol is known as an etiological factor in a proportion of patients with end-stage heart or liver disease. [ABSTRACT FROM AUTHOR]