Perceived symptom manageability - synthesis of a new use of a known concept based on a sample of HIV outpatients

Symptom management issues are regularly discussed in medical follow-up appointments, however, despite the integration of patients' perspectives in symptom management negotiations, traditional-ly used measures (i.e., symptom severity and frequency) to identify symptoms that need management do not seem to capture the patient's needs and, consequently, patients' expectations are frequently unmet 141. Although symptom frequency, symptom severity, and associated distress or bother are considered core indicators of the patient's individual experience of perceived symptoms 13,60,75,142,143, they do not truly cap-ture the wholeness of PLWHs' lived experience associated with symptoms in the chronic phase of the HIV trajectory. Therefore, they only allow the identification of a limited number of symptoms that need man-agement due to symptom expression and associated distress. Moreover, symptom lists that were invented before cART was widely available may not have been adapted to new symptom profiles, and are of limited value to capture symptoms of concern to patients in a chronic phase. Subjective illness theories, such as the Common sense Theory by Leventhal et al. (1992) support the assumption that objective measures may be of limited importance to patients, as illness perception is greatly determined by individual concepts and interpretations. Patients, according to this model, base the assessment of symptoms that need management not only on symptom expression, but rather on a combination of their own interpretation of perceived symptoms, illness representation (e.g., cause, time-line, control), personal (such as demographic and cul-tural) factors, and social support. Moreover, these factors are mutually influential and individual weighted. Symptom severity or frequency, thus, may or may not be the most important aspects when pa-tients express concern about a symptom. Moreover, to our knowledge, there is no instrument or concept currently used which integrates dimensions of daily living with HIV to identify symptoms that need man-agement in the chronic phase of HIV. The most promising approach to caring for patients with chronic diseases is to approach the illness as a collaborative endeavor, acknowledging the patient as an expert of his condition, living context, and emotional situation. Health care providers and patients not only exchange information but also are partners for negotiating approaches to symptom self-management in every-day life. Comparing the parameters used to identify symptoms that need management and those important for patient self-management in daily life, it becomes clear that the patient perspective on consequences of a symptom for daily life are often neglected. In order to assess a patient's unique and individual perception of symptoms that need management, and in the future, the success of symptom management interventions, we therefore propose to use a meas-ure representing this individuality and uniqueness. As in clinical encounters, patients often describe their life with symptoms using sentences like "I can't manage symptom x or y anymore", or "well, yes, symp-toms are well manageable," thus directly referring to their ability to influence the impact of the symptoms on their life, we suggest "perceived symptom manageability" to meet this condition: the patient is the only person who is able to assess the perceived manageability of a symptom in the context of his or her lived experience

A master of nursing science curriculum revision for the 21st century : a progress report

Background: Preparing a 21st century nursing workforce demands future-oriented curricula that address the population’s evolving health care needs. With their advanced clinical skill sets and broad scope of practice, Advanced Practice Nurses strengthen healthcare systems by providing expert care, especially to people who are older and/or have chronic diseases. Bearing this in mind, we revised our established Master of Nursing Science curriculum at the University of Basel, Switzerland. Methods: Guided by the Advanced Nursing Practice framework, interprofessional guidelines, fundamental reports on the future of health care and the Bologna declaration, the reform process included three interrelated phases: preparation (work packages (WPs): curriculum analysis, alumni survey), revision (WPs: program accreditation, learning outcomes), and regulations (WPs: legal requirements, program launch). Results: The redesigned MScN curriculum offers two specializations: ANP and research. It was implemented in the 2014 fall semester. Conclusions: This curriculum reform’s strategic approach and step-by-step processes demonstrate how, beginning with a solid conceptual basis, congruent logical steps allowed development of a program that prepares nurses for new professional roles within innovative models of care

Academic integrity among nursing students : a survey of knowledge and behavior

Background: Minimal research has been done to determine how well European nursing students understand the core principles of academic integrity and how often they deviate from good academic practice. Aim: The aim of this study was to find out what educational needs nursing students have in terms of academic integrity. Research design: A quantitative cross-sectional study in the form of a survey of nursing students was conducted via questionnaire in the fall of 2020. Participants: The sample was composed of 79 students in the BScN and MScN programs at Zürich University of Applied Sciences. Ethical considerations: An application for a non-competence clearance was approved by the Ethics Committee in Zurich (BASEC No. Req-2020-00868). The survey was anonymous, and informed consent was obtained prior to participation. Results: The participants had a high level of confidence in their own knowledge but were in many cases unable to correctly identify clear-cut examples of misconduct and to differentiate them from questionable practices. About 13% of the participants admitted that during their university education they had copied shorter passages from other sources into their own text without marking them as quotes. Conclusions: The study documents extensive knowledge gaps among nursing students regarding both academic misconduct and questionable practices and indicates a need for improved academic integrity training

Integrated care models in Swiss primary care : an embedded multiple case study

Rationale, Aimsand Objectives: Healthcare systems are confronted with a rising number of patients with chronic conditions and complex care needs, requiring the development of new models of coordinated, patient-centred care. In this study, we aimed to describe and compare a range of new models of care recently implemented in primary care in Switzerland, as well as to gain insight into the type of coordination or integration implemented, the strengths and weaknesses of each model and the challenges they face. Method: We used an embedded multiple case study design to describe in-depth a series of current Swiss initiatives that specifically aim to improve care coordination in primary care. For each model, documents were collected, a questionnaire was administered and semistructured interviews with key actors were conducted. A within-case analysis followed by a cross-case analysis were performed. Based on the Rainbow Model of Integrated Care framework, similarities and differences between the models were highlighted. Results: Eight integrated care initiatives were included in the analysis, representing three types of models: independent multiprofessional GP practices, multiprofessional GP practices/health centres that are part of larger groups and regional integrated delivery systems. Recognized effective activities and tools to improve care coordination, such as multidisciplinary teams, case manager involvement, use of electronic medical records, patient education and use of care plans, were implemented by at least six of the eight initiatives studied. The main obstacles to the implementation of integrated care models were the inadequate Swiss reimbursement policies and payment mechanisms and the desire of some healthcare professionals to protect their territory in a context where new roles are emerging. Conclusion: The integrated care models implemented in Switzerland are promising; nevertheless, financial and legal reforms must be introduced to promote integrated care in practice

Setting new priorities for nursing research: The updated Swiss Nursing Research Agenda—a systematic, participative approach

Aim To identify current key areas for nursing research in Switzerland, we revised the Swiss Research Agenda for Nursing (SRAN) initially published in 2008. Background By developing a research agenda, nursing researchers internationally prioritize and cluster relevant topics within the research community. The process should be collaborative and systematic to provide credible information for decisionmakers in health care research, policy, and practice. Sources of Evidence After a participative, systematic, and critical evaluation within and outside of the Swiss Association for Nursing Science, the updated SRAN 2019–2029 defines four research priorities (new models of care, nursing care interventions, work and care environment, and quality of care and patient safety) and four transversal themes (organization of research, research methodologies, research in health care policy and public health perspectives). Conclusion Adding to other national nursing research agendas, the categories are organized in a framework of key research priorities and transversal themes. They relate to the importance of global and local foci of research as well as challenges in health care services and policy systems. The agenda is an important prerequisite for enhancing the influence of nursing research in Switzerland and provides guidance for the next decade.Implications for Nursing PracticeThe revised agenda ensures that research projects target key knowledge gaps and the discipline's core questions in respective countries.Implications for Health PolicyNursing research should inform and influence health policy on all institutional and political levels. Therefore, the integration of public health perspectives in research is one of the most important new aspects of SRAN 2019–2029

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

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

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.; 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.; 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%).; 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.; Clinical Trial Number: NCT02785666 , 30.05.2016

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Geosciences Roadmap for Research Infrastructures 2025 - 2028 by the Swiss Geosciences Community

This roadmap is the product of a grassroots effort by the Swiss Geosciences community. It is the first of its kind, outlining an integrated approach to research facilities for the Swiss Geosciences. It spans the planning period 2025-2028. Swiss Geoscience is by its nature leading or highly in-volved in research on many of the major national and global challenges facing society such as climate change and meteorological extreme events, environmental pol-lution, mass movements (land- and rock-slides), earth-quakes and seismic hazards, global volcanic hazards, and energy and other natural resources. It is essential to under- stand the fundamentals of the whole Earth system to pro-vide scientific guidelines to politicians, stakeholders and society for these pressing issues. Here, we strive to gain efficiency and synergies through an integrative approach to the Earth sciences. The research activities of indivi- dual branches in geosciences were merged under the roof of the 'Integrated Swiss Geosciences'. The goal is to facilitate multidisciplinary synergies and to bundle efforts for large research infrastructural (RI) requirements, which will re-sult in better use of resources by merging sectorial acti- vities under four pillars. These pillars represent the four key RIs to be developed in a synergistic way to improve our understanding of whole-system processes and me- chanisms governing the geospheres and the interactions among their components. At the same time, the roadmap provides for the required transition to an infrastructure adhering to FAIR (findable, accessible, interoperable, and reusable) data principles by 2028.The geosciences as a whole do not primarily profit from a single large-scale research infrastructure investment, but they see their highest scientific potential for ground-break-ing new findings in joining forces in establishing state-of-the-art RI by bringing together diverse expertise for the benefit of the entire geosciences community. Hence, the recommendation of the geoscientific community to policy makers is to establish an integrative RI to support the ne- cessary breadth of geosciences in their endeavor to ad-dress the Earth system across the breadth of both temporal and spatial scales. It is also imperative to include suffi-cient and adequately qualified personnel in all large RIs. This is best achieved by fostering centers of excellence in atmospheric, environmental, surface processes, and deep Earth projects, under the roof of the 'Integrated Swiss Geosciences'. This will provide support to Swiss geo-sciences to maintain their long standing and internatio- nally well-recognized tradition of observation, monitor-ing, modelling and understanding of geosciences process-es in mountainous environments such as the Alps and beyond