Outcomes of care during the last month of life: a systematic review to inform the development of a core outcome set.

BACKGROUND To date, there is a lack of standardization and consensus on which outcomes are central to assess the care provided to patients in the last month of life. Therefore, we aimed to conduct a systematic review to identify relevant outcomes to inform the development of a core outcome set for the best care for the dying person. METHODS We conducted a systematic review of outcomes reported in the scientific literature about the care for the dying person in the last month of life. We searched for peer-reviewed studies published before February 2022 in four electronic databases. To categorise the outcomes, we employed the taxonomy developed by the "Core Outcome Measures in Effectiveness Trials" collaboration. RESULTS Out of the 2,933 articles retrieved, 619 were included for analyses. The majority of studies (71%) were retrospective and with data extracted from chart reviews (71%) . We extracted 1,951 outcomes in total, from which, after deletion of repeated outcomes, we identified 256 unique ones. The most frequently assessed outcomes were those related to medication or therapeutic interventions and those to hospital/ healthcare use. Outcomes related to psychosocial wellbeing were rarely assessed. The closer to death, the less frequently the outcomes were studied. CONCLUSIONS Most outcomes were related to medical interventions or to hospital use. Only a few studies focused on other components of integrated care such as psychosocial aspects. It remains to be defined which of these outcomes are fundamental to achieve the best care for the dying

Internal health locus of control as a predictor of pain reduction in multidisciplinary inpatient treatment for chronic pain: a retrospective study.

Purpose Chronic pain is a major health concern and its treatment requires physiological as well as psychological interventions. This study investigates the predictive value of health locus of control (HLOC) in pain intensity in chronic pain patients in an inpatient treatment setting. Patients and methods Data of 225 patients with a chronic pain condition were collected in a psychosomatic university clinic in Switzerland. Self-report assessment tools were used to measure pain intensity pre- and posttreatment and with a questionnaire dimensions of the HLOC were captured. Using hierarchic linear regression analysis, the predictive value of HLOC was investigated. Results A higher internal HLOC at pre-treatment was associated with a greater reduction in pain intensity from pre- to posttreatment (β = -0.151, p<0.05). For social-external and fatalistic-external HLOC no significant effects were observed. Conclusion Internal HLOC showed predictive value regarding the reduction in pain intensity in a multidisciplinary inpatient treatment for chronic pain, whereas social-external and fatalistic-external HLOC did not. Early interventions to strengthen internal beliefs of health control may be a promising component in multidisciplinary inpatient treatment for patients with chronic pain

Kleinsäuger mit Haarproben zuverlässig bestimmen

Um das Vorkommen der Schweizer Kleinsäugetiere zu untersuchen, müssen diese lebend gefangen und bestimmt werden. Gewisse ähnliche Arten lassen sich jedoch morphologisch nicht genau unterscheiden. Für eine sichere Artbestimmung ist deshalb bei einigen Arten eine DNA-Analyse unumgänglich. Die Entnahme von Haarproben ermöglicht eine für das Tier schnelle und schonende Gewinnung von DNA

The relationship between negative symptoms and cognitive functioning in patients at clinical high risk for psychosis

Negative symptoms and neurocognitive performance have been reported to be negatively associated in patients with emerging psychosis. However, most previous studies focused on patients with frank psychosis and did not differentiate between subdomains of negative symptoms. Hence, we aimed to elucidate the specific relationship between negative symptoms and cognitive functioning in patients at clinical high risk (CHR) for psychosis. Data from 154 CHR patients collected within the prospective Früherkennung von Psychosen (FePsy) study were analyzed. Negative symptoms were assessed with the Scale for the Assessment of Negative Symptoms (SANS) and cognitive functioning with an extensive neuropsychological test battery. Regression analyses revealed significant negative associations between negative symptoms and cognitive functioning, particularly in the domains of nonverbal intelligence and verbal fluency. When analyzing each negative symptom domain separately, alogia and asociality/anhedonia were significantly negatively associated with nonverbal intelligence and alogia additionally with verbal fluency. Overall, our results in CHR patients are similar to those reported in patients with frank psychosis. The strong negative association between verbal fluency and negative symptoms may be indicative of an overlap between these constructs. Verbal fluency might have a strong influence on the clinical impression of negative symptoms (particularly alogia) and vice versa

Live well, die well – an international cohort study on experiences, concerns and preferences of patients in the last phase of life: the research protocol of the iLIVE study

Introduction Adequately addressing the needs of patients at the end of life and their relatives is pivotal in preventing unnecessary suffering and optimising their quality of life. The purpose of the iLIVE study is to contribute to high-quality personalised care at the end of life in different countries and cultures, by investigating the experiences, concerns, preferences and use of care of terminally ill patients and their families. Methods and analysis The iLIVE study is an international cohort study in which patients with an estimated life expectancy of 6 months or less are followed up until they die. In total, 2200 patients will be included in 11 countries, that is, 200 per country. In addition, one relative per patient is invited to participate. All participants will be asked to fill in a questionnaire, at baseline and after 4 weeks. If a patient dies within 6 months of follow-up, the relative will be asked to fill in a post-bereavement questionnaire. Healthcare use in the last week of life will be evaluated as well; healthcare staff who attended the patient will be asked to fill in a brief questionnaire to evaluate the care that was provided. Qualitative interviews will be conducted with patients, relatives and healthcare professionals in all countries to gain more in-depth insights. Ethics and dissemination The cohort study has been approved by ethics committees and the institutional review boards (IRBs) of participating institutes in all countries. Results will be disseminated through the project website, publications in scientific journals and at conferences. Within the project, there will be a working group focusing on enhancing the engagement of the community at large with the reality of death and dying. Trial registration number NCT04271085

Internal health locus of control as a predictor of pain reduction in multidisciplinary inpatient treatment for chronic pain: a retrospective study

Purpose: Chronic pain is a major health concern and its treatment requires physiological as well as psychological interventions. This study investigates the predictive value of health locus of control (HLOC) in pain intensity in chronic pain patients in an inpatient treatment setting. Patients and methods: Data of 225 patients with a chronic pain condition were collected in a psychosomatic university clinic in Switzerland. Self-report assessment tools were used to measure pain intensity pre- and posttreatment and with a questionnaire dimensions of the HLOC were captured. Using hierarchic linear regression analysis, the predictive value of HLOC was investigated. Results: A higher internal HLOC at pre-treatment was associated with a greater reduction in pain intensity from pre- to posttreatment (β = −0.151, p<0.05). For social-external and fatalistic-external HLOC no significant effects were observed. Conclusion: Internal HLOC showed predictive value regarding the reduction in pain intensity in a multidisciplinary inpatient treatment for chronic pain, whereas social-external and fatalistic-external HLOC did not. Early interventions to strengthen internal beliefs of health control may be a promising component in multidisciplinary inpatient treatment for patients with chronic pain

Rethinking the criteria for fibromyalgia in 2019: the ABC indicators

Purpose: Diagnostic criteria for fibromyalgia have been subject to debate and controversy for many years. The preliminary diagnostic criteria introduced in 2010 and 2011 have been criticized for different reasons, including questionable diagnostic specificity and a lack of an etiopathogenetic foundation. The “ABC indicators” presented in this study reflect a further development of the 2011 criteria and refer to (A) algesia, (B) bilateral, axial-symmetric pain distribution, and (C) chronic distress. Patients and methods: We compared the diagnostic performance of the ABC indicators with that of the 2011 criteria by analyzing the data of 409 inpatients with chronic functional pain divided into two subgroups of pain patients: Those with whole-body pain and those with pain not involving the whole body. Under the premise that FM phenotypically represents a whole-body pain disorder, sensitivity, specificity, correct classification and diagnostic odds ratios were calculated. Results: The 2011 criteria demonstrated a specificity of 68.1%, a sensitivity of 75.5%, a correct classification of 71.0% and a diagnostic odds ratio of 6.56 (CI: 4.17–10.31). The ABC indicators achieved a specificity of 88.3%, a sensitivity of 62.3%, a correct classification of 78.6%, and a diagnostic odds ratio of 12.47 (CI: 7.30–21.28). Conclusion: The ABC fibromyalgia indicators demonstrated better specificity, lower sensitivity, and better overall diagnostic effectiveness than the original 2011 criteria