Entwicklung und Validierung des Bedürfnisinventars bei Gedächtnisstörungen (BIG-65): Krankheitskorrelierte Bedürfnisse bei Menschen mit Hirnleistungsstörungen und Demenz

Zusammenfassung: Hintergrund: Der Bedarf an einer systematischen Erfassung krankheitskorrelierter Patientenbedürfnisse bei Hirnleistungsstörungen und Demenz zur Auswahl optimaler Behandlungsoptionen steigt zunehmend. Es fehlt jedoch an validen Messinstrumenten, die zur Erfassung krankheitskorrelierter Bedürfnisse auch bei Menschen mit Demenz eingesetzt werden können. Methode: Die Studie umfasst die Konstruktion und Validierung des Bedürfnisinventars bei Gedächtnisstörungen (BIG-65) zur Erfassung krankheitskorrelierter Bedürfnisse. Der BIG-65 wurde theoriegeleitet entwickelt und basiert auf einer systematischen Literaturrecherche. Er wurde in einer Abklärungsstation, nach umfassender Untersuchung und Diagnosestellung, hinsichtlich seiner psychometrischen Eigenschaften an einer Gelegenheitsstichprobe (n = 83) validiert. Ergebnisse: Der BIG-65 hat 66Items und bietet neben einer breiten Auswahl an biopsychosozialen und umweltbezogenen Bedürfnissen eine geeignete Struktur zur Erfassung krankheitskorrelierter Bedürfnisse bei Menschen mit Hirnleistungsstörungen. Er verfügt über eine besonders hohe Augenscheinvalidität und eine sehr hohe Test-Retest-Reliabilität (rtt = 0,916). Im Mittel wurden 3,5 (SD = 3,7) unabgedeckte Bedürfnisse angegeben. Am häufigsten genannt wurden: "weniger vergessen" (50%), "bessere Konzentration" (23,2%), "Informationen zur Krankheit" (20,7%), "Informationen über Behandlungen" (17,1%) sowie "sich weniger Sorgen machen", "weniger gereizt sein", "Verbesserung der Stimmung", "Verbesserung der Orientierung" (alle 13,4%). Bedürfnisprofile unterscheiden sich zwischen verschiedenen Patientengruppen mit präklinischen (subjektive und milde kognitive Beeinträchtigung) und klinischen (Demenz) Hirnleistungsstörungen. Schlussfolgerungen: Krankheitskorrelierte Bedürfnisse können mit dem BIG-65 bis zu einer mittelschweren Demenz reliabel erfasst werden. Mit zunehmendem Demenzschweregrad oder einem Mini-Mental-Status <20Punkten sollte die Erfassung, z.B. mit zusätzlichen Beobachtungsmethoden des emotionalen Ausdrucks, ergänzt werden. Die Ergebnisse zeigen, dass Menschen mit Hirnleistungsstörungen individuelle Strategien zur Stabilisierung von Lebensqualität verfolgen. Neben einem objektiven Assessment von Krankheitssymptomen kann die Priorisierung optimaler Behandlungsmaßnahmen von der systematischen Erfassung krankheitskorrelierter Patientenbedürfnisse profitiere

How Is Variety in Daily Life Related to the Expression of Personality States? An Ambulatory Assessment Study

People differ in the way they live their daily lives. For some people, daily life is characterized by multiple and diverse experiences, while others have more stability and routine in their lives. However, little is known about how variety in daily life relates to the expression of personality states. The present study examined within-person associations between variety in social partners, places, and activities with state expression. Data came from an ambulatory assessment study (N = 962, Mage = 25.49) with four assessments per day over a period of six consecutive days. The results of the multilevel modeling analyses suggest that variety in daily life is associated with some, but not all, state expressions. For instance, on days when participants experienced a greater variety in activities, they reported being less neurotic and conscientious, but also more agreeable. In addition, the links between all social partners, places, and activities with the expression of the state were examined simultaneously to obtain more detailed information on the multifaceted nature of situation-state expression links. We conclude that variety in daily life has both theoretical and empirical relevance for the expression of personality states

Optimized patient transfer using an innovative multidisciplinary assessment in the Kanton Aargau (OPTIMA I): an observational survey in lower respiratory tract infections

BACKGROUND: Current medical scores have limited efficiency and safety profiles to enable assignment to the most appropriate treatment site in patients with lower respiratory tract infections (LRTIs). We describe our current triage practice and assess the potential of a combination of CURB65 with proadrenomedullin (ProADM) levels for triage decisions. METHODS: Consecutive patients with LRTIs presenting to our emergency department were prospectively followed and retrospectively classified according to CURB65 and ProADM levels (CURB65-A). Low medical risk patients were further subgrouped according to biopsychosocial and functional risks. We compared the proportion of patients virtually allocated to triage sites with actual triage decisions and assessed the added impact of ProADM in a subgroup. RESULTS: Overall, 93% of 146 patients were hospitalised. Among the 138 patients with available CURB65-A, 17.4% had a low medical risk indicating possible treatment in an outpatient or non-acute medical setting; 34.1% had an intermediate medical risk (short-hospitalisation); and 48.6% had a high medical risk (hospitalisation). Fewer patients were in a low CURB65-A class (I) than a low CURB65 class (0,1) (17.4% vs. 46.3%, p >0.001). Mean length of hospitalisation was 9.8 days including 3.6 days after reaching medical stability. In 60.3% of patients, hospitalisation was prolonged after medical stability mainly for medical reasons. CONCLUSIONS: Current rates of hospitalisation are high in patients with LRTI and length of stay frequently extended beyond time of medical stabilization. The lower proportion of patients reclassified as low risk by adding ProADM to the CURB65 score might improve confidence in the triage algorithm

Cross-sectional observational study of 208 patients with non-classical urea cycle disorders.

Urea cycle disorders (UCDs) are inherited disorders of ammonia detoxification often regarded as mainly of relevance to pediatricians. Based on an increasing number of case studies it has become obvious that a significant number of UCD patients are affected by their disease in a non-classical way: presenting outside the newborn period, following a mild course, presenting with unusual clinical features, or asymptomatic patients with only biochemical signs of a UCD. These patients are surviving into adolescence and adulthood, rendering this group of diseases clinically relevant to adult physicians as well as pediatricians. In preparation for an international workshop we collected data on all patients with non-classical UCDs treated by the participants in 20 European metabolic centres. Information was collected on a cohort of 208 patients 50% of which were ≥ 16 years old. The largest subgroup (121 patients) had X-linked ornithine transcarbamylase deficiency (OTCD) of whom 83 were female and 29% of these were asymptomatic. In index patients, there was a mean delay from first symptoms to diagnosis of 1.6 years. Cognitive impairment was present in 36% of all patients including female OTCD patients (in 31%) and those 41 patients identified presymptomatically following positive newborn screening (in 12%). In conclusion, UCD patients with non-classical clinical presentations require the interest and care of adult physicians and have a high risk of neurological complications. To improve the outcome of UCDs, a greater awareness by health professionals of the importance of hyperammonemia and UCDs, and ultimately avoidance of the still long delay to correctly diagnose the patients, is crucial

Enhancement of CURB65 score with proadrenomedullin (CURB65-A) for outcome prediction in lower respiratory tract infections: Derivation of a clinical algorithm

Proadrenomedullin (ProADM) confers additional prognostic information to established clinical risk scores in lower respiratory tract infections (LRTI). We aimed to derive a practical algorithm combining the CURB65 score with ProADM-levels in patients with community-acquired pneumonia (CAP) and non-CAP-LRTI

Cross-sectional observational study of 208 patients with non-classical urea cycle disorders

Urea cycle disorders (UCDs) are inherited disorders of ammonia detoxification often regarded as mainly of relevance to pediatricians. Based on an increasing number of case studies it has become obvious that a significant number of UCD patients are affected by their disease in a non-classical way: presenting outside the newborn period, following a mild course, presenting with unusual clinical features, or asymptomatic patients with only biochemical signs of a UCD. These patients are surviving into adolescence and adulthood, rendering this group of diseases clinically relevant to adult physicians as well as pediatricians. In preparation for an international workshop we collected data on all patients with non-classical UCDs treated by the participants in 20 European metabolic centres. Information was collected on a cohort of 208 patients 50% of which were ≥ 16 years old. The largest subgroup (121 patients) had X-linked ornithine transcarbamylase deficiency (OTCD) of whom 83 were female and 29% of these were asymptomatic. In index patients, there was a mean delay from first symptoms to diagnosis of 1.6 years. Cognitive impairment was present in 36% of all patients including female OTCD patients (in 31%) and those 41 patients identified presymptomatically following positive newborn screening (in 12%). In conclusion, UCD patients with non-classical clinical presentations require the interest and care of adult physicians and have a high risk of neurological complications. To improve the outcome of UCDs, a greater awareness by health professionals of the importance of hyperammonemia and UCDs, and ultimately avoidance of the still long delay to correctly diagnose the patients, is crucial