Evaluation of Central Auditory Discrimination Abilities in Older Adults

The present study focuses on auditory discrimination abilities in older adults aged 65-89 years. We applied the ‘Leipzig Inventory for Patient Psychoacoustic’ (LIPP), a psychoacoustic test battery specifically designed to identify deficits in central auditory processing. These tests quantify the just noticeable differences (JND) for the three basic acoustic parameters (i.e. frequency, intensity, and signal duration). Three different test modes (monaural, dichotic signal/noise [s/n] and interaural) were used, stimulus level was 35dB sensation level. The tests are designed as three-alternative forced-choice procedure with a maximum-likelihood procedure estimating p=0,5 correct response value. These procedures have proven to be highly efficient and provide a reliable outcome. The measurements yielded significant age-dependent deteriorations in the ability to discriminate single acoustic features pointing to progressive impairments in central auditory processing. The degree of deterioration was correlated to the different acoustic features and to the test modes. Most prominent, interaural frequency and signal duration discrimination at low test frequencies was elevated which indicates a deterioration of time- and phase-dependent processing at brain stem and cortical levels. LIPP proves to be an effective tool to identify basic pathophysiological mechanisms and the source of a specific impairment in auditory processing of the elderly

The use of pure and impure placebo interventions in primary care - a qualitative approach

Background: Placebos play an important role in clinical trials and several surveys have shown that they are also common in daily practice. Previous research focused primarily on the frequency of placebo use in outpatient care. Our aim was to explore physicians' views on the use of placebos in daily practice, whereby distinction was made between pure placebos (substances with no pharmacological effect, e.g. sugar pills) and impure placebos (substances with pharmacological effect but not on the condition being treated, e.g. antibiotics in viral infections or vitamins). Methods: We performed semi-structured interviews with a sample of twelve primary care physicians (PCPs). The interview addressed individual definitions of a placebo, attitudes towards placebos and the participants' reasons for prescribing them. The interviews were transcribed and analysed using qualitative content analysis. Results: The definition of a placebo given by the majority of the PCPs in our study was one which actually only describes pure placebos. This definition, combined with the fact that most impure placebos were not regarded as placebos at all, means that most of the participating PCPs were not aware of the extent to which placebos are used in daily practice. The PCPs stated that they use placebos (both pure and impure) mainly in the case of non-severe diseases for which there was often no satisfactory somatic explanation. According to the PCPs, cases like this are often treated by complementary and alternative therapies and these, too, are associated with placebo effects. However, all PCPs felt that the ethical aspects of such treatment were unclear and they were unsure as to how to communicate the use of placebos to their patients. Most of them would appreciate ethical guidelines on how to deal with this issue. Conclusions: Many PCPs seem to be unaware that some of the drugs they prescribe are classified as impure placebos. Perceptions of effectiveness and doubts about the legal and ethical aspects of the use of placebos by PCPs may discourage their application. Dissemination of guidelines and consensus papers may be one approach, but it has to be acknowledged that the topic itself is in conflict with the PCPs' perception of themselves as professional and reliable physicians

Toward a loss of functional diversity in stream fish assemblages under climate change

The assessment of climate change impacts on biodiversity has so far been biased toward the taxonomic identification of the species likely either to benefit from climate modifications or to experience overall declines. There have still been few studies intended to correlate the characteristics of species to their sensitivity to climate change, even though it is now recognized that functional trait-based approaches are promising tools for addressing challenges related to global changes. In this study, two functional indices (originality and uniqueness) were first measured for 35 fish species occurring in French streams. They were then combined to projections of range shifts in response to climate change derived from species distribution models. We set out to investigate: (1) the relationship between the degrees of originality and uniqueness of fish species, and their projected response to future climate change; and (2) the consequences of individual responses of species for the functional diversity of fish assemblages. After accounting for phylogenetic relatedness among species, we have demonstrated that the two indices used measure two complementary facets of the position of fish species in a functional space. We have also rejected the hypothesis that the most original and/or less redundant species would necessarily experience the greatest declines in habitat suitability as a result of climate change. However, individual species range shifts could lead simultaneously both to a severe decline in the functional diversity of fish assemblages, and to an increase in the functional similarity among assemblages, supporting the hypothesis that disturbance favors communities with combination of common traits and biotic homogenization as well. Our findings therefore emphasize the importance of going beyond the simple taxonomic description of diversity to provide a better assessment of the likely future effects of environmental changes on biodiversity, thus helping to design more effective conservation and management measures

Factors influencing post-ICU psychological distress in family members of critically ill patients: a linear mixed-effects model

Background: Adverse responses to critical illness, such as symptoms of depression, anxiety or posttraumatic stress, are relatively common among family members. The role of risk factors, however, remains insufficiently understood, but may be important to target those family members most in need for support. We therefore examined the association of patient-, family member- and care-related factors with post-ICU psychological distress in family members in a general population of critical ill patients. Methods: We conducted a prospective, single-centre observational study in a twelve-bed surgical ICU in a 900-bed University Hospital in Switzerland. Participants were family members of patients treated in ICU who completed the Family Satisfaction in ICU-24 Survey, the Hospital Anxiety Depression Scale, Impact of Event Scale-Revised-6, and a demographic form within the first 3 months after their close other’s ICU stay. Data were analysed using linear mixed-effects models, with depression, anxiety, and posttraumatic stress as outcome measures. Results: A total of 214 family members (53% return rate) returned a completed questionnaire. We found that higher levels of satisfaction were significantly associated with lower levels of depression, anxiety and posttraumatic stress. There was no statistically significant association between family member characteristics and any measure of psychological distress. Among the included patient characteristics, younger patient age was associated with higher levels of depression, and patient death was associated with higher levels of depression and posttraumatic stress. Conclusions: Our results suggest that satisfaction with ICU care is strongly associated with family well-being post-ICU. Family members of younger patients and of those who die seem to be most at risk for psychological distress, requiring specific support, whereas family member characteristics may have less relevance

Impact of a nurse-led family support intervention on family members' satisfaction with intensive care and psychological wellbeing: A mixed-methods evaluation

Background: Families of critically ill persons face uncertainty and experience distress during and after their close other's stay in an intensive care unit (ICU). Proactive nurse engagement and support is recommended to meet families' needs in the ICU, but little is known about its impact on quality of family care. We introduced a family support intervention that consisted of an interprofessional family support pathway and a new role of an advanced practice family nurse. Objectives: The aim of the study was to examine the effect of an advanced practice nurse-led family support intervention on family members' satisfaction, wellbeing, and psychological distress. Methods: We conducted a quasi-experimental before-and-after study with embedded qualitative interviews in a Swiss University Hospital from March 2018 to July 2019 using a questionnaire (Family Satisfaction in the ICU-24 Survey, Hospital Anxiety and Depression Scale, and Impact of Event Scale-Revised-6) and qualitative interviews (n = 19) after patient discharge. Results: Families in the intervention group (n = 75) showed a trend for increased overall satisfaction (difference of 5.544, 95% confidence interval [CI]: -0.11 to 11.20), a statistically significant increase in satisfaction with decision-making (7.258, 95% CI: 0.89 to 13.63), and a nonsignificant increase in satisfaction with care (4.178, 95% CI: -1.53 to 9.89). Psychological distress was higher in the intervention group, with depression reaching statistical significance (difference of 1.706, 95% CI: 0.16 to 3.25), which may be explained by longer ICU stays and higher proportion of deaths in the intervention group. Families receiving the intervention reported to be feeling cared for, well informed, and better able to cope. Data integration suggests that early onset, fit to need, and quality of intervention were the most important intervention characteristics impacting family wellbeing. Conclusions: Our study found that family members experience a nurse-led support intervention as beneficial for their wellbeing. It increased their satisfaction, but was unable to demonstrate a favourable impact on psychological distress. Keywords: Advanced practice nurse; Anxiety; Depression; Family; Intensive care; Nursing intervention; Post-traumatic stress; Postintensive care syndrome – family; Psychological distress; Satisfaction

Adaption, benefit and quality of care associated with primary nursing in an acute inpatient setting: A cross‐sectional descriptive study

Aims: The aim of this study was to investigate the adoption of primary nursing and to determine the quality of primary nurse-led care in an acute inpatient setting. Design: Descriptive cross-sectional study. Methods: Participants included inpatients (N = 369) and nurses (N = 381). To assess adoption of primary nursing, patient records were analysed and an online survey of nurses was conducted from May–June 2017. To measure quality of nursing care, a structured questionnaire was administered to inpatients. Results: Patients reported high quality of individualized, responsive and proficient care, but lower levels of coordinated care. Most nurses agreed that primary nursing is beneficial for person-centred caring. However, only two-thirds found that it was practiced on their unit and only half of care planning activities were attributable to primary nurses. Conclusion: While perceived as beneficial, adoption of primary nursing in clinical practice remains partial. Hence, primary nursing may not be enough to ensure continuity and coordination of acute care

Spiritual Care als Bestandteil interprofessioneller Akutbehandlungen: Einstellungen und Praktiken von Gesundheitsfachpersonen

Spiritual care has gained importance in various areas of the healthcare system in recent years. Treatment models try to integrate spiritual concerns and needs and strengthen inter-professional cooperation in this context. How this is practised in Switzerland has not yet been comprehensively evaluated. The aim of our study was to examine to what extent and in what ways health professionals consider spiritual issues to be already taken into account or are willing to do so in their professional practice. A total of 196 people took part in the online survey. The results show that many healthcare professionals in acute settings regard spiritual care as an important part of interdisciplinary care, even if it is not yet well established. End-of-life situations are most strongly associated with spiritual care. The study provides an insight into the state of development of professional spiritual care in Switzerland and forms a basis for further research in and development of interprofessional spiritual care in acute settings

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