Erfassung der Patientenzufriedenheit in der stationären und teilstationären psychiatrischen Behandlung einer Abteilungspsychiatrie in einem Klinikum der Schwerpunktversorgung

Die Erfassung der Patientenzufriedenheit ist ein wichtiges Thema in der Versorgungsforschung und in der Qualitätssicherung. Ziel der vorliegenden Untersuchung war die Einführung einer praktikablen Methode der Routineerhebung der Patientenzufriedenheit mit der erhaltenen Klinikbehandlung sowie die Evaluation der vorhandenen Ergebnisse. Die Studie wurde in einer Abteilungspsychiatrie in einem Haus der Schwerpunktversorgung durchgeführt. Als Erhebungsinstrument wurde der ZUF-8 eingesetzt – ein Zufriedenheitsfragebogen zur globalen Erfassung von Patientenzufriedenheit mit der erhaltenen stationären Behandlung – ein kurzes, zeitökonomisches und dabei psychometrisch überprüftes Verfahren. Die Untersuchung dauerte drei Monate, von Mitte Mai bis Mitte August 2009. In der Studie wurden Patienten, die sich in stationärer oder teilstationärer Behandlung länger als sieben Tage befanden, am Entlassungstag nach ihrer Zufriedenheit mit der erhaltenen Klinikbehandlung befragt. Um Zusammenhänge zwischen der Zufriedenheitsausprägung und den Patientendaten zu erforschen, wurden von den entlassenen Patienten mittels BADO (psychiatrischer Basisdokumentation) Patientenmerkmale: Demographische Daten und Krankheitsvariablen erhoben. Um die Patientenzufriedenheitserfassung weiter zu etablieren wurden die ZUF-8-Fragebogen nach der Beendigung der dreimonatigen Periode fortlaufend gesammelt und nach einem weiteren dreimonatigen Abschnitt ausgewertet. Die Rücklaufquote in der ersten Untersuchungsperiode betrug im Durchschnitt 54%, wobei die Rücklaufquote bei den stationär behandelten Patienten 53,1% betrug und bei den Tagesklinikpatienten 77,2%. In der zweiten Periode der Untersuchung betrug die Rücklaufquote 31,5%. Die gesamte Zufriedenheit ist in der vorliegenden Studie, ähnlich wie in den vergleichbaren Veröffentlichungen, hoch und beträgt – als Mittelwert – 26,93, bei einer Standardabweichung von 4,00. Hinsichtlich der Zusammenhänge der Zufriedenheitswerte und der Patientenvariablen zeigten sich in der vorliegenden Untersuchung statistisch signifikante Korrelationen zwischen Zufriedenheitsgrad und der Ausprägung der Erkrankung zum Entlassungszeitpunkt, gemessen als CGI (Clinical Global Impression): Je weniger krank die Patienten bei Entlassung waren, desto zufriedener sie sich zeigten, des Weiteren je größer die CGI-Abnahme war, d.h. je gesünder die Patienten im Verlauf der Behandlung wurden, desto größer war ihre Zufriedenheit. Zudem zeigten sich Patienten ohne Medikationsprobleme zufriedener als diejenigen Patienten mit solchen Problemen (Nebenwirkungen, mangelnde Wirkung). Es konnten auch Zusammenhänge zwischen der Zufriedenheit und bestimmten Diagnosegruppen nachgewiesen werden: Die Patienten mit Diagnosen aus den ICD-10 Gruppen F2 (Schizophrenie) und F6 (Persönlichkeitsstörungen) waren statistisch signifikant weniger zufrieden mit der Behandlung. Es ergaben sich hingegen keine signifikanten Unterschiede oder Zusammenhänge zwischen der Zufriedenheit und den Patientenvariablen wie: Geschlecht, Alter, Muttersprache, Anzahl früherer stationärer Aufenthalte, Behandlungsstationen, Aufenthaltsdauer, Schulbildung, körperlicher Beeinträchtigung, Anzahl somatischer Diagnosen, Erkrankungsdauer oder Psychopharmakabehandlung (versus keine). Die Erhebung zeigte, dass eine Erfassung der Patientenzufriedenheit in einer Abteilungspsychiatrie eines Schwerpunktkrankenhauses machbar ist. Diskutiert wird, dass die Befragungen der Patientenmeinung Konsequenzen für die weitere Versorgung haben: sie können die Behandlungscompliance der Patienten verbessern und sind für die Konzepte, Behandlungsstrategien und qualitätsverbessernde Maßnahmen relevant

Characterization of thiamine uptake and utilization in Candida spp. subjected to oxidative stress

Candida species are associated with an increasing number of life-threatening infections (candidiases), mainly due to the high resistance of these yeast-like fungi to antifungal drugs and oxidative stress. Recently, thiamine (vitamin B1) was found to alleviate stress responses in Saccharomyces cerevisiae; however, thiamine influence on defense systems in pathogenic fungi has never been investigated. The current work was aimed to elucidate the role of thiamine in stress reactions of C. albicans, C. glabrata, C. tropicalis and C. dubliniensis, subjected to hydrogen peroxide treatment. As compared to S. cerevisiae, Candida strains exposed to oxidative stress showed: (i) a much higher dependence on exogenous thiamine; (ii) an increased demand for thiamine diphosphate (TDP) and TDP-dependent enzyme, transketolase; (iii) no changes in gene expression of selected stress markers - superoxide dismutase and catalase - depending on thiamine availability in medium; (iv) a similar decrease of reactive oxygen species (ROS) generation in the presence of thiamine. Moreover, the addition of therapeutic doses of thiamine to yeast culture medium revealed differences in its accumulation between various Candida species. The current findings implicate that the protective action of thiamine observed in S. cerevisiae differs significantly form that in pathogenic Candida strains, both in terms of the cofactor functions of TDP and the effects on fungal defense systems

The upregulation of thiamine (vitamin B1) biosynthesis in Arabidopsis thaliana seedlings under salt and osmotic stress conditions is mediated by abscisic acid at the early stages of this stress response

<p>Abstract</p> <p>Background</p> <p>Recent reports suggest that vitamin B₁(thiamine) participates in the processes underlying plant adaptations to certain types of abiotic and biotic stress, mainly oxidative stress. Most of the genes coding for enzymes involved in thiamine biosynthesis in <it>Arabidopsis thaliana </it>have been identified. In our present study, we examined the expression of thiamine biosynthetic genes, of genes encoding thiamine diphosphate-dependent enzymes and the levels of thiamine compounds during the early (sensing) and late (adaptation) responses of Arabidopsis seedlings to oxidative, salinity and osmotic stress. The possible roles of plant hormones in the regulation of the thiamine contribution to stress responses were also explored.</p> <p>Results</p> <p>The expression of Arabidopsis genes involved in the thiamine diphosphate biosynthesis pathway, including that of <it>THI1</it>, <it>THIC</it>, <it>TH1 </it>and <it>TPK</it>, was analyzed for 48 h in seedlings subjected to NaCl or sorbitol treatment. These genes were found to be predominantly up-regulated in the early phase (2-6 h) of the stress response. The changes in these gene transcript levels were further found to correlate with increases in thiamine and its diphosphate ester content in seedlings, as well as with the enhancement of gene expression for enzymes which require thiamine diphosphate as a cofactor, mainly α-ketoglutarate dehydrogenase, pyruvate dehydrogenase and transketolase. In the case of the phytohormones including the salicylic, jasmonic and abscisic acids which are known to be involved in plant stress responses, only abscisic acid was found to significantly influence the expression of thiamine biosynthetic genes, the thiamine diphosphate levels, as well as the expression of genes coding for main thiamine diphosphate-dependent enzymes. Using Arabidopsis mutant plants defective in abscisic acid production, we demonstrate that this phytohormone is important in the regulation of <it>THI1 </it>and <it>THIC </it>gene expression during salt stress but that the regulatory mechanisms underlying the osmotic stress response are more complex.</p> <p>Conclusions</p> <p>On the basis of the obtained results and earlier reported data, a general model is proposed for the involvement of the biosynthesis of thiamine compounds and thiamine diphosphate-dependent enzymes in abiotic stress sensing and adaptation processes in plants. A possible regulatory role of abscisic acid in the stress sensing phase is also suggested by these data.</p

Validation of polish version of the Basel extent of rationing of nursing care revised questionnaire

Development of simple, valid and reliable instruments to determine nursing care rationing is a subject of ongoing research. One such instrument, which is gaining popularity worldwide and has significant research applicability, is the Basel Extent of Rationing of Nursing Care (BERNCA) and its revised version, the BERNCA-R. The aim of this study was to translate and adapt the BERNCA-R into a Polish-language version and to assess its reliability and validity in evaluating the level of implicit rationing of nursing care in Poland. Standard methodological requirements were followed during translation and cultural adaptation of the English version of the BERNCA-R questionnaire into Polish. The cross-sectional validation study was conducted between May and September 2017, which included 175 nurses undergoing specialisation and qualification courses at the European Postgraduate Education Centre in Wrocław, Poland. Cronbach’s alpha and inter-item correlations were used to analyse the internal consistency of the Polish BERNCA-R questionnaire. The mean total BERNCA-R score was 1.9 points (SD = 0.74) on a scale of 0-4. Cronbach’s alpha for the unidimensional scale was 0.96. The mean inter-item correlation was 0.4 (range 0.1-0.84), which indicates high internal consistency. A single-factor solution demonstrated stable loadings above 0.5 for almost all items of the Polish BERNCA-R questionnaire. The study using the Polish BERNCA-R questionnaire demonstrated that the instrument is valid and reliable for use in investigating care rationing in groups of Polish nurses

Submersions involving some special classes of K-manifolds

We study properties of invariant submanifolds ofK-manifolds as well as of somespecial types of K-manifolds. Moreover, we investigate properties of submersions between f-manifolds. In particular, we find some curvature identities when the total space is an S-manifoldand the base space is K ̈ahler

Kinetic and thermodynamic characterization of the interactions between the components of human plasma kinin-forming system and isolated and purified cell wall proteins of Candida albicans

Cell wall proteins of Candida albicans, besides their best known role in the adhesion of this fungal pathogen to host's tissues, also bind some soluble proteins, present in body fluids and involved in maintaining the biochemical homeostasis of the human organism. In particular, three plasma factors - high-molecular-mass kininogen (HK), factor XII (FXII) and prekallikrein (PPK) - have been shown to adhere to candidal cells. These proteins are involved in the surface-contact-catalyzed production of bradykinin-related peptides (kinins) that contribute to inflammatory states associated with microbial infections. We recently identified several proteins, associated with the candidal cell walls, and probably involved in the binding of HK. In our present study, a list of potential FXII- and PPK-binding proteins was proposed, using an affinity selection (on agarose-coupled FXII or PPK) from a whole mixture of β-1,3-glucanase-extrated cell wall-associated proteins and the mass-spectrometry protein identification. Five of these fungal proteins, including agglutinin-like sequence protein 3 (Als3), triosephosphate isomerase 1 (Tpi1), enolase 1 (Eno1), phosphoglycerate mutase 1 (Gpm1) and glucose-6-phosphate isomerase 1 (Gpi1), were purified and characterized in terms of affinities to the human contact factors, using the surface plasmon resonance measurements. Except Gpm1 that bound only PPK, and Als3 that exhibited an affinity to HK and FXII, the other isolated proteins interacted with all three contact factors. The determined dissociation constants for the identified protein complexes were of 10-7 M order, and the association rate constants were in a range of 104-105 M-1s-1. The identified fungal pathogen-host protein interactions are potential targets for novel anticandidal therapeutic approaches

Inactivation of \alpha1-proteinase inhibitor by Candida albicans aspartic proteases favors the epithelial and endothelial cell colonization in the presence of neutrophil extracellular traps

Candida albicans, a causative agent of opportunistic fungal infections in immunocompromised patients, uses ten secreted aspartic proteases (SAPs) to deregulate the homeostasis of the host organism on many levels. One of these deregulation mechanisms involves a SAP-dependent disturbance of the control over proteolytic enzymes of the host by a system of dedicated proteinase inhibitors, with one important example being the neutrophil elastase and alpha1-proteinase inhibitor (A1PI). In this study, we found that soluble SAPs 1-4 and the cell membrane-anchored SAP9 efficiently cleaved A1PI, with the major cleavage points located at the C-terminal part of A1PI in a close vicinity to the reactive-site loop that plays a critical role in the inhibition mechanism. Elastase is released by neutrophils to the environment during fungal infection through two major processes, a degranulation or formation of neutrophil extracellular traps (NET). Both, free and NET-embedded elastase forms, were found to be controlled by A1PI. A local acidosis, resulting from the neutrophil activity at the infection sites, favors A1PI degradation by SAPs. The deregulation of NET-connected elastase affected a NET-dependent damage of epithelial and endothelial cells, resulting in the increased susceptibility of these host cells to candidal colonization. Moreover, the SAP-catalyzed cleavage of A1PI was found to decrease its binding affinity to a proinflammatory cytokine, interleukin-8. The findings presented here suggest a novel strategy used by C. albicans for the colonization of host tissues and overcoming the host defense

Longitudinal effects of a nurse-managed comprehensive cardiovascular disease prevention program for hospitalized coronary heart disease patients and primary care high-risk patients

Background: The EUROACTION study (nurse‑coordinated multidisciplinary, family‑based cardiovascular disease prevention program) documented the efficacy of a nurse‑managed, comprehensive prevention program in reducing risk factors for cardiovascular disease (CVD). No information was available on survival. Aims: The aim of the study was to assess the effects of EUROACTION intervention on CVD risk factors and 12‑year survival in the Polish component of the study. Methods: Two district hospitals and 2 primary care practices were allocated randomly to intervention (INT) or usual care (UC). The primary endpoints were lifestyle and risk factors changes at 1‑year follow‑up. Differences in survival were analyzed using the multivariable Cox proportional hazards regression models. Results: The study involved 628 patients with coronary heart disease (CHD) and 711 high‑risk patients. Compared to UC, INT patients achieved healthier lifestyles and a larger reduction of risk factors at 1 year but these differences were not maintained 12 years after the intervention. Less deaths occurred in patients from the INT hospital and from INT primary practice (hazard ratio [HR], 0.58; 95% CI, 0.42–0.82 and HR, 0.53; 95% CI, 0.3–0.95, respectively). Adjustment for the covariates slightly attenuated the estimates and removed significance (HR, 0.74; 95% CI, 0.52–1.04 and HR, 0.66; 95% CI, 0.36–1.24, respectively). For combined CHD and high‑risk patient groups, compared with UC, INT patients had a 36% lower risk of death after adjustment for age, sex, and history of CHD (HR, 0.64; 95% CI, 0.48–0.86). Conclusions: The impact of the EUROACTION intervention on lifestyle and CVD risk factors could have contributed to lower mortality in INT coronary and high‑risk patients. These results emphasize the need for sustaining the interventions to help patients maintain a healthy lifestyle

Co-rumination buffers the link between social anxiety and depressive symptoms in early adolescence

Objectives: We examined whether co-rumination with online friends buffered the link between social anxiety and depressive symptoms over time in a community sample. Methods: In a sample of 526 participants (358 girls; Mage = 14.05) followed at three time points, we conducted a latent cross-lagged model with social anxiety, depressive symptoms, and co-rumination, controlling for friendship stability and friendship quality, and adding a latent interaction between social anxiety and co-rumination predicting depressive symptoms. Results: Social anxiety predicted depressive symptoms, but no direct links between social anxiety and co-rumination emerged. Instead, co-rumination buffered the link between social anxiety and depressive symptoms for adolescents with higher but not lower levels of social anxiety. Conclusions: These findings indicate that co-rumination exerted a positive influence on interpersonal relationships by diminishing the influence from social anxiety on depressive symptoms over time