[The review of questionnaires and scales evaluating patients with amyotrophic lateral sclerosis]. / Prehled dotazníku a skál hodnotících pacienty s amyotrofickou laterární sklerózou.

In patients with amyotrophic lateral sclerosis (ALS), it is advisable to provide multidisciplinary care, due to rapid progression and specific disease symptoms, in order to maintain the best quality of life for the patient and their family. Abroad, questionnaires and scales are used to assess the patient´s health condition, to determine disease progression, followed by the provision of personalized care. The aim of this review article is to describe and analyze the scales used in evaluating ALS patients in both functional and psychosocial areas. Having searched in electronic databases, 14 scales for patients with ALS or motor neuron disease were found, and 4 scales for patients with chronic diseases, which are appropriate and used also in patients with ALS. The ALSFRS scale (The Amyotrophic Lateral Sclerosis Functional Rating Scale) is most often used for assessment of functional status. All areas of care are best covered in the ALSSQOL-R (Amyotrophic Lateral Sclerosis Specific Quality of life) questionnaire, designed for assessment of quality of life. The use of both scales is recommended in clinical practice and research.

Predictors of Change in Quality of Life in Patients With End-Stage Disease During Hospitalization.

BACKGROUND: Currently, there are no studies aimed at evaluating the quality of life (QoL) of patients with end-stage disease during hospitalization and the factors that influence it. AIM: The aim of the research was to identify predictors of change in the QoL of patients hospitalized due to advanced stage of disease. METHODS: The sample consisted of 140 patients with end-stage disease who were hospitalized on this account. For evaluation of QoL, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) was used. The Hospital Anxiety and Depression Scale and Karnofsky Performance Status questionnaires were used for the assessment of mental and functional status. For the evaluation of predictors of negative change in QoL, a logistic regression analysis was used. RESULTS: During hospitalization, there was a significant deterioration in the scores given for all domains of the functional QLQ-C30 scale, but not the symptomatic scale. Predictors of change in overall QoL detected were marital status, improved functional status, and depression detected on admission to hospital. Gender and age were found to be protective factors against deterioration in overall QoL. CONCLUSION: Sociodemographic characteristics and mental and functional status may be associated with change in QoL of patients with end-stage disease during hospitalization.

Measuring quality of life of cognitively impaired elderly inpatients in palliative care: psychometric properties of the QUALID and CILQ scales.

OBJECTIVES: The study aimed to assess the psychometric properties of the Czech versions of the Quality of Life in Late-Stage Dementia (QUALID) and the Cognitively Impaired Life Quality (CILQ) scales for use in the palliative care setting in terminally ill patients with cognitive impairment. METHODS: The sample comprised 306 cognitively impaired inpatients with advanced cancer and non-cancer conditions. In this cross-sectional study, two Quality of Life (QoL) measurements were performed at baseline and after five days. The dimensionality of the QUALID and CILQ scales was evaluated using a principal component analysis with Varimax rotation. Reliability was assessed using Cronbach's alpha; inter-rater reliability was evaluated with Kappa index. Test-retest stability was calculated using the intraclass correlation coefficients (ICCs) comparing scores from baseline and 3-5 days post-baseline. The construct validity of the QUALID and CILQ scale was established by Spearman's correlation coefficients with the Symptom Management at the End-of-Life in Dementia (SM-EOLD). RESULTS: Both scales were shown to have adequate validity and reliability (Cronbach's α = 0.812 for QUALID, and α = 0.73 for CILQ), good inter-rater agreement (QUALID: κ = 0.760; CILQ: κ = 0.801) as well as test-retest reliability (QUALID: ICC = 0.847; CILQ: ICC = 0.925). CONCLUSION: The Czech versions of the QUALID and CILQ scales may be recommended for use in the Czech Republic in the area of palliative care.

Assessing Patients' Palliative Care Needs in the Final Stages of Illness During Hospitalization.

This study aimed to explore the palliative care needs of inpatients in the final stages of illness and to analyze the factors that influence them. The survey comprised 349 inpatients in the terminal stage of disease. Needs were assessed with the Patient Needs Assessment in Palliative Care (PNAP) questionnaire; mental status was evaluated using the Hospital Anxiety and Depression Scale (HADS) questionnaire. The importance of needs varied with respect to patients' diagnosis, age, gender, religion, and their levels of anxiety and depression. Most frequently, predictors of needs importance were lower age, poorer functional status, higher anxiety, and lower depression scores. Unmet needs were more likely to be indicated by nonreligious patients with better functional status and higher anxiety and depression scores.

Development and psychometric evaluation of patient needs assessment in palliative care (PNAP) instrument.

OBJECTIVE: Although assessment of palliative patients' needs is a key issue in palliative care, a suitable instrument for identification of such needs is not available in Central European countries. Our objectives were to produce an adequate tool for identifying the importance and satisfaction of palliative patients' needs and to verify its psychometric properties. METHOD: The patient needs assessment in palliative care (PNAP) instrument was constructed based on a literature review and qualitative research (focus groups, n = 5). The psychometric properties of the questionnaire were verified by a cross-sectional study. The convergent validity of the questionnaire was determined by confirmatory factor analysis. Furthermore, internal consistency, test-retest reliability, and construct validity were also tested. The qualitative research group comprised 30 participants (27 experts in palliative care, 1 patient, and 2 family members). Psychometric properties were evaluated in a group of 349 hospital inpatients terminally ill with chronic disease or cancer and receiving palliative care. RESULTS: Based on the qualitative data analysis, a questionnaire was constructed that contained 42 items grouped into 5 domains. When testing the psychometric properties of the questionnaire, a new model containing 40 items in 7 domains was produced. Cronbach's α for the entire PNAP questionnaire was 0.89 on the importance scale and 0.80 on the satisfaction scale. Test-retest reliability was higher than 0.7 for all domains in both scales. SIGNIFICANCE OF RESULTS: The results of tests on the psychometric properties of the PNAP questionnaire showed at least satisfactory validity and reliability, and it can be employed to assess the needs of palliative care patients in Central European countries.

Assessment of Quality of Life of Family Members of Inpatients with End-Stage Disease.

BACKGROUND: An important aim of palliative care is to ensure the highest possible quality of life (QoL) for the family members of patients. AIM: We aimed to determine the QoL of family members of hospitalized patients with end-stage disease, as well as differences in QoL based on socio-demographic characteristics and the patient's functional status, psychological distress, and QoL. METHODS: Study participants were 292 family members of terminally ill patients at University Hospital, Ostrava, Czech Republic. To evaluate family members' QoL, we used the Quality of Life in Life-Threatening Illness--Family Carer Version (QOLLTI-F). We used the Hospital Anxiety and Depression Scale (HADS) and the Karnofsky Performance Status (KPS) Scale to assess patients' functional status and psychological distress. RESULTS: A statistically significant difference was found in QoL evaluation based on family members' socio-demographic characteristics in education, employment, and age. A significantly lower QoL score was observed for patients' life partners in six domains. A correlation was found between patients' poorer functional status and family members' lower QoL. We found lower global QoL in family members of patients with depression. CONCLUSION: Family support is a cornerstone of palliative care. Palliative care professionals should focus on at-risk family members--the life partners of patients, the unemployed, younger people, and those whose ill loved one has a poor functional status.

Moral judgment competence of nursing students in the Czech Republic.

The aim of this cross-sectional study was to determine the level of moral judgment competence in students of nursing at the University of Ostrava Faculty of Medicine, and whether it is influenced by the field of study, type of study, current year of study and age. The design of the study was cross-sectional. The survey sample comprised 662 full-time and part-time students of General Nursing and Midwifery. To measure ethical competence, Lind's Moral Judgment Test (MJT, 1995) was used. The nursing students showed low C-index scores (the mean C-index was 14.24 ± 9.56). The C-index was significantly influenced only by the type of study and age (p<0.05). Part-time students and those over 30 years of age had the lowest C-index scores. On average, the students preferred stages 5 and 6 of moral judgment, that is the post-conventional level. Due to the nursing students' lower C-index scores, methods developing ethical argumentation should be introduced into nursing ethics courses.

[Evaluation of malnutrition of hospitalized children by the Screening Tool for the Assessment of Malnutrition in Paediatrics]. / Hodnocení malnutrice hospitalizovaných detí pomocí skály The Screening Tool for the Assessment of Malnutrition in Paediatrics.

BACKGROUND: Among the major tasks of medical and nursing care during child hospitalization belong nutritional risk screening and identification of patients requiring nutritional support. The main objective of the study was to verify the usefulness of rating scale The Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) to assess the risk of development of malnutrition in hospitalized children. METHODS: To compare results of risk of development of child malnutrition was used the score of Paediatric nutritional risk. The sample consisted of 130 respondents (73 boys, 57 girls) aged 2 months to 18 years (average 8 years), who were hospitalized at the University Hospital of Ostrava- at the Department of Paediatrics. RESULTS: A difference was found in detection of risk of development of malnutrition though STAMP scale between children with different medical diagnoses (p=0.000) and in different age categories (p=0.0418). No difference was found in detection of malnutrition among the sexes. A significant difference was found in detecting risk of malnutrition between the scales (p=0.000). The overall consensus of risk of formation of malnutrition between the two scales was 46.9%. A higher number of high risk of development of malnutrition was found by the STAMP scale. CONCLUSION: Screening of malnutrition through the STAMP scale can identify paediatric patients who suffer from malnutrition or are threatened with its development.

[Effect of non-pharmacological methods for alleviation of pain in newborns]. / Efekt nefarmakologických metod tlumících bolest u novorozencu

BACKGROUND: The aim of the paper is to analyze currently most used non-pharmacological methods for pain alleviation in newborns for the best evidence-based practice. METHODS: Source of the required data for the period 2000-2011 were electronic licensed and freely accessible databases. Evaluation found evidence (30 studies) was carried out according to the table-level evidence (Fineout-Overholt, Johnston 2005). The selection was included in the evidence level I, II, III. RESULTS: Nutritive sucking is currently considered the most effective method for alleviating pain in newborns. Analysis of studies shows that non-pharmacological methods used to control pain in neonates are much more effective when used in combination with other non-pharmacological methods, such as music therapy, swaddling, facilitated tucking, multiple-stimulation, kangaroo care and non-nutritive suction. CONCLUSIONS: Non-pharmacological procedures are effective and lead to pain relief especially in procedural performance as heel lancet and venipuncture for blood sampling, etc.

The needs of mothers to newborns hospitalised in intensive care units.

OBJECTIVE: The aim of the survey was to identify the needs of mothers to infants hospitalized in intensive care units (ICUs) and second, to assess the level of parental support provided by the health personnel. METHODS: The sample consisted of 147 mothers to infants hospitalized in ICUs. The research was conducted over six months in ICUs for newborns at two hospitals in Ostrava. The study used two standardized questionnaires: The parental stressor questionnaire scale: Neonatal Intensive Care Unit which measures the degree of stress in parents of hospitalized infants and the questionnaire The Nurse Parent Support Tool which evaluates the level of parental support provided by nursing staff. RESULTS: The highest level of stress was identified in the parental role. Specifically, the inability to help the child remain separate from the mother, a feeling of helplessness and inability to protect the child from painful procedures and the inability to feed her baby. Mothers evaluated the support of nursing staff in most of these areas as high. Top were rated the ability of the caring staff to respond well to the questions of parents and the mother's willingness to engage in childcare. CONCLUSION: Intensive care units for the newborn obviously need to be family-centered care and at the same time they must be aware of all the factors that can be sources of stress for the parents.Only in this way can stress be eliminated with positive impact on the relationship between mother and child.

The effect of psychological intervention on perceived pain in children undergoing venipuncture.

AIMS: The main objective of the study was to determine the effect of structured psychological intervention on the level of perceived pain in children undergoing venipuncture. A second goal was to investigate how pain behavior during venipuncture is affected by age, sex, previous number of venipunctures, the presence of parents during the procedure and reason for the venipuncture. METHODS: Children with indications for venipuncture aged 5-10 years, were randomly divided into a control group and an intervention group. The control group was prepared for the venipuncture routinely. Children in the intervention group were prepared according to prior structured psychological consultation. Perceived pain levels were assessed by the CHEOPS scale and the self report Wong and Baker faces pain rating scale. RESULTS: A significant difference in evaluated pain between the intervention group and the control group was found. The psychological intervention carried out by a nurse proved to lower pain levels from venipuncture as measured by the CHEOPS scale and evaluated using the self-report scale. A greater level of pain was found in children in the age group 5-7 years, in children where peripheral venous catheter was introduced and in children where the parents were present. Special consultation with the child one day before venipuncture reduced pain levels, especially in children below the age-category mentioned. Consultation should be part of the standard of care for children with indications for venipuncture.