The German version of the Mini Suffering State Examination (MSSE) for people with advanced dementia living in nursing homes.

BACKGROUND: The Mini Suffering State Examination (MSSE) has been explicitly recommended to assess suffering in dementia patients. This study aimed to develop a German version of the MSSE and assess its psychometric properties involving people with advanced dementia (PAD) in a nursing home setting. METHODS: The MSSE was translated into German, and 95 primary nurses administered it cross-sectionally to 124 PAD in Zurich, Switzerland. The psychometric properties of the German MSSE version were calculated for this population. RESULTS: The mean age of the PAD was 83.3 years (SD = 9.1, range = 55-102 years), and 98 of them (79.0%) were women. The Kuder-Richardson Formula 20 coefficient for the entire scale (0.58), the eight items relating to objective health conditions (0.39), and the professional and family estimation of the patient's suffering (0.64) indicated low internal consistency. A confirmatory factor analysis indicated an unsatisfactory fit to a one-factor structure, with a comparative fit index and root mean square error of approximation of 0.71 and 0.08, respectively, and a Tucker-Lewis index of 0.64. The MSSE total score was significantly but moderately correlated with the total scores of the Symptom Management-End-of-Life with Dementia (SM-EOLD) scale (Pearson's correlation coefficient (r) = -0.44; p < 0.05), the physical suffering scores (r = 0.41; p < 0.05), and the psychological suffering scores (r = 0.55; p < 0.05). CONCLUSIONS: The German version of the MSSE questionnaire did not perform well in the nursing home setting involving PAD. The instrument had low internal consistency, doubtful validity, and could not discriminate between suffering and other distressing symptoms. We do not recommend its use in this population.

The last phase of life with dementia in Swiss nursing homes: the study protocol of the longitudinal and prospective ZULIDAD study.

BACKGROUND: The proportion of older people with advanced dementia who will die in nursing homes is constantly growing. However, little is known about the dying phase, the type of symptoms, the management of symptoms and the quality of life and dying in people with advanced dementia. The ZULIDAD (Zurich Life and Death with Advanced Dementia) study aims at extending the current scientific knowledge by providing first data from Switzerland. METHODS: The ZULIDAD study employs a prospective design to study nursing home residents with advanced dementia for three years or until their death in eleven nursing homes in Zurich. Observational data from quarterly questionnaires for relatives and primary nurses is combined with data from the Resident Assessment Instrument - Minimum Data Set (RAI-MDS). Special focus is put on 1) the cross-sectional analysis of baseline and post-mortem data regarding quality of life and quality of dying and how the perceptions of these measures differ between relatives and primary nurses, 2) the longitudinal analyses of established health outcome measures (e.g., EOLD, MSSE, BISAD, QUALID) in order to understand their trajectories and 3) international comparisons of cross-sectional and longitudinal data. DISCUSSION: The ZULIDAD study is one of the few existing prospective studies on end-of-life care in dementia and it is the first prospective study to describe the situation in Switzerland. Its multi-perspective approach allows a comprehensive approximation to central health outcome measures at the end of life such as pain, suffering or quality of life. Providing insights into the current provision of care, it can serve as a basis for improving dementia end-of-life care in Switzerland and internationally.

Assessment of Patient Participation in Physical Rehabilitation Activities: An Integrative Review.

PURPOSE: In addition to the amount and intensity of rehabilitation interventions and the number of therapies, the degree of patient participation in physical rehabilitation activities is key. For this reason, adequate information regarding participation is necessary to evaluate patient performance. This article reviews instruments designed to assess participation in physical rehabilitation activities. DESIGN: Integrative review. METHODS: Pubmed, CINAHL, PsycInfo, Embase, and Cochrane Library database were searched for publications between January 1976 and July 2012. Secondary searches were also conducted and reference lists scanned for relevant publications. FINDINGS: Fourteen articles reporting on three instruments were found. They differ with regard to their underlying theoretical concepts. Each instrument was tested in medical inpatient rehabilitation settings. CONCLUSIONS/CLINICAL RELEVANCE: Each instrument appears to be useful for assessing specific aspects of patient participation in rehabilitation activities. More theoretical work is needed to clarify the underlying concepts as these instruments are not yet ready for clinical application.

[Living with a multitude of medicaments: experiences of patients with cancer]. / Leben mit einer Vielzahl von Medikamenten: Eine qualitative Studie zu Erfahrungen von Patient(inn)en mit Krebs.

The ability to handle a complex medication regimen is important for patients with cancer being treated on an outpatient basis, because many of them have to take drugs for oral chemotherapy, against cancer-related symptoms, side effects of the treatments, and preexisting conditions. This qualitative study examined how patients experienced a complex medication regimen and how they managed it at home. Interviews were conducted with 12 patients from oncology outpatients units and analysed by means of content analysis. Patients knew their medications. They took them mainly as prescribed because they regarded them as a safeguard against deterioration and a life-saver. In addition, they trusted their doctors and felt obliged to them to take the medications. The doctor-patient relationship was supported by constant treatment settings. Even so, the patients would rather have taken less or no medications at all, primarily because of fear of side effects. In order to guarantee a regular intake, the patients linked the medications with specific places, times, and activities and developed routines and rituals. Nurses were hardly perceived with regard to medications and medication management. It is recommended that patients with complex medication regimens are assigned to constant mentors amongst health professionals. These mentors should check patients' medication knowledge, attitudes and management strategies on a regular basis and either encourage sound performance or assist patients in developing an acceptable way of medication taking and handling.

Feasibility of a 12-Month Follow-Up in Swiss Older Adults after Post-Acute Care in Nursing Homes-A Pilot Study.

(1) Background: Post-acute care (PAC) aims to support functional recovery in older adults after acute hospitalization in order to regain a sufficient level of self-care facilitating their return home. However, the long-term outcomes of PAC are understudied due to challenges in recording a follow-up. We aimed to investigate the feasibility of a 12-month follow-up after PAC in Swiss nursing homes, examining practicability and potential factors influencing participation rate. (2) Methods: Collection of one-year follow-up data among 140 eligible patients after PAC in nursing homes was attempted. Patients were recruited using letters and phone calls between August and December 2017. We compared baseline data of all initial PAC patients with those who declined participation in the follow-up to identify factors potentially influencing participation. (3) Results: Overall mortality at 12 months was 25% (n = 35 of 140). Of the 105 survivors, 53 (50%) refused participation, 26 (25%) were interviewed, and 26 (25%) were lost to follow-up. Comparison of baseline characteristics between participants and objectors indicated significant statistical differences in Mini-Mental State Examination (MMSE) scores (participants mean of 26.0 [SD 3.92] vs. objectors mean of 23.5 points [SD 4.40], p = 0.015). Further, logistic regression showed statistically significantly greater odds of participation (OR 1.25 [95% CI 1.06-1.48]) for each point increase in MMSE scores. (4) Conclusions: Long-term follow-up studies in older adults after PAC are challenging due to high mortality and dropout rates. Of note, intact cognitive function at baseline was associated with a higher willingness to participate in a follow-up phone interview. The assessment of cognitive function should be considered when estimating the participation rate in older patients.

On-Site Quantification and Infection Risk Assessment of Airborne SARS-CoV-2 Virus Via a Nanoplasmonic Bioaerosol Sensing System in Healthcare Settings.

On-site quantification and early-stage infection risk assessment of airborne severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with high spatiotemporal resolution is a promising approach for mitigating the spread of coronavirus disease 2019 (COVID-19) pandemic and informing life-saving decisions. Here, a condensation (hygroscopic growth)-assisted bioaerosol collection and plasmonic photothermal sensing (CAPS) system for on-site quantitative risk analysis of SARS-CoV-2 virus-laden aerosols is presented. The CAPS system provided rapid thermoplasmonic biosensing results after an aerosol-to-hydrosol sampling process in COVID-19-related environments including a hospital and a nursing home. The detection limit reached 0.25 copies/µL in the complex aerosol background without further purification. More importantly, the CAPS system enabled direct measurement of the SARS-CoV-2 virus exposures with high spatiotemporal resolution. Measurement and feedback of the results to healthcare workers and patients via a QR-code are completed within two hours. Based on a dose-responseµ model, it is used the plasmonic biosensing signal to calculate probabilities of SARS-CoV-2 infection risk and estimate maximum exposure durations to an acceptable risk threshold in different environmental settings.

[How do users experience the handling of the Observed Emotional Rating Scale?]. / Wie erleben Erfasserinnen den Umgang mit der Observed Emotional Rating Scale?

As barely any empirical data on the application of the Observed Emotion Rating Scale (OERS) on sufferers of dementia is available for German-speaking Europe, the pilot project titled "Agitation" aimed to see how those persons entering the data get along with the OERS instrument. For this purpose, 12 test persons were persuaded to carry out observations with the OERS instrument in three care centres located in the Swiss Canton of Zurich. The test persons were predominantly holders of nursing qualifications and/or experienced in caring for patients suffering from dementia. Data collection was undertaken on the basis of three focus group interviews which were evaluated via qualitative content analysis. The preliminary results gained in the focus group interviews were validated by the same people using a questionnaire. The categories were titled "Missing Clearness", "Missing Possibility to Encode", "Level of Dementia", "Estimation of Emotions", "Influencing Factors" and "User Training". These indicated that know-ledge of dementia is just as important as skilled use of OERS.

Rehabilitation in acute stroke patients in German-speaking Switzerland.

PRINCIPLES: The aim of this study was to obtain an overview of stroke-specialised rehabilitation facilities in German-speaking Switzerland, as well as the numbers of stroke patients treated. It also focused on the mode of goal-setting and evaluation, and the use of instruments to assess the patient's state and progress. METHOD: Out of 28 stroke rehabilitation facilities, 21 participated in a structured telephone interview. Of these, 18 institutions provided full data. RESULTS: The results show that the facilities (n = 18) vary considerably in numbers of patients treated per year (Ø 124, range 7-500) and length of stay (Ø 40 +/- 17.23). Goal-setting and evaluation, including the setting of short term and long term goals, is a common feature. They differ, however, in terms of patient involvement, processes and professions participating in goal-setting and evaluation. A variety of instruments are used for patient assessment at admission and during rehabilitation. Admission to rehabilitation does not rely on standardised patient health status assessment. CONCLUSIONS: Stroke rehabilitation in German-speaking Switzerland embraces a heterogeneous landscape with respect to use of instruments, goal-setting and evaluation process and patient involvement. To facilitate comparison, the same core instruments for assessment and evaluation should be selected and consistently applied. Also, the admission criterion "potential for rehabilitation" should be transformed into a universally and scientifically valid term. The effect of patient involvement in goal-setting on rehabilitation outcome has not yet been investigated. Thus no recommendations can be made for the moment.

[Nursing unit: nurses co-ordinating hospital care--an answer to new challenges in acute medicine]. / Nursing Unit: Pflegende koordinieren die Spitalbetreuung--eine Antwort auf neue Herausforderungen in der Akutmedizin.

Some patients at university hospital no longer need frequent medical treatment but complex professional nursing care. At University Hospital (Inselspital) Bern a Nursing Unit with six beds was run as a pilot project based on experiences in British Nursing Development Units. The care concept was specifically developed and based on a definition of professional nursing, an evidence-based practice approach, resource oriented self management, and caring. Primary nursing was used, and the primary nurse was responsible for the coordination and steering of patient care. The project was evaluated prospectively. During the pilot phase, 37 patients were cared for on the NU. On average, 85% of the beds were occupied, patients were hospitalized for 21.5 days and had a mean age of 68.9 years. They were older than the University Hospital's average patient, and cases were more complex than the University Hospital's average case. The nurses' experiences were mainly positive. Their enhanced responsibility and the structured care process were seen as a challenge allowing them to enlarge their abilities. With this project, the University Hospital built up innovative services for patients with complex nursing problems. The project showed that well trained nurses can take on more responsibility for this patient group than in the context of conventional care models.

Nursing interventions in cases of agitation and dementia.

This study had two objectives: firstly, to assess and compare the frequency and circumstances of agitation and, secondly, to generate decision-making aids for the treatment of agitation patients by applying a nursing intervention in cases of dementia and agitation. For that purpose, 1002 measurements of open nursing interventions in cases of agitation were obtained over a period of 11 weeks in two nursing homes in the city of Zurich and in the nursing home Sonnweid. Before, during and after two intervention periods of four weeks each, data were collected for 60 persons suffering from severe dementia. The results show that two-thirds of the residents were never agitated, one-quarter was moderately agitated and only very few suffered from medium-to-severe agitation. In almost half the cases, agitation occurred while the person was alone (46%), followed by cases of agitation as a constant state (26%). There was rarely any agitation while the residents were engaged in activities. After analysing 433 documented cases, it turned out that the most successful care interventions were avoiding noise, accompanying the person to the toilet, communication/validation, walking about/movement and administering beverages. Being based on newly translated observational methods and a unique longitudinal study design with combined intervention, this study provides important insights into how agitation in dementia can be influenced within the care context, as well as a practical evaluation of interventions specific to different institutions.