Conference report: dementia research and care and its impact in Switzerland

In October 2019, a Swiss panel of experts met for the Dementia Summit in Brunnen, Switzerland, to discuss the latest scientific findings on basic and clinical research, as well as practical and political approaches to the challenges of dementia disorders in Switzerland. Here, we present the conference summary. To study pathophysiological changes, as well as the underlying mechanism of fluid biomarker changes, excellent experimental approaches, including transgenic mouse models, are available. Current knowledge about presymptomatic disease progression is largely derived from the longitudinal study of individuals with autosomal dominant mutations (Dominantly Inherited Alzheimer Network). Importantly, more than one third of identified dementia risk factors can be modified. For example, sleep disturbances are not only associated with dementia and neurodegeneration in specific brain regions, but also precede cognitive decline and contribute to the development of brain pathology. Regarding the neuropsychological examination of dementia disorders, standardised tests of social cognition, one of the six cognitive domains that must be assessed according to the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders, are missing, but now under development. The most important new therapeutic approach in the treatment of Alzheimer’s disease is the current attempt to prevent β-amyloid accumulation. While until now clinical studies have failed because of side effects or insufficient clinical effectiveness, Biogen recently announced positive results of high doses of aducanumab, a monoclonal antibody against β-amyloid. Other approaches also show promise. In China, sodium oligomannate has been approved to treat Alzheimer's disease. The substance suppresses gut bacterial amino acids-shaped neuroinflammation to inhibit Alzheimer’s disease progression. Assistive technologies for dementia patients can help identify relevant information for care and nursing, as well as measurements for clinical interventions. Dementia patients have a high risk of developing delirium, even in the home environment. Therefore, it is necessary to use and further develop multi-disciplinary and systematic detection and prevention strategies. Homecare models for dementia patients with multidisciplinary teams have been established and evaluated and should be expanded. Dementia is the third-leading cause of death in Switzerland. In palliative care for severe dementia, the improvement of quality of life is of primary importance. The goals of the National Dementia Strategy, to increase the quality of life in those affected and to reduce taboos surrounding the disease, are still unrealised. The need for further national and regional engagement in order to implement the different findings of the strategy has largely been acknowledged, and these implementations have become the core tasks of a national dementia platform.

Insights from inside: the duties and activities of nurses at the psychiatric clinic Münsterlingen (CH). A qualitative study

In the German-speaking countries: Austria, Germany and Switzerland, which have a joint annual conference in psychiatric nursing, the process of academization of nursing has led to a discussion about which adaptations to make in psychiatric nursing in order to develop a profile, which is practicable in the future. Therefore, it was necessary to describe the current duties and activities of psychiatric nurses. With this, the knowledge and abilities of the nurses were to be made more explicit and their identity was to be strengthened. Data were generated by using participant observation and group discussions with the involved nurses to validate the observations and the emerging categories of activities. Participant observation took place in a psychiatric clinic in Switzerland over a period of 11 months on 14 psychiatric wards with different specializations. Data analysis followed a qualitative content analysis. Findings show that by means of descriptions of nursing situations the duties and activities of the nurses can be summarized into 12 categories. Many of the described activities can be found in psychiatric nursing textbooks. This concurrence suggests that there is something like a basic framework of psychiatric nursing. In addition, the findings illustrate how wide the variety of tasks are and how challenging psychiatric nursing is.

Thrombophilie bei Patienten mit venösen Ulzera

Hintergrund: Bei Patienten mit venösen Ulzera liegt die Prävalenz der Faktor-V-Leiden-Mutation bei 23 bis 26%. Wir untersuchten die wichtigsten Thrombophilie-assoziierten Gerinnungsparameter bei Patienten mit venösem Ulkus mit oder ohne postthrombotischem Syndrom. Patienten, Methodik: Fall-Kontroll-Studie mit 73 konsekutiven Patienten mit venösen Ulzera und 45 Kontrollpersonen. Anamnese und duplexsonographische bzw. phlebographische Abklärung. Folgende Gerinnungsparameter wurden bestimmt: Antithrombin III, Protein C und Protein S, Faktor-V-Leiden-Mutation, Prothrombinmutation (G20210A), Lupus Antikoagulans, Antikardiolipin-Antikörper, Homocysteinkonzentration und die Mutation (C677T) der Methylentetrahydrofolat-Reduktase (MTHFR). Ergebnisse: 42 Patienten hatten ein postthrombotisches Syndrom: 52% hatten mindestens einen Thrombophilie-assoziierten Gerinnungsbefund (p = 0,001), 33% eine Zweier-Kombination (p = 0,001) und zusätzlich in 14% eine Dreier-Kombination (p = 0,0002). Die Faktor-V-Leiden-Mutation fand sich in 38% (p = 0,0001). 31 Patienten hatten eine primäre venöse Insuffizienz (kein postthrombotisches Syndrom): 39% hatten mindestens einen Thrombophilie-assoziierten Gerinnungsparameter (p = 0,14), 3% eine Zweier-Kombination (p = 1,0) und 0% eine Dreier-Kombination. Die Faktor-V-Leiden-Mutation fand sich in 16% (p = 0,11). Schlussfolgerung: Patienten mit postthrombotischen venösen Ulzera haben stark gehäuft (52%) Thrombophilie-assoziierte Gerinnungsbefunde. In 47% liegen Kombinationen der „klassischen“ Thrombophilie-Parameter vor. Routinemäßige Abklärungen des Thrombophiliestatus bei venösen Ulzera sind mangels Konsequenzen und wegen der hohen Kosten jedoch nicht angezeigt.

Direct determination of the energy required to operate a single molecule switch

Using a noncontact atomic-force and scanning-tunneling microscope in ultrahigh vacuum, we have measured the switching energy of a single molecule switch based on the rotation of a di-butyl-phenyl leg in a Cu-tetra-3,5 di-tertiary-butyl-phenyl porphyrin. The mechanics and intramolecular conformation of the switched leg is controlled by the tip apex of the noncontact atomic-force microscope. The comparison between experimental and calculated force curves shows that the rotation of the leg requires an energy less than 100 x 10(-21) J, which is 4 orders of magnitude lower than state-of-the-art transistors.

Impact of teaching interventions on nurse compliance with hand disinfection

The impact of teaching interventions and the availability of additional dispensers for alcoholic hand disinfection was measured during three study periods. A nursing care system of relevant nursing interventions was found to be a useful tool for the assessment of compliance with hand hygiene requirements if combined with an analysis of hand disinfectant use. This study shows that compliance with hand disinfection can be improved through targeted teaching and supportive structural improvements, and that this positive impact may persist even after targeted teaching activities have ended.

Factor V Leiden mutation in postthrombotic and non-postthrombotic venous ulcers

OBJECTIVE

To determine the prevalence of the factor V Leiden mutation in patients with postthrombotic and non-postthrombotic venous ulcers.

DESIGN

Case-control study.

SETTING

Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.

PARTICIPANTS

Seventy-three consecutive outpatients and inpatients with venous ulcers and 45 age- and sex-matched control subjects (matched to the 42 patients with postthrombotic syndrome).

MAIN OUTCOME MEASURES

Frequency of postthrombotic and non-postthrombotic findings in patients with venous ulcers. Prevalence of the factor V Leiden mutation in these different subgroups.

RESULTS

Postthrombotic syndrome was identified as the cause of 42 (58%; 95% confidence interval [CI], 45%-69%) of 73 venous ulcers, and the remainder were caused by primary valvular insufficiency. In postthrombotic ulcers, the prevalence of the factor V Leiden mutation was 38% (95% CI, 24%-54%) (16/42), which corresponds to an odds ratio of 13.2 (95% CI, 2.8-62.3; P<.001). In non-postthrombotic venous ulcers, the prevalence was 16% (95% CI, 5%-34%) (5/31), which corresponds to an odds ratio of 3.2 (95% CI, 1.0-10.0; P =.07).

CONCLUSIONS

The factor V Leiden mutation is highly prevalent in patients with postthrombotic venous ulcers. Even patients with non-postthrombotic venous ulcers show a moderately elevated prevalence of the factor V Leiden mutation. Some of the latter might be misclassified because of near-to-perfect revascularization after asymptomatic deep venous thrombosis. However, as long as the therapeutic consequences of the factor V Leiden mutation are not established, systematic screening cannot be recommended in patients with venous ulcers.

Sled-Type Motion on the Nanometer Scale: Determination of Dissipation and Cohesive Energies of C60

The tribological properties of C(60) on the mesoscopic scale were investigated with a scanning force microscope, which allowed simultaneous measurements of normal and lateral forces under ultrahigh-vacuum conditions. Islands of C(60), deposited on NaCl(001), could be moved by the action of the probing tip in a controlled way. Different modes of motion, such as translation and rotation, were observed. An extremely small dissipation energy of about 0.25 millielectron volt per molecule and a cohesive energy of 1.5 electron volts were determined in these nanometer-scale experiments. The corresponding shear strength of 0.05 to 0.1 megapascal was smaller by one order of magnitude than typical values of boundary lubricants. For C(60) on graphite, disruption of the islands was observed and collective motion of the islands could not be achieved. These results could find use in the field of nanotechnology; for example, C(60) islands could be developed into a sled-type transport system on the nanometer scale.

The significance of morphine concentrations in the cerebrospinal fluid in morphine caused deaths

Morphine analysis was performed using a variety of immunoassay methods in blood, urine and the cisternal cerebrospinal fluid (CSF) from 23 patients dying opiate-related deaths. Of these, 16 were a result of intravenous morphine or heroin use. The blood and CSF morphine concentrations were determined using both fluorescence polarization immunoassay (FPIA) and radioimmunoassay (RIA), while urine was analyzed by enzyme multiplied immunoassay technique (EMIT). Urine morphine concentrations were greater than 0.300 microgram/mL in all but one case. Blood and CSF morphine concentrations were found to be poorly correlated, and it was concluded that one should not be used to predict the other. Following intravenous administration, CSF morphine concentrations of greater than 0.02 microgram/mL were however found to be consistent with death from morphine related respiratory depression. As intrathecal or epidural administration of morphine can greatly influence the CSF concentration without inducing respiratory depression, the site of collection of the CSF must be known, as must the route of administration in order to properly interpret CSF morphine concentrations.

[The Berne Härz-As (Ace of Hearts) Project: goals, study plan and initial results]

The Berne Härz-As (Ace of Heart) project is a randomized trial in changing cardiovascular risk factors, morbidity and subjective health. It further investigates to what extent psychosocial and somatic factors account for these health indicators in the course of at least 4 years. A pilot study conducted in two companies (N = 620) indicates that the project is feasible and acceptable to both management and employees and that the intervention goals are justified.

[Vasospastic syndrome in a young women with migraine, Raynaud's disease, cerebral ischemia and myocardial infarction]

The case is described of a 32-year-old female patient who has suffered since puberty from acute migraine attacks and Raynaud syndrome of both hands. In June 1981 acute posterior cerebral ischemia occurred. 11/2 years later the patient was hospitalized for acute myocardial infarction with normal and patent coronary arteries. Thereafter, the patient was treated with nifedipin and anticoagulation, and no other vascular complications have since occurred. The authors suggest that the patient is suffering from a diffuse vasospastic disorder leading to migraine attacks, Raynaud syndrome, cerebrovascular ischemia and myocardial infarction, in view of the fact that the patient has no other known risk factors for early vascular complications.

[Preventive parent training: results in the cognitive area]

In an intervention study, parents were offered courses on interpersonal interaction and child education. The evaluation procedures are briefly described and results concerning two types of course contents (knowledge of definition of a technical term; familiarity with an educational concept) are presented. It appears that after 45 months, knowledge transmitted in the course is still present, although with a loss of differentiation, depending on practical relevance of the course materials.

[Use of mediators/multiplicators--a sketch]

The poster "Intervention through Mediators/Multiplicators" outlines a extended model for mediators and multiplicators. It mentions different sources of the idea to use mediators or multiplicators and shows, how they can be engaged in different tasks. A combination of both concepts to one model for mediators/multiplicators seems to be favorable for interventions in social and preventive medicine.

[Preventive training of parents]

General conditions, the theoretical frame, the contents and purposes of our preventive training of parents are discussed. The attention is drawn to the fact that our preventive training of parents is--at the time being--examined in a pilot study with regard to acceptability and understanding. First results let suppose that our preventive training supports the parents in their educational behavior. An extensive study with two control groups and an accompanying study basing on psycho-pedagogical and social-medical criteria are planned.