1350 “TO BE A DEMENTIA-FRIENDLY HOSPITAL, I THINK YOU NEED TO HAVE…” - THE PERSPECTIVES OF PROFESSIONAL DEMENTIA EXPERTS

Introduction

Dementia-friendly hospitals (DFH) are mentioned as one of several key initiatives in national dementia strategies. In our previous integrative review, we identified 17 descriptions of DFHs and analysed six characteristics of DFH: continuity, person-centredness, consideration of phenomena within dementia, environment, valuing relatives and knowledge and expertise within the hospital (Manietta, Purwins, Reinhard et al., BMC Geriatrics, 2022, 22, 468, 1-16). We also learned that the term DFH is based more on healthcare practice than research. To address this research gap, one step of our DEMfriendlyHospital study is to examine the perspectives of professional dementia experts working in hospitals in Germany.

Method

We used a qualitative design and conducted 14 semi-structured interviews with professional dementia experts from various healthcare professions (12 nurses, two physicians, and one physiotherapist). Data were collected between November 2021 and March 2022. Using an inductive content analysis, we furthermore analysed the interviews in a participatory way involving a group of research associates and professional dementia experts.

Results

From the professional dementia experts’ perspectives, a DFH is characterised by specific hospital processes, structures and environment which consider the needs of people with dementia, dementia-specific knowledge and the skills of hospital staff, their awareness and attitude towards people with dementia. A DFH needs the social inclusion of patients with dementia and their perception as a person as well as the involvement of relatives, who are an important support for the patients and their care.

Conclusion

There are links between our results from interviews with professional dementia experts and our integrative review. At the same time, the perspectives of patients with dementia and their relatives are underrepresented. To fill this gap, our next step is to interview people with dementia who are hospitalised and their relatives, aiming to enhance the description of a DFH and its characteristics.

Escalating incidence of eosinophilic esophagitis in Canton of Vaud, Switzerland, 1993-2013: a population-based study

BACKGROUND

Eosinophilic esophagitis (EoE) is a chronic, inflammatory disease of the esophagus with a rapidly increasing incidence. However, population-based epidemiologic data on EoE are rare and limited to regions with less than 200,000 inhabitants. We evaluated the incidence and prevalence of EoE over time in Canton of Vaud, Switzerland.

MATERIALS AND METHODS

Canton of Vaud lies in the French-speaking, Western part of Switzerland. As of December 2013, it had a population of 743,317 inhabitants. We contacted all pathology institutes (n = 6) in this canton to identify patients that have been diagnosed with esophageal eosinophilia between 1993 and 2013. We then performed a chart review in all adult and pediatric gastroenterology practices to identify patients with EoE.

RESULTS

Of 263 patients with esophageal eosinophilia, a total of 179 fulfilled the diagnostic criteria for EoE. Median diagnostic delay was 4 (IQR 1-9) years. No patient was diagnosed with EoE prior to 2003. Incidence of EoE increased from 0.16/100,000 inhabitants in 2004 to 6.3/100,000 inhabitants in 2013 (P < 0.001). The cumulative EoE prevalence in 2013 was 24.1/100,000. The incidence in males was 2.8 times higher (95% CI 2.01-3.88, P < 0.001) when compared to that in females. The annual EoE incidence was 10.6 times higher (95%-CI 7.61-14.87, P < 0.001) in the period from 2010 to 2013 when compared to that in the period from 1993 to 2009.

CONCLUSIONS

The incidence and cumulative prevalence of EoE in Canton of Vaud, Switzerland, has rapidly increased in the past 10 years.

[Laryngomalacia: principal cause of stridor in infants and small children]

Laryngomalacia (LM) is the most common cause of congenital stridor. It is caused by obstruction of the upper airway by collapse of redundant supraglottic tissues during inspiration. In the management of a child with congenital stridor, it is important to rule out other malformations of the upper airway that could mimic or be synchronous with LM. Symptoms of LM are usually mild and disappear spontaneously by 2 years. About 20% of patients with LM may have extreme symptoms (severe stridor, feeding difficulties and growth retardation) requiring treatment by endoscopic surgery (supraglottoplasty), which has an excellent success rate with little risk of recurrence and complications.

Swallowed topical corticosteroids reduce the risk for long-lasting bolus impactions in eosinophilic esophagitis

BACKGROUND

Long-lasting food impactions requiring endoscopic bolus removal occur frequently in patients with eosinophilic esophagitis (EoE) and harbor a risk for severe esophageal injuries. We evaluated whether treatment with swallowed topical corticosteroids is able to reduce the risk of occurrence of this complication.

METHODS

We analyzed data from the Swiss EoE Cohort Study. Patients with yearly clinic visits, during which standardized assessment of symptoms, endoscopic, histologic, and laboratory findings was carried out, were included.

RESULTS

A total of 206 patients (157 males) were analyzed. The median follow-up time was 5 years with a total of 703 visits (mean 3.41 visits/patient). During the follow-up period, 33 patients (16 % of the cohort) experienced 42 impactions requiring endoscopic bolus removal. We evaluated the following factors regarding the outcome 'bolus impaction' by univariate logistic regression modeling: swallowed topical corticosteroid therapy (OR 0.503, 95%-CI 0.255-0.993, P = 0.048), presence of EoE symptoms (OR 1.150, 95%-CI 0.4668-2.835, P = 0.761), esophageal stricture (OR 2.832, 95%-CI 1.508-5.321, P = 0.001), peak eosinophil count >10 eosinophils/HPF (OR 0.724, 95%-CI 0.324-1.621, P = 0.433), blood eosinophilia (OR 1.532, 95%-CI 0.569-4.118, P = 0.398), and esophageal dilation (OR 1.852, 95%-CI 1.034-3.755, P = 0.017). In the multivariate model, the following factors were significantly associated with bolus impaction: swallowed topical corticosteroid therapy (OR 0.411, 95%-CI 0.203-0.835, P = 0.014) and esophageal stricture (OR 2.666, 95%-CI 1.259-5.645, P = 0.01). Increasing frequency of use of swallowed topical steroids was associated with a lower risk for bolus impactions.

CONCLUSIONS

Treatment of EoE with swallowed topical corticosteroids significantly reduces the risk for long-lasting bolus impactions.

Characterization of 700 μJ T rays generated during high-power laser solid interaction

Laser-produced solid density plasmas are well-known as table-top sources of electromagnetic radiation. Recent studies have shown that energetic broadband terahertz pulses (T rays) can also be generated from laser-driven compact ion accelerators. Here we report the measurement of record-breaking T-Ray pulses with energies no less than 0.7 mJ. The terahertz spectrum has been characterized for frequencies ranging from 0.1-133 THz. The dependence of T-Ray yield on incident laser energy is linear and shows no tendencies of saturation. The noncollinear emission pattern and the high yield reveal that the T rays are generated by the transient field at the rear surface of the solid target.

[Vestibular neuritis: treatment and prognosis]

Vestibular neuritis is a sudden unilateral peripheral vestibular deficit of unknown origin without associated hearing loss. It is the second cause of peripheral vertigo after Benign Paroxysmal Positional Vertigo (BPPV). The etiology remains unclear and some treatments are still controversial. The prognosis is good. The differential diagnosis of the disease mainly includes an acute vertigo of central origin. This article summarizes the management and prognosis of vestibular neuritis.

Observation of gigawatt-class THz pulses from a compact laser-driven particle accelerator

We report the observation of subpicosecond terahertz (T-ray) pulses with energies ≥460 μJ from a laser-driven ion accelerator, thus rendering the peak power of the source higher even than that of state-of-the-art synchrotrons. Experiments were performed with intense laser pulses (up to 5×10(19) W/cm(2)) to irradiate thin metal foil targets. Ion spectra measured simultaneously showed a square law dependence of the T-ray yield on particle number. Two-dimensional particle-in-cell simulations show the presence of transient currents at the target rear surface which could be responsible for the strong T-ray emission.

Pyrrolizidine alkaloids in honey: comparison of analytical methods

Pyrrolizidine alkaloids (PAs) are a structurally diverse group of toxicologically relevant secondary plant metabolites. Currently, two analytical methods are used to determine PA content in honey. To achieve reasonably high sensitivity and selectivity, mass spectrometry detection is demanded. One method is an HPLC-ESI-MS-MS approach, the other a sum parameter method utilising HRGC-EI-MS operated in the selected ion monitoring mode (SIM). To date, no fully validated or standardised method exists to measure the PA content in honey. To establish an LC-MS method, several hundred standard pollen analysis results of raw honey were analysed. Possible PA plants were identified and typical commercially available marker PA-N-oxides (PANOs). Three distinct honey sets were analysed with both methods. Set A consisted of pure Echium honey (61-80% Echium pollen). Echium is an attractive bee plant. It is quite common in all temperate zones worldwide and is one of the major reasons for PA contamination in honey. Although only echimidine/echimidine-N-oxide were available as reference for the LC-MS target approach, the results for both analytical techniques matched very well (n = 8; PA content ranging from 311 to 520 µg kg(-1)). The second batch (B) consisted of a set of randomly picked raw honeys, mostly originating from Eupatorium spp. (0-15%), another common PA plant, usually characterised by the occurrence of lycopsamine-type PA. Again, the results showed good consistency in terms of PA-positive samples and quantification results (n = 8; ranging from 0 to 625 µg kg(-1) retronecine equivalents). The last set (C) was obtained by consciously placing beehives in areas with a high abundance of Jacobaea vulgaris (ragwort) from the Veluwe region (the Netherlands). J. vulgaris increasingly invades countrysides in Central Europe, especially areas with reduced farming or sites with natural restorations. Honey from two seasons (2007 and 2008) was sampled. While only trace amounts of ragwort pollen were detected (0-6.3%), in some cases extremely high PA values were detected (n = 31; ranging from 0 to 13019 µg kg(-1), average = 1261 or 76 µg kg(-1) for GC-MS and LC-MS, respectively). Here the results showed significantly different quantification results. The GC-MS sum parameter showed in average higher values (on average differing by a factor 17). The main reason for the discrepancy is most likely the incomplete coverage of the J. vulgaris PA pattern. Major J. vulgaris PAs like jacobine-type PAs or erucifoline/acetylerucifoline were not available as reference compounds for the LC-MS target approach. Based on the direct comparison, both methods are considered from various perspectives and the respective individual strengths and weaknesses for each method are presented in detail.

Microdeletion/duplication at 15q13.2q13.3 among individuals with features of autism and other neuropsychiatric disorders

BACKGROUND

Segmental duplications at breakpoints (BP4-BP5) of chromosome 15q13.2q13.3 mediate a recurrent genomic imbalance syndrome associated with mental retardation, epilepsy, and/or electroencephalogram (EEG) abnormalities.

PATIENTS

DNA samples from 1445 unrelated patients submitted consecutively for clinical array comparative genomic hybridisation (CGH) testing at Children's Hospital Boston and DNA samples from 1441 individuals with autism from 751 families in the Autism Genetic Resource Exchange (AGRE) repository.

RESULTS

We report the clinical features of five patients with a BP4-BP5 deletion, three with a BP4-BP5 duplication, and two with an overlapping but smaller duplication identified by whole genome high resolution oligonucleotide array CGH. These BP4-BP5 deletion cases exhibit minor dysmorphic features, significant expressive language deficits, and a spectrum of neuropsychiatric impairments that include autism spectrum disorder, attention deficit hyperactivity disorder, anxiety disorder, and mood disorder. Cognitive impairment varied from moderate mental retardation to normal IQ with learning disability. BP4-BP5 covers approximately 1.5 Mb (chr15:28.719-30.298 Mb) and includes six reference genes and 1 miRNA gene, while the smaller duplications cover approximately 500 kb (chr15:28.902-29.404 Mb) and contain three reference genes and one miRNA gene. The BP4-BP5 deletion and duplication events span CHRNA7, a candidate gene for seizures. However, none of these individuals reported here have epilepsy, although two have an abnormal EEG.

CONCLUSIONS

The phenotype of chromosome 15q13.2q13.3 BP4-BP5 microdeletion/duplication syndrome may include features of autism spectrum disorder, a variety of neuropsychiatric disorders, and cognitive impairment. Recognition of this broader phenotype has implications for clinical diagnostic testing and efforts to understand the underlying aetiology of this syndrome.

Double-resonance spectroscopy of interacting Rydberg-atom systems

The energy level spectrum of a many-body system containing two shared, collective Rydberg excitations is measured using cold atoms in an optical dipole trap. Two pairs of independently tunable laser pulses are employed to spectroscopically probe the spectrum in a double-resonance excitation scheme. Depending on the magnitude of an applied electric field, the Rydberg-atom interactions can vary from resonant dipole-dipole to attractive or repulsive van der Waals, leading to characteristic signatures in the measured spectra. Our results agree with theoretical estimates of the magnitude and sign of the interactions.

Rydberg-Rydberg collisions: resonant enhancement of state mixing and penning ionization

In rubidium Rydberg states, the collision nD_(5/2)+nD_(5/2)-->(n-2)F_(7/2)+(n+2)P_(3/2) is nearly resonant in the vicinity of n=43. As a result, over a short range of n centered around n approximately 43 the Rydberg-Rydberg interaction potential is quite large and turns from repulsive to attractive [Phys. Rev. A 75, 032712 (2007)10.1103/PhysRevA.75.032712]. We use state-selective field ionization to investigate the effect of this resonance on instantaneous excitation of mixed two-particle states, state-mixing collisions, and Penning ionization. We find that these processes depend on the magnitude and sign of the two-particle interaction potential, and thus on n near the resonance. The large magnitude of the observed state mixing provides evidence for many-body effects.

Atom counting statistics in ensembles of interacting Rydberg atoms

We show that the probability distributions for the number of Rydberg excitations in small ensembles of cold atoms, excited using short (100 ns) laser pulses, can be highly sub-Poissonian. The phenomenon occurs if the atom density and the principal quantum number of the excited Rydberg level are sufficiently high. Our observations are attributed to a blockade of the Rydberg atom excitation.

[Characterization of fungi isolated from woody-chip piles, especially thermophilic and thermotolerant isolates]

Samples were taken in order to isolate fungi from four woodychip piles (three of these were treated with liquid manure) from different depths. 39 species of 121 isolates could be determined. They represent 28 genera. Aspergillus fumigatus, Trichoderma reseei, Corynascus sespedonium and Mucor hiemalis were isolated most frequently. The isolates were examined for their temperature requirements. Following the definitions of Hawskworth (1983) they could be classified into the three groups of "thermophilic" (28 isolates), "thermotolerant" (29 isolates) and "mesophilic" (64 isolates) fungi. The temperature requirements for sporulation were also examined. Partly sporulation could be observed within more restricted temperature borders than growth but optimal sporulation occurs within wider temperature areas than optimal growth. The optimal sporulation-temperature was defined as the temperature at which sporulation began fastest.

Palliative treatment of inoperable patients with carcinoma of the cardia region

Endoscopic palliative treatment of inoperable patients with carcinoma of the cardia region is superior to surgical procedures that allow the feeding of patients. After dilating the malignant stenosis with an Eder-Puestow dilator, a Celestin or Atkinson tube is inserted endoscopically by means of the Nottingham introducer. In 25 of 26 patients the inserted tube functioned well until the death of the patient for an average of 109 days. Six patients are still alive and one patient has had the tube for almost 3 years. Of the 19 patients who died, 18 retained the tube until they died. The complication rate of the procedure was 11.5% with a 3.8% mortality related to tube insertion.

Polyethylene catheter embolism. Review of the literature and report of a case with associated fatal tricuspid and systemic candidiasis

A 62-year-old man died from tricuspid monilial endocarditis and systemic candidiasis associated with embolization to the right heart of a 36-cm fragment of one polyethylene catheter received in the venous system approximately one year earlier. Thirty-six additional cases of catheter embolism are reviewed and tabulated. In 17 of the 37 patients the catheter fragment had reached the right side of the heart, and in eight, a branch of the pulmonary artery. In six of 13 patients who died, catheter embolism was the exclusive or a major contributory cause of death. Measures designed to prevent the breakage and embolization of polyethylene tubes and to facilitate their retrieval in case of loss are discussed. If a catheter fragment has been lost into the venous system, it should be located and removed at once.

Monilial endocarditis and systemic candidiasis are briefly reviewed. The reported case is the first in which these entities have been associated with catheter embolism to the heart, and the fourth in which monilial endocarditis affected the tricuspid valve.