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.

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.

BackgroundThe 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.MethodsThe 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.DiscussionThe 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.

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.

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.

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Zusammenfassung. Die Stadt Zürich hat ein gut ausgebautes ambulantes Angebot für Menschen mit Demenz. Dieses soll den Zeitpunkt der Institutionalisierung von Demenzkranken in der Stadt hinauszögern können. Anhand des Mini Mental Status (MMS) und der Cognitive Performance Scale (CPS) untersucht diese Studie den Schweregrad der Demenz beim Heimeintritt in zwei grossen Pflegezentren der Stadt Zürich in den Jahren 2009, 2010 und 2013. MMS- und CPS-Scores dieser Jahre wurden retrospektiv analysiert (n = 375). Die Resultate zeigen im Jahr 2013 einen höheren mittleren CPS- (M = 2,88 vs. 3,06) und einen tieferen MMS-Wert (M = 15,43 vs. 12,67) als im Jahr 2009, was einem späteren Heimeintritt, also erst in fortgeschrittenen Demenzstadien, entspricht.

Printed by FO-Smartprint, www.fo-smartprint.ch Cover design István Fata, www.fata.ch Layout Heike M Geschwindner, Horst Rettke ISBN 978-90-367-6026-3 ISBN (e-book) 978-90-367-6027 RIJKSUNIVERSITEIT GRONINGEN