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In Switzerland, 39% of nursing home residents have a dementia related disease. Behavioral symptoms are increasingly observed as dementia progresses. These symptoms impair patients’ quality of life and are distressing to family caregivers and nurses. A person-centered approach, which includes the resident’s individual biography, reduces such symptoms. The most current literature describes how therapists include biographical information in designated therapies. However person-centered care takes place not only in specific activities. Nurses are responsible for their patients’ care 24 hours a day.

Objectives: We aimed to assess the efficacy of a person-centered care intervention in improving quality of life (QoL) for people with dementia in long-term care facilities., Design: This study was a stepped-wedge cluster-randomized clinical trial of monthly person-centered outcome measurements, followed by collaborative nurse-led person profile interventions involving nursing staff and family members, compared with monthly person-centered outcome measurements alone., Setting and Participants: We included people with a medical diagnosis of Alzheimer's disease or vascular dementia or with clinical symptoms of dementia from 23 long-term care facilities in the German-speaking part of Switzerland., Methods: The primary outcome was QoL, as assessed using the QUALIDEM. Secondary outcomes were the QUALIDEM subscales and the Integrated Palliative Care Outcome Scale for People with Dementia subscales. The study duration was 15 months, and linear mixed-effect models were used for the analysis., Results: We recruited 240 people with dementia from 23 long-term care facilities. Modeling 1143 observations, we found a statistically significant positive intervention effect of 2.6 points according to the QUALIDEM (95% CI, 1.34-3.86; P < .001; total QUALIDEM intervention: 67; 95% CI, 64.8-69.1 vs 64.4; 95% CI, 62.3-66.4 for the control). We also found positive effects of the intervention on all secondary outcomes., Conclusions and Implications: Once-a-month person profile interventions based on person-centered outcome measurements provided a small but significant improvement in QoL. Thus, our findings suggest a potential benefit to the broader implementation of person profiles involving nursing staff and family members in long-term care facilities., Competing Interests: Disclosure The authors declare no conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Caring for a person with dementia can be a challenging experience, often associated with chronic stress and a heavy burden on family caregivers. Dementia also impacts the relationship between the caregiver and the person with dementia. The quality of this relationship is, in turn, an important factor influencing the well-being of both dyad members. The psychoeducational intervention "Learning to feel better . . . and help better" has shown positive results regarding family caregivers' subjective burden, psychological distress, and self-efficacy. However, relationship quality has not been addressed in the context of this intervention., Methods: A longitudinal constructivist grounded theory approach was used to explore relationship quality as perceived by caregivers, possible changes and intervention components facilitating or preventing such changes. Three qualitative, semi-structured interviews (before, during and after the intervention) were performed with 13 family caregivers from three different intervention groups. The resulting 39 interviews were analysed regarding individual caregiver trajectories, per time point for all caregivers and regarding specific caregiver subgroups., Findings: A model focusing on sustaining relationship quality in dementia was developed. It shows strategies that family caregivers develop and apply to facilitate positive interactions and feelings of connectedness with their family members with dementia. It also indicates that mastering such strategies requires reflective skills based on specific knowledge of dementia and coping strategies, which can be enhanced through active skills training, in which caregivers are guided to work on their individual stressful situations. Factors hampering change included difficulties in accepting dementia-related changes., Conclusion: Findings suggest that psychoeducation, with active skills training based on caregivers' current daily life situations, providing systematic procedures to handle daily challenges and specific knowledge about the impact of the disease, could support them in developing and applying supportive strategies to sustain or improve their relationship to their family member with dementia., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: 'Learning to feel better… and help better' is a psychoeducational intervention that aims to empower family caregivers of people with dementia by helping them cope better with the daily stress of dementia caregiving. The intervention has been adapted to a Swiss context and evaluated with a mixed-method design, yielding promising results in caregivers, such as a reduced subjective burden and improved self-efficacy. Qualitative findings have provided insight into potentially relevant intermediate changes that must be further explored to better understand how the intervention precipitates the achieved changes. We aim to qualitatively explore such changes, related mechanisms and key intervention components in the context of this intervention., Methods: A constructivist grounded theory approach was used to achieve this aim. Changes, related mechanisms and key intervention components were identified by exploring the following: 1) longitudinal qualitative data, collected from 13 family caregivers via interviews performed before, during and after the intervention (39 interviews total) and 2) cross-sectional post-intervention interview data collected from 22 family caregivers (22 interviews)., Results: Experiencing calmness was the most important change for caregivers in the context of this intervention. The calmness model, developed based on the qualitative analysis, illustrates the intermediate changes that contributed to calmness, such as being able to cope with daily life and experiencing positive interactions with the family member with dementia. Related key intervention components were the coping strategy 'reframing', employed in diverse ways by the caregivers to reduce daily stress, and the didactic method 'active skills' training', which involved active participation by the caregivers and the guidance of a professional group leader. One important factor hampering changes in caregivers was having difficulties accepting the caregiver role or accepting the losses due to dementia., Conclusion: The calmness model offers valuable insight into how this intervention can benefit family caregivers and aid in developing interventions targeting similar mechanisms and changes., Trial Registration: ISRCTN13512408 (registration date 17.05.2021, retrospectively registered)., (© 2024. The Author(s).)

Purpose: Women remain underrepresented in radiology and there is a paucity of literature examining the recognition of their professional contributions to the discipline. The purpose of this study was to examine the gender distribution of award winners across all North American radiology societies., Methods: The gender distribution of 1923 award recipients from 21 North American radiology societies between 1960 and 2021 was examined. Awards were divided into four categories: leadership, teaching, contribution to radiology, and promising new/young societal member. Primary outcome was the total proportion of awards received by gender. All data was compared to the gender distribution of working radiologists in North America., Results: A total of 1923 award recipients were identified between 1960 and 2021. Seventy-nine percent of award recipients were men (n = 1527) and 21 % were women (n = 396). As of 1970, the proportion of women award recipients increased 0.55 % ± 0.07 % each year. The proportion of women receiving radiological awards after 2018 is equal to or surpassing the percentage of women radiologists. Women received 36.4 % of leadership, 33.6 % of promising new member, 30.1 % of teaching, and 14.4 % of lifetime contribution awards., Conclusions: In the last five years, the proportion of women receiving awards was equal to or greater than the proportion of women radiologists. Women received more leadership awards and fewer lifetime contributor awards compared to men., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The aim of this study is to assess the Internet usage pattern amongst glioma patients and to characterize its impact in their decision-making and clinical interactions. Glioma patients attending a tertiary cancer center between June and December 2019 were invited to participate in this study. A 26-item survey consisting of closed and open-ended questions was distributed with a unique identifier. Quantitative data were analyzed with descriptive statistics using SPSS Statistical package, and qualitative data with grounded theory approach. Thirty-two patients completed the survey. Demographics varied in age, time since diagnosis, glioma type, and level of education. Eighty-one percent were identified as "Internet users" who sought online glioma information. Google was the most popular search engine (96%), with "glioma" being the most frequent search term. The selection of websites often relied on perceived credibility and top search hits. The most searched topic was prognosis (73%). The majority of patients found that online information was easy to understand, and this did not vary significantly amongst age groups. Website quality was always assessed by 60% of patients. Only 62% patients found the Internet a useful resource, and 70% patients found it facilitated their understanding. Most patients discussed their Internet findings with a physician, largely regarding concerns about reliability. There is variable glioma information available online. Patients with glioma use the Internet as a resource, with variable impact on their interactions and decision-making. This information can be used by physicians, educators, and website developers to support glioma patients' needs., (© 2021. American Association for Cancer Education.)

Question: I frequently encounter infants with symptoms suggestive of allergy after being introduced to standard cow's milk formula. Parents are concerned and ask for recommendations regarding formula alternatives. Which formulas are best for children with cow's milk allergy?, Answer: Cow's milk allergy is common, and the criterion standard for diagnosis is elimination, provocation (with a double-blind, placebo-controlled food challenge protocol), and re-elimination. The allergy is treated by eliminating cow's milk protein from the diet. Formula alternatives include hydrolyzed cow's milk formula, rice-based formula, soy-based formula, and amino acid-based formula, which are all nutritionally adequate alternatives to cow's milk formula. Symptom severity, patient preference, cost, and efficacy are factors to be considered when choosing an alternative., (Copyright© 2021 the College of Family Physicians of Canada.)

Objective: The objective of this review was to identify reliable and/or valid needs assessment instruments for informal dementia caregivers that are relevant for clinical practice, research and informal caregivers., Introduction: Informal dementia caregivers report important unmet needs at all stages of the disease. In addition, they often indicate that health care providers insufficiently attend and adapt to their multiple needs. A systematic and patient-centered assessment is needed to address this lack of knowledge and understanding. However, existing quantitative needs assessment questionnaires are limited in terms of psychometric testing. Qualitative measures are time-intensive and difficult to conduct on a large scale, with growing economic pressure. Information about the methodological quality and the characteristics of needs assessment instruments are crucial for clinicians and researchers to make informed decisions about the most reliable and valid tool for their specific purpose., Inclusion Criteria: This review considered studies on multidimensional needs assessment instruments for informal dementia caregivers living at home. Psychometric studies or other types of studies with sufficient data to evaluate methodological quality were included if they considered at least one outcome for reliability or validity., Methods: Studies in English, French or German and published until February 2019 were searched in four databases: Embase, MEDLINE, CINAHL and PsycINFO. After screening the titles, abstracts or full texts for eligibility, the provisional included studies were assessed for methodological quality with a standardized tool for systematic reviews of measurement properties. After data extraction using a standardized tool, the quality of the measurement properties was rated and compared using predefined quality criteria., Results: Eighteen articles covering 14 different needs assessment instruments were included in the review. Eleven publications focused on the development or the evaluation of an instrument. In addition, a development report, a manual and five studies, not aimed primarily at validation but containing sufficient information about the development or the evaluation of the used instruments, were included. The systematic evaluation of the instruments revealed that half of them had excellent content validity. In contrast, structural validity was rarely examined, and mostly with an insufficient sample size or a questionable analysis. None of the instruments had optimally tested and good internal consistency. Regarding reliability, test-retest agreement was rarely tested and inter-rater agreement was evaluated using controversial procedures. Comparing the different instruments reviewed, the "Partnering for better health - living with chronic illness: dementia" had the best psychometric evidence, and the "Questionnaire of consultation expectations" was also partly supported, while most other instruments presently had limited psychometric soundness., Conclusions: Despite the good evidence for some psychometric properties, further developments in the field of needs assessment for informal dementia caregivers are needed, particularly regarding structural and construct validity, as well as test-retest reliability and sensitivity to change. To enhance conceptual clarity, the development of an underlying theoretical model of needs should be prioritized.

Review Question/objective: The objective of this psychometric review is to identify needs assessment instruments for informal dementia caregivers which are:More specifically, the aim is to present an overview and an evaluation of the available needs assessment instruments, including: i) their psychometrics (reliability and validity) when available, and ii) their relevance according to the instrument characteristics, namely, their purpose, application method, administration burden, number of items and domain structure.

In April 2015, a 20-year-old woman with multiple sclerosis (MS) presented with acute onset of repetitive abnormal postures and choreatic movements of the right arm, precipitated by voluntary movements (online video 1 and 2). Brain magnetic resonance imaging (MRI) showed a new active MS lesion involving the basal ganglia on the left side (Figure 1(a)). Intravenous steroid treatment resulted in rapid regression of this paroxysmal kinesigenic dyskinesia (PKD)-like hyperkinetic movement disorder. The patient became asymptomatic within 3 months. PKD is characterized by recurrent uni- or bilateral choreoathetosis and usually represents an autosomal dominant inherited disorder caused by PRRT2 gene mutations. As in the present case, a PKD-like phenotype may be associated with MS relapses in presumably genetic negative cases.

Background: Caring for palliative patients at home is complex and challenging. Specialist palliative care exists to provide high quality of care in complex situations. This study aimed to describe the characteristics of a specialist nurse-led palliative care service in an urban Swiss region., Methods: A qualitative study design adopting a grounded theory approach was used. Semi-structured interviews were conducted with 41 participants including family caregivers, home care nurses, referring services, treating physicians, specialist nurses and external politicians. In addition, statistical information was included., Findings: Specialist nurses played an important role in building and maintaining an interdisciplinary network of care, necessary for the management of complex palliative situations. They performed tasks such as to "include" members and to "negotiate" the network of care with the family and providers. They "tailored" the support to patients and families' needs and as a result "empowered" the network of care., Conclusion: A nurse-led palliative care service facilitated interdisciplinary palliative home care to the benefit of all agents involved.

Background: Alleviating symptoms, fulfilling psychosocial needs, and the inclusion of family are among the criteria that determine care quality in palliative treatment. The care quality is especially inadequate for people with dementia (PwD) at the end of life. To improve this, it is necessary to understand the process of nurses' clinical decision-making in symptom management in the terminal phase of PwD., Aim: The aim of the study was to examine the decision-making process of symptom management for PwD in nursing homes in their terminal phase of life., Design: A qualitative design was chosen with a constructivist approach. Individual interviews were conducted with nurses (n=32) in four Swiss nursing homes., Results: 'Recount and reflect' plays a vital role in the care of PwD in terminal phase, enabling symptom recognition and facilitating symptom management. A process of thinking during the course of action enables nursing staff members to understand what, when, and how symptom changes have taken place., Conclusion: Highly-trained nurses need to support health care assistants through counselling, coaching, and leadership to help reduce the symptom burden experienced by PwD. Relatives are necessary to maintain an exchange of ideas regarding the appropriate treatment to reduce symptom burden.

Autosomal-dominant episodic ataxias (EAs) represent a clinically and genetically heterogeneous group of disorders characterized by recurrent episodes of cerebellar ataxia (CA). Ataxia episodes are usually of short duration and often triggered by specific stimuli. There are currently seven classified subtypes of EA. EA types 1 and 2 have the highest prevalence and are therefore the clinically most relevant. Between attacks, EA 1 is associated with myokymia. In EA 2, often an interictal downbeat nystagmus with other cerebellar ocular dysfunctions is present; patients with EA 2 may display slowly progessive ataxia and vermian atrophy. EA 1 and 2 are both channelopathies, affecting the potassium channel gene, KCNA1 , in EA 1 and the PQ calcium channel-encoding gene, CACNA1A , in EA 2. The types EA 3 to 7 are very rare and have to be further elucidated. Here, we review the historical, clinical, and genetic aspects of autosomal-dominant EAs and their current treatment, focusing on EA 1 and 2.

Predilection sites for infratentorial multiple sclerosis lesions are well known and frequently involve the fasciculus longitudinalis medialis leading to classical internuclear ophthalmoplegia. We report a very rare oculomotor disorder due to a demyelinating central nervous system (CNS) lesion in the medial part of the lower pontine tegmentum. A 36-year-old man presented with sudden onset of blurred vision. Clinically there was limited eye adduction and abduction to either side, which corresponds to bilateral horizontal gaze palsy. Brain magnetic resonance imaging (MRI) showed a demyelinating CNS lesion affecting the fasciculus longitudinalis medialis, abducens nuclei or abducens fibres in the medial part of the lower pontine tegmentum. Furthermore there were six further demyelinating white matter lesions fulfilling all Barkhof criteria for multiple sclerosis. Demyelinating CNS lesions causing isolated bilateral horizontal gaze palsy are exceptional and usually associated with further focal neurological deficits, which was not the case in the presenting patient. This is a unique video report of isolated bilateral horizontal gaze palsy as the initial manifestation of demyelinating CNS disease, which lead to definite diagnosis of relapsing remitting multiple sclerosis.

Mutations in the voltage-gated Cav2.1 P/Q-type calcium channel (CACNA1A) can cause a wide spectrum of phenotypes, including the episodic ataxia type 2. Beside the growing number of descriptions of novel CACNA1A mutations with episodic ataxia type 2 phenotype; there are only rare reports on interictal oculomotor signs other than nystagmus. We describe a novel CACNA1A mutation and an unclassified CACNA1A in-frame variant in a Swiss family presenting as the episodic ataxia type 2 phenotype associated with reduced saccade velocity. In this case series interictal clinical examination showed only minimal neurological findings as mild limb ataxia and nystagmus, but most interestingly saccade analysis of all three affected individuals demonstrated reduced mean saccade velocity. Genetic testing of CACNA1A revealed a de novo frame-shift mutation (c.2691dupC/p.Thyr898Leufs 170) in the index patient in addition to an unclassified in-frame variant (c.6657&#95;6659dupCCA/p.His2220dup) segregating in all three affected individuals. The de novo frame-shift CACNA1A mutation and the unclassified in-frame CACNA1A variant were associated with the episodic ataxia type 2 phenotype and reduced mean saccade velocity, which suggests involvement of brainstem or neural pathways connecting brainstem and the cerebellum in this disease.

Background: It is unclear whether patients with different clinical subtypes of Parkinson disease (PD) differ in their risk of developing levodopa-induced dyskinesia (LID) and whether resting tremor is negatively correlated with this risk., Objectives: To determine whether resting tremor as an initial manifestation of PD negatively correlated with subsequent occurrence and severity of LID and to study the correlations between LID and other epidemiological factors (eg, age at onset of PD and duration of PD)., Design: Logistic regression analysis was used to determine predictive factors of LID. Spearman rank correlations between LID and epidemiological factors and motor signs (including tremor) were calculated., Setting: Institutional tertiary referral center for movement disorders., Patients: Cohort of 85 patients with PD., Main Outcome Measure: Occurrence of LID according to the Unified Parkinson Disease Rating Scale part IV., Results: Resting tremor as an initial manifestation of PD was associated with reduced risk of developing LID independent of other predictors of LID (duration of PD, axial signs, and levodopa dose)., Conclusion: Resting tremor as an initial manifestation of PD predicts lower probability of developing LID under levodopa treatment.

Nitric oxide (NO) mediates a variety of physiological functions in the central nervous system and acts as an important developmental regulator. Striatal interneurons expressing neuronal nitric oxide synthase (nNOS) have been described to be relatively spared from the progressive cell loss in Huntington's disease (HD). We have recently shown that creatine, which supports the phosphagen energy system, induces the differentiation of GABAergic cells in cultured striatal tissue. Moreover, neurotrophin-4/5 (NT-4/5) has been found to promote the survival and differentiation of cultured striatal neurons. In the present study, we assessed the effects of creatine and NT-4/5 on nNOS-immunoreactive (-ir) neurons of E14 rat ganglionic eminences grown for 1 week in culture. Chronic administration of creatine [5mM], NT-4/5 [10ng/ml], or a combination of both factors significantly increased numbers of nNOS-ir neurons. NT-4/5 exposure also robustly increased levels of nNOS protein. Interestingly, only NT-4/5 and combined treatment significantly increased general viability but no effects were seen for creatine supplementation alone. In addition, NT-4/5 and combined treatment resulted in a significant larger soma size and number of primary neurites of nNOS-ir neurons while creatine administration alone exerted no effects. Double-immunolabeling studies revealed that all nNOS-ir cells co-localized with GABA. In summary, our findings suggest that creatine and NT-4/5 affect differentiation and/or survival of striatal nNOS-ir GABAergic interneurons. These findings provide novel insights into the biology of developing striatal neurons and highlight the potential of both creatine and NT-4/5 as therapeutics for HD.