Resident Assessment Instrument (RAI): a review of international research on the psychometric qualities and effects of implementation in nursing homes

This article is a review of the available literature on psychometric qualities and effects of implementation of the Resident Assessment Instrument (RAI) on quality of care and health of nursing homes residents. The RAI was developed in the USA to assess the needs of nursing home residents. It consists of a comprehensive assessment of the resident (the Minimum Data Set) and 18 protocols (Resident Assessment Protocols) for further analysis of major problem areas. RAI is implemented in nursing homes in the United States, Canada, Japan and several European countries. The interrater reliability was adequate for clinical use in several studies. The validity is good for the appraisal of ADL- and cognitive functions, but moderate for mood and behaviour. In Japan and the United States positive effects were found after implementation of the RAI, especially on the care process. Implementation of RAI has shown to have positive effects on the physical and cognitive function of the resident, but there were negative effects on a number of psychosocial domains. Fourteen Dutch nursing homes have recently implemented the RAI. Studies concerning reliability, validity and effects on quality of care and quality of life are underway.     

Activities of Daily Living,Depression, and Quality of Life in Parkinson's Disease

This study examined whether activities of daily living (ADL) mediate the relationship between depression and health-related quality of life (HR-QOL) in people with Parkinson''s disease (PD). A cross-sectional, correlational research design examined data from 174 participants who completed the Geriatric Depression Scale (GDS-15), Parkinson''s Disease Questionnaire-39 (PDQ-39), and Unified Parkinson''s Disease Rating Scale-section 2 (UPDRS-section 2 [ADL]). Multiple Regression Analysis (MRA) was used to examine the mediator model. Depression and ADL significantly (p<.001) predicted HR-QOL, and depression significantly (p<.001) predicted ADL. Whilst ADL did not impact on the relationship between depression and HR-QOL, there was a significant (p<.001) indirect effect of depression on HR-QOL via ADL, suggesting both direct and indirect (via ADL) effects of depression on HR-QOL. The magnitude of this effect was moderate (R² = .13). People with PD who report depression also experience greater difficulty completing ADL, which impacts upon their HR-QOL. It is recommended that clinicians adopt a multidisciplinary approach to care by combining pharmacological treatments with psycho/occupational therapy, thereby alleviating the heterogeneous impact of motor and non-motor symptoms on HR-QOL in people with PD.     

Project models to improve the ambiance during meal times in Dutch nursing homes: incentives and barriers for implementation

In many Dutch nursing homes, meals are not served in a cozy setting. This study makes an inventory of project models used in nursing homes to improve the ambiance during mealtimes and identifies the beneficial factors (incentives) and barriers of the meal ambiance models. Three different meal ambiance project models were found: restaurant, cooking on the nursing ward and bulkmeals. Each of the three models was experienced as a success by the nursing home inhabitants, the nursing home management and the staff. They pointed out that the cooperation and motivation of staff, sufficient space and management support were the most important beneficial factors of the project models. The most important barriers were absence of cooperation and motivation of the staff, insufficient finances and insufficient personnel.     

Care quality: reliability and usefulness of observation data in bench marking nursing homes and homes for the aged in the Netherlands

Before including quality of care indicators in the Benchmark of Nursing Homes and Homes for the Aged in the Netherlands the reliability of the patient data collection, and usefulness had to be established. The patient data items were derived from the Resident Assessment Instruments (RAI) and a questionnaire on social interaction in elderly people. Three nursing homes and three homes for the aged participated in the test with 550 patients. 279 x 2 assessments were collected by independent raters for an inter rater reliability test; 259 x 2 by the same rater for a reliability test-retest; and 24 by a single rater. The scores on paired assessment forms were compared with the weighted Kappa agreement test. The test results allowed 10 of the 13 quality indicators from RAI to be retained. In addition new quality indicators could be defined on 'giving attention' and 'unrespectful addressing'. We estimate on the basis of a questionnaire for the raters that on average 9 to 12 minutes per patient are needed to collect and enter data for the resulting 12 quality indicators.     

Quantitative EEG data and comprehensive ADL (Activities of Daily Living) evaluation of stroke survivors residing in the community

The purpose of this study was to investigate the hypothesis that EEG values match other comprehensive activities of daily living (ADL) evaluations between stroke survivors and normal controls. Various functions related to ADL were examined by means of ADL assessments (Measurement of Competence in the Elderly Living at Home, Barthel Index, Stroke Impairment Assessment Set, time needed to walk 10 metres) and biosocial synchronization (the questionnaire on biosocial rhythms of daily living). EEG was undertaken using a computer-assisted portable EEG recorder. The power spectra were computed using a fast Fourier transformation analysis (FFT). The absolute and relative powers (percent of the total EEG power) of 5 frequency bands (delta, theta, alpha 1, alpha 2 and beta) and the peak frequency were analyzed. In comparing stroke survivors and the independent elderly, the latter had higher scores than the former in assessments of various functions related to ADL. The absolute and relative power of the delta band were lower in normal controls, and the relative power of the alpha (2) band and the peak frequency were higher than those of stroke survivors. Among the correlations between EEG and ADL assessments, the absolute and relative power of the alpha (2) band correlated significantly with ADL assessments of stroke survivors with right hemiplegia. The peak frequency was significantly increased in cases with high ADL scores. In conclusion, significant correlations were identified between the quantitative EEG data of stroke survivors in the chronic stage, living in the community, and ADL-related functions. Computer-assisted portable EEG recording is a potentially useful screening tool for objectively evaluating the functional levels of stroke survivors in field work.     

Three stages of meiotic homologous chromosome pairing in wheat: cognition, alignment and synapsis

 Chromosome painting enabled the study of homologous chromosome behaviour prior to and during meiosis. Total genomic DNA from rye, used as a probe for in situ hybridization, identified the rye chromosome arm in a wheat-rye translocation line (T5AS·5RL) at meiotic prophase and the preceding interphase. Accurate staging of the development of the meiocytes was attained by parallel studies of chromatin morphology, nucleolar behaviour and synaptonemal complex formation in electron microscopy thin sections and silver-stained surface spreads. Three stages of pairing were identified for the large cereal genomes that are organized in a Rabl configuration: first, cognition occurs during the long interphase before leptotene, bringing the homologous chromosome domains into close proximity and possibly starting at the centromere; second, homologous chromosome segments align at late leptotene; and third, zygotene synapsis initiates near the telomere, although it was also observed to occur near the centromere. A pairing model is proposed for wheat, with a genome size of 17000 Mbp, that shows prallels to and notable differences from yeast and mammalian models of meiosis. Received: 25 January 1997 / Revision accepted: 14 July 1997     

Anxiety disorders in nursing homes: a literature review of prevalence, course and risk indicators

Psychiatric disorders such as dementia and depression are highly prevalent in nursing homes. The prevalence of anxiety disorders is less clear. Prevalence, course and risk-indicators of anxiety disorders among nursing home residents were examined, based on a review of the literature. Medline and PsychINFO searches were conducted for 1966-2002. Twelve studies were considered relevant. These differed substantially with respect to study-population, diagnostic instruments and diagnostic criteria that were used and the specific anxiety disorders investigated. The prevalence of anxiety disorders ranged from 0-20%. Only in one study the course of anxiety disorders was investigated. About 60% of the nursing home residents recovered in one year. The most important risk-indicators for anxiety disorders identified were: female sex, depression, lack of social support, poor physical health and functional and cognitive impairments. Generalization of these results to the Dutch nursing home population is restricted by the substantial heterogeneity of the studies. Further studies are required to provide reliable estimates of prevalence, course and risk-indicators of anxiety disorders among nursing home residents using appropriate diagnostic instruments and adjusted diagnostic criteria. This will enhance detection and improve treatment of anxiety disorders among nursing home residents.     

术前衰弱对老年心脏手术患者术后跌倒坠床发生率、认知功能和日常生活活动能力的影响分析

摘要 目的：探讨术前衰弱对老年心脏手术患者术后跌倒坠床发生率、认知功能和日常生活活动能力的影响。方法：选择我院2018年1月~2021年1月收治的271例拟行心脏手术的老年患者,按照术前是否合并衰弱情况,将患者分别纳入衰弱组、非衰弱组,对比两组患者术后跌倒坠床发生率、并发症发生率、住院时间及术前、术后认知功能和日常生活活动能力的变化。结果：271例患者中,共有78例（28.78%）符合衰弱判断。衰弱组术后跌倒坠床、并发症发生率高于非衰弱组,其住院时间较非衰弱组更长,差异有统计学意义（P＜0.05）。两组患者术后7 d简易智力精神状态检查量表（MMSE）评分均较术前下降,衰弱组术后7 d MMSE评分低于非衰弱组,差异有统计学意义（P＜0.05）。衰弱组术后认知功能障碍（POCD）发生率为11.54%（9/78）,高于非衰弱组的1.04%（2/193）,差异有统计学意义（P＜0.05）。两组患者术后7 d基础性日常生活活动能力（BADL）及工具性日常生活活动能力（IADL）评分均较术前下降,衰弱组术后7 d BADL、IADL评分低于非衰弱组,差异有统计学意义（P＜0.05）。结论：合并术前衰弱的老年患者较非衰弱患者心脏手术后跌倒坠床发生率、并发症发生率更高,认知功能、日常生活活动能力受影响越明显,且术后恢复速度更慢。     

中国四川花蝇科三新种及一新记录种(双翅目:蝇总科)

报道采自中国四川西部花蝇科(Anthomyiidae)3新种:隰蝇属的乌亮隰蝇(Hydrophoria nigrinitidaFeng,sp.nov.);壮叶隰蝇(H.robustisurstylusFeng,sp.nov.);泉蝇属的黑前足泉蝇(Pegomya nigripraepedaFeng,sp.nov.)。模式标本存在中国科学院上海生命科学研究院植物生理生态研究所。同时记录泉蝇属(PegomyaRob ineau-Desvoidy,1830)的一中国新记录种:丽足泉蝇[Pegomya pulchripes(Loew,1857)]。     

中国四川花蝇科三新种及—新记录种（双翅目：蝇总科）

报道采自中国四川西部花蝇科（Anthomyiidae）3新种：隰蝇属的乌亮隰蝇（Hydrophoria nigrinitida Feng,sp．nov．）;壮叶隰蝇（H．robustisurstylus Feng,sp．nov．）;泉蝇属的黑前足泉蝇（Pegomya nigripraepeda Feng,sp．nov．）。模式标本存在中国科学院上海生命科学研究院植物生理生态研究所。同时记录泉蝇属（Pegomya Robineau—Desvoidy,1830）的一中国新记录种：丽足泉蝇[Pegomya pulchripes（Loew,1857）]。     

Detecting signatures of competition from observational data: a combined approach using DNA barcoding,diversity partitioning and checkerboards at small spatial scales

相似文献   

Living on three time scales: the dynamics of plasma cell and antibody populations illustrated for hepatitis a virus

Understanding the mechanisms involved in long-term persistence of humoral immunity after natural infection or vaccination is challenging and crucial for further research in immunology, vaccine development as well as health policy. Long-lived plasma cells, which have recently been shown to reside in survival niches in the bone marrow, are instrumental in the process of immunity induction and persistence. We developed a mathematical model, assuming two antibody-secreting cell subpopulations (short- and long-lived plasma cells), to analyze the antibody kinetics after HAV-vaccination using data from two long-term follow-up studies. Model parameters were estimated through a hierarchical nonlinear mixed-effects model analysis. Long-term individual predictions were derived from the individual empirical parameters and were used to estimate the mean time to immunity waning. We show that three life spans are essential to explain the observed antibody kinetics: that of the antibodies (around one month), the short-lived plasma cells (several months) and the long-lived plasma cells (decades). Although our model is a simplified representation of the actual mechanisms that govern individual immune responses, the level of agreement between long-term individual predictions and observed kinetics is reassuringly close. The quantitative assessment of the time scales over which plasma cells and antibodies live and interact provides a basis for further quantitative research on immunology, with direct consequences for understanding the epidemiology of infectious diseases, and for timing serum sampling in clinical trials of vaccines.     

Dermo-epidermal interactions in reptilian scales: speculations on the evolution of scales, feathers, and hairs

The dermal influence on the epidermis during scale formation in reptiles is poorly known. Cells of the superficial dermis are not homogeneously distributed beneath the epidermis, but are instead connected to specific areas of the epidermis. Dermal cells are joined temporarily or cyclically through the basement membrane, with the reactive region of the epidermis forming specific regions of dermo-epidermal interactions. In these regions morphoregulatory molecules may be exchanged between the dermis and the connected epidermis. Possible changes in the localization of these regions in the skin may result in the production of different appendages, in accordance with the genetic makeup of the epidermis in each species. Regions of dermo-epidermal interactions seem to move their position during development. A hypothesis on the development and evolution of scales, hairs, and feathers from sarcopterigian fish to amniotes is presented, based on the different localization and extension of regions of dermo-epidermal interactions in the skin. It is hypothesized that, during phylogenesis, possible variations in the localization and extension of these regions, from the large scales of basic amniotes to those of sauropsid amniotes, may have originated scales with hard (beta)-keratin. In extant reptiles, extended regions of dermo-epidermal interaction form most of the expanse of outer scale surface. It is hypothesized that the reduction of large regions of dermo-epidermal interactions into small areas in the skin were the origin of dermal condensations. In mammals, small regions of dermo-epidermal interactions have invaginated, forming the dermal papilla with the associated hair matrix epidermis. In birds, small regions of dermo-epidermal interactions have reduced the original scale surface of archosaurian scales, forming the dermal papilla. The latter has invaginated in association with the collar epidermis from which feathers were produced.     

Daily Activity Patterns and Thermal Tolerance of Three Sympatric Dung Beetle Species (Scarabaeidae: Scarabaeinae: Eucraniini) from the Monte Desert,Argentina

Tolerance to extreme temperatures, thermal limits, and the mechanisms of thermoregulation are related to internal functions of insects and partly define their ecological niche. We study the association between daily activity of dung beetles from the Monte Desert in Argentina and their tolerance to high temperatures. Results indicate that for all three sympatric species studied, Eucranium belenae Ocampo, Anomiopsoides cavifrons (Burmeister), and Anomiopsoides fedemariai Ocampo, daily activity is associated to ground temperature. Eucranium belenae is active when ground temperature is relatively low and it is less tolerant to long periods of activity at high temperatures in the lab, while A. cavifrons and A. fedemariai are active when ground temperatures are higher, and they tolerate high temperatures for longer periods of time than E. belenae in the lab. These species coexist and use similar food sources, and this eco-physiological study may help to explain how they differentiate under the same environmental conditions. The Monte Desert is considered an extreme environment, and studies on thermal tolerance offer testable predictions to understand how species would respond to climate change.     

吉林省蓝藻门单歧藻属三新种

报道了采自吉林省五女峰的蓝藻门单歧藻属三新种,纤细单岐藻、长枝单岐藻、普通单岐藻。