Rationale and protocol of the ENGAGE study: a double-blind randomized controlled preference trial using a comprehensive cohort design to measure the effect of a cognitive and leisure-based intervention in older adults with a memory complaint.

BACKGROUND: Leisure activities can be both enjoyable and cognitively stimulating, and participation in such activities has been associated with reduced age-related cognitive decline. Thus, integrating stimulating leisure activities in cognitive training programs may represent a powerful and innovative approach to promote cognition in older adults at risk of dementia. The ENGAGE study is a randomized controlled, double-blind preference trial with a comprehensive cohort design that will test the efficacy and long-term impact of an intervention that combines cognitive training and cognitively stimulating leisure activities. METHODS: One hundred and forty-four older adults with a memory complaint will be recruited in Montreal and Toronto. A particular effort will be made to reach persons with low cognitive reserve. Participants will be randomly assigned to one of two conditions: cognitive + leisure training (ENGAGE-MUSIC/SPANISH) or active control (ENGAGE-DISCOVERY). The ENGAGE-MUSIC/SPANISH training will include teaching of mnemonic and attentional control strategies, casual videogames selected to train attention, and classes in music or Spanish as a second language. The ENGAGE-DISCOVERY condition will comprise psychoeducation on cognition and the brain, low-stimulating casual videogames and documentary viewing with discussions. To retain the leisure aspect of the activities, participants will be allowed to exclude either music or Spanish at study entry if they strongly dislike one of these activities. Participants randomized to ENGAGE-MUSIC/SPANISH who did not exclude any activity will be assigned to music or Spanish based on a second random assignment. Training will be provided in 24 2-h sessions over 4 months. Outcomes will be measured at baseline, at 4-month follow-up, and at 24-month follow-up. The primary outcome will be cognitive performance on a composite measure of episodic memory (delayed recall scores for words and face-name associations) measured at baseline and at the 4-month follow-up. Secondary outcomes will include a composite measure of attention (speed of processing, inhibition, dual tasking, and shifting), psychological health, activities of daily living, and brain structure and function and long-term maintenance measured at the 24-month follow-up. Information on cognitive reserve proxies (education and lifestyle questionnaires), sex and genotype (apolipoprotein (Apo)E4, brain-derived neurotrophic factor (BDNF), and catechol-O-methyltransferase (COMT)) will be collected and considered as moderators of training efficacy. DISCUSSION: This study will test whether a program combining cognitive training with stimulating leisure activities can increase cognition and reduce cognitive decline in persons at risk of dementia. TRIAL REGISTRATION: NCT03271190 . Registered on 5 September 2017.

Acceptability of a wearable hand hygiene device with monitoring capabilities.

Transmisssion of infection within healthcare institutions is a significant threat to patients and staff. One of the most effective means of prevention is good hand hygiene. A research team at Toronto Rehabilitation Institute, Ontario, Canada, developed a wearable hand disinfection system with monitoring capabilities to enhance hand wash frequency. We present the findingsof the first phase of a larger study addressing the hypothesis that an electronic hand hygiene system with monitoring and reminding propertieswill increase hand hygiene compliance. This first phase focused on the acceptability and usability of the wearable electronic hand wash device ina clinical environment. The feedback from healthcare staff to the first prototype has provided evidence for the research team to continue with the development of this technology.

The effects of perceived and preferred control on nurses' job satisfaction in long term care environments.

The purpose of this study is to explore how perceived and preferred clinical control and organizational control are associated with nurses' job satisfaction in long-term care settings. A sample of 113 nurses who work in long-term care units of a community hospital or a teaching hospital completed a questionnaire that included a job satisfaction scale, an organizational control scale, and a set of vignettes specific to long-term care developed to examine clinical control. There was a positive relationship between perceived organizational control and job satisfaction and a negative relationship between preferred clinical control and job satisfaction. Furthermore, as predicted, congruence between perceived and preferred control in the clinical and in the organizational domains were related to job satisfaction. Counter to prediction, organizational control explained more variance in job satisfaction than clinical control. The challenges of conceptualizing clinical control and its measurement are discussed.

Can we help persons with dementia find their way in a new environment?

The objective of this study was to conduct a randomized controlled trial to examine the effects of a way-finding intervention on residents' ability to find their way in a new environment. The effect of the intervention on the residents' spatial orientation and agitation were also examined. The study was conducted on four nursing home units in a geriatric center and the final sample consisted of 32 residents with Alzheimer's disease (17 in the treatment group and 15 in the control group). The intervention consisted of the use of a location map and a behavioral training technique, which was provided to residents over the course of a month. Repeated measures analysis of variance and McNemar tests were used to compare the groups in regard to changes in the outcomes over time. Results indicated that the residents' in the treatment group demonstrated an increased ability to find their way to the dining room one week after the intervention. The intervention effect was not sustained three months later.