The effects of promoting oral intake using the Kuchi-kara Taberu index, a comprehensive feeding assistant tool, in older pneumonia patients: a cluster randomized controlled trial.

BACKGROUND: The multidisciplinary comprehensive care (MDCC) program promotes the improvement of oral intake for older patients. The Kuchi-kara Taberu (ingesting orally in Japanese, KT) index was developed to objectively assess patient conditions in the MDCC program. This trial examined the effects of the index in promoting oral intake in older patients with pneumonia. METHODS: A cluster randomized controlled trial was conducted in 10 local hospitals targeting older patients with pneumonia (≥65 years). Ten hospitals were allocated randomly to either the intervention or the control group. Both groups (each with five hospitals) received the MDCC program for oral feeding, which consisted of professional assessment, care, and treatment. The KT index was used by the intervention group, focusing on improving low score items. The primary outcome was determined using the Functional Oral Intake Scale (FOIS) at discharge or 1 month after admission. RESULTS: One hundred and twelve patients (46 women and 66 men) who participated from 10 hospitals, with a median age of 88 years (interquartile range [IQR], 80-91), were examined. The median FOIS level and the number of patients with oral intake (FOIS ≥ level 4) at discharge were 4 (IQR, 4-6) and 89 (79.5%), respectively. The duration of nil per os was 2 (IQR, 1-5) days. Clusters were not matched in the presence of Kuchi-kara Taberu Shiawase-wo Mamoru-kai-certified medical staff promoting oral intake in patients with dysphagia in each hospital. The median FOIS levels of 53 patients in the intervention group and 59 patients in the control group were 5 (IQR, 4-6) and 4 (IQR, 4-5), respectively, showing no statistically significant difference (P = 0.76). According to a multivariate analysis, the KT index had no positive effect on FOIS levels. CONCLUSIONS: This trial was not able to demonstrate the usefulness of the KT index due to random assignment failure. However, both the intervention and control groups showed a high prevalence of oral intake (FOIS ≥ level 4) at discharge. TRIAL REGISTRATION: UMIN-Clinical Trial Registry, UMIN000025172, December 17, 2016.

Multidisciplinary Comprehensive Care for Early Recommencement of Oral Intake in Older Adults With Severe Pneumonia.

HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.3 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Multidisciplinary Comprehensive Care for Early Recommencement of Oral Intake in Older Adults With Severe Pneumonia" found on pages 21-29, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until September 30, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Describe the effect of multidisciplinary comprehensive care (MDCC) on oral intake in older adults with severe pneumonia at the time of discharge. 2. Explore the impact of MDCC on the length of stay for hospitalized older adults with severe pneumonia. DISCLOSURE STATEMENT Neither the planners nor the authors have any conflicts of interest to disclose. The current study was designed to assess the effect of multidisciplinary comprehensive care (MDCC) on (a) oral intake at discharge and (b) hospital stay duration in older adult patients with severe pneumonia. Participants were divided into two groups: receiving and not receiving MDCC. MDCC comprises regular assessment of swallowing ability, aspiration risk management, improvement of oral hygiene, serving of nutritious texture-modified foods, and encouragement of early mobilization. The MDCC group (164 women, 206 men; mean age = 82.7, SD = 8.4 years) had severe pneumonia as well as high proportions of poor premorbid physical function and consciousness disturbance compared to the non-MDCC group (45 women, 56 men; mean age = 81.1, SD = 8.6 years). Nevertheless, MDCC was an independent determinant of hospital stay duration and oral intake (Functional Oral Intake Scale score ≥4) at discharge with Cox regression analysis (hazard ratio = 1.42, 95% confidence interval [1.09, 1.85]). MDCC may promote early oral intake and hospital discharge in older adults with severe pneumonia. [Journal of Gerontological Nursing, 42(10), 21-29.].

Feeding Assistance Skill Score: development and verification of reliability and validity.

PURPOSE: Feeding assistance should be safe and improve the assisted individual's ability to feed, yet objective tools for evaluating these skills are lacking. This study focuses on developing a tool for assessing feeding assistance skills. METHODS: A group consisting of 25 experts employed the Delphi method to achieve a consensus on the essential items necessary for assessing feeding assistance skills. Subsequently, a draft score using a three-point scale was developed. To test the reliability of the draft scores, a group of 20 patients and 20 nurses was matched to record a meal assistance scene, which were independently evaluated by three raters. We computed the AC1 statistic to assess both intra- and inter-rater reliability, and further examined correlations between the Feeding Assistance Skill Score (FASS) scores and outcome items to verify validity. RESULTS: Initially, an 18-item draft score was generated using the Delphi method. Subsequently, seven items were omitted from the intra- or inter-rater reliability analysis. Furthermore, after discussion, researchers removed one item that assessed food cognition, because the agreement score between the two items was 91%. Finally, the 10-item FASS was developed, showing a correlation with dietary intake upon validation. CONCLUSIONS: We successfully developed a scoring system for peer evaluation of feeding assistance skills. Future studies should aim to validate the FASS. The implementation of the FASS aims to assess the effectiveness of feeding assistance training and care quality, potentially improving safety and satisfaction for those receiving feeding assistance.

A Comparison of the Contents of Disaster Nursing Practices and Perceived Difficulties among Nurses Working at Welfare Evacuation Shelters during Natural Disasters and Multiple Disasters: A Qualitative Study.

In this study, we compared the disaster relief practices of nurses who worked in welfare shelters in Iwate and Miyagi Prefectures, areas in which only natural disasters occurred, and nurses who worked in Fukushima Prefecture, an area in which both nuclear and natural disasters occurred during the Great East Japan Earthquake in 2011, in order to identify commonalities and differences between them. We conducted semi-structured interviews with two nurses from each prefecture. The results revealed that "nursing practice with minimal available materials and personnel" and "nursing practice based on knowledge and experience as a nurse" were common themes in the content of nursing practices, whereas "securing human resources during disasters and considering ideal welfare evacuation centers" and "recording the difficulties in dealing with nuclear disasters" were uncommon themes. The findings confirmed that even in Fukushima Prefecture, in which the nuclear disaster occurred, participants did not talk about their concerns regarding radiation exposure while working at welfare evacuation shelters where people with special requirements were evacuated, and that they were expected to respond in the same way as they would in natural disasters. However, participants reported several difficulties relating to nuclear disasters that should be considered in future disaster support.

Effect of iron overload from multi walled carbon nanotubes on neutrophil-like differentiated HL-60 cells.

Multi walled carbon nanotubes (MWCNTs) are one of the most intensively explored nanomaterials because of their unique physical and chemical properties. Due to the widespread use of MWCNTs, it is important to investigate their effects on human health. The precise mechanism of MWCNT toxicity has not been fully elucidated. The present study was designed to examine the mechanisms of MWCNT toxicity toward human promyelocytic leukemia HL-60 cells. First, we found that MWCNTs decreased the viability of neutrophil-like differentiated HL-60 cells but not undifferentiated HL-60 cells. Because neutrophil-like differentiated HL-60 cells exhibit enhanced phagocytic activity, the cytotoxicity of MWCNTs is dependent on the intracellularly localized MWCNTs. Next, we revealed that the cytotoxicity of MWCNTs is correlated with the intracellular accumulation of iron that is released from the engulfed MWCNTs in an acidic lysosomal environment. The intracellular accumulation of iron was repressed by treatment with cytochalasin D, a phagocytosis inhibitor. In addition, our results indicated that iron overload enhanced the release of interleukin-8 (IL-8), a chemokine that activates neutrophils, and subsequently elevated intracellular calcium concentration ([Ca2+]i). Finally, we found that the sustained [Ca2+]i elevation resulted in the loss of mitochondrial membrane potential and the increase of caspase-3 activity, thereby inducing apoptotic cell death. These findings suggest that the iron overload caused by engulfed MWCNTs results in the increase of IL-8 production and the elevation of [Ca2+]i, thereby activating the mitochondria-mediated apoptotic pathway.

Comparison of the effects of multiwall carbon nanotubes on the epithelial cells and macrophages.

Effects of two kinds of multiwall carbon nanotubes (MWCNTs) on cells were examined. The effects of MWNT-7, which has been reported to be carcinogenic, and MWCNT-B, whose toxicity is unclear, were examined in both epithelial cells and macrophages. Human lung carcinoma A549 cells were used as representative epithelial cells and differentiated human monocyte THP-1 cells, as well as rat pulmonary macrophages NR8383, were employed to examine possible harmful effects of the MWCNTs. The MWCNTs induced the production of chemokines such as interleukin-8 (IL-8). MWCNTs were found to more strongly affect macrophages than epithelial cells. In addition, the toxicity was more pronounced in the MWNT-7 exposed cells than in those exposed to MWCNT-B. Cytochalasin D and amiloride treatment of differentiated THP-1 cells reduced cell-associated MWCNTs and IL-8 induction. To confirm these cellular influences in vivo, intratracheal administration of each type of MWCNT was performed by pharyngeal aspiration in the mouse lung. Analysis of bronchoalveolar lavage fluid (BALF) showed increase of inflammatory monocyte in MWNT-7 exposed animals at 1week after. In addition, neutrophils in the BALF were also significantly increased MWNT-7 exposed animals at 1 week and 1 month after. Aspiration of MWNT-7 caused formation of granulomas in the lung. Formation of the granulomas was not observed in the case of MWCNT-B. These results suggest that cellular uptake of the MWCNTs by phagocytosis and chemokine induction is important aspects of their toxicity.

Reliability and Validity of a Simplified Comprehensive Assessment Tool for Feeding Support: Kuchi-Kara Taberu Index.

OBJECTIVES: To verify the reliability and validity and develop an English version of an instrument (Kuchi-Kara Taberu Index (KT Index)) to comprehensively assess and intervene in problems with eating and swallowing. DESIGN: Multicenter cross-sectional study. SETTING: Nursing homes. PARTICIPANTS: Individuals aged 65 and older (mean age 88.3 ± 6.8; 80.0% female) who had lived in a nursing home for longer than 1 month (N = 115). MEASUREMENTS: The KT index consisted of 13 items: desire to eat, overall condition, respiratory condition, oral condition, cognitive function while eating, oral preparatory and propulsive phases, dysphagia severity, position and endurance while eating, eating, daily life, food intake level, food modification, and nutrition. Weighted kappa coefficients, Cronbach alpha, and Spearman rank correlation coefficients were determined. RESULTS: Weighted kappa values in the inter- and intrarater reliability tests ranged from 0.54 to 0.96 and 0.68 to 0.98, respectively. Cronbach alpha was 0.892. Spearman rank correlation coefficients (r) between the total KT index and external criteria were determined (Functional Oral Intake Scale, r = 0.790; Barthel Index, r = 0.830; Mini Nutritional Assessment Short Form, r = 0.582; Cognitive Performance Scale, r = -0.673; all P < .001). Similar correlations were observed when some items related to each external criterion were removed from the total KT index. Translation-retranslation procedures were conducted to develop an English version of the KT index. CONCLUSION: The study provided evidence of the reliability and validity of the KT index and developed an English version. Future studies regarding validation of health-related quality of life indices and their effect on clinical courses of eating and swallowing conditions are needed.