[Utility of a Life-trouble Scale-based care planning tool for elderly patients living in a long-term care health facility: Effects of an intervention based on person-centered care].

PURPOSE: This study aimed to clarify the utility of the Life-trouble Scale-based care planning tool for elderly patients with dementia (Life-trouble Scale, viewpoints, and care points of the elderly with dementia suffering from life troubles) in order to develop an appropriate care plan and practices in a long-term care health facility. METHOD: Participants were elderly patients with dementia who were evaluated by care staff using the abovementioned scale at baseline and after intervention (one month later) from September to December 2017. The patients were divided into an intervention group, which received care based on the Life-Trouble Inclusion Scale, and the control group, which received the usual care. The outcomes of these two groups were compared. RESULTS: The intervention and control groups comprised 14 and 12 elderly patients with dementia, respectively. More than 60% of the care staff worked with both groups. Scores on the agitation sub-scale of the NPI [please define abbreviation] and "life-trouble associated with irritation and confusion" sub-scale of the Life-Trouble Scale improved significantly in the intervention group. Among the care staff, self-efficacy related to caring for elderly patients with dementia and scores on the Emotional Exhaustion and Depersonalization sub-scales of the Japanese version of the Maslach Burnout Inventory improved significantly. CONCLUSION: The present findings suggest that care intervention using the Life-trouble Scale-based care planning tool was beneficial for both elderly patients with dementia and their care staff.

Mutational and biochemical analyses of the endolysin Lys(gaY) encoded by the Lactobacillus gasseri JCM 1131T phage phi gaY.

The Lys(gaY) of Lactobacillus gasseri JCM 1131(T) phage phigaY endolysin was purified to homogeneity using the Escherichia coli/His.Tag system. Zymographic and spectrophotometric assays showed that Lys(gaY) lysed over 20 heated Gram-positive bacterial species as the substrates, including lactobacilli, lactococci, enterococci, micrococci, and staphylococci. The enzymatic activity had the pH and temperature optima of about 6.5 and 37 degrees C, respectively. Amino-acid substitution analysis revealed that 13 residues of Lys(gaY) were involved in cell-lytic activity: in the beta/alpha(gaY) domain, G10, D12, E33, D36, H60, Y61, D96, E98, V124, L132, and D198; in the SH3b(gaY) domain, Y272 and W284. In addition, deletion analysis demonstrated that the beta/alpha(gaY) domain of N-terminal 216 residues is the core enzyme portion, although the cell-lytic ability is lower than that of Lys(gaY). These mutational experiments suggested that beta/alpha(gaY) (in which two acidic residues of D12 and E98 likely act as catalytic residues) is responsible for cell-lytic activity, and SH3b(gaY) promotes beta/alpha(gaY) possibly through cell-wall binding function. The purified His-tagged SH3b(gaY) domain containing 94 residues from S217 to K310 (i) bound to Gram-positive bacteria susceptible to Lys(gaY), (ii) induced aggregation of exponentially growing cells of L. gasseri JCM 1131(T), L. casei IAM 1045, Lactococcus lactis C2, L. lactis MG 1363, and Enterococcus hirae IAM 1262 by forming thread-like chained cells, (iii) inhibited lytic activity of Lys(gaY), and (iv) impeded autolysis of L. gasseri JCM 1131(T) in buffer systems. A truncated protein HDeltaSH3b(gaY) lacking in N-terminal 21 residues (from S217 to E237) of SH3b(gaY) and an amino-acid substituted protein HSH3b(gaY)G (W284G) lost the activities of HSH3b(gaY), showing that the N-terminal region and W284 probably play important roles in the SH3b(gaY) function(s).