Chair based exercise in community settings: a cluster randomised feasibility study.

BACKGROUND: Some older people who find standard exercise programmes too strenuous may be encouraged to exercise while remaining seated - chair based exercises (CBE). We previously developed a consensus CBE programme (CCBE) following a modified Delphi process. We firstly needed to test the feasibility and acceptability of this treatment approach and explore how best to evaluate it before undertaking a definitive trial. METHODS: A feasibility study with a cluster randomised controlled trial component was undertaken to 1. Examine the acceptability, feasibility and tolerability of the intervention and 2. Assess the feasibility of running a trial across 12 community settings (4 day centres, 4 care homes, 4 community groups). Centres were randomised to either CCBE, group reminiscence or usual care. Outcomes were collected to assess the feasibility of the trial parameters: level of recruitment interest and eligibility, randomisation, adverse events, retention, completion of health outcomes, missing data and delivery of the CCBE. Semi- structured interviews were conducted with participants and care staff following the intervention to explore acceptability. RESULTS: 48% (89 out of 184 contacted) of eligible centres were interested in participating with 12 recruited purposively. 73% (94) of the 128 older people screened consented to take part with 83 older people then randomised following mobility testing. Recruitment required greater staffing levels and resources due to 49% of participants requiring a consultee declaration. There was a high dropout rate (40%) primarily due to participants no longer attending the centres. The CCBE intervention was delivered once a week in day centres and community groups and twice a week in care homes. Older people and care staff found the CCBE intervention largely acceptable. CONCLUSION: There was a good level of interest from centres and older people and the CCBE intervention was largely welcomed. The trial design and governance procedures would need to be revised to maximise recruitment and retention. If the motivation for a future trial is physical health then this study has identified that further work to develop the CCBE delivery model is warranted to ensure it can be delivered at a frequency to elicit physiological change. If the motivation for a future trial is psychological outcomes then this study has identified that the current delivery model is feasible. TRIAL REGISTRATION: ISRCTN27271501 . Date registered: 30/01/2018.

Approaches to co-production of research in care homes: a scoping review.

BACKGROUND: Using the technique of co-production to develop research is considered good practice. Co-production involves the public, practitioners and academics working together as equals throughout a research project. Co-production may help develop alternative ways of delivering care for older adults that are acceptable to those who live and work in care homes. However, guidance about applying co-production approaches in this context is lacking. This scoping review aims to map co-production approaches used in care homes for older adults in previous research to support the inclusion of residents and care staff as equal collaborators in future studies. METHODS: A scoping review was conducted using the Joanna Briggs Institute scoping review methodology. Seven electronic databases were searched for peer-reviewed primary studies using co-production approaches in care home settings for older adults. Studies were independently screened against eligibility criteria by two reviewers. Citation searching was completed. Data relating to study characteristics, co-production approaches used, including any barriers and facilitators, was charted by one reviewer and checked by another. Data was summarised using tables and diagrams with an accompanying narrative description. A collaborator group of care home and health service representatives were involved in the interpretation of the findings from their perspectives. RESULTS: 19 studies were selected for inclusion. A diverse range of approaches to co-production and engaging key stakeholders in care home settings were identified. 11 studies reported barriers and 13 reported facilitators affecting the co-production process. Barriers and facilitators to building relationships and achieving inclusive, equitable and reciprocal co-production were identified in alignment with the five NIHR principles. Practical considerations were also identified as potential barriers and facilitators. CONCLUSION: The components of co-production approaches, barriers and facilitators identified should inform the design of future research using co-production approaches in care homes. Future studies should be explicit in reporting what is meant by co-production, the methods used to support co-production, and steps taken to enact the principles of co-production. Sharing of key learning is required to support this field to develop. Evaluation of co-production approaches, including participants' experiences of taking part in co-production processes, are areas for future research in care home settings.

Co-production involves people from different backgrounds working together as equals throughout a research project. Co-production may be a useful approach to help ensure that research in care homes focuses on approaches that are important and agreeable to older people and staff. A wide range of research and guidance about co-production has been published but there is limited guidance about how to do co-production in care homes. We carried out a review that involved pulling together previous research that used co-production in care homes for older adults. We looked at published research studies to learn about: Key components of the strategies used to achieve co-production, How care home residents and care home staff were involved, What helped or made co-production difficult to achieve. A collaborator group including representatives from care homes and healthcare services were involved in this research. They helped decide what was most important about the results.We found 19 published research articles that used co-production in care homes. The strategies used in the articles differed. There were also differences in how care home residents and staff were involved in co-production. Factors that helped people involved to work together in an inclusive and equal way were identified. At the same time, there were also many challenges.These results should be used to design future research using co-production in care homes. Future studies should clearly report what is meant by co-production, the strategies used and key learning points. Evaluation of co-production and the experiences of people involved is needed.

Xenopus neural crest cell migration in an applied electrical field.

Xenopus neural crest cells migrated toward the cathode in an applied electrical field of 10 mV/mm or greater. This behavior was observed in relatively isolated cells, as well as in groups of neural crest cells; however, the velocity of directed migration usually declined when a cell made close contact with other cells. Melanocytes with a full complement of evenly distributed melanosomes did not migrate of their own accord, but could be distorted and pulled by unpigmented neural crest cells. Incompletely differentiated melanocytes and melanocytes with aggregated melanosomes displayed the same behavior as undifferentiated neural crest cells, that is, migration toward the cathode. An electrical field of 10 mV/mm corresponded to a voltage drop of less than 1 mV across the diameter of each cell; the outer epithelium of Xenopus embryos drives an endogenous transembryonic current that may produce voltage gradients of nearly this magnitude within high-resistance regions of the embryo. We, therefore, propose that electrical current produced by the skin battery present in these embryos may act as a vector to guide neural crest migration.

Ion currents and membrane domains in the cleaving Xenopus egg.

We used an extracellular vibrating probe to measure ion currents through the cleaving Xenopus laevis egg. Measurements indicate sharp membrane heterogeneities. Current leaves the first cleavage furrow after new, unpigmented membrane is inserted. This outward current may be carried by K+ efflux. No direct involvement of the Na+,K+-ATPase in the generation of this outward current is detected at first cleavage. Inward current enters the old, pigmented membrane; however, it does not enter uniformly. The inward current is largest at the old membrane bordering the new membrane. This suggests a heterogeneous ion channel distribution within the old membrane. Experiments suggest that the inward current may be carried by Na+ influx, Ca2+ influx, and Cl- efflux. No steady currents were detected during grey crescent formation, the surface contraction waves preceding cleavage, or with groove formation at the beginning of cleavage.

Cytochalasin treatment disrupts the endogenous currents associated with cell polarization in fucoid zygotes: studies of the role of F-actin in embryogenesis.

We determined the distribution of F-actin in fucoid (Pelvetia, Fucus) embryos with nitrobenzoxadiazole-phallacidin, and studied the effect of cytochalasin upon the endogenous currents associated with cell polarization by using the vibrating probe. F-actin is not localized at the presumptive rhizoid immediately after experimental induction of the polar axis with a light gradient; however, a preferential distribution of F-actin develops at the presumptive rhizoid by the time the position of the polar axis is fixed. F-actin continues to be localized at the tip of the rhizoid after germination, except during cytokinesis, when the furrow is the only brightly staining region of the embryo. Incubation with cytochalasin can result in either an enhanced or a diminished pool of F-actin in the embryonic cortex (see Results). Cytochalasin D (100 micrograms/ml) significantly reduces the inward current at the rhizoid pole (n = 11) after a 2.5-h incubation. This drop is concentration dependent and occurs within approximately 30 min at 100 micrograms/ml and approximately 60 min at 10 micrograms/ml. Cytochalasin treatment eliminates the pulsatile component of the current. Preliminary results suggest that 100 micrograms/ml cytochalasin D prevents development of inward current at the presumptive rhizoid but does not completely delocalize this locus if added after photopolarization. We conclude that microfilaments are required for the establishment and maintenance of the pattern of endogenous currents observed during early embryogenesis. This suggests a new model for axis formation and fixation.

Polarization of fucoid eggs by a calcium ionophore gradient.

When the eggs of the brown alga Pelvetia were grown in a gradient of the calcium ionophore A23187, they tended to form their rhizoidal outgrowths on the sides that were exposed to the higher concentration of ionophore. This result supports the hypothesis that the formation of an intracellular calcium gradient is an essential step in the polarization of these eggs; the rhizoid forms at the pole that has the higher concentration of calcium.

Polarizing fucoid eggs drive a calcium current through themselves.

Calcium ions enter the prospective growth pole of polarizing Pelvetia eggs faster than the opposite pole and leave this antipode faster than the growth pole. The calcium current is greatest when first measured at 6 hours after fertilization and decreases as the time of final commitment to growth in a particular direction approaches.

Measurement of stress-induced Ca(2+) pulses in single aequorin-transformed tobacco cells.

Signaling patterns measured in large cell populations are the sum of differing signals from separate cells, and thus, the detailed kinetics of Ca(2+) pulses can often be masked. In an effort to evaluate whether the cytosolic Ca(2+) pulses previously reported in populations of elicitor- and stress-stimulated tobacco cells accurately represent the pulses that occur in individual cells, a study of single cell Ca(2+) fluxes in stress-stimulated tobacco cells was undertaken. Individual aequorin-transformed cells were isolated from a tobacco suspension culture and placed directly on a sensitive photo-multiplier tube mounted in a dark chamber. Ca(2+)-dependent luminescence was then monitored after stimulation with hypo- or hyper-osmotic shock, cold shock, or defense elicitors (oligogalacturonic acid and harpin). Hypo-osmotic shock induced a biphasic Ca(2+) transient in 67% of the single cells tested that exhibited similar kinetics to the biphasic pulses measured repeatedly in 1ml cell suspensions. In contrast, 33% of the stimulated cells displayed Ca(2+) flux patterns that were not previously seen in cell suspension studies. Additionally, because only 29% of the cells tested responded with measurable Ca(2+) pulses to oligogalacturonic acid and 33% to the harpin protein, we conclude that not all cells in a suspension are simultaneously sensitive to stimulation with defense elicitors. In contrast, all cells tested responded with an immediate Ca(2+) influx after cold or hyperosmotic shock. We conclude that in many cases the Ca(2+) signaling patterns of single cells are accurately represented in the signaling patterns of large populations, but that single cell measurements are still required to characterize the Ca(2+) fluxes of the less prominent cell populations.

Effects of calcium on the steady outward currents at the equator of the rat lens.

The relationships between calcium and the steady outward currents at the equator of the rat lens were studied using the vibrating probe technique. In a calcium-free medium, the current was greatly increased and it returned to its original level when calcium was restored to the medium. The Ca-free effect was not observed in Na-free medium. Iodoacetate (IAA) inhibited the initial current, but a current then returned which is referred to as a secondary current. The secondary current was not observed in a Ca-free medium and, therefore, it is thought to be a calcium-dependent potassium current. These responses are consistent with effects on potassium efflux measured by others and lend support to the interpretation that the outward currents observed at the equator of the rat lens are potassium currents. The currents are partially inhibited but not abolished in Na-free bathing medium. This is consistent with the view that the inward currents at the optical poles may be related to the influx of sodium.

A computerized 2-dimensional vibrating probe for mapping extracellular current patterns.

We describe a computer-assisted 2-dimensional vibrating probe system for mapping endogenous electric current patterns in biological preparations. This system overcomes some of the main limitations of the original 1-dimensional vibrating probe design and adds several new capabilities. Two piezo-electric bender elements mounted perpendicularly are used to vibrate the probe in a circle by applying 2 sine waves (1 to each element) that are 90 degrees out-of-phase with each other. The circular rotation of the probe allows it to detect simultaneously the 2 orthogonal components of a current in the horizontal plane. The voltages measured by the probe are digitized and analyzed by a computer and are used to calculate a current vector. A graphical representation of the current vector is then superimposed on a video image of the experimental preparation. This probe system responds to known currents in the expected manner and exhibits a low inherent noise level. Also included in this paper are some preliminary measurements made with this instrument on neurulating Xenopus embryos and on transected larval sea lamprey (Petromyzon marinus) spinal cords.

The neural tube of the Xenopus embryo maintains a potential difference across itself.

In Xenopus embryos, the ectodermal epithelium generates a substantial transepithelial potential (TEP) during certain periods of early development. In this study, we have found that the neural tube (which is derived from the embryonic ectodermal epithelium) of stage 21-25 Xenopus embryos also maintains a potential across itself, with the lumen being, on average, 18 +/- 1 mV negative relative to the interstitial spaces. This transneural tube potential (TNTP) declines gradually from a maximum of -21 +/- 2 mV at stage 23 to a minimum of -14 +/- 2 mV at stage 25. Vibrating probe measurements on transected embryos suggest that the neural tube is capable of driving a current. Large outward currents ranging from 10 to 26 microA/cm2 were detected just dorsal to the center of wounds in transected stage 21-24 embryos, but near the dorsal margin of the wound, in the region corresponding to the cut face of the neural tube, outward current densities were less than half the maximum, ranging from 3 to 9 microA/cm2. The reduced outward current near the dorsal margin suggests a locus of inward current in this region that is subtracted from the much larger outcurrents. Such greatly reduced outward currents were not detected near the ventral margin of the wound.

Localization of steady currents in the lens.

Steady currents around the rat lens were measured with a vibrating probe. Inward currents were found at the anterior pole and to a lesser degree at the posterior pole. Outward currents were localized at the equator. These currents were inhibited and even reversed by high concentrations of potassium. Ouabain blocked currents after 24 hrs but not after 6 hrs of exposure. The composition of the medium was not critical. For example, currents were observed in NaCl and in MgSO4 solutions.

Calcium does not act as a second messenger for adrenergic and cholinergic agonists in corneal epithelial cells.

The role of changes in intracellular [Ca2+]i as a second messenger in response to either adrenergic or cholinergic agonists was determined in isolated bovine corneal epithelial cells. [Ca2+]i was measured in suspensions of cells loaded with either of the fluorescent indicators quin2 or indo-1, as well as in single cells loaded with fura-2. Fluorescence from the cell suspensions was measured in a spectrofluorometer while single cell fluorescence was measured using a modified fluorescence microscope with a photon counting photometer. Cells were loaded with these dyes by incubation in Ringer's (pH 8.1) containing 2-50 microM of the acetoxymethyl ester of the indicator. Fluorescence was measured before and after exposure to either, one of the adrenergic agonists isoproterenol, phenylephrine or epinephrine, or the cholinergic agonist carbachol. The resting [Ca2+]i level from the quin2 experiments was 115 nM +/- 41 nM (SEM) (n = 23) whereas with fura-2 it was 71 +/- 10 nM (n = 30). In no case did we see any change in [Ca2+]i within 15 min after addition of any agonist but we were able to observe increased calcium when 0.5 microM ionomycin was added to either the same or untreated cells. The disparity in the resting levels determined by the two methods may result from various calibration problems. Our results indicate that changes in [Ca2+]i have no second messenger role in response to these agonists.

Survey of the degree to which critical care nurses are performing current procedural terminology-coded services.

PURPOSE: To identify the degree to which current procedural terminology-coded services are provided by critical care nurses. Current procedural terminology codes are used by government and private insurers for reimbursement for office, home, hospital, nursing home and emergency department services. METHOD: Out of 100 randomly selected registered nurses invited to participate in this national survey, 43 completed the survey questionnaire. The majority of respondents were 18 to 40 years old, had a bachelor's degree, had practiced nursing between 5 and 10 years, and were employed as staff or charge nurses in an intensive care or emergency room setting. RESULTS: More than 70% of the group were found to perform 28 codes. The codes performed by the greatest number (42) were blood or blood component transfusion and cardiopulmonary resuscitation. One-way analysis of variance applied to the amount of supervision the nurses received while performing the codes and the educational level of the nurses revealed a significant difference between the groups. Post hoc analysis of all possible group comparisons showed that diploma-prepared nurses reported significantly more supervision than nurses having a bachelor's or master's degree. CONCLUSION: This exploratory study indicates that critical care nurses frequently perform selected codes with little or no supervision by a physician.

Developing a scale to measure denial levels of clients with actual or potential myocardial infarctions.

OBJECTIVE: To refine and test the Robinson Self-Appraisal Inventory-Form D (RSAI-Form D), a self-administered scale designed to measure denial in coronary clients. DESIGN: Exploratory research. SETTING: Two midwestern medical centers. SAMPLE: The sample was composed of 130 patients 75 years of age and younger with actual or potential myocardial infarction. MEASURES: Two instruments, the Demographic Data Form and the RSAI-Form D, were completed by the participants. RESULTS: Cronbach's coefficient alpha, factor analysis, t test, and stepwise multiple regression were used in the data analysis. A coefficient alpha for the 20-item scale was 0.80 for both Day 2 and Day 4. Day 2 and Day 4 oblique rotations revealed that items loaded on four factors but did not load on the same factors for both days: therefore, factors were identified for each day. There was a significant decrease in RSAI-Form D scores from the second to fourth hospitalized day (t = 5.83, p = 0.001). Two predictors, number of prior hospitalizations of chest pain, and whether or not the individual had sustained a myocardial infarction this admission (identified by stepwise multiple regression) explained 9.4% of the variance in the change in RSAI-Form D scores from Day 2 to Day 4 (F[2, 127] = 6.55, p = 0.001). CONCLUSIONS: Findings of the study did provide preliminary evidence that the RSAI-Form D is a reliable and valid inventory. Four aspects of denial were extracted, thus providing supportive evidence to the nurse that the use of single specific or global criteria does not provide sufficient data for assessing denial.

Denial in myocardial infarction patients.

Since nurses are the health professionals who have the closest and most frequent contact with patients, they are in the best position to assist the MI patient with management of denial. It is important for nurses to recognize the manifestations of denial and then be able to assess the amount that denial accelerates or impedes the patient's progress toward regained health. With this increased awareness, nurses become the major influence in helping the MI patient recover psychologically as well as physically.

Nurse-managed primary care delivery clinics.

Health care presently is an ever-changing environment for all Americans, including the veteran population. New and innovative approaches to health care must include goals that maximize quality care, improve access and cost effectiveness, facilitate patient satisfaction, and optimize the functional status of patients. Recognizing the opportunities in this challenging environment, advanced practice nurses are stepping forward as competent primary care providers who can meet these goals. This article describes the establishment of primary care clinics run by advanced practice nurses in the US Department of Veterans Affairs Upper Midwest Healthcare Network, in the states of Minnesota, North Dakota, and South Dakota.

Denial: an adaptive response.

Denial is a common nursing diagnosis for cardiac patients; yet, not all denial situations are bad. This author describes when denial is actually a successful coping mechanism and describes how to decide when to intervene and when to allow the patient to use this coping technique.

The role of nursing in the influenza epidemic of 1918-1919.

Just as the horrors of World War I were winding down, millions of people were stricken by an influenza epidemic that displaced war as the tragic focus of everyday life. The disease was known as the Spanish influenza and was pandemic in scope. Since the epidemic defied the capabilities of prevailing medicine, good nursing care was the best predictor of outcome. Nurses came to the rescue by working long, hard and tirelessly. One important outcome of the epidemic was a general recognition of the visiting nurse service and all nursing as a valuable and essential community service.