Toileting Disability in Older People Residing in Long-term Care or Assisted Living Facilities: A Scoping Review of the Literature.

For purposes of this review, we defined toileting disability as a result of practices, procedures, or conditions that result in an individual requiring assistance using the bathroom. This scoping review synthesizes existing knowledge of extrinsic and/or intrinsic factors that might lead to or be associated with toileting disability and identified knowledge gaps related to toileting disability in older adults residing in long-term care or assisted living facilities. A search of 9 electronic databases and the gray literature identified 3613 articles. After exclusions and screening of the full text of 71 articles, 7 remaining eligible articles mapped research activity and identified knowledge gaps in this area. Only 1 study used toileting disability as the primary outcome; it was present in 15% of older adults without dementia living in long term-care facilities (a subgroup that comprised 34% of all residents). The other 6 articles examined factors and treatment of overall activities of daily living (ADL) performance as their primary outcome; in these, toileting disability was added to other difficulties, yielding a summary ADL outcome score. No study reported the incidence, distribution, or factors that affect toileting disability in long-term care; findings of this scoping review suggest a rich research agenda for future investigation.

SCOPEOUT: sustainability and spread of quality improvement activities in long-term care- a mixed methods approach.

BACKGROUND: Interventions to improve quality of care for residents of long-term care facilities, and to examine the sustainability and spread of such initiatives, remain a top research priority. The purpose of this exploratory study was to assess the extent to which activities initiated in a quality improvement (QI) collaborative study using care aide led teams were sustained or spread following cessation of the initial project and to identify factors that led to its success. METHODS: This study used an exploratory mixed methods study design and was conducted in seven residential long-term care facilities in two Canadian provinces. Sustainability and spread of QI activities were assessed by a questionnaire over five time points for 18 months following the collaborative study with staff from both intervention with non-intervention units. Semi-structured interviews were conducted with care managers at six and 12 months. QI team success in applying the QI model was ranked as high, medium, or low using criteria developed by the research team. Descriptive statistics, bivariate analyses, and General Estimating Equations were used to analyze the data. Interview data were analyzed using thematic analysis. RESULTS: In total, 683 surveys were received over the five time periods from 476 unique individuals on a facility unit. Seven managers were interviewed. A total of 533 surveys were analyzed. While both intervention and non-intervention units experienced a decline over time in all outcome measures, this decline was significantly less pronounced on intervention units. Facilities with medium and high success ranking had significantly higher scores in all four outcomes than facilities with a low success ranking. Care aides reported significantly less involvement of others in QI activities, less empowerment and less satisfaction with the quality of their work life than regulated care providers. Manager interviews provided evidence of sustainability of QI activities on the intervention units in four of the seven facilities up to 18 months following the intervention and demonstrated the need for continued staff and leadership engagement. CONCLUSION: Sustainability of a QI project which empowers and engages care aides is possible and achievable, but requires ongoing staff and leadership engagement.

The effect of light-emitting diode and laser on mandibular growth in rats.

OBJECTIVE: To evaluate the effect of a light-emitting diode (LED) and/or low-level laser (LLL) with or without the use of anterior bite jumping appliances (also known as functional appliances [FAs]) on mandibular growth in rats. MATERIALS AND METHODS: Thirty-six 8-week-old male Sprague-Dawley rats weighing 200 g were obtained from Charles River Canada (St. Constant, QC, Canada) and were divided into six groups of six animals each. Groups were as follows: group 1: LLL; group 2: LLL + FA; group 3: LED; group 4: LED + FA; group 5: FA; and group 6: control (no treatment). Mandibular growth was evaluated by histomorphometric and micro computed tomographic (microCT) analyses. RESULTS: The LED and LED + FA groups showed an increase in all condylar tissue parameters compared with other groups. CONCLUSION: The LED-treated groups showed more mandibular growth stimulation compared with the laser groups.