Motivations of family advisors in engaging in research to improve a palliative approach to care for persons living with dementia: an interpretive descriptive study.

Background: A Strategic Guiding Council (SGC) was created within a Family Carer Decisions Support study, to engage family carers of persons with advanced dementia as advisors to inform the design and implementation of the study. The SGC consists of an international group of family advisors from Canada, the Republic of Ireland, the United Kingdom, the Netherlands, and the Czech Republic. There are limited studies that have explored the integration of Patient and Public Involvement (PPI) in dementia research, end-of-life care and long-term care.

Quantifying Mobility Scooter Performance in Winter Environments.

Objectives: To quantify mobility scooter performance when traversing snow, ice, and concrete in cold temperatures and to explore possible performance improvements with scooter winter tires.

Design: Cross-sectional.

Setting: Hospital-based research institute.

Effect of intermittent deployment of an electronic monitoring system on hand hygiene behaviors in healthcare workers.

Background: Improving hand hygiene compliance among healthcare professionals is the most effective way to reduce healthcare-acquired infections. Electronic systems developed to increase hand hygiene performance show promise but might not maintain staff participation over time. In this study, we investigated an intermittent deployment strategy to overcome potentially declining participation levels.

Secondary measures of hand hygiene performance in health care available with continuous electronic monitoring of individuals.

Background: Hand hygiene (HH) compliance in health care is usually measured against versions of the World Health Organization's "Your 5 Moments" guidelines using direct observation. Such techniques result in small samples that are influenced by the presence of an observer. This study demonstrates that continuous electronic monitoring of individuals can overcome these limitations.

Effect of electronic real-time prompting on hand hygiene behaviors in health care workers.

Background: Poor hand hygiene by health care workers is a major cause of nosocomial infections. This research evaluated the ability of an electronic monitoring system with real-time prompting capability to change hand hygiene behaviors.

Methods: Handwashing activity was measured by counting dispenser activations on a single nursing unit before, during, and after installation of the system.

Care Challenges in the Bathroom: The Views of Professional Care Providers Working in Clients' Homes.

In home care, bathroom activities-particularly bathing and toileting-present a unique set of challenges. In this focus group study, professional home care providers identified factors that increase the danger and difficulty of assisting their clients with bathing and toileting. These included small restrictive spaces, a poor fit between available equipment and the environment, a reliance on manual handling techniques (but insufficient space to use optimal body mechanics), attempts to maintain normalcy, and caring for unsteady and unpredictable clients.

A biomechanical assessment of floor and overhead lifts using one or two caregivers for patient transfers.

This study investigated the differences in peak external hand forces and external moments generated at the L5/S1 joint of the low back due to maneuvering loaded floor-based and overhead-mounted patient lifting devices using one and two caregivers. Hand forces and external moments at the L5/S1 joint were estimated from ground reaction forces and motion capture data. Caregivers gave ratings of perceived exertion as well as their opinions regarding overhead vs.

Design of built environments to accommodate mobility scooter users: part II.

PURPOSE.Accessibility standards for wheeled mobility devices currently use a 1.5 m turning circle, designed to accommodate manual wheelchairs.

The experiences of using an anti-collision power wheelchair for three long-term care home residents with mild cognitive impairment.

Purpose: Presented are three case analyses of long-term care home residents with cognitive impairment who tested an anti-collision power wheelchair. We discuss technology design and research implications for this population.

Method: Case studies involved 371  h of participant observation and 7  h of open-ended interview with residents (n = 3), family members (n = 3) and clinical staff (n = 11).

Design of built environments to accommodate mobility scooter users: part I.

Purpose: To determine the minimum dimensions needed to allow five models of powered mobility scooters to manoeuvre within five commonly encountered indoor spatial configurations.

Method: We measured manoeuvrability of five scooters judged by their manufacturers to have a good combination of indoor mobility and outdoor performance (including in rural environments). We determined the minimum space needed to manoeuvre the scooters through the following five spatial configurations: turning 180° in a corridor, performing U-turns around 50 mm (2″) and 1200 mm (4') obstacles, turning 90° from a doorway and approaching a counter or work surface from the side.

The Pseudomonas aeruginosa Chp chemosensory system regulates intracellular cAMP levels by modulating adenylate cyclase activity.

Multiple virulence systems in the opportunistic pathogen Pseudomonas aeruginosa are regulated by the second messenger signalling molecule adenosine 3', 5'-cyclic monophosphate (cAMP). Production of cAMP by the putative adenylate cyclase enzyme CyaB represents a critical control point for virulence gene regulation. To identify regulators of CyaB, we screened a transposon insertion library for mutants with reduced intracellular cAMP.

Power mobility for a nursing home resident with dementia.

Objective: This case study describes an occupational therapy intervention to increase the self-mobility and social participation of a nursing home resident with dementia using a power wheelchair equipped with a collision-prevention system.

Method: We used an exploratory case study design. Data sources included the medical record, standardized assessments, interviews, observations of daily activities, and a driving log.

Advanced technologies to curb healthcare-associated infections.

The commentary was prepared in response to the manuscript "Healthcare-Associated Infections as Patient Safety Indicators," by Gardam, Lemieux, Reason, van Dijk and Goel. Healthcare-associated infections are a severe patient safety hazard. Current patient safety initiatives targeting increased healthcare worker hand hygiene to prevent some of these infections have had limited effect.

Stimulation of mammalian G-protein-responsive adenylyl cyclases by carbon dioxide.

Carbon dioxide is fundamental to the physiology of all organisms. There is considerable interest in the precise molecular mechanisms that organisms use to directly sense CO(2). Here we demonstrate that a mammalian recombinant G-protein-activated adenylyl cyclase and the related Rv1625c adenylyl cyclase of Mycobacterium tuberculosis are specifically stimulated by CO(2).

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.

Understanding and measuring powered wheelchair mobility and manoeuvrability. Part I. Reach in confined spaces.

Purpose: To determine: (1) what wheelchair manoeuvrability factors are important and (2) the effects of powered wheelchair design on the ability to reach in a confined space.

Method: The relative importance of five aspects of wheelchair manoeuvrability was determined through a survey of users of wheelchairs (N = 52) and health care professionals and others (N = 89). A single young, non-disabled subject undertook repeated trials of reach distance on to a counter at the end of a corridor whose width could be adjusted by moving Styrofoam walls.

Psychological indicators of balance confidence: relationship to actual and perceived abilities.

Background: This study compares several psychological indicators of balance confidence in relation to physical performance, past and current experience, gender bias, and other perceptions of daily functioning.

Methods: Sixty community-dwelling ambulatory elders (aged 65-95) were administered the Falls Efficacy Scale (FES), the Activities-Specific Balance Confidence Scale (ABC), and three dichotomous questions on fear of falling, activity avoidance, and perceived need for personal assistance to ambulate outdoors. Performance measures on walking (average speed) and balance (static posturography) were obtained on a subsample of 21 subjects.

The impact of new lifting technology in long term care: a pilot study.

1. The researchers conducted a pilot study to test a new lifting system developed with the assistance of nurses. 2.

A prospective study of postural balance and risk of falling in an ambulatory and independent elderly population.

Background: An ability to predict risk of future falling is needed in order to target high-risk individuals for preventive intervention. The purpose of this study was to compare the ability of different measures of postural balance to predict risk of falling prospectively in an ambulatory and independent elderly population.

Methods: Balance tests were performed on 100 volunteers (aged 62-96), and falling was then monitored prospectively over a one-year period.

Functional performance measures: are they superior to self-assessments?

Background: It has been suggested that performance measures of functional status have several advantages over self-report measures for both clinical and research purposes, including: greater patient acceptability, interpretability, reproducibility, sensitivity to change, and the focus on actual ability rather than presumed capability. This article challenges this assumed superiority of "objective," "behavioral" measures by directly comparing self-assessments and blindly rated performance assessments on a specific item by task basis, using an identical rating format.

Methods: A set of 14 performance tasks, consisting of a range of functional abilities (including simulations of cooking and sweeping), was administered to 99 community-dwelling older adults (aged 60-92) who had previously completed a 50-item instrumental activities of daily living (IADL) questionnaire.

Are activity-based assessments of balance and gait in the elderly predictive of risk of falling and/or type of fall?

Objective: To determine whether an activity-based test of balance and gait is predictive of the risk of: (1) falling in situations that are related to specific tasks evaluated as part of the test, (2) experiencing falls precipitated by different classes of biomechanical events, or (3) falling in general; and to compare the predictive ability of the activity-based test for the falls described in (2) and (3) to that of a posturography test that has been found previously to be predictive of falling risk.

Design: Cohort study.

Setting: Baseline tests performed in balance laboratory; subsequent history of falling monitored prospectively for 1 year in two residential-care facilities.

Bladder volume estimation in the elderly using a portable ultrasound-based measurement device.

We assessed the accuracy and ease of use of the BladderScan (BVI 2000) portable ultrasound-based bladder volume measurement device in a geriatric outpatient population. The Geriatric Continence Clinic nurse and physician each made 73 measurements on 36 subjects. Although the correlation coefficients between the true and ultrasound measurements were highly significant the mean differences were significantly different from zero.