[Development of the Home Care Quality Assessment Index (HCQAI)].

AIM: To develop a Home Care Quality Assessment Index (HCQAI) that may be used for overall assessment of home care in three areas: 1) conditions of the impaired elderly (outcome); 2) caregiver and caregiving situation (process); and 3) the home care environment (input). METHODS: To develop the HCQAI, a list of items for assessment was drawn up, and the reliability of each item was verified. Reliability was investigated by a) test-retest reliability, and b) inter-rater reliability. Impaired elderly and their family caregivers who used the visiting nurse station of the Okazaki Medical Association were surveyed. A kappa coefficient of 0.4 or greater generally served as the inclusion criteria for test-retest and inter-rater reliability of each item. A factor analysis was conducted for items satisfying the above criteria, using 10 scales. RESULTS: Cronbach's alpha showing internal consistency (reliability) for these scales was 0.6-0.9. Two scales corresponded to care within the home: the "barrier-free" and "improvement of water facilities"; three to the caregiver situation: "dressing appropriate for the season," "mistreatment by the elderly," and "hygiene and assistance"; and five involved conditions of the impaired elderly: "cognition," "paralysis," "vision and hearing," "ADL," and "gross motor." CONCLUSION: The HCQAI developed in the present study, consisting of 41 items, can assess quality of home care both objectively and comprehensively, based on professional staff observation. Few indexes of this kind exist worldwide to scientifically assess input, process and outcome in the delivery of quality home care for the impaired elderly.

Morphological study of disordered myelination and the degeneration of nerve fibers in the spinal cord of mice lacking complex gangliosides.

Gangliosides, a family of glycosphingolipids that contain sialic acid, are abundant on the neuronal cell membranes, but their precise functions in the central nervous system remain largely undefined. In a previous study of GalNAc-T(-/-) mice engineered to lack beta1,4-N-acetylgalactos-aminyltransferase (GM2/GD2 synthase) to abolish any, complex gangliosides, we observed the reduction of nerve conduction velocity but did not find any obvious morphological change in the brain. In the present study, we observed morphological changes in the nerve fiber tracts of the spinal cord in these mice. In GalNAc-T(-/-) mice, the number of degenerated axons was markedly increased in the dorsal funiculus, tract of Lissauer, and dorsolateral funiculus of the cervical segment of the spinal cord as well as the dorsal funiculus and tract of Lissauer of the lumbar segment of the spinal cord. There were also increased numbers of unmyelinated fibers in GalNAc-T(-/-) mice. Loosened myelin sheaths and myelin sheaths separated from axons by wide spaces were also observed in GalNAc-T(-/-) mice. These results provide a morphological basis for the previously observed reduction in the nerve conduction velocity and suggest that complex gangliosides are essential for the maintenance of myelin and the integrity of nerve fibers of the spinal cord.