Effect of an end-of-life gerontological nursing education programme on the attitudes and knowledge of clinical nurses: A non-randomised controlled trial.

AIMS: To evaluate how a structured interactive two-day education programme for clinical nurses on end-of-life (EOL) care for older people affects nurses' attitudes and knowledge. DESIGN: Non-randomised controlled trial. METHODS: Nurses were recruited separately for intervention and control groups. The intervention group assisted older patients with EOL care and recruited patients for the programme. To prevent sampling bias, control group nurses were recruited from a facility with numerous EOL care opportunities. The intervention was a two-day educational programme. Using valid and reliable scales, we evaluated the attitudes (total score range: 26-130) and knowledge (total score range: 0-51) of the intervention group four times (pretraining, post-training, 3 months, 6 months) and the control group three times (baseline, 3 months, 6 months) between January 2016 and April 2017. Analysis of covariance examined both groups' score changes at 3 and 6 months while adjusting for confounding factors. RESULTS: Participants were 338 nurses caring primarily for older people (intervention group: 164; control group: 174); 142 responded at all measurement points. The change in mean value of the attitude scale from baseline to 3 months (differences in the groups' attitude scores = 7.33; 95% CI = 2.43-12.24; p = .004) and 6 months (differences in groups' attitude scores = 5.77; 95% CI = 0.17-11.37; p = .044) was greater in the intervention group. Moreover, the mean knowledge scale score change from baseline to 3 months was greater in the intervention group (differences in groups' knowledge scores = 5.74; 95% CI = 4.07 to 7.39; p < .001). There was no evidence of a change in this score between baseline and 6 months. CONCLUSION: The programme improved nurses' medium- to long-term attitudes and knowledge. Thus, it may help nurses enhance the quality of care they provide. IMPLICATIONS FOR PRACTICE: A two-day educational program improves nurses' medium- to long-term attitudes and knowledge on end-oflife care. For quality end-of-life care for older people, a structured and evidence-based educational program should be provided to nursing staff.

Developing a Measure of End-of-Life Care Nursing Knowledge for Japanese Geriatric Nurses.

This study developed an end-of-life (EOL) care nursing knowledge scale for Japanese geriatric nurses (ELNKS-JG) to measure nurse knowledge of EOL care for older adults. It also was used to evaluate the quality of The End-of-Life Nursing Education Consortium-Japan Geriatric. Participants were 1168 nurses employed in 32 institutions across Japan. The items of our measure were developed to cover 8 important topics: principles of EOL care for older adults; pain management; symptom management; ethics of care; cultural and spiritual considerations; communication; loss, grief, and bereavement; and caring for final days. The measure included 51 items with an overall Cronbach α coefficient of 0.87 and an intraclass correlation coefficient of 0.81. Our measure, the ELNKS-JG, was confirmed to have good internal consistency, test-retest reliability, content validity, and known-groups validity. This scale's items included knowledge about noncancerous diseases, physical changes due to aging, family care, and multidisciplinary collaboration. The ELNKS-JG comprehensively measures a nurse's knowledge of EOL care for older adults in any EOL setting. Furthermore, this scale can evaluate educational programs aimed at improving care quality and encouraging related activities in facilities that provide EOL care.

Development of the End-of-Life Care Nursing Attitude Scale for Japanese Geriatrics.

This study aimed to develop an end-of-life (EOL) care nursing attitude scale for Japanese geriatric nurses (ELNAS-JG). The items of the ELNAS-JG were developed to cover important topics related to EOL care (eg, motivation for providing EOL care, pain and symptom management, and decision-making support care for older adults). Participants were 1663 nurses employed in 32 institutions across Japan. Of these, 1298 participants were analyzed. An exploratory factor analysis of the 26 scale items revealed a 3-factor solution describing the concepts of responsibility, willingness, and confidence: responsibility and willingness were captured in factor 1 (16 items), and confidence was split into factor 2 (6 items) and factor 3 (4 items) to capture individual and collaborative behaviors. The overall Cronbach α coefficient for the 26 items was 0.95, and the intraclass correlation coefficient was 0.83. Overall, the ELNAS-JG was confirmed to have good internal consistency, test-retest reliability, content validity, known-groups validity, and construct validity. It can comprehensively measure nurses' attitudes toward EOL care for older adults in any EOL setting. Furthermore, this scale can be used to evaluate educational programs aimed at improving care quality and encouraging related activities in facilities that provide EOL care.

Consensus development of quality indicators for end-of-life care for elders in Japan.

AIMS AND OBJECTIVES: Quality indicators for end-of-life care have been published; however, none have been developed specifically for nursing in the cultural and traditional context of Japan. This study aimed to develop and build a consensus of quality indicators for end-of-life care for elders in Japan from the perspective of nursing science. METHODS: To develop the quality indicators, we used a literature review, expert panel process, and the Delphi technique among clinical nurse specialists in geriatrics. RESULTS: Quality indicators were identified in 7 major areas: advance directives and surrogate continuity, ethical daily care, care preferences and decisions about life-sustaining treatment, assessment and management of pain and other symptoms, daily care for the dying, family care, and institutional systems for end-of-life care. CONCLUSIONS: These quality indicators represent the first attempt to develop a best practices approach toward improving the quality of elderly end-of-life care in nursing.

Cage-shaped borate esters with tris(2-oxyphenyl)methane or -silane system frameworks bearing multiple tuning factors: geometric and substituent effects on their Lewis acid properties.

Boron complexes that contain new tridentate ligands, tris(o-oxyaryl)methanes and -silanes, were prepared. These complexes had a cage-shaped structure around a boron center and showed higher Lewis acidity and catalytic activity than open-shaped boron compounds. The cage-shaped ligands determined the properties of the borates by altering the geometry and were consistently bound to the metal center by chelation. The synthesized compounds were L⋅B(OC(6)H(4))(3)CH, L⋅B(OC(6)H(4))(3)SiMe, and its derivatives (L=THF or pyridine as an external ligand). Theoretical calculations suggested that the cage-shaped borates had a large dihedral angle (C(ipso)-O-B-O) compared with open-shaped borates. The geometric effect due to the dihedral angle means that compared with open-shaped, the cage-shaped borates have a greater Lewis acidity. The introduction of electron-withdrawing groups on the aryl moieties in the cage-shaped framework increased the Lewis acidity. Substitution of a bridgehead Si for a bridgehead C decreased the Lewis acidity of the boron complexes because the large silicon atom reduces the dihedral angle of C(ipso)-O-B-O. The ligand-exchange rates of the para-fluoro-substituted compound B(OC(6)H(3)F)(3)CH and the ortho-phenyl-substituted compound B(OC(6)H(3)Ph)(3)CH were less than that of the unsubstituted borate B(OC(6)H(4))(3)CH. The ligand-exchange rate of B(OC(6)H(4))(3)SiMe was much faster than that of B(OC(6)H(4))(3)CH. A hetero Diels-Alder reaction and Mukaiyama-type aldol reactions were more effectively catalyzed by cage-shaped borates than by the open-shaped borate B(OPh)(3) or by the strong Lewis acid BF(3) ⋅OEt(2). The cage-shaped borates with the bulky substituents at the ortho-positions selectively catalyzed the reaction with less sterically hindered substrates, while the unsubstituted borate showed no selectivity.

Mental health and emotional relationships of family members whose relatives have drug problems.

The presence of a drug abuser in a family can seriously affect the family's mental health and relationships. This study focuses on the stress of families of drug abusers, relationships, and their relevant factors, as well as examines ways to support them. The subjects of this study were family members of drug abusers treated at drug abuser family support groups, medical institutions, or municipal mental health and welfare centers. To these institutions, 1,298 questionnaires were sent, and 543 responses with sufficient data were used for analysis. The survey consisted of the 12-item General Health Questionnaire (GHQ-12), and questionnaire items regarding disruptions to family life, relationship with drug users, and the use of family support services. The survey results showed that the mean GHQ score was 4.5, and those whose score are cut-off 3 and more, indicating poor mental health accounted for 54.7%. More than half of the subjects responded that drug problems have affected family members in terms of the health condition, daily living, and financial problems. Regarding emotional relationships with the addicts, most of the families answered that they have had negative feelings toward them, such as "being dragged into drug problems" and "being over-protective". A significant correlation was observed between the GHQ score and family members' relationship with the addict, and these variables were closely correlated with participation in the family group, the status of drug abstinence, living environment, and participation in a self-support group by the addict. As the results, most of the family members of drug users have problems with mental health and the recovery of relationships even though they have accessed support centers, and it was verified that the family support group works effectively to help solve their problems.

Fine-tuning of boron complexes with cage-shaped ligand geometry: rational design of triphenolic ligand as a template for structure control.

Boron complexes surrounded with organic cages were controlled precisely by a remote atom placed at the bottom of the cage. A replacement of the bottom tether atom (carbon or silicon) changed the characteristics (kinetic and thermodynamic factors) of boron complexes by geometric effects. A theoretical study shows that the bottom atoms also control eigenvalues of MO. This cage complex will provide a systematic template for fine-tuning of metal complexes to create various properties.

Brønsted acid catalyzed formal insertion of isocyanides into a C-O bond of acetals.

The Brønsted acid catalyzed formal insertion of an isocyanide into a C-O bond of an acetal is described. A diverse array of acyclic and cyclic acetals can be applied to the catalytic insertion to form alpha-alkoxy imidates. Functional groups, such as nitro, cyano, halogen, ester, and alkoxy groups, are tolerant to the reaction conditions employed. The course of the reaction is highly dependent on the structure of the isocyanide. The use of an electron-deficient aryl isocyanide, such as 2c and 2d, is required to selectively obtain the monoinsertion product. When aryl isocyanides containing alkyl substituents, such as 2a and 2b, are employed, two molecules of the isocyanide are incorporated, and the double-insertion product is obtained. The reaction of tert-octyl isocyanide also induces a double incorporation, but the subsequent acid-mediated fragmentation leads to the 2-alkoxy imidoyl cyanide. The monoinsertion products, alpha-alkoxy imidates, can readily be hydrolyzed to alpha-alkoxy esters, realizing the formal carbonylation of an acetal.

Cage-shaped borate esters with enhanced Lewis acidity and catalytic activity.

[structure: see text] A cage shape causes high Lewis acidity and catalytic activity on boron. Borate esters that have cage-shaped ligands have accessible LUMO with lower eigenvalues than normal open-shaped borate esters. A large dihedral angle at C-O-B-O in cage-shaped borate esters induces less overlap between p-orbitals on O and B. The hetero-Diels-Alder reaction is effectively catalyzed by the cage-shaped borate, although the open-shaped borate does not act as a catalyst.

GaCl3-catalyzed insertion of isocyanides into a C-O bond in cyclic ketals and acetals.

The reaction of cyclic ketals or acetals with 2,6-dibromophenylisocyanide in the presence of a catalytic amount of GaCl(3) results in the insertion of isocyanide into the carbon-oxygen bond of cyclic ketals and acetals. [reaction: see text]

Chemiluminescence in autoxidation of phosphonate carbanions. Phospha-1,2-dioxetanes as the most likely high-energy intermediates.

Autoxidation of the phosphonate carbanions derived from 9-phosphono-10-hydroacridanes provided chemiluminescence ascribed to the excited acridone anion. The intramolecular CIEEL (chemically initiated electron exchange luminescence) mechanism can be applied to this chemiluminescence because of the much higher emission efficiency compared to that of 9-phosphono-10-methylacridanes. The effect of the phosphonate substituents on the emission efficiency and especially on the rates of the chemiluminescence decay can be interpreted to originate from the valence deviation of the phosphorus atoms, which is connected with the substituent effect on the geometrical selectivity in the olefination reaction of the phosphonate carbanions. The enhanced chemiluminescence in the presence of the fluorophores was also detected in autoxidation of the carbanions of diethyl diphenylmethylphosphonate and fluorenylphosphonate. Although the evidence is circumstantial, these results strongly support the belief that phospha-1,2-dioxetane is the most likely high-energy intermediate generating the excited molecules.

Transcriptional regulators of the 51D surface protein gene of Paramecium tetraurelia.

The alpha-51D gene encodes surface protein 51D, which specifies serotype 51D of Paramecium tetraurelia stock 51. Previously, we isolated the gene as one expressed at much higher levels in a short-lived mutant than in its parental wild-type stock and characterized its expression to be up-regulated with increased clonal age of the wild-type stock. Here we investigated the transcriptional mechanism for the serotype expression in light of its possible causal relationship to the Paramecium clonal life span. DNA-protein binding analyses of the upstream of the alpha-51D gene identified a stretch of DNA sequence that interacted specifically with macronuclear proteins prepared from the 51D-expressing mutant. The DNA sequence was mapped to the 23 bp between -310 and -288, counting from the initiation position of 51D transcription. A protein with a binding ability for this DNA element was purified to homogeneity from the macronuclear proteins by chromatography using the specific DNA-protein interaction. In vitro transcriptional analyses showed that both the purified protein and its target domain are essential for increased synthesis of the 51D transcript. These results showed that the DNA-protein interaction is required for induction of the 51D expression in the mutant. However, aged wild-type paramecia, in which the serotype is also highly expressed, lacked the same specific transcriptional activity as detected in the mutant, suggesting another DNA-protein interaction involved in the 51D up-regulation.

Growth phase-dependent transcription of emrKY, a homolog of multidrug efflux emrAB genes of Escherichia coli, is induced by tetracycline.

The genes emrK and emrY were found between genes dsdA and evgA at 51 min on the Escherichia coli chromosome and form an operon. EmrK and EmrY are 50.4 and 63.3% identical in amino acid sequences to EmrA and EmrB, respectively, which together make up a multidrug resistant pump. To show that the emrKY operon can be expressed, we cloned the promoter with pMC1403 and constructed an emrK-lacZ' protein fusion plasmid, pMKD1. In E. coli MC4100 containing pMKD1, its expression was increased in the presence of a subinhibitory concentration of tetracycline, chloramphenicol or salicylate, but not by carbonylcyanide m-chlorophenylhydrazone, nalidixic acid or kanamycin. Furthermore, we have shown that emrKY transcription dependent on the growth phase is actually induced by tetracycline using a S1 nuclease protection assay.