Implementing Evidence-Based Guidelines for Falls Prevention: Observations of Nursing Activities During the Care of Older People With Cognitive Impairment.

BACKGROUND: Evidence-based guidelines assist clinicians in practice, but how the guidelines are implemented is less established. AIM: To describe the nurses' implementation of activities recommended in evidence-based guidelines for falls prevention and care of older people with cognitive impairment. METHODS: Structured observation with a categorical checklist was used. Nursing personnel were recruited from one subacute and two acute wards in two hospitals in one tertiary-level health service in south-eastern Queensland, Australia. The data collection instrument identified 31 activities drawn directly from the evidence-based guidelines, which were categorized into six domains of nursing practice: clinical care, comfort, elimination, mobility, nutrition and hydration, and social engagement. Four-hour observation periods, timed to occur across the morning and evening shifts, were conducted over 2 months. RESULTS: Nineteen registered nurses, six enrolled nurses, and 16 assistants in nursing (N = 41) were observed for 155 hr of observation. There was variability in adherence with specific activities, ranging from 21% to 100% adherence. Three categories with the highest adherence were nutrition and hydration, mobilization safety, and social engagement. The clinical care, comfort, and elimination categories had lower adherence, with lowest adherence in activities of education provision about falls risk, pain assessment, using a clock or calendar to reorient to time and place, and bowel care. LINKING EVIDENCE TO ACTION: Nursing care is delivered within an interdisciplinary team. Therefore, responsibility for the everyday fundamental care activities known to prevent falls in older people with cognitive impairment requires localized negotiation. A practical guide for preventing in-hospital falls in older people with cognitive impairment addressing the interdisciplinary context of practice is required. Interdisciplinary teams should develop strategies to enhance the implementation of pain assessment and prevention of constipation in the context of regularly implemented hydration, nutrition, and mobilization care strategies.

Caring for the older person with cognitive impairment in hospital: Qualitative analysis of nursing personnel reflections on fall events.

AIMS AND OBJECTIVES: To explore nurse and nursing assistant reflections on the care of older patients with cognitive impairment who have experienced a fall. BACKGROUND: While there are evidence-based clinical guidelines for the prevention and management of falls and for the care of older people with cognitive impairment, the falls rates for older people with cognitive impairment are three times as high as those without. DESIGN: Critical incident technique. METHODS: Eleven registered and two enrolled nurses and four assistants in nursing working in one subacute and two acute wards within two hospitals of a tertiary level health service in south-east Queensland. Individual semistructured interviews focused on two past events when a patient with cognitive impairment had fallen in hospital: one when there was minimal harm and the second when there was significant harm. Thematic analysis was undertaken. The COREQ checklist was followed. RESULTS: Three themes emerged from 23 reflective accounts of fall events: "direct observation is confounded by multiple observers" and "knowing the person has cognitive impairment is not enough," and "want to rely on the guideline but unsure how to enact it." While participants were aware of the falls prevention policy and techniques available to prevent falls, the implementation of these was challenging due to the complexity of care required by the older person with cognitive impairment. CONCLUSIONS: Falls prevention for older people with cognitive impairment is complex and belies the simple application of policy. RELEVANCE TO CLINICAL PRACTICE: To reduce falls, nurses can involve the family to support "knowing the patient" to enable prediction of impulsive actions; shift the focus of in-service from lectures to specific case presentations, with collaborative analysis on person-focused strategies to prevent falls in older people with cognitive impairment; and reconsider the sitter role from simple observer to assistant, focused on ambulation and supporting independence in activities of daily living.

A unique lineage gives rise to the meibomian gland.

PURPOSE: To identify the lineage that contributes to the morphogenesis of the meibomian gland. METHODS: To examine which cell lineage gives rise to the meibomian gland, the expression of Pax6 as well as that of various cytokeratin markers, including keratin 14 (Krt14), Krt15, Krt4, and Krt10, was examined with immunofluorescent staining of C57BL/6J mouse eyelids from P2 to P11 pups and adult mice. RESULTS: Pax6 was localized to the cytoplasm within the acinar region of the meibomian glands during morphogenesis but was absent in the fully developed gland. Keratin 14 was expressed throughout the gland at all stages whereas keratin 15 was absent at all stages. Keratin 4, a marker of mucosal lineage, was present throughout the gland and was colocalized with keratin 10 (epidermal lineage marker) in the developing duct at P4. This colocalization region decreased as the gland developed becoming restricted to the central duct near the opening to the acini in the fully developed gland. CONCLUSIONS: We identified a unique cell lineage that expresses markers characteristic of mucosal and epidermal epithelia during meibomian gland morphogenesis. This unique group of cells was located in the central duct with a concentration near the ductule orifice. The expression of these cells reduced during meibomian gland morphogenesis and may play a role in the development and homeostasis of the gland.

Distinct subtypes of zona pellucida morphology reflect canine oocyte viability and cumulus-oocyte complex quality.

The aim of this study was to analyze surface morphology of the zona pellucida (ZP) and assess its relationship with oocyte viability, cumulus-oocyte complex (COC) quality, and oocyte donor age in dogs. Canine ovaries were sliced to release COCs for use in three experiments. In Experiment 1, oocytes from high-quality (grade I) COCs were viewed with scanning electron microscopy to visualize the zona surface. Four zonae, classified as types I, II, III, and IV, were detectable on high-quality oocytes. Most (95.5%) dog donors had oocytes with two or three ZP types. The ZP type I had a smooth compact surface with few pores. The ZP type II was less compact with many distinct circular or elliptical pores. The ZP type III had a rough surface with folds and many irregular shaped pores and hollows. The ZP type IV also had a rough surface with folds, but in addition, stringy filaments obscured the pores and hollows. The frequency of ZP type I in the oocyte population was low (2.7%), whereas ZP types II, III, and IV each occurred in approximately one-third of the oocyte population. In Experiment 2, oocytes from high-quality COCs were stained with propidium iodide (PI) before scanning electron microscopy to investigate the relationship of oocyte viability with ZP morphology. In Experiment 3, oocytes were collected from low-quality (grade 2) and high-quality (grade 1) COCs to investigate the role of COC quality on zona structure. Zonae types I and II were characteristic of PI-positive (dead) oocytes and oocytes from low-quality COCs, whereas ZP types III and IV were prevalent on PI-negative (living) oocytes and oocytes from high-quality COCs. We concluded that the heterogeneous ZP surface underwent structural rearrangements related to oocyte viability and COC quality. This warrants further investigation into ZP structure and may be useful for canine-assisted reproduction.

Imaging the zona pellucida of canine and feline oocytes using scanning electron microscopy.

Ultrastructure of the zona pellucida (ZP) of canine and feline oocytes has not been fully investigated. The objective of the study was to evaluate the potential use of the low vacuum scanning electron microscope (LVSEM) with oocytes. This required development of a method to prepare canine and feline cumulus-oocyte complexes (COCs) for LVSEM to provide ultrastructural information on the ZP. COCs were collected from ovaries, and cumulus cells were either partially or completely removed to reveal the ZP. COCs and zona-intact oocytes were fixed at 4 degrees C for 1 h in 2.5% glutaraldehyde in 0.1 M sodium cacodylate buffer, pH 7.4 and subsequently viewed wet or further processed by critical point drying, and viewed uncoated or sputter coated with gold. Although the spongy surface of the ZP was visible at low vacuum in uncoated oocytes, coated oocytes had more details at high vacuum. The ZP surface of canine and feline oocytes contained numerous various-sized, spherical or elliptical pores that narrowed centripetally splitting into several smaller, deep pores. The round to oblong cumulus cells tightly surrounded the ZP. Each corona radiata cumulus cell tapered into a thin projection that entered the ZP. Our detailed techniques will enable future studies connecting ultrastructural and molecular aspects of oocyte maturation and development in mammals.

Highly active and stereoselective zirconium and hafnium alkoxide initiators for solvent-free ring-opening polymerization of rac-lactide.

Under solvent-free conditions (at 130 degrees C), zirconium and hafnium amine tris(phenolate) alkoxides are extremely active, well-controlled, single-site initiators for the ring-opening polymerization of rac-lactide, yielding highly heterotactic polylactide.

Robust chiral zirconium alkoxide initiators for the room-temperature stereoselective ring-opening polymerisation of rac-lactide.

Chiral Schiff bases (1H to 4H) and a series of their Group 4 metal alkoxide complexes [(R-1)2Ti(O(i)Pr)2, (R-2)2Ti(O(i)Pr)2, (R-1)(2)Zr(O(i)Pr)2, (R-2)2Zr(O(i)Pr)2, (R-3)2Zr(O(i)Pr)2, (R-4)2Zr(O(i)Pr)2, (S-1)2Zr(O(i)Pr)2 and (rac-1)2Zr(O(i)Pr)2] have been prepared and characterised by 1H, and 13C NMR spectroscopy. In solution, both Lambda and Delta isomers were observed, suggesting a low degree of chiral induction from the ligand. One ligand (R-4H) and three complexes [Delta-(R,R-2)2Ti(O(i)Pr)2, Lambda-(R,R-1)2Zr(O(i)Pr)2 and Delta-(R,R-3)2Zr(O(i)Pr)2] have also been characterised by single crystal X-ray diffraction. All complexes were found to have a pseudo-octahedral alpha-cis geometry. The complexes were tested as initiators for the ring-opening polymerisation of rac-lactide in solution and in the melt. The titanium complexes are inactive in solution and afford atactic polylactide in the melt. Zr(iv) complexes afford heterotactically enriched polylactide both in toluene solution (at 20 degrees C and 80 degrees C) and in the melt. Polymerisations were generally found to be well-controlled, giving predictable molecular weights and low molecular weight distributions. Ligand variation (substituents and/or chirality) has little effect on either the activity or selectivity of initiators. Zirconium initiators were found to be unusually robust as they were able to maintain well-controlled polymerisation following addition of water to reactions in solution and when using unpurified monomer for reactions in the melt.

Luminescent dinuclear lanthanide complexes of 5-Me-HXTA.

The synthesis and characterization of a series of anionic homobimetallic lanthanide complexes of the septadentate chelate 5-Me-HXTA (N,N-(2 hydroxy-5-methyl-1,3-xylylene)bis(N-(carboxymethyl)glycine) is described (Ln = Nd, Sm, Eu, Tb, Dy, Ho, Er, Yb). Single X-ray crystallography confirms that the complexes exist as discrete dimeric pairs in the solid state. Proton NMR, diffusion-ordered spectroscopy, and luminescence solution studies suggest that the binuclear stoichiometry is retained in aqueous solution over a range of analytically useful concentrations. The phenolic chromophores effectively sensitize the visible and near-infrared lanthanide-centered emission in the terbium, neodymium, and ytterbium derivatives, giving rise to particularly long-lived green and near-infrared emission. The terbium complex displays a high quantum yield of around 50% in aqueous solution with a low detection limit of 1 x 10(-12) M, rendering this compound a potential candidate for time-resolved applications.

Air-stable titanium alkoxide based metal-organic framework as an initiator for ring-opening polymerization of cyclic esters.

An air-stable titanium-organic framework, prepared from Ti(OiPr)4 and 1,4-butanediol, has been characterized via single-crystal X-ray diffraction, revealing a unique supramolecular structure. Its functionality as a highly active initiator for the ring-opening polymerization of cyclic esters is demonstrated. A discrete titanium trimer containing the related ligand (2R,3R)-2,3-butanediol has also been prepared, and it shows analogous activity as a polymerization initiator.

Synthesis and X-ray structures of new titanium(IV) aryloxides and their exploitation for the ring opening polymerization of epsilon-caprolactone.

A series of titanium catecholates have been prepared and characterized by single-crystal X-ray diffraction studies. Complexes 1a-7a were synthesized by the reaction of 1 equiv of ligand with Ti(OiPr)4. All are dimers in the solid-state, in which a catechol bridges between two titanium centers. Electronic (nitro and methoxy groups) and steric (tert-butyl groups) effects of the ligand have been investigated. Complex 1b was synthesized by reaction of 2 equiv of ligand with Ti(OiPr)4. A dimer is again observed with the same bridging ligand together with a terminal catechol moiety. All complexes contain a coordinated 2-propanol ligand on each titanium center forming pseudo-octahedral metal centers. All complexes were tested for the ring-opening-polymerization of epsilon-caprolactone to afford polycaprolactone (PCL). Reasonable yields (up to 79%) were obtained at room temperature, and narrow molecular weight distributions (1.13-1.27) were observed for the PCL produced. The most active complex was found to be complex 1a, containing unsubsituted catechol ligands.

Group 4 complexes of amine bis(phenolate)s and their application for the ring opening polymerisation of cyclic esters.

A series of amine bis(phenolate) ligand precursors and their group 4 metal complexes have been prepared, characterised by single-crystal X-ray diffraction, and tested for ring opening polymerisation of epsilon-caprolactone.