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Background The multidisciplinary comprehensive care (MDCC) program promotes the improvement of oral intake for older patients. The Kuchi-kara Taberu (ingesting orally in Japanese, KT) index was developed to objectively assess patient conditions in the MDCC program. This trial examined the effects of the index in promoting oral intake in older patients with pneumonia. Methods A cluster randomized controlled trial was conducted in 10 local hospitals targeting older patients with pneumonia (≥65 years). Ten hospitals were allocated randomly to either the intervention or the control group. Both groups (each with five hospitals) received the MDCC program for oral feeding, which consisted of professional assessment, care, and treatment. The KT index was used by the intervention group, focusing on improving low score items. The primary outcome was determined using the Functional Oral Intake Scale (FOIS) at discharge or 1 month after admission. Results One hundred and twelve patients (46 women and 66 men) who participated from 10 hospitals, with a median age of 88 years (interquartile range [IQR], 80–91), were examined. The median FOIS level and the number of patients with oral intake (FOIS ≥ level 4) at discharge were 4 (IQR, 4–6) and 89 (79.5%), respectively. The duration of nil per os was 2 (IQR, 1–5) days. Clusters were not matched in the presence of Kuchi-kara Taberu Shiawase-wo Mamoru-kai-certified medical staff promoting oral intake in patients with dysphagia in each hospital. The median FOIS levels of 53 patients in the intervention group and 59 patients in the control group were 5 (IQR, 4–6) and 4 (IQR, 4–5), respectively, showing no statistically significant difference (P = 0.76). According to a multivariate analysis, the KT index had no positive effect on FOIS levels. Conclusions This trial was not able to demonstrate the usefulness of the KT index due to random assignment failure. However, both the intervention and control groups showed a high prevalence of oral intake (FOIS ≥ level 4) at discharge. Trial registration UMIN-Clinical Trial Registry, UMIN000025172, December 17, 2016.

Objectives To verify the reliability and validity and develop an English version of an instrument (Kuchi-Kara Taberu Index (KT Index)) to comprehensively assess and intervene in problems with eating and swallowing. Design Multicenter cross-sectional study. Setting Nursing homes. Participants Individuals aged 65 and older (mean age 88.3 ± 6.8; 80.0% female) who had lived in a nursing home for longer than 1 month (N = 115). Measurements The KT index consisted of 13 items: desire to eat, overall condition, respiratory condition, oral condition, cognitive function while eating, oral preparatory and propulsive phases, dysphagia severity, position and endurance while eating, eating, daily life, food intake level, food modification, and nutrition. Weighted kappa coefficients, Cronbach alpha, and Spearman rank correlation coefficients were determined. Results Weighted kappa values in the inter- and intrarater reliability tests ranged from 0.54 to 0.96 and 0.68 to 0.98, respectively. Cronbach alpha was 0.892. Spearman rank correlation coefficients (r) between the total KT index and external criteria were determined (Functional Oral Intake Scale, r = 0.790; Barthel Index, r = 0.830; Mini Nutritional Assessment Short Form, r = 0.582; Cognitive Performance Scale, r = −0.673; all P < .001). Similar correlations were observed when some items related to each external criterion were removed from the total KT index. Translation-retranslation procedures were conducted to develop an English version of the KT index. Conclusion The study provided evidence of the reliability and validity of the KT index and developed an English version. Future studies regarding validation of health-related quality of life indices and their effect on clinical courses of eating and swallowing conditions are needed.

How to Obtain Contact Hours by Reading This Article Instructions 1.3 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf . To obtain contact hours you must: 1. Read the article, “Multidisciplinary Comprehensive Care for Early Recommencement of Oral Intake in Older Adults With Severe Pneumonia” found on pages 21–29, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until September 30, 2019. Contact Hours This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. Activity Objectives 1. Describe the effect of multidisciplinary comprehensive care (MDCC) on oral intake in older adults with severe pneumonia at the time of discharge. 2. Explore the impact of MDCC on the length of stay for hospitalized older adults with severe pneumonia. Disclosure Statement Neither the planners nor the authors have any conflicts of interest to disclose. The current study was designed to assess the effect of multidisciplinary comprehensive care (MDCC) on (a) oral intake at discharge and (b) hospital stay duration in older adult patients with severe pneumonia. Participants were divided into two groups: receiving and not receiving MDCC. MDCC comprises regular assessment of swallowing ability, aspiration risk management, improvement of oral hygiene, serving of nutritious texture-modified foods, and encouragement of early mobilization. The MDCC group (164 women, 206 men; mean age = 82.7, SD = 8.4 years) had severe pneumonia as well as high proportions of poor premorbid physical function and consciousness disturbance compared to the non-MDCC group (45 women, 56 men; mean age = 81.1, SD = 8.6 years). Nevertheless, MDCC was an independent determinant of hospital stay duration and oral intake (Functional Oral Intake Scale score ≥4) at discharge with Cox regression analysis (hazard ratio = 1.42, 95% confidence interval [1.09, 1.85]). MDCC may promote early oral intake and hospital discharge in older adults with severe pneumonia. [ Journal of Gerontological Nursing, 42 (10), 21–29.]

Several class of dyes doped in deoxyribonucleic acid (DNA) derived from salmon show enhancement of fluorescence due to suppression of molecular aggregation. Also, some recent studies support electric conduction in DNA strands. Combination of these properties suggests the possibility to develop organic LED devices (OLED) based on biopolymer systems. Furthermore, the electroluminescence (EL) effect can be employed as a probe for electrical and optical properties of DNA. We fabricated OLED devices based on DNA- lipid complex and dopant dyes (ethidium bromide and fluorescein). Devices are composed of hole injection layer, dye-doped DNA-lipid layer and electrodues. OLED with ethidium bromide doped DNA showed LED emission under DC bias, but the origin of the emission was tris-(8- hydroxyquinolinato)aluminum(III)(Alq3) which was employed as an electron transporter. The current-voltage characteristics of the devices show apparent rectification behavior. From these experimental results, it is confirmed that DNA transports hole current under external DC bias. When employing fluorescein as a dopant in DNA and fabricating the devices without Alq3 layer, we observed emission from the dyes incorporated in DNA. Although the origins of the emission centers in spectra are not clear, it shows that the DNA-lipid complex will be basically applicable to OLED if additional improvements are made.