須釜 淳子

AIM: To identify the competencies required for hospital-based WOC nurses to provide direct pressure injury (PI) care in home care settings in Japan. DESIGN: Mixed methods convergent design. METHODS: The qualitative strand used a descriptive design to explore competencies for overcoming barriers faced by hospital-based WOC nurses when providing PI care at home. The quantitative strand used a cross-sectional design to assess competencies in organising the hospital PI management system. RESULTS: Six competencies were identified: (1) Establish relationships with home healthcare professionals; (2) Promote hospital-based WOC nurse's expertise to home healthcare professionals; (3) Collaborate with the regional medical liaison office in WOC nurse's hospital; (4) Involve hospital administrators in home PI management; (5) Utilise social media/Information and Communication Technology for patient or home-visiting nurse communication; and (6) Utilise public or academic support projects to facilitate home-based activities. The median scoring rate for each medical staff domain on the revised Collaboration Competency Scale for WOC Nurses ranged from 80% to 91%. CONCLUSION: The results of this study can serve as a practical resource to help WOC nurses expand their activities into home-care settings. IMPLICATIONS FOR THE PROFESSION: Their ability to coordinate with staff and manage PI care within hospitals supports active engagement in home care, improving continuity and quality. IMPACT: This study addressed the issue that many hospital-based WOC nurses cannot visit patients at home. The competencies identified may enable these nurses to expand their role into home care. REPORTING METHOD: This study followed EQUATOR guidelines, with the STROBE Statement applied to the quantitative part and the COREQ checklist to the qualitative part. PATIENT OR PUBLIC CONTRIBUTION: Patients or the public were not involved in the study's design, conduct, or reporting.

OBJECTIVES: The taxane chemotherapeutic agent docetaxel has been used as a therapy for various cancers. Some patients receiving docetaxel develop serious problems with fluid retention, which leads to peripheral edema formation, reducing the patient's quality of life. This study investigated the effect of docetaxel administration on fluid dynamics in mice as a step toward developing advanced preventive measures in nursing. METHODS: Mice were administered 10 mg/kg/day of docetaxel intravenously for 5 days as the intervention group or with normal saline as the control group. To investigate fluid dynamics on day 5, the leakage of blood plasma, interstitial fluid volume, and fluid transportation capacity into lymph vessels were evaluated and compared between the two groups. RESULTS: The Miles assay with Evans Blue, an albumin-binding dye, revealed that leakage of blood plasma was significantly increased in the control group compared with the intervention group (p<0.01). Results of the interstitial fluid volume and fluid transportation capacity were similar between the two groups, but the fluid transportation capacity tended to be higher in the intervention group. CONCLUSIONS: Docetaxel administration in our mouse model caused the leakage of blood plasma without proteins from the blood vessels into the interstitial tissues, which appeared at the initial stage of edema formation. This model might be useful for assessing the leakage of blood plasma and, subsequently, the development of preventive measures against edema formation.

BACKGROUND: The use of mobile apps to promote knowledge level, practice, and behavioral change potential has become increasingly common. However, studies on apps targeting social welfare employees working in the home-care setting to prevent pressure injury (PI) are lacking. The care manager (CM) plays a key role in connecting the demand and supply of home-care services. PI is more prevalent in the home-care setting, where resources are limited, than in acute settings. OBJECTIVE: The research hypothesis was that CMs who use a mobile app will have improved general knowledge and heightened practice for PI prevention, compared to that before using the app. This study aimed to assess the effectiveness of a PI prevention support mobile app prototyping model (Pips-Map) in improving the knowledge level, practice, and behavioral change potential of CMs in PI prevention in the home-care setting. METHODS: This was conducted between December 2021 and December 2023 as a single-arm, pre-post pilot study including 27 CMs who worked in a Japanese city. Pips-Map was used for 6 months in daily practice, and a self-administered test questionnaire was used to assess participants' knowledge and practice in PI prevention before or after using Pips-Map. At the end of the posttest, a validated App Behavior Change Scale was used to analyze behavioral change potential. This study followed the Consolidated Standards of Reporting Trials (CONSORT) extension to pilot and feasibility trials. RESULTS: In total, 19 participants were analyzed. Out of 55 points, the total mean knowledge score significantly increased from 30.9 (SD 5.9) in the pretest group to 36.1 (SD 5.9) in the posttest group (P=.0003). The number of participants with a total score of >70% (adequate knowledge level) increased from 2 (11%) to 7 (36.8%), but the difference was not statistically significant (P=.07). For the level of practice, out of 21 points, the total score increased from 15.2 (SD 3.1) in the pretest group to 16.2 (SD 3.0) in the posttest group, but no statistically significant differences were observed (P=.16). The behavior change scale revealed that participants positively evaluated the Pips-Map to provide information on PI prevention guidelines but had concerns regarding inadequate usability and financial incentives of Pips-Map. CONCLUSIONS: The use of Pips-Map for 6 months in actual practice increased the knowledge level of Japanese CMs in PI prevention, but it did not change the level of practice. Considering the need for updating apps that aim to promote behavioral change, this study identified some limitations of Pips-Map. Thus, revisions must be made to adapt Pips-Map to home-based care needs.

本研究では症状を訴えられない高齢者のための超音波検査を用いた便秘の検出精度に関して調べることを目的とした。英語および日本語の文献で便秘の検出における超音波検査の診断精度を示す研究（縦断的観察研究、横断的研究、症例対照研究）を、MEDLINE、The Cochrane Library/CENTRAL、医中誌Web、Embase、CINAHL、およびCochrane Database of Systematic Reviewで検索した。それぞれの研究において、便秘評価ツールとしての超音波検査の感度と特異度を計算し、統合した推定の感度特異度を算出した。その結果、6 つの研究が対象として含まれ、超音波検査は1 日1 回、または排便前に実施されていた。超音波検査による便秘検出の統合した感度と特異度は、それぞれ0.93（95% CI: 0.63-0.99）および0.81（95% CI: 0.60-0.92）であった。対象となった研究の全体的なエビデンスの確実性は、「不明」なバイアスリスクが50％以上評価領域に存在し、また研究間で結果が異なっており、研究数が10件未満であったため、非常に低いと評価された。したがって、超音波検査は便秘検出において高い診断精度を示しており、その携帯性および非侵襲性から臨床現場で有用な評価ツールとなる可能性があると考えられる。しかし、エビデンスレベルが低いため、今後さらなる研究が必要である。

OBJECTIVES: We aimed to determine (1) the prevalence of constipation among inpatients, (2) the prevalence and symptoms of difficult defecation among constipated inpatients, and (3) the factors associated with constipation. METHODS: We performed a retrospective cohort study over a single day at one university hospital. We analyzed the nursing records for inpatients who had been hospitalized for at least 3 days. The survey items included the symptoms associated with defecation difficulty and nutritional intake. The symptoms of difficult defecation were defined as (1) fewer than three spontaneous bowel movements per week; (2) lumpy or hard stools (Bristol stool form scale types 1-2); (3) straining during defecation; and (4) the sensation of incomplete evacuation during defecation, based on the Roma-IV diagnostic criteria. Constipation was defined as the presence of two or more symptoms of defecation difficulty. Univariate and multivariate analyses were performed to determine the constipation status of the patients. RESULTS: The prevalence of constipation in the university hospital was 12.2%, and the department with the highest prevalence of difficulty with defecation was the Psychiatry Department (64.1%). Of the patients with constipation, 36.8% exhibited symptoms of defecation difficulty other than low frequency of defecation. The factor that was significantly associated with constipation after admission was pre-admission constipation (odds ratio=8.92, p<0.01). CONCLUSIONS: Subjective assessment has limitations for the accurate determination of constipation status. In addition, patients with a history of constipation before admission require early interventions to aid defecation following their admission.

We aimed to investigate the association between the presence of cutaneous urease-producing bacteria and the development of incontinence-associated dermatitis (IAD) using an original urea agar medium as a step toward developing advanced preventive measures. In previous clinical assessments, we developed an original urea agar medium to detect urease-producing bacteria via the medium's colour changes. In a cross-sectional study, specimens were collected via the swabbing technique at genital skin sites in 52 stroke patients hospitalised in a university hospital. The primary objective was to compare the presence of urease-producing bacteria between the IAD and no-IAD groups. Determining the bacterial count was the secondary objective. The prevalence of IAD was 48%. A significantly higher detection rate of urease-producing bacteria was observed in the IAD group than in the no-IAD group (P = .002) despite the total number of bacteria being equivalent between them. In conclusion, we discovered that there was a significant association between the presence of urease-producing bacteria and IAD development in hospitalised stroke patients.

AIM: To compare the isolated and identified bacterial species colonizing on the genital skin between patients with and without incontinence-associated dermatitis. METHODS: This cross-sectional study included 102 patients with stroke admitted to an acute hospital in Japan. Swabs were collected, and bacterial species found in swabs were isolated and identified using a selective agar medium and simple identification kits. In addition to demographic information, severity of incontinence-associated dermatitis and the total bacterial counts were measured. RESULTS: Incontinence-associated dermatitis was present in 53.9% of the participants. Staphylococcus aureus was found in 50% of the participants with incontinence-associated dermatitis and only 17.9% of those without incontinence-associated dermatitis (P = 0.0029). Bacterial species distribution by erythema and skin erosion, which denote severity of incontinence-associated dermatitis, was different, but not significant; additionally, the total number of bacterial colonies was equivalent. CONCLUSIONS: Bacterial species distribution differed between patients with and without incontinence-associated dermatitis, whereas the total number of bacterial colonies was equivalent. A high detection rate of S. aureus on genital skin sites potentially affects the presence of incontinence-associated dermatitis and its severity. Geriatr Gerontol Int 2023; 23: 537-542.

BACKGROUND: Aspiration pneumonia (AP), which is a major cause of death in the elderly, does present with typical symptoms in the early stages of onset, thus it is difficult to detect and treat at an early stage. In this study, we identified biomarkers that are useful for the detection of AP and focused on salivary proteins, which may be collected non-invasively. Because expectorating saliva is often difficult for elderly people, we collected salivary proteins from the buccal mucosa. METHODS: We collected samples from the buccal mucosa of six patients with AP and six control patients (no AP) in an acute-care hospital. Following protein precipitation using trichloroacetic acid and washing with acetone, the samples were analyzed by liquid chromatography and tandem mass spectrometry (LC-MS/MS). We also determined the levels of cytokines and chemokines in non-precipitated samples from buccal mucosa. RESULTS: Comparative quantitative analysis of LC-MS/MS spectra revealed 55 highly (P values < 0.10) abundant proteins with high FDR confidence (q values < 0.01) and high coverage (> 50%) in the AP group compared with the control group. Among the 55 proteins, the protein abundances of four proteins (protein S100-A7A, eukaryotic translation initiation factor 1, Serpin B4, and peptidoglycan recognition protein 1) in the AP group showed a negative correlation with the time post-onset; these proteins are promising AP biomarker candidates. In addition, the abundance of C-reactive protein (CRP) in oral samples was highly correlated with serum CRP levels, suggesting that oral CRP levels may be used as a surrogate to predict serum CRP in AP patients. A multiplex cytokine/chemokine assay revealed that MCP-1 tended to be low, indicating unresponsiveness of MCP-1 and its downstream immune pathways in AP. CONCLUSION: Our findings suggest that oral salivary proteins, which are obtained non-invasively, can be utilized for the detection of AP.

皮膚・排泄ケア認定看護師(WOCN)の資格をもちWOC領域の専門外来に従事している11名にアンケートとインタビューを行い、以下の項目について調査した結果を報告した。1)実施している特定行為の内容。2)従事している専門外来の概要。3)同行訪問の状況。4)専門外来における診療報酬の算定。5)専門外来におけるアウトカム評価。6)主治医との連携。7)病棟との連携。8)訪問看護師との連携。9)在宅医療との連携。10)高齢者施設との連携。11)施設管理職との関係性。12)所属する施設の組織体制。13)所属施設での環境調整。14)施設の医師との関係性。15)施設の職員との関係性。16)複数のWOCN間の連携。17)WOCNの業務の調整。18)物品の調達。19)専門外来におけるWOCNの存在意義。20)専門外来におけるWOCNの役割。

皮膚・排泄ケア認定看護師(WOCN)の資格をもちWOC領域の専門外来に従事している11名にアンケートとインタビューを行い、以下の項目について調査した結果を報告した。1)実施している特定行為の内容。2)従事している専門外来の概要。3)同行訪問の状況。4)専門外来における診療報酬の算定。5)専門外来におけるアウトカム評価。6)主治医との連携。7)病棟との連携。8)訪問看護師との連携。9)在宅医療との連携。10)高齢者施設との連携。11)施設管理職との関係性。12)所属する施設の組織体制。13)所属施設での環境調整。14)施設の医師との関係性。15)施設の職員との関係性。16)複数のWOCN間の連携。17)WOCNの業務の調整。18)物品の調達。19)専門外来におけるWOCNの存在意義。20)専門外来におけるWOCNの役割。

【目的】信頼でき、継続性があり、正確な創傷の記述は創傷評価において重要な要素である。この創傷アセスメントは創傷ケアの専門家に創傷管理の適切な情報を与え、臨床上の意思決定を支援する。糖尿病足潰瘍の創縁のレッドリングの形態的特徴と発生要因について、いまだ明らかにされていない。本研究の目的は、糖尿病足潰瘍の創縁のレッドリングの特徴を記述し、その発生要因を探索することである。<br> 【方法】本調査は、過去にわれわれが行ったインドネシアの創傷クリニックで局所管理を受けた糖尿病足潰瘍の治癒過程に関する2つの前向き調査で収集したデータを用いて行った。35名の患者の足潰瘍の創状態に関する質的記述的研究を行った。また、レッドリング所見の有無で患者ならびに創傷の特徴を比較した。<br> 【結果】35名中10名の足潰瘍に鮮紅色の線状の形状を認めた。すべてのレッドリングは線状であった。この線は、創底のスラフに沿って出現していた。また、この所見を有する創の深さ、浸軟、炎症／感染、創底組織のタイプのDMIST得点が、所見がない潰瘍とくらべて有意に高かった。<br> 【結論】鮮紅色の線状は局所の感染と関連があると示唆された。創傷管理において、創縁の鮮紅色の線上所見にも注視して創評価を行う必要がある。

A non-thermal atmospheric pressure plasma jet (APPJ) may stimulate cells and tissues or result in cell death depending on the intensity of plasma at the target; therefore, we herein investigated the effects of non-thermal plasma under non-contact conditions on the healing of full-thickness wounds in diabetic mice (DM+ group) and normal mice (DM- group). A hydrogen peroxide colorimetric method and high performance liquid chromatography showed that APPJ produced low amounts of reactive oxygen and nitrogen species. Ten-week-old male C57BL/6j mice with normal blood glucose levels (DM- group) and 10-week-old male C57BLKS/J Iar-+Leprdb/+Leprdb mice (DM+ group) received two full-thickness cutaneous wounds (4 mm in diameter) on both sides of the dorsum. Wounds were treated with or without the plasma jet or argon gas for 1 minute and were then covered with a hydrocolloid dressing (Hydrocolloid), according to which mice were divided into the following groups: DM+Plasma, DM+Argon, DM+Hydrocolloid, DM-Plasma, DM-Argon, and DM-Hydrocolloid. Exudate weights, wound areas, and wound area ratios were recorded every day. Hematoxylin and eosin staining was performed to assess re-epithelialization and α-SMA immunohistological staining to evaluate the formation of new blood vessels. Non-thermal plasma under non-contact conditions reduced the production of exudate. Exudate weights were smaller in the DM+Plasma group than in the DM+Hydrocolloid and DM+Argon groups. The wound area ratio was smaller for plasma-treated wounds, and was also smaller in the DM+Plasma group than in the DM+Hydrocolloid and DM+Argon groups on days 1–21 (p&lt;0.01). Wound areas were smaller in the DM-Plasma group than in the DM-Argon group until day 14 and differences were significant on days 1–5 (p&lt;0.01). The percentage of re-epithelialization was significantly higher in the DM+Plasma group than in the DM+Argon and DM+Hydrocolloid groups (p&lt;0.01). The number of new blood vessels that had formed by day 7 was significantly higher in the DM+Plasma group than in the DM+Hydrocolloid and DM+Argon groups (p&lt;0.05). These results indicate that treatment with the current non-thermal plasma APPJ device under non-contact conditions accelerated wound healing in diabetic mice.

INTRODUCTION: Compression therapy is important in oedema control in lymphoedema. However, some patients have difficulties starting compression therapy because standard self-care education does not enable them to fully understand lymphoedema and recognise it as their problem. To overcome this, real-time image-sharing education, using a combination of indocyanine green lymphography (ICG) and ultrasonography, may be used to educate patients. In this case study, real-time image-sharing education promoted decision-making and behaviour change in a patient with lower extremity lymphoedema so she would wear elastic stockings. CASE: A 51-year-old woman with a BMI of 31.7 kg/m2 and secondary lower extremity lymphoedema following cervical cancer surgery did not adhere to self-care instructions regarding wearing elastic stockings for 5 years. The oedema worsened, her limb circumference increased and she had two episodes of cellulitis within a year. Because the patient had a negative attitude towards elastic stockings, real-time image-sharing education was used to promote recognition of illness using ICG and an understanding of the condition of lymphoedema using ultrasonography. After the images were shared and explained, the patient discussed her recognition and understanding of lymphoedema, then decided to use compression stockings. She continued to wear them for 4 months, and her limb circumference decreased. CONCLUSION: Real-time image-sharing education using ICG and ultrasonography as self-care support for a lymphoedema patient who would not start compression therapy could result in behavioural changes and the patient starting and continuing to wear elastic stockings.

AIM: This study aimed to evaluate the use of multilayered silicone foam dressings for preventing pressure injury recurrence by reducing friction, pressure, and shear force at skin sites where previous pressure injuries closed. METHODS: A bench-to-clinical bedside investigation was conducted. In the bench, three multilayered silicone foam dressings were assessed. The simulated skin-shearing test consisted of a weight, a polyurethane-based skin model containing a three-axis tactile sensor, dressings, a table covered with bedsheets, and a mechanical tester. The mechanical tester simultaneously measured the interface friction force and internal shear force and pressure continuously during skin model movements. No-dressing was used as a negative control. In clinical bedside assessments, a multilayered silicone foam dressing with lower friction and shear force was applied to two bedridden patients. Photographs and ultrasound images were used to assess the recurrence of pressure injury. RESULTS: The dressings significantly reduced friction, pressure, and shear force compared with these parameters in the negative control. No significant differences in the shear forces between the dressings were observed. One clinical case did not develop a new pressure injury reaching the dermis. However, the second case developed a new pressure injury within one month after the first pressure injury closed. CONCLUSION: Our bench-to-clinical bedside study revealed that multilayered silicone foam dressings can potentially prevent pressure injury recurrence.

Chronic constipation is a common gastrointestinal disorder in older adults, and it is very important to manage chronic constipation. However, evaluating these subjective symptoms is extremely difficult in cases where patients are unable to express their symptoms because of a cognitive or physical impairment. Hence, it is necessary to observe the patient's colonic faecal retention using objective methods. Ultrasonography observation for colonic faecal retention is useful for diagnosing constipation and evaluating the effectiveness of treatment. Since there was no standard protocol for interpreting rectal ultrasonography findings, we developed an observation protocol through an expert consensus. We convened a group of experts in the diagnosis and evaluation of chronic constipation and ultrasonography to discuss and review the current literature on this matter. Together, they composed a succinct, evidence-based observation protocol for rectal faecal retention using ultrasonography. We created an observation protocol to enhance the quality and accuracy of diagnosis of chronic constipation, especially rectal constipation. This consensus statement is intended to serve as a guide for physicians, laboratory technicians and nurses who do not specialise in ultrasound or the diagnosis of chronic constipation.

In the present study, we aimed to identify the normal hindlimb lymphatic systems in rats and compare them with the detours after lymphatic flow blockage. The lymphatic systems of the hindlimbs of normal rats were investigated via lymphography using a near-infrared fluorescence imaging system. The lymphatic vessels were stained using Evans Blue. The lymphatic flow was blocked through lymphatic vessel ligation combined with inguinal and popliteal lymph node dissection. Detours that appeared after 30 days were visualized using lymphography and immunostaining with anti-podoplanin antibodies. Three main results were obtained in the present study. First, the deep medial system, the superficial medial system, a connection between the superficial and deep medial lymphatic systems, and the superficial lateral system, were elucidated. Second, three types of detours, namely the detour of the lateral abdomen, the detour to the lymphatic vessel near the midline of the abdomen, and the detour to the contralateral inguinal lymph node, were identified after lymphatic flow blockage. Lastly, detours were located in the fatty layer above the panniculus carnosus muscle and their lumina were wide. The histology suggested that the detour was a pre-collecting lymphatic vessel. Lymphatic routes in the rat hindlimbs after lymphatic flow blockage were different from those of the normal rat lymphatic system. It was suggested that the detour is a pre-collecting lymphatic vessel and that encouraging its development may be a new method of simple lymphatic drainage.

Background: Cellulitis is frequently encountered in patients with lymphedema despite existing prevention protocols. To resolve this issue, social aspects surrounding patients, such as communication with patients and professionals, are necessary to consider new approaches. This study aimed to clarify the association between the history of cellulitis in patients with lymphedema and access to specialists after adjustment for relevant confounding factors. Methods and Results: This study was a secondary analysis of the Lymphoedema IMpact and PRevalence-INTernational (LIMPRINT) study using a national Japanese database of adult lymphedema compiled between 2014 and 2015 (n = 113). Descriptive data were collected for patient characteristics. Multivariate logistic regression analysis was conducted to explore possible risk factors for patients having experienced cellulitis. The duration of edema ranged from <6 months (16.2%) to 10 years or longer (25.2%), with varying severity. History of cellulitis was observed in 31.9% of patients. The prevalent treatment techniques within the context of complex decongestive therapy included skin care advice (52.2%), compression garments (55.8%), exercise advice (41.6%), multilayer bandages (38.1%), cellulitis advice (49.6%), and massage (61.1%). Overall, 57.1% of patients had access to lymphedema specialists. Longer duration of lymphedema (adjusted odds ratio [AOR] = 4.10, p = 0.005) and access to lymphedema specialists (AOR = 0.28, p = 0.009) were significantly associated with a history of cellulitis. Conclusions: A history of cellulitis in patients with lymphedema is associated with limited access to specialists. To support self-care in this patient population, reasonable consideration systems, including telehealth, should be developed to facilitate communication between specialists and patients and decrease the occurrence of cellulitis in lymphedema.

AIM: To investigate how nursing faculties' perceived time devoted to research changed during the first wave of the pandemic in Japan (April-June 2020) compared to pre-pandemic. METHODS: This cross-sectional study was conducted online from July 1 to August 10, 2020 and involved 1,023 nursing faculties in Japan. Participants were asked to respond to a questionnaire based on their experiences from April to June 2020. We calculated descriptive statistics for several measures and examined associations between professional/personal demographic factors and declines in overall research time. RESULTS: Of the 1,023 participants, 71.1% were spending less time on overall research activity; 79.6% spent less time attending academic events/conferences, and 77.4% spent less time conducting experiments/surveys. In contrast, 81.2% spent more time teaching, a much greater proportion than the global scientific community in a previous survey. As for work time allocation during the pandemic, teaching was by far the one activity that participants spent the most time on. Logistic regression analysis revealed that declines in overall research time were associated with several professional demographic factors, such as type of university, current academic position, and acquisition status of Japan's major research grant (KAKENHI) (all p < .05). CONCLUSIONS: Nursing faculties in Japan clearly spent less time on research, and more time on teaching during the first wave of the pandemic compared to pre-pandemic. The initial impact of the pandemic on nursing faculties revealed through this study is an eye-opener and a start for addressing the long-term impact on the nursing scientific community.

Advances in patient care for pressure injuries (PIs) have reduced the prevalence of PIs in Japan, although not in recent years. Several single-nucleotide polymorphisms (SNPs) have been identified in genes potentially associated with PIs. However, individual variance among PI risks require targeted investigations that may lead to the identification of PI susceptibilities or preventive care options that directly influence PI development pathways. This cross-sectional study examined the association between PIs and SNPs in genes related to tissue tolerance in patients in a long-term care hospital in Japan. A total of 178 participants (130 control, 20 with superficial PI history, and 28 with deep PI history) were enrolled in this study of eight SNPs in hypoxia inducible factor 1 subunit alpha (HIF1A), vascular endothelial growth factor C (VEGFC), heat shock protein 90 alpha family class A member 1 (HSP90AA1), myostatin (MSTN), and vitamin D receptor (VDR). The primary outcome was a history of superficial and deep PIs in the last 6 months. SNPs were examined by real-time polymerase chain reaction, followed by multivariate logistic regression analyses of the associations between the SNPs and PI history. The results showed a significant association between VEGFC rs1485766 and the history of superficial PIs (odds ratio = 2.95; 95% confidence interval = 1.07-8.11; p = 0.04). Stratified analysis using the Braden Scale (≤14) indicated a significant association between HIF1A rs11549465 and deep PIs (p = 0.04). Our study demonstrated that VEGFC rs1485766 and HIF1A rs11549465 were associated with superficial and deep PI susceptibilities, respectively.

BACKGROUND: This study seeks to establish the skin barrier dysfunction model at the heel via tape-stripping (TS) by evaluating the skin moisturizing effects. MATERIALS AND METHODS: Nineteen young, female participated in the study. A sequence of TS was performed at the heel and trans-epidermal water loss (TEWL), stratum corneum (SC) hydration, and surface pH were measured. Following TS, the subjects were divided into three groups: moisturizer, emollient, and overcoat. These agents were applied daily at night, and the skin parameters were measured the next morning for a week. RESULTS: The TEWL value of TS immediately and 5 min after TS were significantly higher than what was obtained before TS, while the SC hydration after TS was significantly lower than what was obtained before TS. However, there were no significant differences in the skin parameters among the three agents on day 7 after application, with the two-way ANOVA showing no interaction among the agents and number of days. CONCLUSION: The skin barrier dysfunction model at the heel was established by TS in healthy, young adults. However, the physiological function of the skin at the heel did not change drastically and showed no differences even after continuous application for 7 days.

Pressure injuries have been identified as one of the main health hazards among bedridden elderly people. Bedridden elderly people often stay in the same position for a long time, because they cannot switch positions; thus, the blood flow in the part of the body that is being compressed between the bed and their own weight is continuously blocked. As a result, redness and ulcers occur due to lacking oxygen and nutrients in the skin tissues, and these sites are often infected with microorganisms and, thus, become suppurative wounds, a condition commonly determined as pressure injuries. If left untreated, the pressure injury will recur with microbial infections, often resulting in cellulitis, osteomyelitis, and sepsis. The skin microbiome, in which many types of bacteria coexist, is formed on the skin surface. However, it remains unclear what characteristic of the skin microbiome among the bedridden elderly constitutes the development and severity of pressure injuries and the development of post-pressure injury infections. Thus, in this review article, we outlined the changes in the skin microbiome among the bedridden elderly people and their potential involvement in the onset and recurrence of pressure injuries.

AIM: The purpose of this study is to describe the influences of lower limb edema on the daily lives of elderly individuals in elderly day care to describe the necessity of care for lower limb edema. METHODS: Semi-structured interviews based on a quality of life questionnaire for limb lymphedema were conducted. Two types of text mining analysis methods were used: a frequent word analysis and a content analysis. The edema severity was graded on a scale of 0 to 3, and the sum of the numerical values of the grades for each person was defined as the pitting score. RESULTS: The seven participants had a mean age of 83.4 ± 4.6 years (mean ± SD). The pitting scores ranged from 1 to 25 in the participants. The words "think" (389 times), "walk" (136 times), and "put on" (135 times) were extracted frequently. The content analysis focused on the words "walk" and "put on." The participants complained of difficulty walking, pain, and numbness when walking, weakness of their lower limbs, difficulty putting on shoes, restrictions on shoe types, and difficulty finding shoes. CONCLUSIONS: These results demonstrate that elderly individuals experienced troubles during their daily lives caused by lower limb edema, which highlights the necessity of symptom management. Active interventions for edema by nurses are necessary to improve quality of life in elderly individuals.

AIMS: Critical colonization in pressure ulcers delays healing and has been studied. However, local wound management includes no clear strategy for preventing the development of biofilms. Therefore, this multicenter, prospective, observational study was conducted to examine the effect of local management on the biofilm area of pressure ulcers with critical colonization. METHODS: Participants were 34 patients with a pressure ulcer deeper than the dermis and in a state of critical colonization. The primary outcome was the change over a week in the proportion of the biofilm area in relation to that of the pressure ulcer area. We investigated the relationship between primary outcome and local wound management. The wound-blotting method was used for determining the biofilm area. To calculate the change in the biofilm area, baseline proportion was subtracted from proportion 1 week later. RESULTS: Six types of topical treatment were used in three facilities. The proportion of the biofilm area at 1 week follow-up was significantly smaller with iodine ointment than that without iodine ointment (p = .02). The standardized partial regression coefficient of iodine ointment adjusted by the type of medical facility was -0.26 (p = .003). CONCLUSION: This study revealed that the use of iodine ointment reduced the proportion of the biofilm area in the pressure ulcer surface. To manage pressure ulcers in a state of critical colonization, these results suggest that local management include the use of iodine ointment.

AIM: To estimate diagnostic accuracy of ultrasonography for detecting aspiration and pharyngeal residue in patients with dysphagia. METHODS: A systematic search was conducted in MEDLINE (via PubMed), CINAHL, EMBASE, Ichushi-Web, and Cochrane Library databases to identify articles that showed diagnostic accuracy of ultrasonography for detecting aspiration and residue published in English and Japanese until August 2019. Cross-sectional studies, case-control studies, and cohort studies were included. The diagnostic accuracy results were extracted and the pooled estimated sensitivity and specificity were calculated. The risk of bias of the studies was assessed using the Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies 2. The certainty of the evidence was assessed using the Grades of Recommendation Assessment, Development, and Evaluation methodology. RESULTS: Five studies were included in this review. The pooled estimated sensitivity and specificity for detecting aspiration were 0.82 (95% CI: 0.72-0.89) and 0.87 (95% CI: 0.81-0.92), respectively. One study was included that evaluated ultrasound assessments of pharyngeal residue. The sensitivity and specificity were 0.62 (95% CI: 0.32-0.86) and 0.67 (95% CI: 0.22-0.96), respectively. The certainty of the evidence was low and very low for the diagnostic accuracy of aspiration and pharyngeal residue, respectively. CONCLUSION: Ultrasound is a non-invasive method with good sensitivity and specificity in detecting aspiration as well as reference standards. While risk of bias and small number of studies limited the strength of this systematic review, our results suggested that ultrasound examination was useful as a bedside screening tool for detecting aspiration.

BACKGROUND: Energy inadequacy has a great impact on health outcomes in older adult patients; however, it is difficult to evaluate energy adequacy in these patients, especially in home-care settings. We recently reported that temporal muscle thickness can be an indicator of nutritional status. The present study aims to examine whether a change in temporal muscle thickness is directly correlated with energy adequacy and, if so, to determine the cutoff value of a change in temporal muscle thickness to detect energy inadequacy. METHODS: A prospective cohort study was conducted from September 2015 to June 2016 in two hospitals in Japan, and included bedridden older adult patients aged ≥65 years. Temporal muscle thickness was measured using ultrasonography. Energy intake was estimated by photographic diet records. Total energy expenditure (TEE) was estimated by multiplying basal energy expenditure calculated using the Harris- Benedict equation by activity and stress factors. Energy adequacy was then calculated by dividing TEE by energy intake. Pearson's correlation coefficient was used to examine the relationship between percentage change in temporal muscle thickness and energy adequacy. Multiple logistic regression analysis was conducted to determine the direct relationship between percentage change in temporal muscle thickness and moderate energy inadequacy (energy adequacy< 75%). Receiver operating characteristic (ROC) analysis was performed to determine the cutoff point for percentage change in temporal muscle thickness to detect moderate energy inadequacy. RESULTS: Forty-eight patients were analyzed (mean age 84.4 ± 7.8 years; 54.2% were women). The percentage change in muscle thickness was significantly correlated with energy adequacy (r = 0.733, p < 0.001). ROC analysis identified a percentage change in temporal muscle thickness of - 3.6% as the optimal cutoff point for detecting moderate energy inadequacy. Percentage change in muscle thickness was independently correlated with energy inadequacy after adjusting for age, sex, and masticatory status (AOR 0.281, 95% CI 0.125-0.635). CONCLUSIONS: Changes in temporal muscle thickness are directly correlated with energy adequacy and can indicate moderate energy inadequacy in bedridden older adults. These results suggest the assessment of changes in temporal muscle thickness could be useful for guiding nutritional care in older adult patients in home-care settings.

We herein used MAZ51 to inhibit lymphangiogenesis and aimed to clarify the effect of inhibition of lymphangiogenesis on wound healing. BALB/c male mice were divided into two groups: the control group which was injected the dimethyl sulfoxide (DMSO), the experiment group was injected MAZ51 in the DMSO. All wounds were observed for 15 days and the wound areas were measured. Tissue samples were harvested on day 3, 7, 9, 11, 13 and 15, and subjected to immunostaining of blood vessels and lymphatic vessels. There are no significant differences between two groups in the wound area, the number of blood vessels and lymphatic vessels. The number of blood vessels peaked on day 7 in both groups as with previous studies, while the number of lymphatic vessels peaked on 13 or 15 in both groups. This result revealed delayed lymphangiogenesis in comparison with previous studies. The wound healing process in the control and experiment groups were similar, but both groups seemed delayed lymphangiogenesis comparing with previous studies. Injections of MAZ51 or/and DMSO did not affect angiogenesis, while they may affect lymphangiogenesis.