須釜 淳子

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.