Yuka Miura

© 2020 by the Wound, Ostomy and Continence Nurses Society. BACKGROUND: Although previous studies have demonstrated the ability of ultrasound to detect stool in the colon and rectum, the clinical utility of evaluating constipation via ultrasonic imaging by nurses has not been determined. In this case report, we observed fecal retention, assessed the presence of constipation, and performed defecation care in an older adult patient in a home care setting in a city near the metropolitan area in Japan. CASE: An 85-year-old male with advanced stage prostate cancer and multiple metastases was diagnosed with fecal impaction via digital rectal examination and evaluation of stool consistency. He was managed by regular digital evacuation of stool, but ultrasonic imaging indicated constipation with fecal retention in both the rectum and the colon despite this bowel evacuation program. When faced with this situation, we advocate a bowel management program that considers both intestinal elimination dysfunction and fecal transport dysfunction. Based on ultrasonic imaging, stool consistency was altered by promoting water intake, and we promoted self-defecation by asking the patient to attempt to move his bowels (regardless of cues to defecation) by sitting on the toilet every morning. As a result, the number of weekly enemas and digital dis-impaction episodes decreased while the number of spontaneous defecations increased. CONCLUSION: This case report demonstrated that ultrasonography improved bowel management in this patient with clinically severe chronic constipation.

BACKGROUND: Food boluses in the pharynx without enough bolus formation sometimes cause aspiration among older adults; however, the relationship between food bolus-forming ability and incidence of aspiration pneumonia is unclear. OBJECTIVE: To investigate the relationship between food bolus-forming ability and incidence of aspiration pneumonia by evaluating the condition of chew-swallow managing food transported into the pharynx. METHODS: A prospective observational study conducted in a nursing home for the elderly between April 2016 and February 2018. Seventy-three residents who swallowed thickened liquids and consistent boluses without aspiration were included. Food boluses were graded into three categories in the pharynx using videoendoscopic evaluation. Boluses that retained their original shape were defined as Grade 1. A mixture of large and small boluses was defined as Grade 2. Boluses that had completely transformed into a paste were defined as Grade 3. The relationship between the bolus formation grade and incidence of aspiration pneumonia over 6-month follow-up was investigated. RESULTS: Seventeen residents developed aspiration pneumonia. The incidence rate of aspiration pneumonia was highest among residents with Grade 1 boluses, at an incidence rate of .187 cases per person-month (95% confidence interval (CI): 0.097-0.359). Cox regression showed residents with Grade 1 boluses had a hazard ratio of 4.548 (1.393-14.85) for incidence of aspiration pneumonia compared with residents who had Grade 2 or 3 boluses. CONCLUSION: Insufficient food bolus-forming ability predicted high incidence of aspiration pneumonia. Healthcare professionals should evaluate the food bolus-forming ability, as well as swallowing function, to prevent aspiration pneumonia.

目的:「エコーを用いた排尿管理教育プログラム」修了後の看護師が取得した膀胱内尿量測定用の膀胱像について、その信頼性を検討する。対象と方法:プログラム履修後の看護師1名と超音波検査士1名が、一般病院の入院患者19名(平均年齢79.2歳)を被験者とし、独立して2Dエコーを用いて膀胱内尿量測定用の膀胱像を取得した。取得画像から別の看護師が膀胱内尿量を計測し、超音波検査士による測定を基準として看護師の画像の信頼性を検討した。結果:看護師と超音波検査士が取得した画像を用いて計測した膀胱内尿量の級内相関係数は0.83(p<0.01)であった。各1名の患者で、約100mLの過小誤差と約200mLの過大誤差が生じた。結論:本教育プログラムを受けた看護師は、超音波検査士とほぼ同程度の信頼性で膀胱内尿量計測用の膀胱像の取得が可能であることが示唆された。プログラムの改善と教育効果の検証のためには、今後とも検討が必要である。(著者抄録)

目的:「エコーを用いた排尿管理教育プログラム」修了後の看護師が取得した膀胱内尿量測定用の膀胱像について、その信頼性を検討する。対象と方法:プログラム履修後の看護師1名と超音波検査士1名が、一般病院の入院患者19名(平均年齢79.2歳)を被験者とし、独立して2Dエコーを用いて膀胱内尿量測定用の膀胱像を取得した。取得画像から別の看護師が膀胱内尿量を計測し、超音波検査士による測定を基準として看護師の画像の信頼性を検討した。結果:看護師と超音波検査士が取得した画像を用いて計測した膀胱内尿量の級内相関係数は0.83(p<0.01)であった。各1名の患者で、約100mLの過小誤差と約200mLの過大誤差が生じた。結論:本教育プログラムを受けた看護師は、超音波検査士とほぼ同程度の信頼性で膀胱内尿量計測用の膀胱像の取得が可能であることが示唆された。プログラムの改善と教育効果の検証のためには、今後とも検討が必要である。(著者抄録)

Prevention for aspiration pneumonia requires assessment of aspiration and adequate swallowing care. This randomized controlled trial aimed to investigate the effectiveness of ultrasound examination and recommendations for swallowing care for the reduction of aspiration and pharyngeal post-swallow residue as compared with standard swallowing care. Twenty-three participants were randomized to the intervention group and 23 to the control group. The intervention consisted of four ultrasound examinations during mealtimes and recommendations for swallowing care every 2 weeks during an 8 week period. No recommendations concerning swallowing care based on ultrasound examinations were provided to the control group. The frequency of aspiration or residue was defined as x/y × 100% when aspiration or residue were detected x times from y times concerning the total ultrasound measurements. The proportion of the residents with reduced frequency of aspiration which was detected by ultrasonography at eight weeks were 4.3% in the intervention group and 0% in the control group. The median reduction in the frequency of aspiration and residue in the intervention group was 31%, and that in the control group was 11%. In conclusion, swallowing care guided by frequent ultrasound examinations during mealtimes had a trend of reducing the frequency of aspiration and residue during an 8-week period in individuals relative to standard swallowing care alone.

<p>Providing defecation care can be challenging because bowel movements cannot be directly observed in home-care settings, and the objective evaluation of constipation symptoms is difficult, particularly for elderly patients with cognitive impairment. We evaluated the use of rectal ultrasonography (US) to assess the properties and volume of feces in three cases with different fecal properties. Case 1: In a 94-year-old man with normal feces (Bristol stool score: BS type 4), rectal US revealed a crescent-shaped high-echo area without acoustic shadow that was present until the next defecation. Case 2: In a 92-year-old woman with hard stool (BS type 1), rectal US showed a crescent-shaped strong-echo area with acoustic shadow that was present until the next defecation. The length of the high-echo area gradually increased during the observation period and decreased after defecation in Cases 1 and 2. Case 3: In a 67-year-old man with watery stool (BS type 7), rectal US revealed a low-peripheral-frequency-echo area without acoustic shadow. Rectal ultrasonography was able to demonstrate the presence or absence of hard stool, which was observed as a crescent-shaped a strong, high-echo area with acoustic shadow; the presence or absence of hard stool may be evaluated based on these findings. Furthermore, the fecal volume may be able to be evaluated based on the long diameter of the crescent-shaped high-echo area. Determining the best course of defecation care based on the fecal properties/volume evaluated using rectal US will likely be possible in the future.</p>

Background/Purpose: Promoting physical activity and maintenance of adherence to exercise are required for healthy aging. Previous studies showed the relationship between health literacy and health outcomes including physical function. The aim of this study was to investigate the relationship between adherences to exercise classes in health care facilities and health literacy. Methods: This cross-sectional study was conducted in January 2015. Participants were recruited from two health care facilities for functional training in the Tokyo metropolitan area. Adults who had participated in exercise classes for more than 3 months were included in this study. The dependent variable was the percentage of the participants’ attendance to the exercise classes during the past 3 months, which was defined as adherence to the exercise classes. Health literacy was assessed using the 14-item health literacy scale for Japanese adults, which consists of three sub-scales: functional health literacy, interactive health literacy, and critical health literacy. Results: The median level of the adherence was 0.92. Participants whose adherence was &lt 0.92 had significantly higher critical health literacy than participants whose adherence was ≥ 0.92 (12.0 ± 3.5 vs 9.5 ± 3.5, P = 0.049). In a multivariate analysis, a 5-point increment in critical health literacy was associated with an odds ratio of high adherence of 0.34 (95 % confidence interval 0.15 - 0.75). Conclusions: High critical health literacy was associated with low adherence to exercise classes. Future qualitative studies are needed to investigate the reason of negative effect of critical health literacy to adherence to exercise classes.

AIMS: Prevention of aspiration pneumonia is a great concern in the era of global aging. The assessment of pharyngeal post-swallow residue is important because remaining food and liquid in the pharyngeal area has a possibility of flowing into the lower airway which can cause aspiration pneumonia. Ultrasound examination has been recently used to assess swallowing disorders because of its noninvasiveness. The aim of this study was to investigate the performance for detecting pharyngeal post-swallow residue using an ultrasound examination by comparing with those using a fiberoptic endoscopic evaluation of a swallowing study as a reference. MATERIAL AND METHODS: A linear array transducer attached to the thyroid cartilage to visualize the vocal folds in the sagittal plane. The pharyngeal post-swallow residue in the ultrasound movie was interpreted as a misty hyperechoic area above the vocal folds that remained after swallowing. Nineteen ultrasound images simultaneously obtained with fiberoptic endoscopic evaluation of swallowing study images from nine participants (eight men) with a median age of 70 years at a dysphagia outpatient clinic were analyzed by the montage of swallowing examinations. RESULTS: Misty hyperechoic areas above the vocal folds that remained after swallowing were detected in 10 ultrasound images. Eight US images out of ten correctly detected pharyngeal post-swallow residue. The sensitivity for detecting pharyngeal post-swallow residue of 19 images from nine participants by US examination was 62%, and the specificity was 67%. CONCLUSIONS: The proposed detection method of pharyngeal post-swallow residue by ultrasound examination enabled the real-time assessment for swallowing of people with dysphagia. Ultrasound assessment-based daily swallowing care which detects pharyngeal residue will be useful for preventing aspiration pneumonia.

AIM: The purpose of the present study was to assess the difference in foot temperature between tinea unguium-positive older adults with subungual hyperkeratosis and tinea unguium-negative older adults with subungual hyperkeratosis to develop a temperature-based screening method for tinea unguium. METHODS: The present cross-sectional, observational study investigated 51 residents with subungual hyperkeratosis in two facilities covered by long-term care insurance between October 2011 and December 2011. One dermatologist recorded the clinical signs of abnormal toenails. Nail specimens were collected from all abnormal nails, and the presence of tinea unguium was confirmed when fungus was detected by direct microscopy. Foot temperature was measured by infrared thermography. A receiver operating characteristic curve was used to assess the ability to determine whether residents with subungual hyperkeratosis have tinea unguium and to determine the cut-off point. RESULTS: Among the people with subungual hyperkeratosis, the mean toe temperature in the tinea unguium-positive group (30.2 ± 2.6°C) was significantly lower than that in the tinea unguium-negative group (32.8 ± 3.2°C, P = 0.001). The area under the receiver operating characteristic curve was 0.74 (95% confidence interval 0.621-0.876), and the threshold temperature was set at 33.0°C, resulting in a sensitivity of 81.8% and specificity of 65.7%. CONCLUSION: Our study suggests that foot temperature can be used to screen for tinea unguium in people with subungual hyperkeratosis. This non-invasive and simple screening method would help clinicians to set priorities in terms of carrying out direct microscopy to diagnose tinea unguium in elderly residents in care facilities.

In this study, we aimed to develop a new method for detection of aspiration based on B-mode video ultrasonography and to evaluate its performance. To detect aspirated boluses by B-mode video ultrasonography in patients with dysphagia, we placed a linear array transducer above the thyroid cartilage and observed the area around the vocal folds. Forty-two ultrasonographic measurements were obtained from 17 patients with dysphagia who also underwent videofluoroscopy or videoendoscopy measurements at the same time. Aspirated boluses were observed in B-mode video ultrasonographic images as hyperechoic, long, narrow objects that passed through the vocal folds beneath the anterior wall of the trachea, with movement different from that of the surrounding structure. The sensitivity of aspiration detection was 0.64, and the specificity was 0.84. This newly developed detection method will enable patients with dysphagia to receive appropriate daily swallowing care.

Background The direct microscopy, fungal culture and histopathology that are necessary for the definitive diagnosis of tinea unguium are disadvantageous in that detection sensitivity is affected by the level of skill of the person who performs the testing, and the procedures take a long time. Objectives The Dermatophyte Test Strip, which was developed recently, can simply and easily detect filamentous fungi in samples in a short time, and there are expectations for its use as a method for tinea unguium screening. With this in mind, we examined the detection capacity of the Dermatophyte Test Strip for tinea unguium. Methods The presence or absence of fungal elements was judged by direct microscopy and Dermatophyte Test Strip in 165 nail samples obtained from residents in nursing homes for the elderly. Moreover, the minimum sample amount required for positive determination was estimated using 32 samples that showed positive results by Dermatophyte Test Strip. Results The Dermatophyte Test Strip showed 98% sensitivity, 78% specificity, 84·8% positive predictive value, 97% negative predictive value and a positive and negative concordance rate of 89·1%. The minimum sample amount required for positive determination was 0·002-0·722 mg. Conclusions The Dermatophyte Test Strip showed very high sensitivity and negative predictive value, and was considered a potentially useful method for tinea unguium screening. Positive determination was considered to be possible with a sample amount of about 1 mg. What&#039;s already known about this topic? Tinea should be diagnosed based on mycological examinations. Direct microscopy, culture and histopathology are employed to detect fungal elements. These methods require technical skill and/or consume time. What does this study add? The Dermatophyte Test Strip visualizes mycotic antigens by immunochromatography. It allows easier and faster detection of fungi in samples, with very high sensitivity. It is a useful method for screening of tinea unguium. © 2013 British Association of Dermatologists.

A life pattern estimation method and its application to anomaly detection of a single elderly are proposed. Our observation system deploys some pyroelectric sensors in an elderly's house and monitors and measures activities 24 hours a day to grasp residents' life patterns. Activity data is successively forwarded to the nurse operation center and displayed to nurses at the center. The system reports status related to anomalies together with the basic activities of elderly residents to the nurses, who decide whether recent accumulated data expresses an anomaly or not based on suggestions from the system. In the system, residents whose lifestyle features resemble each other are categorized into the same group. Anomalies that occurred in the past are shared in the group and utilized in an anomaly detection algorithm. This algorithm is based on an "anomaly score." The score is figured out by utilizing the activeness of the house's elderly resident. This activeness is approximately proportional to the frequency of sensor response within one minute. The anomaly score is calculated from the difference between activeness in the present and in the past averaged over the long term. The score is thus positive if activeness in the present is greater than the average in the past, and the score is negative if the value in the present is less than average. If the score exceeds a certain threshold, it means that an anomaly event has occurred. An activity estimation algorithm is also developed that estimates the basic activities of residents such as getting up in the morning, or going out. The estimation is also shown to nurses with the anomaly score of residents. Nurses can understand the condition of elderly residents' health by combining the information and planning the most appropriate way to respond.