三浦 由佳

© 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.

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>在宅では看護師が排便を直接観察できない場合があり，特に認知機能が低下した高齢者では客観的指標による便秘症状の評価が難しいため，症状に応じた排便ケアが提供できていない可能性がある．そこで我々は超音波検査（エコー）により直腸の便の有無が確認できることをこれまで明らかにしてきたが，エコーにより便性状と量を区別できるかは明らかになっていない．今回，便性状の異なる3症例において直腸エコーによる便性状と便量の評価が可能かを検討したので報告する．長期療養型施設に入院する高齢者3名を対象にし，排便後より次回排便後まで，直腸のエコー画像を経時的に収集した．直腸のエコー所見および直腸に高エコー域が確認された場合は，その長径（連続した高エコー域の始点と終点を結ぶ直線の長さ）を計測した．エコー所見と便性状は研究者が直接観察し，ブリストル便性状スコア（以下BS）によって評価した．症例1：94歳男性で，便性状はBSタイプ4の普通便であった．直腸エコーでは，排便後より次回排便後に至るまで，直腸内腔に後方音響陰影を伴わないCrescent shapeの高エコー域が観察された．高エコー域の長径は観察期間中に徐々に上昇し，排便後に低下した．症例2：92歳女性で，便性状はBSタイプ1の硬便であった．直腸エコーでは，排便後より次回排便後に至るまで，直腸内腔に後方音響陰影を伴うCrescent shapeの強い高エコー域が観察された．高エコー域の長径は観察期間中に徐々に上昇し，排便後に低下した．症例3：67歳男性で，BSタイプ7の水様便であった．直腸エコーでは，Crescent shapeの高エコー域を認めず，後方音響陰影を伴わない全周性の低エコー域が観察された．硬便の有無は後方音響陰影を伴うCrescent shapeの強い高エコー域の有無で評価できる可能性があり，Crescent shapeの高エコー域の長径により便量を評価できる可能性がある．今後エコーを用いて評価した便性状・便量に基づく排便ケア選択が可能となると考えられる．</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.