Insulin balls are subcutaneous induration caused by amyloid deposition due to repeated insulin injections to the same site, and subcutaneous injections in this area cause poor glycemic control. Therefore, it is important to assess the site for insulin balls and change the injection site at an early stage, but the assessment method remains unclear. Therefore, we aimed to clarify the available methods for insulin ball assessment. Using the scoping review method, we searched Japanese and English literature from January 1964 to November 2022 using the keywords "insulin ball" and "assessment" and included those that met the selection criteria. Database searches were conducted in Japan Abstracts Society, PubMed, Scopus, and CINAHL. The number of adopted studies regarding insulin ball assessment was 11. Palpation and visual examination were the assessment methods used in all studies. Blood tests and ultrasonography were both performed in nine articles, magnetic resonance imaging (MRI) was performed in five articles, and computed tomography (CT) was performed in four articles. There were two types of insulin balls: palpable and nonpalpable. A paper reporting that nonpalpable insulin balls can be detected by ultrasonography was noted. In addition to palpation and visual examination, imaging tests such as ultrasonography, MRI, and CT are necessary because some insulin balls cannot be palpated. This study suggested that incorporating ultrasonography in addition to palpation and visual examination may be useful as a screening tool for the early detection of insulin balls. We now need to validate the accuracy of the assessment by ultrasonography.
Objective: This study aims to measure the health-related quality of life (HR-QOL) of patients with heart failure (HF) after using two types of telemonitoring (TM) tools and to evaluate which type of tool contributes to improving patient outcomes. Methods: We measured the HR-QOL and psychological status of patients with HF after using two types of TM systems (smartphone application or web-based), and the data from baseline to six months were compared. Results: A total of 24 patients with HF completed the study period of six months. The mean age of the participants was 60.58 ± 12.81 years, and 70.8% were male. The major differences between the study groups comprised support and access to home visit services. The physical HR-QOL scores increased significantly from baseline to six months in the web-based group (baseline vs. six months, 4.04 ± 1.02 vs. 4.58 ± 1.18, p =.034), but no significant difference (baseline vs. six months, 5.05 ± 1.00 vs. 5.20 ± 1.24, p =.410) was found in the smartphone application group. The mean scores for anxiety and depression in both groups were not significantly different. Conclusions: Using the TM system for patients with HF may improve global HR-QOL and psychological status. In addition, adding nursing support using a TM system may be more effective in improving patient-reported outcomes.
Objective: Psychosocial interventions during nursing consultations emotionally support and inform patients undergoing cancer diagnosis. In Japan, certified nurse specialists (CNSs) and certified nurses (CNs) mainly provide nursing consultations. Using communication skills in therapeutic nurse-patient relationships is an effective advanced nursing practice when performed consciously. We developed a scale to measure the frequency of oncology nurses' intentional use of communication skills in the initial oncology nursing consultation after a cancer diagnosis. Methods: Based on a literature review, we identified nine initial dimensions and developed a 32-item questionnaire. After the focus group interviews and pilot study between January and March 2018, the final questionnaire was administered to CNSs and CNs who offered nursing consultations to patients with cancer in Japanese hospitals. The properties of all scales and subscales were assessed using item-to-item and mean item-to-item correlations. The reliability was evaluated using Cronbach's alpha. Construct validity was assessed using exploratory factor analysis, correlations between all scales and characteristics, and contrast group comparisons. Results: The communication skills scale comprised 29 items across six dimensions of communication skills: Exploring, Listening, Acceptance, Silence, Approval, and Empathy. The scale has good reliability and validity. Conclusions: This scale is a valid and reliable item for self-assessing nurses' communication skills in the initial oncology nursing consultation after a cancer diagnosis.
Objective: This study aimed to examine the presence of high-risk women developing type 2 diabetes mellitus among women with a history of gestational diabetes mellitus (GDM) who had not undergone a postpartum oral glucose tolerance test (OGTT). Methods: This was a retrospective observational study. The participants were Japanese women diagnosed with GDM and were managed at two perinatal medical centers. We compared the risk factors for developing type 2 diabetes between women who had undergone a postpartum OGTT (examinees) and those who had not had it (nonexaminees). In addition, we divided the participants with a history of GDM into high- and low-risk groups and examined the presence of high-risk women developing type 2 diabetes mellitus. Results: Of the 117 participants, 77 (65.8%) underwent a postpartum OGTT and 40 (34.2%) did not. There were no significant differences in the risk factors for developing type 2 diabetes between the two groups, except for the premature birth rate. We divided the 80 participants into two groups, including 30 nonexaminees and 50 examinees, and 34 high- and 46 low-risk women. Although there was no significant difference in the percentage of high-risk women who had undergone a postpartum OGTT, 10 (33.3%) of the 30 nonexaminees were assessed as high-risk. Conclusions: Our results indicate that 10 (12.5%) of 80 women with a history of GDM did not undergo a postpartum OGTT despite being in the high-risk group and improving the rate of postpartum OGTT may contribute to the prevention and early detection of type 2 diabetes.
Advance care planning (ACP) has various potential benefits. However, patients with hematologic malignancies (HMs) have fewer chances of accessing ACP compared with patients with solid tumors. It has been reported that one of the main factors is the characteristics of the disease, such as its complex and uncertain trajectories. This study aims to clarify the actual conditions of ACP for patients with HMs in Japan. A nationwide, cross-sectional, self-questionnaire was administered to 346 hematology nurses in government-designated cancer hospitals in Japan. Consequently, 209 valid questionnaires were returned (response rate: 58.5%). All respondents answered that ACP is important in patients with HMs. However, approximately 80% experienced difficulties with ACP. The topics "Surrogate decision-makers," "Understanding of their illness and prognosis," and "Place of care" were identified as the most difficult. Notably, respondents recognized that most ACP topics tended to be discussed with family members rather than with patients. Additionally, between 60% and 70% of nurses reported that "Improvement of healthcare professionals' knowledge and skills" and "Education for healthcare professionals" were the challenges of ACP. Further research to explore the reasons related to the current state of ACP is needed.
Japan is a super-aging society, so nurses are expected to hold increasingly essential roles in both hospital- and community-based settings in the future. To strengthen community-oriented geriatric and community health nursing competencies among undergraduate nursing students, we implemented an undergraduate nursing practicum called the Preventive Home Visits Practicum (PHVP). In the PHVP, students are grouped into teams of four (a freshman, sophomore, junior, and senior) before visiting healthy community-dwelling older adults to discuss life, health, and activities of daily living. A qualitative descriptive focus group design was used to examine student learning outcomes across 4 years of participation in the PHVP. The data obtained in focus group interviews were descriptively analyzed. Students deepened their understanding of health and aging lives in an aging population and developed interpersonal relationships and communication through the practicum across the 4-year period. Additionally, we found that a team composed of students from all different grades achieved very effective learning through interactions among team members. These findings suggest that nursing practicums that require nursing students to visit community-dwelling older adults longitudinally, such as the PHVP, may have an important educational impact and may address the needs of the aging population.
Objectives: The purpose of this study is to examine the sense of coherence (SOC), occupational stress, organizational climate, and identity of new graduate nurses in a specified functional hospital to identify factors related to mental health. It will also identify the relationship between SOC and generalized resilience resources. Methods: This study employed a self-completion questionnaire on SOC (29 items), an identity scale (20 items), a job content questionnaire (22 items), an organizational climate scale (12 items), and a general health questionnaire (GHQ; 12 items) among 105 new graduate nurses in specialized hospitals. Results: A multiple regression analysis was performed with each subscale of the GHQ-12 and SOC-29 as dependent variables. The mental health of new graduate nurses was found to be strongly associated with their SOC. Furthermore, the organizational environment and basis of identity contributed to a sense of comprehensibility, which is a factor in SOC. A sense of manageability and meaningfulness is also related to the basis and establishment of identity. Conclusions: Increasing SOC as a mental health measure for new graduate nurses is pivotal. Thus, creating an organizational environment may strengthen SOC.