Objective: To develop a remote, live ultrasound education program using video conferencing and an on-demand ultrasound program utilizing virtual reality (VR) as nonface-to-face modes of education to obtain learning outcomes comparable to those of face-to-face education for beginners. Methods: Undergraduate nursing students, the participants, were divided into face-to-face, remote live, and VR-on-demand groups; each group was enrolled in a 30-min program. The volume of the participants’ bladder urine was measured using ultrasonography. Then, the difference between the measured volume (ml ) and the true value was calculated for each group and compared among the three groups. Furthermore, subjectivity was assessed after the completion of the program. Results: There was no significant difference between the groups in terms of the value of the difference between the bladder urine volume (ml) and the true value. The face-to-face/remote live group demonstrated considerably higher satisfaction than the other two groups, whereas the remote live group showed considerably higher comprehension than the VR on-demand group. Conclusions: A new educational program enabling beginners to learn how to measure the amount of urine in the bladder using ultrasonography in 30 min is as effective in nonface-to-face education as in face-to-face education.

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　To improve the work environment, nursing managers need to understand the actual conditions and analyze objective data on nurses’ workloads and movement lines obtained from long-term surveys. In this paper, we aim to validate an accuracy of a method for estimating nurses’ movement lines in an unattended time study using beacons and mobile devices and discuss the practicality of the visualization software framework using the estimation method. To do so, a pilot experiment was conducted in a surgical ward of a large acute care hospital. To evaluate the impact of parameter settings on estimation accuracy, we proposed a new approach for determining optimal thresholds based on the F-measure. By comparing the proposed optimization-based and conventional heuristic approaches, we demonstrate the effectiveness of the heuristic approach in achieving the high accuracy of position estimation. After that, we validated the high accuracy of movement lines estimated by the heuristic approach. Error evaluation for entering/leaving timing and staying periods showed that the method has a time resolution of a few seconds. Results suggest that the framework enables nursing managers to easily capture nurses’ movement lines throughout the ward and analyze them qualitatively to improve nursing workflows.

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　In aging societies, the number of wheelchair users continues to rise, which in turn has increased the need for caregivers to provide assistance. However, research on the effects of cross slopes on wheelchair running trajectories has been lacking. We carried out experiments to measure the effects of cross slopes on the upper-limb muscle activity of caregivers, strength when gripping the wheelchair, and the wheelchair trajectory. To act as caregivers, 10 healthy participants were asked to drive wheelchairs carrying passengers along a 5-m-long experimental track. Three cross slopes were tested: 0%, 2%, and 5%. Increasing the cross slope significantly increased the activities of the forearm flexor muscles on the downslope side and extensor muscles on the upslope side, as well as the strength when gripping the wheelchair. In addition, the coefficients of variation for the wheelchair trajectory were significantly higher on the 5% cross slope than on the other cross slopes. These results suggest that wheelchair caregivers mainly use their forearms to handle cross slopes, especially as the cross slope increases. This study can help with training wheelchair caregivers to effectively handle cross slopes.

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　The Lyapunov dimension allows for observation of the complexity and temporal dynamics of chaotic systems. Here, we examined the changes in the Lyapunov dimensions of the heart sounds of human mother-fetus pairs from early pregnancy to after birth. Time-series data of the heart sounds of four pregnant women and their fetuses were obtained at four phases (early, mid, and late pregnancy, and the early postnatal period) under five different vocal stimulation conditions (no stimulation, during and after stimulation with a recording of the mother′s voice, and during and after stimulation with a recording of a stranger′s voice), and the medium Lyapunov dimension for each mother and fetus at each phase and under each stimulation condition was determined. The Lyapunov dimension of the mother did not significantly change from early pregnancy to the postnatal period. In contrast, that of the fetus increased dramatically at each gestation phase (p<0.001) until it matched that of the mother during the postnatal period. These findings imply that mothers maintain a mature chaotic state throughout pregnancy whereas fetuses harbor a changing, more complex chaotic state.

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　This study aimed to examine the usefulness of a surgical recording system utilizing a speech recognition system. The subjects were 15 nurses and ten students in the operating department. Cataract surgery records were converted to text by the speech recognition system or typed, and the following items were measured: input time, number and content of wrong entries, noise level, and problems and feelings related to the burden of recording and operation. Recording time for nursing students was significantly shorter with the speech recognition system, reducing recording time by approximately 53%. The average number of mis recordings was 3 for nurses and 2.5 for nursing students. In a comparison of questionnaires regarding voice input, nursing students were significantly lower in “increased workload,” with students thinking less impact on workload. In summary, it is clear that nurses expect the speech recognition system to reduce their workload and be utilized in the future; however, improvement of the recognition rate and handling personal information from an ethical standpoint are future issues to be addressed.

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　To identify risk factors for developing febrile neutropenia (FN), a retrospective study was conducted at an advanced treatment hospital in Japan. Data from 193 patients with lung, breast, and colorectal cancers undergoing outpatient chemotherapy were analyzed. Patient background information, blood test results, and vital signs were extracted from the electronic health records. Using multivariate logistic regression analysis, factors associated with FN or infection-related fever were determined. The results showed that the therapeutic use of granulocyte-colony stimulating factor (G-CSF) agents, use of antibiotics, and a history of sepsis were significant risk factors for FN. Additionally, body mass index, cancer type, therapeutic use of G-CSF agents and steroids, also contributed to the risk of developing neutropenia. At the beginning of the chemotherapy cycle, our models predicted the onset of infection or neutropenia during the cycle. For the safe continuation of outpatient chemotherapy, the above risk factors should be considered in the treatment plan and management.

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Aim: Dysbiotic wound microbiota, which is dissimilar to those of the peri-wound skin, is likely to cause delayed wound healing. However, no point-of-care microbiota test is available. This study aimed to investigate the relationship between wound pH and microbial dissimilarity in wound and peri-wound skin. Methods: This cross-sectional study investigated hard-to-heal wounds extending into the subcutaneous tissue without macroscopic signs of infection. Wound pH was measured using a pH meter and microbiota were characterized by 16S rRNA gene analyses. Spearman′s rank correlation coefficient between the weighted UniFrac dissimilarity index measured microbial dissimilarity, and wound pH was calculated. Results: Thirteen wounds were investigated. The median dissimilarity index and pH value were 0.36 (IQR: 0.30-0.38) and 7.71 (IQR:7.61-7.83), respectively. There was a significant positive correlation between the dissimilarity index and wound pH (p=0.75, p<0.01). Conclusions: Microbial dissimilarity was associated with increased wound pH. This finding is compatible with the fact that alkaline tissue environments impair wound healing and that wound healing is delayed with dysbiosis. Further studies are needed to compare these relationships based on the healing status, which is necessary for the clinical use of wound pH as an indicator of dysbiosis.

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　Skin blotting is a method to non-invasively evaluate local cytokines and other substances in the skin. Still, its clinical application is difficult due to the need for advanced immunostaining techniques. The liquid-phase method, which collects skin blot samples in liquid form, has the potential for simple testing, but the validity of liquid-phase method needs to be clarified. This study evaluated the validity of the liquid-phase method by assessing (1) the recovery rate of liquid-phase protein and (2) the correlation between the amount of applied protein and that of protein recovered by the liquid-phase method, using five types of proteins. The results showed that (1) while the recovery rate of urease was significantly lower (P = 0.046), (2) there was a significant, high correlation (0.90 ≤ r ≤ 0.98; P < 0.05) between the amount of applied and liquidphased proteins for all proteins. Therefore, the validity of the liquid-phase skin blot sample method was demonstrated quantitatively.

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Purpose: To examine the effectiveness of local alpha-blocker injection for prevention of alpha-1 receptor activation in development of skin lesions induced by extravasation of administered dobutamine using a rat model. Methods: Skin lesions were induced in rats by subcutaneous injection of dobutamine into the back skin, and the rats were divided into two groups - a group given topical injection of alpha-blocker and an untreated group - and observed for 3 days. Results: In the group given topical injection of alpha-blocker, six out of ten injection sites turned black on the first day, and this gradually became ulcerated by the third day. On the other hand, in the untreated group, six out of ten injection sites also turned black on the first day, and this gradually became ulcerated by the third day in all of them. Conclusion: When extravasation of dobutamine occurs, prevention of alpha-1 receptor activation has been recommended. However, the present findings suggest that rats develop ulcers irrespective of whether or not they have received topical injection of alpha-blocker.

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　This study examined regional disparities in secondary medical areas for hemodialysis (HD) and endovascular surgery (EVS) for vascular access occlusion (VAO) among patients with end-stage renal disease in Japan using two types of open data: the National Database of Health Insurance Claims and Specific Health Checkups of Japan Open Data and the geographic information system. Analysis of secondary medical areas revealed a weak positive correlation for thrombectomy, while no spatial autocorrelation was observed for other procedures. Principal component and K-means clustering analyses categorized the regions into four distinct groups. The implementation of HD was consistent across clusters, whereas regional differences were observed in advanced treatments, including nocturnal dialysis and EVS-VAO. Notably, the cluster with the highest aging rate showed the lowest EVS-VAO implementation rate. These findings indicate regional disparities in the provision of advanced dialysis treatments and EVS-VAO, despite the consistency of basic HD services. The results suggest potential variations in the provision of comprehensive care for dialysis patients across different regions.

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　In recent years, Japan has been facing a serious aging population issue. Efforts are being made to utilize various sensors to enhance care quality in the field of caregiving to address this challenge. However, the use of sensors directly observing the caregiver′s state can be burdensome. In this study, we implemented a method to estimate the caregiver′s behavioral state using machine learning and environmental sensor data, which can be obtained without imposing a significant burden on the caregiver. Specifically, we utilized LSTM (long short-term memory), a machine learning technique capable of capturing the long-term time dependency of time-series data, to classify the caregiverbs state into three categories at each time point: sleeping, waking up, and going out. The proposed method was compared with an existing method that does not employ machine learning in terms of accuracy. It was confirmed that the proposed method outperforms the existing method. Finally, potential applications of the proposed method in the field of nursing care were discussed.

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[in Japanese]

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