We aimed to clarify the progress of acute graft-versus-host disease（aGVHD）after homogeneous blood formation stem cells were transplanted, as well as the appearance of the disease and the methods of skin care. We monitored the characteristics of skin physiology on the basis of both gross macroscopic findings and skin microstructure. Results of these analyses revealed that the skin manifestations of aGVHD tended to occur in the epidermis from the third day after allogeneic hematopoietic stem cell transplantation. The onset of skin manifestations was accompanied by quantifiable changes: the pH of the skin on the fifth day（p=0.05）and the amount of sebum on the seventh day（p=0.02）after transplantation were significantly lower in the outbreak group than in the no outbreak group, whereas the lymphocyte count on the seventh day（p < 0.01）after transplantation was significantly higher in the outbreak group than in the no outbreak group. Different disease patterns corresponded with the degree of severity. When a rash developed on the palm of the hand, the skin condition spread to the upper half of the body, but when a rash developed on both the palm of the hand and the foot, the condition spread to the body. Therefore, we were able to obtain a suggestion about appropriate skin care according to acute GVHD and the appearance of disease progression that developed after allogeneic hematopoietic stem cell transplantation.
The present study elucidated the features and advantages of collaboration between wound, ostomy, and continence nurses（WOCN）and a pressure ulcer management team. Among the WOCN, 21 semi-structured interviews about practice and cognition regarding cooperation in pressure ulcer management were conducted, and the data acquired were qualitatively analyzed. This study was approved by the Health Ethics Committee of the facility with which the researchers were affiliated. In the pressure ulcer management team, WOCN follow the base-shaft practice to enforce pressure ulcer care. While facing challenges such as the inability to understand occupations other than nursing, the WOCN adopted the following measures for efficient working with the pressure ulcer management team: to derive benefit from the expertise of other individuals, to regulate team members for comfortable and smooth functioning of all activities, to share the outcomes and motivate and boost the self-confidence among team members, and to broaden the organization of the pressure ulcer management team. In this way, the WOCN encouraged cooperation within the team in order to promote prevention and cure of pressure ulcers. For the effective management of pressure ulcers, continuous training and continuation programs regarding collaboration with WOCN will be necessary in the future.
The present study involved experiments on mice with the objective of elucidating histological changes after extravasation of irritant agents, as well as the effects of applying a poultice on these changes. Macroscopically, no marked lesions such as redness or ulceration were observed after extravasation of an anticancer agent（cyclophosphamide）classified as an irritant. Histologically, findings such as degeneration of panniculus carnosus muscle and accumulation of inflammatory cells were observed in the subcutaneous layer on days 1 and 3 in the group in which no treatment was given after extravasation. On days 5 and 7, regeneration of panniculus carnosus muscle was observed. While similar changes were seen on days 1 and 3 in the group in which a cold poultice was applied after extravasation, inflammatory cells were also seen on day 5 in this group, and no regeneration of panniculus carnosus muscle was observed. In the group in which a hot poultice was applied, while degeneration of panniculus carnosus muscle was seen on days 1, 3, and 5, no accumulation of inflammatory cells was observed. Moreover, degeneration of panniculus carnosus muscle had disappeared by day 7. These findings indicate that, in cases of extravasation of irritant agents, tissue injuries occur in layers below the subcutaneous tissue, even if no macroscopic changes are seen. These findings also suggest that, as opposed to a cold poultice, a hot poultice may be a more effective method of care for extravasation under these experimental conditions.