Patients’ voided urine volume or uroflowmetry is routinely examined at the urology department of healthcare facilities to diagnose urinary diseases or manage the systemic metabolism. However, conventional uroscopy has several issues. For example, patients often experience mental anguish and shame because they are required to leave their urine in plain view in inspection rooms at hospitals. The preparations for urine sampling and disposal after clinical examinations also adds to the nurses’ already heavy workload, and physicians may be put at risk of contracting an infection if the urine is not properly disposed. In the present study, we newly developed a toilet system equipped with uroflowmetry for use in healthcare facilities and demonstrated the utility of its calibration system in experiments involving the drainage load before and after completion. Our study found that toilets in healthcare facilities can solve most of the problems related to conventional urinalysis if made available for routine clinical use. As a form of medical equipment, the toilet can help decrease the workload of nurses and bring a measure of comfort to patients.

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　Rectal cancer surgery and the associated stoma creation have changed with the development of anus-preserving internal sphincter muscle resection（ISR）. On the other hand, low anterior resection syndrome（LARS）, an anal dysfunction frequently observed after anus-preserving surgery for rectal cancer, decreases patients’ quality of life（QOL）and warrants research aimed at finding an effective intervention. In addition, the increasing use of diverting stomas to prevent anastomotic leakage, one of the most serious postoperative complications of anuspreserving surgery, has in turn increased the rate of postoperative, stoma-related complications, such as peristomal skin disorders, which can decrease patients’ QOL by causing itching and pain, and increase their financial burden by requiring frequent changes of equipment. Although the increase in the anus preservation rate owing to advances in surgical technology is significant, efforts to improve patients’ QOL after rectal cancer surgery are more than ever urgently needed. Sharing information about stomas, postoperative anal dysfunctions, and postoperative QOL with patients who have received anorectal surgery and actively intervening to improve their postoperative QOL through team medicine are issues that warrant our active engagement.

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　The present study aimed to examine the experiences of patients who underwent sacral neuromodulation therapy to collect data applicable to nursing support. The data were collected from semi-structured interviews of six patients who were undergoing sacral neuromodulation therapy and were analyzed using a qualitative, inductive approach. Five categories were extracted as a result. The patients had various responses regarding the pain and discomfort stemming from the therapy and reported feeling the implanted neurotransmitter as a source of irritation. As the patients adjusted to the discomfort, they learned how to operate the program with the support and encouragement provided by the nursing staff despite initially feeling uncertain and confused. While feeling thankful for the ability to increase their daily activities as their fecal incontinence improved, the patients experienced post-treatment changes attendant upon device implantation and the stimulation of the therapy. Because the therapy is semipermanent, the patients were “concerned about the future” as well as having “ expectations for the future of sacral neuromodulation”, including improvements in the program and wider dissemination of knowledge about the treatment. The present study revealed a wide variation among patients undergoing sacral neuromodulation in terms of their feelings about and understanding of the treatment and their daily life circumstances. Therefore, it is essential for nursing staff to provide personalized information about each patient, recognize that patients undergoing sacral neuromodulation have concern and expectations regarding the therapy, and to help them to live positively.

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　We examined resilience and related factors following ostomy in elderly individuals by distributing selfadministered questionnaires to residents aged 65 years who had undergone ostomy surgery. We investigated basic attributes, number of years since ostomy surgery, frequency of stoma outpatient visits, and resilience by analyzing associations using t-tests or one-way analyses of variance. Of 416 individuals surveyed, 116 responded and 112 forms with valid responses were included in the analysis. Respondents were 74 men (66.0%) and 38 women (34.0%) , with a mean age (SD) of 73.6 (6.0) years (men 74.5 (6.9) , women 71.8 (4.7)) . Individuals with spouses and children had significantly higher resilience scores compared with individuals with neither, and having a social role was associated with significantly higher resilience scores compared with individuals having none, suggesting that the presence of family might contribute to resilience. We observed a significant correlation between the number of years since ostomy surgery and frequency of stoma outpatient consultations. While more than 80% of individuals returned for consultations 1 or more times per month in the first year after ostomy surgery, the consultation rate had decreased to slightly more than 20% between 2 and 3 years after the surgery. Less than 1 year after the surgery, few respondents had experienced maturation of the stomal mucosa and stability of the abdominal wall, which is perhaps what led to the monthly stoma outpatient visits. We did not observe a significant association between the number of years since ostomy surgery and resilience score. In other words, wound, ostomy, and continence nursing activities may have helped maintain resilience for elderly persons following ostomy surgery. This study revealed that outpatient nursing stoma care plays an important role in maintaining resilience in elderly individuals and that enhancement of nursing care is necessary in the future.

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　Objective: To identify factors associated with out-of-pocket expenses for stoma supplies and the sense of burden which they cause in ostomates.
　Methods: The present study was a secondary analysis of a fact-finding survey conducted in 2017 by the incorporated NPO Stoma ImageUp Project and enrolling 3,000 ostomates nationwide. The patient demographics were descriptively analyzed. Chi-square test, residual analysis, φ coefficient, Cramer’s coefficient of association, and logistic regression analysis were performed to identify associated factors.
　Results: The analysis enrolled 1,010 patients. Of these, 703（69.60%）had a permanent stoma. The most common type of stoma was the ileostomy, which 564（55.84%）patients had received. Stoma supplies most frequently cost < 5,000 yen for ≥ 1 item（40.40%）, followed by ≥ 5,000 < 10,000 yen（21.98%）and ≥ 10,000 < 15,000 yen（14.55%）. Temporary stoma use was identified as a factor associated with out-of-pocket expenses for stoma supplies. Factors associated with the sense of burden caused by the expenses were the use of a temporary stoma or two-piece system, sleep, diet, family relationships, and experience of others’ not understanding their condition.
　Conclusion: The results indicated that support for patients with a temporary stoma should take into consideration the amount of out-of-pocket expenses for stoma supplies and the sense of burden which they cause. The results also suggested that support focusing on troubles experienced by the patients in daily life, such as those related to sleep, family relationships, and the perception of lack of understanding in others, can lead to reducing the sense of burden caused by the cost of stoma appliances.

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　Objective: Complications of peripheral venous infusion are an important problem that can lead to subcutaneous tissue damage. Although the select of vessels with high blood flow has been shown to have the potential to prevent complications, a method for measuring peripheral venous blood flow has not been established.
　This study aimed to verify the reliability and validity of blood flow measurement in the veins of the upper limb using ultrasonography with auto volume flow (AVF) function.
　Method: This observational study was involved eight healthy participants with 12 arms. Blood flow was measured in the basilic vein of the upper arm and forearm, the median cubital vein of the forearm, and the cephalic veins of the forearm. Measurements were performed using the portable ultrasound system by a trained nurse researcher. Intra-rater reliability was assessed by intraclass correlation coefficients (ICC). For concurrent validity, Pearson’s correlation coefficients were calculated between the manual measurement method and the AVF function. Known-group validity was assessed by comparing the blood flow volume in the basilic vein of the upper arm to that in the forearm veins.
　Results: The ICCs (1.1) of the manual procedure and AVF function were 0.91 and 0.92, respectively, and the ICCs (1.3) were 0.97 and 0.97, respectively (p < 0.01). A correlation was found between the manual procedure and the AVF function (r = 0.96, p < 0.01). Significant differences in blood flow were evident between the basilic vein of the upper arm and the forearm veins when using the AVF function (p < 0.01).
　Conclusion: This study demonstrated the reliability and validity of blood flow measurement in the upper limbs using the AFV function.

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　Nurses are required to have a high level of competency in preventing and managing pressure ulcers, skin tears, and incontinence-associated dermatitis prevalent in elderly patients. Many nurses, however, need support because they lack the adequate training. The present study aimed to identify the support needed by nurses to prevent and manage these three skin problems in long-term care wards housing elderly patients.
　The present, qualitative, descriptive study collected data using two approaches. First, a questionnaire was administered to nurses working in long-term care wards to identify the difficulties they faced in preventing and managing the previously mentioned skin problems. Second, one of the co-authors（a WOCN）observed skin care practices in the wards and documented deficiencies in the practices. The information collected through these two approaches was categorized by skin problem. Then, the authors identified practices required of nurses based on the categorized information, grouped similar practices, and formulated support recommendations.
　Twenty-six nurses from nine wards at six hospitals participated. In total, 19 support recommendations for pressure ulcers, ten for skin tears, and 12 for incontinence-associated dermatitis were formulated. The participating nurses agreed that these 41 support recommendations were needed by nurses employed in long-term care wards.
　The support recommendations were grouped under six concepts, three of which were reported in previous studies: knowledge, in-hospital education, and consultation. The other, three, previously unreported concepts are recordkeeping, conferences, and circumstances preventing or limiting skin care.

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Purpose
　A date and honey mixture is used in Indonesia to promote wound healing. However, no studies have evaluated its effects. Thus, this study evaluated the effectiveness of the date and honey mixture in promoting diabetic foot ulcer (DFU) healing, and its effects on biofilm intensity and biomarker levels.
Methods
　This observational study enrolled 30 patients with recurrent DFU treated using the date and honey mixture and 30 patients with recurrent DFU treated only using honey. Both groups were observed every 2 weeks for up to 8 weeks. The Kaplan-Meier method and log-rank test were used to compare the DFU healing proportion. Moreover, the Cox proportional-hazards model was used to assess the effects of the date and honey mixture on wound healing. Superoxide dismutase 3 (SOD3) and interleukin (IL)-6 were evaluated as oxidative stress and inflammatory status markers, respectively. These biomarkers and biofilms were collected using wound blotting every 2 weeks. The linear mixed-effect model was performed for biomarkers.
Results
　No significant difference was noted between the two groups in patient or wound characteristics at baseline, except for the diabetes duration. The proportion of wound healing was significantly higher in DFU treated by the date and honey mixture than when treated only using honey (p=0.015) . The adjusted hazards ratio of the date and honey mixture was 8.55 (95% confidence interval=1.03-70.72; p=0.046) , which was also significantly different for the biofilm intensity (p=0.008) , IL-6 (p=0.015) , and SOD3 (p<0.001) .
Conclusion
　The date and honey mixture may promote wound healing in recurrent DFU.

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　Background: Elastic stockings (ESs) are used for compression therapy, but medical device-related pressure ulcers (MDRPUs) due to ESs (ESRPUs) have been reported. Objective: To clarify the morphological characteristics and factors related to the occurrence of ESRPUs. Method: A qualitative descriptive study was implemented. The setting was a 606-bed university hospital in Japan from 2006 to 2012. The morphological characteristics were analyzed by qualitative descriptions from photographs of hospital-acquired ESRPUs. Factors associated with the occurrence of ESRPUs were analyzed using the medical records. Results: Twenty-four ESRPUs in nine patients were analyzed. The ESRPUs were divided three variables: location, shape, and distribution. Locations were divided into protruding regions (Protrusion) such as bones and tendons, movable regions (Joint) such as joints, and soft regions (Soft). The shapes were irregular, linear, and round. All ESRPUs in the Soft were linear (n=5), and ESRPUs in the Protrusion and the Joint were found irregular (n=12) . BMI was higher than the median in 75% of those with soft region ESRPUs, and thigh-length stocking type was found the only in this region. Patients in the Protrusion exhibited peripheral circulatory insufficiency. Discussion: The region of the Soft and the Joint were a characteristic of ESRPU that was not found in pressure ulcers of its own weight. Linear ESRPUs were considered to be related to BMI and ES length. Conclusion: Location, shape, and distribution were morphological characteristics, and linear shapes were feature in soft regions. ESRPU-related factors were considered BMI, ES length, and peripheral circulatory insufficiency.

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[in Japanese]

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