Study Design : Retrospective study. Objective : To report the clinical and radiological results of posterior lumbar interbody fusion (PLIF) using titanium intervertebral spacers in elderly patients over 70 years. Summary of Background Data : PLIF with intervertebral spacers has been introduced to treat degenerative lumbar disorders. However, in the elderly patients, it is concerned that there are several possible complications that can be associated with the use of interbody support in anterior column reconstruction under weak bone quality. There were few reports about the results of PLIF using titanium intervertebral spacers in elderly patients. Methods : Twenty-six patients with mean age of 73 years (range, 70-78) underwent one or two-level PLIF using titanium intervertebral blocks combined with posterior instrumentation, with minimum 2-year follow-up (average 49 months ; range, 25-88). Radiographic and clinical outcomes analysis was performed. Results : The sagittal alignment (regional lordosis) of the operative segments averaged 7.4° before surgery, 12.7° at discharge, 11.1° post-op 1-year, and 11.8° at the final follow-up. The percentage of posterior disc height was 14.1% before surgery, and was significantly improved after the surgery to 26.9% at discharge and 21.8% at the final follow-up. In 18 patients with spondylolisthesis, the percentage of slip averaged 18.9% before surgery, and was significantly improved after the surgery to 6.8% at discharge and maintained until the final follow-up. All patients had radiographic fusion at the follow-up. The average JOA score was 12.6 points before surgery, and increased significantly to 23.1 points at the final follow-up. Conclusion : Posterior lumbar interbody fusion using titanium spacers is valuable even in the elderly patients. The preservation of bony endplate of vertebral body, and the insertion of spacers as antero-lateraly as possible in the intervertebral space, are important for successful fusion.

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Objective : Feeding and deglutition troubles associated with dementia among seniors have increased rapidly. This study investigated these problems in a geriatric health services facility. Subjects & Methods : Fifty six senior patients with feeding and deglutition trouble due to dementia were classified into five main categories, which were intention to eat, food taste, food recognition, poor eating movement and problems in deglutition movement from chewing. Those issues were subdivided into 28 items. Countermeasures were then carried out according to individual symptoms.The effects were evaluated in 4 stages. Results : Countermeasures for troubles in initiating eating, preference for special food, and attention disorder due to dementia and abnormalities in feeding speed were effective in approximately half of the patients. Conclusion : Countermeasures for feeding and deglutition troubles in seniors with dementia could be effective in about 50% of patients.

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Objective : We clarified body-image changes in breast cancer patients , and how body-image was related to self-perception. Subjects and Methods : Subjects were 30 patients diagnosed with breast cancer and admitted for surgery who consented to take part in the study , and completed a self administered questionnaire survey on Body Image Assessment Tool and Profile of Mood States. Result : Body control and body esteem decreased over time progress. Before surgery patients had more Tension-Anxiety than post-operatively. Body control and body esteem were significantly related to negative self-perception during treatment and body depersonalization post-operatively and after discharge. Body depersonalization , body control and body esteem were significantly related to positive after discharge. Conclusion : Body-image changes in breast cancer patients are greatly influenced by negative self-perception , particularly , body esteem and body control.

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Objectives : The purpose of this study was to identify impact of geriatric certified nurse specialist training on hospital staff. Subject & Method : We made a self-reported questionnaire survey on 74 hospital staff members who agreed to participate in the study. Results : We conducted a self-reported questionnaire survey. Results indicated higher scores in "good care plan made by students", "the opinion and advice for stuff members were good", when staff involvement with students and 6 roles of certified nurse specialist were assessed. Some favorable changes were observed in staff including "I found it was important to strive perseveringly". However, as for these scores, the difference was seen between nurses and other stuff members. Conclusion : It is necessary for students to make their role and significance of their practical training understood by staff, which follows that students need to be willing to establish relationship with people engaged in other medical professions.

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Purpose : To elucidate the current status of lymphedema care associated with surgical therapy for cancer and related issues. Subjects and Method : The subjects were nurses most closely involved in lymphedema care at 136 cooperating facilities that were located throughout the country. A survey using questionnaire was conducted on edema prevention, care of those patients who have developed edema and issues related to the care. Results : Preventive care and instructions were given to all postoperative patients and their families at 4.3% of the facilities but given only to those patients at high risk at 43.5% of them. Care was given to those patients already suffering from edema at specializing ambulatory services at 8.6% of the facilities surveyed. For applying this care, problems cited were : an insufficient number of available specialists, inadequacy of the care system and a lack of correlation with the remuneration for medical services. Recognized as much needed were self-care support, a support system provided by specialized units and information concerning edema. Conclusion : The care for lymphedema is administered to postoperative cancer patients through the independent effort of health personnel in a difficult environment where a specific care system has not been established. A need for an immediate systemic approach to the problem was indicated.

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Purpose : To elucidate the problems recognized by nurses while engaged in the care of lymphedema for postoperative cancer patients. Subjects and Method : A survey was conducted among nurses who were most closely related to lymphedema care of cancer patients in 136 facilities throughout the country. The subject of the current analysis was the responses submitted by 77 nurses who gave their opinions in a narrative form in the designated column.Referring to the method of content analysis, these responses were analyzed qualitatively and descriptively. Results : Through the analysis noted above, 4 categories that concern the issues related to lymphedema care of postoperative cancer patients emerged. These were : "a lack of educational support for those providing or involved in the care"; "inadequacy in organizing the environment providing care"; "a lack of social resources and regional cooperation in promoting care in the community" and "absence of an established method for care ranging from prevention to the period after onset." Conclusion : This analysis of the problems related to lymphedema care that are recognized by nurses led to a recognition of the need for cooperation of facilities, communities and society in their efforts to organize a better care environment.

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Background and objectives : Nursing practices vary from one country as clarified by an analysis of reports and interviews by Japan Overseas Cooperation Volunteers working in China. We extracted and clarified descriptions of nursing, that differed from those in Japan. Subjects and Methods : We analyzed reports by four nurses and interview results. The differences in nursing between two countries were extracted, according to twenty. Results : We found that 41 of 80 items on basic nursing skills differed in Chinese nursing practice from Japan. Differences indicated by all four nurses involved "wound management technology", "technology of medication", "family assistance", and "nursing records". Nursing differences between the two countries indicated by 3 of the 4 nurses were "technology of bladder catheter", and "injection and central veins of liver nutrition management", and "handwashing". Conclusion : The study clarified some differences in nursing between Japan and China. Therefor, we should conduct a research on recent educational status and clinical setting in China.

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Purpose : To identify weighted scores by outcome measures in dementia care and an impact of assessor's factors. Methods : In the primary survey, the large category outcome measures were weighted in 542 persons who participated in the training programs for care manager and by Nursing Association in "A" prefecture. In the secondary survey, we weighted the large and middle categories measures in 22 staff members who experienced dementia care at Mihara memorial hospital and affiliated facilities. The Analytic Hierarchy Process (AHP) was used for the analyses. Results : The assessor's factors affecting weighted scores were occupation, working institution, year of experience in the primary survey, while no relation with assessor's background was found in the secondary survey. The both surveys showed higher scores in "to spend one's life in one's own way." Conclusion : We need to adjust weight scores according to these assessor's factors.

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