Background & Aims: In Japan, there are no reliable instruments to measure the quality of care for a person with end-stage dementia. This study aimed to develop a Japanese version of the End-of-Life in Dementia scales (EOLD-J) and evaluate its reliability and validity.

Methods: The EOLD-J was created by translating measurements of original scales: Satisfaction with Care (SWC-EOLD-J), Symptom Management (SM-EOLD-J), and Comfort Assessment in Dying with Dementia (CAD-EOLD-J). Participants comprised 113 family members of a deceased person with dementia and 113 nurses. The reliability and construct validity of the EOLD-J were evaluated using the scores of the SWC-EOLD-J, the Japanese Decision Regret Scale (DRS-J), the SM-EOLD-J, a short version of the Quality-of-Life Questionnaire for Dementia (short QOL-D), and the CAD-EOLD-J.

Results: Responses from 83 family members and 62 nurses were analyzed. The Cronbach’s alphas of SWC-EOLD-J, SM-EOLD-J, and CAD-EOLD-J were 0.77, 0.60, and 0.88, respectively. While the SWC-EOLD-J score was significantly correlated with DRS-J (r＝0.504, p<0.001), SM-EOLD-J and CAD-EOLD-J scores were significantly correlated with negative dimension scores: r＝0.587, p<0.001 and r＝0.509, p<0.001, respectively.

Conclusions: This study’s results demonstrate the EOLD-J scale’s internal consistency and convergent validity.

Purpose: In gastrointestinal surgery, intestinal blood flow is an important factor that can lead to complications such as suture failure. Many recent reports have evaluated blood flow using an indocyanine green fluorescence method, but as infrared light observation camera systems are relatively expensive, this method is not widely used. In this study, we investigated the possibility of intestinal blood flow evaluation using a tissue oximeter that can non-invasively measure tissue oxygen saturation and hemoglobin index.

Methods: From esophageal and colon/rectal surgeries performed at our hospital, we collected gastrointestinal blood flow evaluation data using a finger-mounted tissue oximeter (toccare® astem).

Results: Ninety-seven measurements were performed in nine cases of esophageal cancer surgery and fourteen cases of colorectal cancer surgery. The tissue oxygen saturation threshold for gastrointestinal anastomosis was calculated to be 45.9％, and the hemoglobin index threshold was calculated to be 0.420. The detection rate for cases without complications was 87.2％, and the detection rate for cases with anastomotic complications was 84.2％.

Conclusion: Our study indicates that the evaluation of gastrointestinal blood flow using a tissue oximeter may be useful for predicting anastomotic complications.

Lymphoid malignancies are associated with autoimmune cytopenia (AIC); however, their possible associated characteristics/complications remain unclear. This study aimed to retrospectively analyze the correlation between elevated immunoglobulin (Ig) levels and the frequency of AIC complications in 155 patients diagnosed at our hospital with low-grade B-cell malignancies (LGBCM). Among the 155 patients, 6 had AIC, of whom four had elevated Ig levels. Three of these four patients had monoclonal IgG, and one of them also had polyclonal IgM. The remaining patient had only polyclonal IgM. Patients with monoclonal IgG had a significantly higher prevalence of AIC (p＝0.018). However, in patients with elevated polyclonal IgG levels or elevated monoclonal IgM and IgA levels, there was no significant difference in the frequency of AIC complications. In patients with LGBCM and monoclonal IgG, it is necessary to pay attention to AIC complications.

Aim: To evaluate the effectiveness of radiation protection training among medical students using X-ray equipment.

Methods: Medical students attended a training class in diagnostic radiology. This training class began with a lecture on radiation protection, followed by experiments to measure the radiation dose. At the beginning and end of the training class, participants answered five-choice questions regarding the three principles of external radiation protection and the dose reduction rate of the lead apron. We also asked participants to provide free-text answers regarding what they learned from the training class and then conducted a text-mining analysis.

Results: In the question regarding the three principles of external radiation protection, only 86% of students correctly answered “time” before the training class, but almost all respondents answered the question correctly after the training class. Before the training class, 81% of the students answered that the shielding rate of the lead apron was 95%, but after the training class, almost all students answered correctly that the shielding rate was 80%. Text-mining showed a co-occurrence network consisting of 10 subgraphs from the frequently occurring words.

Conclusion: Having the students conduct measurement experiments on their own was effective for improving their understanding of radiation protection.

Objectives: In order to examine the first night effect in suspected Obstructive Sleep Apnea Syndrome (OSAS) patients, we performed night Polysomnography (PSG), the long-term actigraphic recording and the self-reported sleep questionnaire.

Methods: Nine patients with mild OSAS and four patients with severe OSAS participated in the study. Sleep evaluation was assessed by PSG, 5 days actigraphic recording including PSG night, and the St Mary’s Hospital Sleep Questionnaire. Objective and subjective sleep quality was compared between two groups.

Results: There were no significant difference between groups in PSG, actigraphic recording of PSG night, and the perceived quality of sleep. However, the patients with severe OSAS showed poor sleep quality in the long-term actigraphic recording.

Conclusions: Our results suggested that long-term recording using actigraphy is useful for sleep evaluation of OSAS patients, and that subjective sleep evaluation may be difficult to adequately assess sleep quality in patients with severe OSAS.

Purpose: To clarify the factors that influence the decision-making in elderly cancer patients aged 75 years or over who choose to receive treatment, with the aim of formulating nursing care plans to support independent decision-making.

Methods: Semi-structured interviews were conducted of 15 elderly cancer patients aged 75 years old or older, and the responses were analyzed qualitatively and inductively.

Results: Factors that influence decision-making were classified into the following 4 categories: [View of life based on the previous way of life], [Healthcare professionals’ technical support that provides a sense of security], [Interpersonal relationships with family and surrounding people], and [Negative feelings associated with treatment in the elderly].

Discussion: We found that support from family members and healthcare professionals assisted decision-making, while negative feelings towards treatment made decision-making difficult. In addition, decision-making was primarily influenced by the way of life and beliefs cultivated through their long lives in the elderly. For nursing care to support the patient’s independent decision-making, it is important to figure out the support the patient receives from family members and surrounding people and promote interpersonal understanding, and also to accept and support the patient’s way of life and beliefs.

Purpose: This study was conducted to clarify the nursing care that eases the emotional burden on a terminally ill cancer patient’s family from the perspective of the palliative care nurse, and obtain palliative care suggestions to assist the family.

Methods: Semi-structured interviews were conducted with 10 nurses in the palliative care wards of two hospitals in the prefecture, and qualitative and inductive analysis was conducted using a content analysis method.

Results: Nursing care that eased such families’ emotional burden was summarized into seven categories, including [expressing the family’s feelings and trying to alleviate their anxiety], [encouraging the family to express their feelings and trying to alleviate their anxiety], [understanding the family’s thoughts and intentions toward the patient and reflecting them in care], and [accepting the patient’s situation and getting involved so that they can prepare for death].

Discussion: To alleviate this burden, nurses need to build deep trust-based relationships through active communication and involvement with patients and their families and provide support that [encourages the family to express their feelings and tries to alleviate their anxiety].

Purpose: To clarify the reality of parent-child conversations among nursing students regarding end-of-life care. Method: The subjects were 399 first- to fourth-year nursing students at University A. The survey included basic attributes, degree of interest in end-of-life care, degree of awareness of the need for parent-child conversations about life-prolonging treatment, end-of-life care, and place to live the end-of-life, and degree of these conversations. The Visual Analogue Scale was used to measure these attributes. The survey method was a self-administered questionnaire. Results: A total of 337 copies were collected, and 302 (89.6%) were valid responses. The mean degree of awareness of the need for life-prolonging treatment conversations was 81.1±20.2 mm, and the mean degree of conversation was 28.0±29.2 mm. The mean degree of awareness of the need for conversation about end-of-life care was 84.4±16.8 mm, and the mean degree of conversation was 27.6±30.7 mm. The mean degree of awareness of the need for conversation about a place to live the end-of-life was 83.7±14.8 mm, and the mean degree of conversation was 33.5±28.7 mm. Conclusion: Nursing students are aware of the need to have conversations with their parents regarding end-of-life care, but they are unable to do so.

Objective: The purpose of this study was to objectively and subjectively evaluate different types of sleep for nurses working in shifts, and to clarify the relationship between each sleep and burnout state.

Methods: The subjects were 20 female shift-working nurses. Actiwatch Spectrum Plus was used for objective evaluation of sleep. The St. Mary’s Hospital Sleep Questionnaire was used for subjective evaluation. In addition, the Maslach Burnout Inventory-HSS Japanese version was used for burnout evaluation.

Results: In objective evaluation, emotional exhaustion was found to have a significant positive correlation with nighttime sleep after the day shift, and a significant negative correlation with the percent sleep of post-night shift sleep. In the subjective evaluation, emotional exhaustion was found to have a significant negative correlation with the depth and soundness of sleep on holidays after the night shift. In the objective evaluation, personal accomplishments were significantly negatively correlated with the percent sleep of sleep after the night shift.

Conclusion: The discrepancy between the subjective and the objective evaluations is suggested to be one characteristic of burnout.

The case was a 71-year-old male who visited a local doctor with a chief complaint of discomfort in his lower right abdomen and so was referred to our hospital for closer scrutiny. On an abdominal contrast-enhanced CT, a concentric multilayer structure was observed in the ileocecal area, leading to a diagnosis of intussusception. Since there were no findings of obstruction or blood flow disorders associated with intussusception, elective endoscopic surgery was performed. From the extracted specimen, it was diagnosed to be ileocecal intussusception due to cecal cancer. We herein report the findings of this case with some bibliographical considerations.

A patient in his forties, who was immobile because of severe pain, visited our emergency room. He had fallen from a height of 3 meters and landed on his right back. Enhanced CT revealed multiple fractures of the right transverse processes (l2, 3, 4) and spinous processes (L3, 4, 5). Hematomas were also noted in the right iliopsoas muscle, erector spinae muscle, subcutaneous on the back, and retroperitoneal space. Active bleeding was not detected； therefore, we did not perform angiography. We opted for conservative therapy, and the patient was uneventfully discharged after 17 days. Transverse process fracture with retroperitoneal hematoma is very rare and may involve injury to the lumbar vessels, which can lead to hemorrhagic shock. This case report emphasizes the need to evaluate vascular injury in such trauma cases.

Purpose: The number of elderly patients with multiple coexisting diseases is increasing. While ALS is a designated intractable disease and characterized by rarity, the number of ALS patients with cancer is also increasing. In order to consider support for ALS and cancer coexisting cases, we aimed to organize existing case reports from literature review and obtain basic data.

Method: We searched the literature from 2010 to 2021 using the Japan Central Revuo Medicina Web (ver. 5) electronic database, with a combination of ‘amyotrophic lateral sclerosis’ and ‘cancer’. We extracted a total of 26 cases from 23 articles.

Results: Out of the 23 articles, the first authors were physicians in 18 articles. In our analysis of 26 cases, 54％ of the patients were in their 70s or over; 18 (69％) cases were diagnosed with ALS before cancer, 3 (12％) with cancer first, and 5 (19％) with both at about the same time. The literature included 9 cases related to surgery, 5 cases for anesthesia for surgery, and 4 cases related to either chemotherapy or radiotherapy. Nine patients were under respiratory management with TPPV. In all but three reports of ALS patients treated for cancer, the cancer treatments were described as successful.

Conclusion: Although multidisciplinary, interdisciplinary, and comprehensive consideration for each case is necessary, recent advances in treatment technology have revealed that aggressive cancer treatment is being used for ALS, which is an incurable disease. This study presented a reference material in decision-making support for ALS patients.