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The purpose of this study is to examine the effect of pelvic floor muscle training on faecal incontinence. Faecal incontinence is a condition in which stool leaks from the anus involuntarily or uncontrollably. Faecal incontinence is common in elderly people and patients with underlying diseases, but the pathophysiology of faecal incontinence is diverse, and treatment methods must be varied accordingly. Among the known treatment methods, in this study, we focused on pelvic floor muscle training, which can be performed in daily life. The literature was searched for papers that present existing knowledge and address current perspectives. Extracted studies included papers that report scientific consensus. After reviewing the literature, it appears that it is possible to effectively train patients to defecate twice a day, approximately 30 min after breakfast and dinner, by having them attempting to defecate, even when there is no such urge. Pelvic floor muscle training can improve urinary and faecal incontinence by strengthening the contractile force of the pelvic floor muscles such as the external anal sphincter and levator ani. However, the specific types of faecal incontinence patients that can effectively benefit from pelvic floor muscle training is unclear. It is important for patients to understand the pelvic floor muscle training program and to develop sufficient motivation to continue training at home. [ABSTRACT FROM AUTHOR]

Japan is becoming a superaged society, and nutrition therapy for the elderly population is very important. Elderly individuals often have multiple diseases and are prone to malnutrition. Furthermore, functional constipation, diarrhoea, faecal incontinence, etc., may occur despite no organic abnormality of digestive tract function. Due to these disabilities, the resulting malnutrition, and the slow recovery, it is often difficult for elderly individuals to reintegrate into society. Secondary or incorrect nutritional management increases complications, decreases physical function and worsens the prognosis. Previous statistical research suggests that in-hospital mortality is significantly higher among hospitalised patients aged ≥65 years who ingest less than half of their caloric needs. Therefore, appropriate nutritional management from an early stage is essential for elderly individuals. Moreover, functional excretion disorders, dementia, and sarcopenia (muscle-wasting disease) are attracting attention as pathological conditions unique to elderly individuals, and it is essential to undergo rehabilitation early with nutritional management. Being elderly does not preclude nutritional management, and it is necessary to reconsider appropriate nutritional therapy even in the terminal stage and in advanced physical and mental illnesses. This review explores the relationship between dietary intake and FGIDs, with a focus on elderly adults. [ABSTRACT FROM AUTHOR]

Aim: This clinical practice guideline aims to provide and recommend methods of assessing aspiration and pharyngeal residue during eating and swallowing and methods of selecting and implementing nursing care for adults to prevent the development of aspiration pneumonia through early and appropriate management of oropharyngeal dysphagia. Methods: In April 2018, the Japan Academy of Nursing Science established the Supervisory Committee in Nursing Care Development/Standardization Committee to develop clinical practice guidelines for aspiration and pharyngeal residual assessment during eating and swallowing for nursing care. This clinical practice guideline was developed according to the Minds Manual for Guideline Development 2017, with the aim of providing a specific pathway for nurses to determine the policy for selecting management for oropharyngeal dysphagia based on research evidence and multifaceted factors including the balance of benefits and harms and patients' values. Results: Based on the 10 clinical questions related to assessment by physical assessment, the Repetitive Saliva Swallowing Test, Modified Water Swallowing Test, Food Test, cervical auscultation, observation using an ultrasound diagnostic device, and an endoscope, 10 recommendations have been developed. Eight recommendations have been evaluated as the Grading of Recommendations Assessment, Development and Evaluation (GRADE) 2C, and the other two have been evaluated as no GRADE. Conclusion: The first reliable clinical practice guideline has been produced from an academic nursing organization that focuses on assessment for nursing care and incorporates the latest findings. [ABSTRACT FROM AUTHOR]

Irritable bowel syndrome (IBS) causes abdominal pain during bowel movements and is diagnosed according to the Rome IV international diagnostic criteria. Patients diagnosed as having IBS experience abdominal pain at least 1 day/week, on average, over a 3-month period and not 3 days per month. A diagnosis of IBS is confirmed if symptoms have persisted for more than 6 months. IBS symptoms negatively affect daily life. First, improving daily habits are important to ameliorating IBS symptoms. IBS symptoms can be alleviated by staying active, sleeping, resting and staying stress-free. In addition, it is important to eat three, balanced meals a day on a regular basis and avoid overeating, especially at night. Spicy foods, high-fat foods, and alcohol can exacerbate symptoms. Researchers found, in a literature review, that IBS symptoms can be ameliorated by improving daily habits, thus relieving abdominal pain and the defecation symptoms of IBS. [ABSTRACT FROM AUTHOR]

Background: Functional gastrointestinal disorders (FGIDs) involve chronic or persistent gastrointestinal symptoms. Laboratory tests show no organic lesions, and the symptoms are due to dysfunction. The most typical FGID is irritable bowel syndrome (IBS). In IBS patients, defecation disorders are common and have adverse effects on daily life. The proper evaluation and analysis of colonic transit are important for the management of defecation disorders in IBS patients. In addition, dietary intake and lifestyle affect colonic transit. An accurate assessment of such factors can guide management, leading to improvements in colonic transit and the resolution of defecation disorders. Main topic: The Rome IV diagnostic criteria for IBS are based on subjective symptoms, which must be communicated and explained by the patient, limiting their application. Colonic transit time and ultrasonography are objective tools that can be used to diagnose IBS. In particular, previous studies used colonic transit to accurately distinguish between constipation and normal stool passage and to assess delayed gastrointestinal motility. Diet and lifestyle modifications can improve colonic transit and ameliorate bowel dysfunction. Conclusion: Colonic transit can be improved by modifying lifestyle factors. Defecation disorders in IBS patients may be resolved by focusing on such factors. In the future, methods of visualizing defecation disorders due to impaired gastrointestinal motility and objective indicators of the associated abdominal symptoms need to be investigated. [ABSTRACT FROM AUTHOR]

Background: The effectiveness of point-of-care ultrasound (POCUS) for nurses has been demonstrated; however, only a limited number of nurses have been trained to perform POCUS. This article reports on a POCUS train-the-trainer program for nurse educators that targets lower urinary track dysfunction. Method: Nurse educators (n = 38) were invited to participate in a POCUS train-the-trainer program, which comprised an e-learning module and a hands-on seminar. Acquisition of knowledge and skills were assessed after the module and seminar, respectively. Results: Questions from the "Basic Knowledge of Ultrasonography" test were answered correctly at a rate of 93.0% (SD, 8.5%). Measured values of bladder urinary volume using ultrasonography were in close agreement with actual values. All of the participants indicated that the program covered the content necessary to use in practice. Conclusion: The POCUS train-the-trainer program equips nurse educators with the knowledge and skills needed for training nurses at their institutions. [J Contin Educ Nurs. 2021;52(8):375–381.] [ABSTRACT FROM AUTHOR]

Aim: Nurses have difficulty assessing the type of constipation by ordinal assessment methods and may therefore struggle to select an appropriate defecation care. Although previous studies described the safety and effectiveness of defecation care based on ultrasonographic observations in the colorectum, no standardized educational program has been established. This study aimed to determine the feasibility of the constipation point‐of‐care ultrasound (POCUS) educational program regarding the use of ultrasonography as an assessment tool to determine different types of constipation. Methods: This descriptive study was conducted for visiting nurses working in Japan. The constipation POCUS educational program that nurses can learn in as short as 7 days comprised four elements: E‐learning, a hands‐on seminar, self‐learning, and objective structured clinical examinations (OSCEs). The nurses were asked to complete a questionnaire regarding the education materials. OSCEs were used to assess the participants' skills in assessing patients based on the use of ultrasound observation in the colorectum. Results: Of the 44 participants who enrolled, 40 were able to complete the program. All the 40 participants (100.0%) who took the OSCEs were able to pass at the first attempt. Moreover, 94.9% of the trainees indicated that this program was able to cover the content necessary to use ultrasonography in home care settings. Conclusions: The results of this study suggest that the 7‐day constipation POCUS educational program provided trainees with a foundational knowledge and skills to observe fecal retention in the colorectum. Thus, further educational program enhancements and clinical skill evaluations are needed to maximize the program's effectiveness in the future. [ABSTRACT FROM AUTHOR]

Aim: Nurses have the potential to perform fiberoptic endoscopic evaluation of swallowing (FEES) in Japan, which can aid in their provision of swallowing care appropriate to individual patients' swallowing functions. We aimed to confirm the safety and effectiveness of a new nursing education program on FEES by examining its impact on autonomy in performing FEES and accuracy in observing bolus swallowing. Methods: In this prospective descriptive study, we developed a FEES education program comprising three phases: (a) obtaining knowledge and skills through e‐leaning and a practical workshop; (b) becoming proficient in skills for assessing healthy adults through self‐learning; and (c) obtaining clinical competence through 30 cases of on‐the‐job training (OJT). The trends in autonomy and in accuracy of FEES were evaluated by the data during OJT. Results: Of the three certified nurses in dysphagia nursing, a trainee completed 30 cases of OJT and the other two trainees experienced 20 cases and 10 cases, respectively without any adverse event. Autonomy in the four major FEES skills gradually increased over the OJT. The correct answer rate, sensitivity, and specificity of the penetration‐aspiration scale and severity of residue in the pyriform sinus and epiglottis valley were above 95% at the first 10 cases of OJT among three trainees and they were 100% after the 11th case of OJT. Conclusions: Our results suggest that the developed education program helped nurses with experience being present at FEES obtain sufficient knowledge and skills to appropriately and safely perform FEES with 30 cases of OJT. [ABSTRACT FROM AUTHOR]

Aim: To verify the efficacy of defecation care based on handheld ultrasonographic observations for functional constipation by visiting nurses skilled in bowel ultrasonography. Methods: Home‐care patients with suspected functional constipation receiving nursing visits were recruited in this multiple‐baseline, single‐case experiment with intervention points shifted by 1 week. A total of 15 older adults were categorized into 3‐, 4‐, 5‐ or 6‐week intervention phases. Ultrasonographic observations of fecal retention in the colorectum and defecation care based on observations during the ordinal physical assessment were reviewed. Tau‐U was used for confirming the efficacy of the intervention by measuring the number of non‐artificial and artificial defecations, as well as hard stools per week, and the amount of non‐stimulant and stimulant laxatives, enemas and suppositories per week. For evaluating safety, adverse events, such as bowel obstruction and incontinence‐associated dermatitis, were confirmed. Results: No adverse events were observed. Statistical analysis showed that hard stools and artificial defecation reduced, and that their effect sizes were significant (Tau = −0.48, P < 0.01; Tau = −0.53, P < 0.01). Even the amounts of stimulant laxative and glycerin enema reduced, and their effect sizes were significant (Tau = −0.56, P < 0.01; Tau = −0.34, P = 0.04). Conclusions: Thus, defecation care based on ultrasonographic assessment by nurses in home‐care settings is safe and effective for improving constipation symptoms and reducing laxative use. Geriatr Gerontol Int 2020; ••: ••–••. [ABSTRACT FROM AUTHOR]

A BSTRACT Background We sought to assess the long-term durability of pericardial valves in patients at age <65 years undergoing aortic valve replacement (AVR), and to determine the timing of redo operations due to structural valve deterioration (SVD). Methods From 1986 to 2001, a total of 574 adult patients underwent AVR with pericardial valves in nine hospitals in Japan. Of these, 53 patients were at age <65 years (group Y). These patients were compared with those of age ≥65 (group O, n = 521). Results The mean follow-up duration was 9.5 years in group Y and 8.1 years in group O. Freedom from reoperation due to SVD was 100% at five years, 90.8% at 10 years, and 47.2% at 15 years in group Y, and 99.3% at five years, 97.4% at 10 years, and 94.4% at 15 years in group O (log-rank test, p < 0.01). In those who required redo AVR in group Y (n = 12), the mean time from initial operation to reoperation was 12.1 years. The reoperation-free survival curve started to decline after eight years postoperation in group Y. Conclusions Redo AVR started to become necessary eight years after surgery in the patients who underwent AVR with pericardial valve at age <65 years. In addition, approximately half of those patients required reoperation due to SVD by 15 years postoperatively. doi: 10.1111/jocs.12537 (J Card Surg 2015;30:405-413) [ABSTRACT FROM AUTHOR]

Hierarchical trimodal porous hydroxyapatite (tpHAP) was fabricated by colloidal crystal templating using single-size latex particles with controlled calcination. In the overall framework structure, the tpHAP was revealed to have three kinds of pores, i.e., periodically ordered submicrometer-sized macropores of inverse opal structure, sponge-like larger macropores, and mesopores. The sponge-like macropores should be formed through removal of a sacrificial latex template, which fused in the process of low-temperature calcination. It was also found that high-temperature calcination leads to an increase in the crystallinity of the tpHAP, which resulted in deterioration of the ordered macropore arrays and a decrease in specific surface areas. Because of the trimodal porous structure, the tpHAP will serve as a multifunctional porous bioceramic in the fields of medical implants, tissue engineering, and drug delivery systems. [ABSTRACT FROM AUTHOR]

Cars The typical urban household in China owns a TV, a refrigerator, a washing machine, and a computer, but does not yet own a car. In this paper, we draw on data for a panel of countries and detailed household level surveys for the largest emerging markets to document a remarkably stable relationship between GDP per capita and car ownership, highlighting the importance of within-country income distribution factors: we find that car ownership is low up to per capita incomes of about US$5000 and then takes off very rapidly. Several emerging markets, including India and China, the most populous countries in the world, are currently at the stage of development when such takeoff is expected to take place. We project that the number of cars will increase by 2.3 billion between 2005 and 2050, with an increase by 1.9 billion in emerging market and developing countries. We outline a number of possible policy options to deal with the implications for the countries affected and the world as a whole. — Marcos Chamon, Paolo Mauro and Yohei Okawa [ABSTRACT FROM AUTHOR]

Objectives: Extensive aortic dissection with multiple entries often found in Marfan’s syndrome patients ultimately requires replacement of the whole aorta. We present a surgical strategy and results for total and subtotal arotic replacement. Methods: Subjects were 18 patients, including 14 Marfan’s patients undergoing total (n=13) or subtotal (excluding aortic arch) aortic replacement (n=5), for DeBakey type I aortic dissection (n=13) and DeBakey type IIIb aortic dissection with annuloaortic ectasia (n=5) between February 1991 and April 2001. Mean age was 39.9±0.8 years—34.9±6.6 years in Marfan’s patients vs. 57.7±4.7 years in non-Marfan patients. All operations were staged, with the mean number required per patient 3.1±0.8. Results: Early mortality was 0% and late mortality 11% (2 of 18). Paraplegia or paraparesis occurring in 11%. Except for these patients, all current survivors enjoy good quality of life. Conclusions: Total and subtotal aortic replacement for extensive aortic dissection may decrease mortality due to rupture or associated disease. [ABSTRACT FROM AUTHOR]

The demand for methods to ensure safe oral consumption of food and liquids in order to prevent aspiration pneumonia has increased over the last decade. This study investigated the safety of swallowing care selected by adding ultrasound-based observation, evaluated its efficacy, and determined effective content of selected swallowing care. The study employed a pragmatic quasi-experimental research design. Participants were 12 community-dwelling adult patients (age: 44–91 years) who had experienced choking within 1 month prior to the study. After the control phase, in which conventional swallowing care was provided, trained nurses provided ultrasound observation-based swallowing care for a minimum period of 2 weeks. Outcome measurements were compared across three points, namely T1—beginning of the control phase, T2 and T3—before and end of the intervention phase. The mean durations of intervention were 30.8 days in the control phase and 36.5 days in the intervention phase. Pneumonia and suffocation did not occur in the control phase or the intervention phase. The safe intake food level and the food intake level score significantly improved during the intervention phase (p = 0.032 and 0.017, respectively) by adding eating training based on the ultrasound observation. However, there was no significant improvement in the strength of the muscle related to swallowing by the selected basic training. Our results suggest that swallowing care selected based on the ultrasound observation, especially eating training, safely improved safe oral intake among community-dwelling adults with swallowing dysfunction. [ABSTRACT FROM AUTHOR]

Background: Functional gastrointestinal disorders (FGIDs) are groups of disorders involving digestive symptoms that chronically persist despite the absence of organic abnormalities in the gastrointestinal tract. Representative FGIDs include functional dyspepsia (FD), irritable bowel syndrome (IBS), and functional constipation (FC). In particular, IBS is a disease representative of FGIDs in which abdominal pain and discomfort associated with abnormal bowel movements chronically persist and recur. These symptoms are known to be related to lifestyle habits, such as meals and stress. In recent years, according to advances in dietary therapy for IBS and FC, specific foods have been shown to alter these symptoms. In IBS, bowel movement abnormalities and abdominal discomfort have been reported to be reduced when patients eat these specific foods. Main topic: Several studies suggest that individuals with certain attitudes toward eating or with preferences for fatty food, fast food, junk snack food, fried food, and hot/spicy food showed a higher prevalence of gastrointestinal (GI) symptoms. Those who are cognizant of nutritional balance or healthy food intake have a lower prevalence of GI symptoms. Thus, eating specific foods with higher dietary fiber and low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharaides, and polyols) is effective for relief from some GI symptoms. First, two kinds of dietary fibers are found in foods: water-soluble dietary fiber and insoluble dietary fiber. Enduring misconceptions about the physical effects of fiber in the gut have led to misunderstandings about the health benefits attributable to insoluble and soluble fiber. Previous reviews suggest that health benefits have been shown in regard to fiber, and reproducible evidence of clinical efficacy has been published. Second, the ingestion of certain carbohydrates causes gastrointestinal symptoms. Foods rich in fermentable oligosaccharides, disaccharides, monosaccharaides, and polyols (collectively known as FODMAP) have been shown to cause abdominal pain and abdominal discomfort in westerners with IBS. Conclusion: Dietary therapy for FGIDs should include specific foods that have been scientifically proven to be effective for managing symptoms of irritable bowel syndrome and functional constipation. [ABSTRACT FROM AUTHOR]