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Aim: Caregivers in home care settings may experience significant physical, emotional, and financial burdens in providing toileting assistance. However, few studies have evaluated these three aspects of caregiver burden. Therefore, this study aimed to clarify the physical, emotional, and financial burdens of toileting assistance and examine the factors associated with each burden. Methods: A self‐administered postal questionnaire was distributed to 405 family caregivers of older adults receiving home care and subsidies for incontinence products in Japan in 2019. Family caregivers answered questions about toileting assistance, the perceived physical, emotional, and financial burdens of providing toileting assistance at home, and the urinary/fecal symptoms of older adults. Results: Of the 242 family caregivers who reported each burden, 213 (88%) had experienced at least one physical, emotional, or financial burden. The prevalence of physical, emotional, and financial burdens was 77.3%, 78.1%, and 70.7%, respectively. Approximately 60% of respondents reported experiencing all three burdens. Physical burden was associated with spouses acting as primary caregivers, nocturia, fecal incontinence, and the odor of urine/feces from toileting assistance. Emotional burden was associated with nighttime assistance, urinary/fecal leakage from absorbent incontinence products, and the odor of urine/feces. Financial burden was associated with frequent assistance, disposal costs of absorbent incontinence products, and the degree of toileting assistance. Conclusions: The results revealed a high prevalence of the three burdens of toileting assistance among family caregivers, suggesting the need to assess these burdens. Furthermore, they suggested the importance of providing guidance to family members, which may help reduce these burdens. [ABSTRACT FROM AUTHOR]

Aim: To epidemiologically determine post‐void residual urine volume (PVR) and identify the characteristics of "potential" older adult patients with voiding dysfunction in an acute‐care hospital. Methods: A cross‐sectional study was conducted on 614 older adult patients in an acute‐care hospital between November 2018 and May 2019. Using portable ultrasound devices, nurses measured the patients' PVR three times after admission. Lower urinary tract symptoms were evaluated using the Core Lower Urinary Tract Symptom Score prior to admission. Results: A total of 107 older adult patients (17.4%) had episodes of abnormal PVR ≥100 mL. An age of over 75 years (adjusted odds ratio [aOR]: 1.899) and feeling of incomplete emptying (aOR: 4.337) were associated with having at least one episode of abnormal PVR, whereas neurological or circulatory diseases (aOR: 3.699) were associated with having two or three episodes. Conclusions: The results showed a high prevalence of abnormal PVR in older adult patients. Screening for PVR in older adult patients aged over 75 years who experience incomplete emptying or neurological or circulatory diseases may help identify those at risk for voiding dysfunction. [ABSTRACT FROM AUTHOR]

Aim: The present study aimed to analyze the use of machine learning in ultrasound (US)‐based fecal retention assessment. Methods: The accuracy of deep learning techniques and conventional US methods for the evaluation of fecal properties was compared. The presence or absence of rectal feces was analyzed in 42 patients. Eleven patients without rectal fecal retention on US images were excluded from the analysis; thus, fecal properties were analyzed in 31 patients. Deep learning was used to classify the transverse US images into three types: absence of feces, hyperechoic area, and strong hyperechoic area in the rectum. Results: Of the 42 patients, 31 tested positive for the presence of rectal feces, zero were false positive, zero were false negative, and 11 were negative, indicating a sensitivity of 100% and a specificity of 100% for the detection of rectal feces in the rectum. Of the 31 positive patients, 14 had hard stools and 17 had other types. Hard stool was detected by US findings in 100% of the patients (14/14), whereas deep learning‐based classification detected hard stool in 85.7% of the patients (12/14). Other stool types were detected by US findings in 88.2% of the patients (15/17), while deep learning‐based classification also detected other stool types in 88.2% of the patients (15/17). Conclusions: The results showed that US findings and deep learning‐based classification can detect rectal fecal retention in older adult patients and distinguish between the types of fecal retention. [ABSTRACT FROM AUTHOR]

Preventing pressure ulcers is important in patients undergoing procedures in the park-bench position. We hypothesized that the microclimate around the skin is a significant risk factor for developing pressure ulcers. This research continuously assessed factors of the microclimate in terms of skin temperature and perspiration as well as the interface pressure in order to determine whether the microclimate is an independent risk factor for the development of park-bench position-related pressure ulcers (PBP-PUs). A prospective observational study was conducted among patients undergoing elective surgery in the park-bench position at a general hospital in the metropolitan area of Japan between April and November 2014. Factors of the microclimate, including skin temperature and perspiration, in addition to the interface pressure were continuously measured throughout surgery. Twenty-nine patients were analyzed (mean age 44.4 ± 13.2 years, male 44.8%). Of these 29 patients, seven (24.1%) developed Category I PBP-PUs. The change in skin temperature from baseline to the end of surgery (2.7 ± 0.3 °C vs. 1.9 ± 0.8 °C) and the average peak pressure (119.1 ± 36.8 mmHg vs. 94.56 ± 3.1 mmHg) were significantly higher in the patients with PBP-PUs than in those without PBP-PUs. There were no significant differences in the amount of perspiration between the two groups. A hierarchical logistic regression analysis showed that the change in skin temperature was significantly related to the development of PBP-PUs (unit=0.1°C: odds ratio 1.44, 95% confidential interval 1.09-2.33) when adjusted for the average peak pressure and length of surgery. Our results suggest that a change in skin temperature toward a higher value is an independent risk factor for the development of PBP-PUs. Proper intraoperative management of skin temperature may therefore be a promising candidate as a preventive method against PBP-PU development. [ABSTRACT FROM AUTHOR]

ABSTRACT Predicting the short-term healing progress of pressure ulcers is important for providing timely and appropriate intervention. Although there are some prediction methods available, these are unsuitable for ulcers with abundant necrotic tissue. We aimed to elucidate the relationship between necrotic tissue alteration and protein distributions on ulcers to establish a new prediction method. Thirty-eight pressure ulcers were retrospectively analyzed. Protein distributions on necrotic tissue were evaluated by the wound blotting at three levels: marker protein positivity, signal patterns (speckled, heterogeneous, or homogeneous), and the occupation of heterogeneous pattern. Peroxidase, alkaline phosphatase, tumor necrosis factor α, and matrix metalloproteinase-2 were used as marker proteins. One-week necrotic tissue alteration was classified as liquefaction or nonliquefaction, and associations with protein distributions were analyzed. The peroxidase positivity was significantly higher in the liquefaction than in the nonliquefaction ( p = 0.031). In peroxidase-positive samples, the proportion of nonliquefaction samples was significantly higher in the heterogeneous pattern ( p = 0.029). In the heterogeneous-patterned samples, the proportion of samples with an occupation values greater than the median value tended to be higher in the nonliquefaction ( p = 0.087). There was no significant relationship between liquefaction and other markers. Peroxidase positivity predicts 1-week liquefaction of necrotic tissue, while a heterogeneous pattern indicates nonliquefaction. [ABSTRACT FROM AUTHOR]

For nurses to provide swallowing care that is appropriate to individual patients' swallowing functions, techniques for using ultrasound to monitor for aspiration and pharyngeal post-swallow residue would be helpful. This study seeks to clarify the effectiveness of an education program concerning the use of ultrasound to assess swallowing function (the "Swallowing Point-of-Care Ultrasound Education Program"). This assessment is based on a comparison of the observation skills of general nurses' and certified nurses in dysphagia nursing in this regard; both groups underwent the education program, but dysphagia nurses have greater knowledge of swallowing functions as a result of their training. This prospective descriptive study was conducted as a post-graduate education program in two locations in Japan. The swallowing point-of-care ultrasound education program comprised four elements: e-learning, practical seminar, self-learning, and objective structured clinical examination. The objective structured clinical examination was used after the program to assess whether the participants had obtained the necessary skills. The general nurses were then asked to report the ease-of-use of the education materials. Of the 32 participants enrolled in the program, 22 general nurses and nine dysphagia nurses completed the program. In the objective structured clinical examination concerning monitoring for aspiration, the dysphagia-nurses group had a higher proportion of participants evaluated as "excellent" (p = 0.007); this group had a significantly higher ability to maintain adequate images during the swallowing process than did the general-nurse group (p = 0.034). However, there was no difference between the two groups regarding monitoring for post-swallowing residue. Further, over 70% of the nurses gave a positive evaluation of the user-friendliness of the e-learning and practical seminar. Our results suggest that the swallowing point-of-care ultrasound education program provides both general nurses and dysphagia nurses with sufficient knowledge and skill to monitor for aspiration and post-swallowing residue. • Nurses should provide swallowing care that is appropriate to individual patients' swallowing functions. • Techniques for using ultrasound to monitor for aspiration and pharyngeal post-swallow residue would be helpful. • The swallowing point-of-care ultrasound education program provides sufficient knowledge and skill to monitor for aspiration and residue. [ABSTRACT FROM AUTHOR]