Relationship between hand-foot skin reaction and external force on patients with hepatocellular carcinoma: A cohort study.

PURPOSE: Hand-foot skin reaction (HFSR), a side effect of tyrosine kinase inhibitor (TKI) treatment, makes it difficult to walk and perform daily activities because of pain in the limbs. HFSR occurs predominantly in the sites where external forces (pressure and shear stress) are applied. This study aimed to determine whether pressure or shear stress induces the occurrence of HFSR. METHODS: This cohort study was conducted in patients who received TKI treatment for hepatocellular carcinoma. The external forces applied to the sole of the patients' foot while walking was measured, and its association with the occurrence of HFSR was examined. The degree of HFSR was assessed by the patient's response during the examination and by photographs of their feet. The patients' feet were divided into low (grade <2) or high (grade ≥2) HFSR foot group, and the differences in external forces between the groups were analyzed using t-test and Cox hazard analysis. RESULTS: Analysis of the feet of 55 study participants (n = 110) showed no significant difference between the groups on t-test (p ≥ 0.05), however, Cox hazard analysis showed an increased risk of HFSR with higher peak shear stress values at the fifth metatarsal head (hazard ratio = 1.01, p = 0.047; 95% confidence interval = 1.00-1.02). CONCLUSION: Shear stress is possibly related to HFSR occurrence. Nurses should assess whether patients' shoes fit their feet before initiating TKI treatment. They should instruct patients to wear shoes that are fit of both diameter and width for their feet.

Examination of a contact detection sensor to prevent self-removal of peripheral intravenous catheters.

If patients are at risk of self-removal of a catheter, it is necessary to check the condition of the catheter frequently. If this is the only way to prevent self-removal, physical restraint of the patient is required. Furthermore, it is currently necessary to reduce human-to-human contact to prevent COVID-19 infection. Therefore, the development of a sensor system to prevent self-removal of a catheter and reduce human-to-human contact is urgent. The purpose of this study is to examine a sensor system that detects the contact of a patient's hand to a peripheral intravenous catheter in order to prevent self-removal in patients with dementia. This study analyzes the use of a capacitance sensor and an energization sensor to detect the contact of a patient's hand to a catheter. Additionally, the time required from the start of peeling the sensor sheet to the removal of the needle was measured. As the results, the capacitance sensor was difficult to use in a clinical setting because the connection between the seat and cable could be unstable depending on the condition of the connections. The energization sensor was able to recognize the contact of a hand to the catheter by detecting its contact with the sensor. It took at least 28 seconds from detection of the hand contact to the beginning of needle removal. Therefore, it is possible for the caregiver to visit the patient's bedside and stop the self-removal when the sensor sheet detects hand contact. This study is the first step in developing the system that prevents self-removal by detecting hand contact and requires several more steps for clinical use. In the future, we will conduct surveys on more subjects and clinical trials on elderly with dementia to examine accuracy, precision, and repeatability. Using the energization sensor, a self-removal prevention system for dementia patients will be further developed.Clinical Relevance- Developing this self-removal prevention system in the future will allow many dementia patients to no longer be physically restrained, and it will make it possible to remotely detect their actions to prevent self-removal while also minimizing the risk of COVID-19 infection.

Impact of nurse-assisted patient turning at different sleep stages on the quality of subsequent sleep.

BACKGROUND: Nursing care performed during sleep, including nurse-assisted patient turning, is one of the factors that deteriorates sleep quality but is necessary for pressure ulcer prevention. Thus, it is important to determine when nurseassisted patient turning has the least impact on sleep quality. AIM: The aim of this study was to clarify the impact of nurseassisted patient turning at different sleep stages and to determine the optimal timing of this aspect during sleep. METHODS: The experiment, which consisted of healthy men in their 20s and 30s, was performed over four successive nights per subject. The first night was dedicated to environment adaptation, and the 2nd to the 4th nights were randomly assigned for shallow sleep intervention, deep sleep intervention, and non-intervention. On the intervention day, nurse-assisted patient turning was conducted twice. Overnight sleep conditions were measured by polysomnography (PSG). The PSG waveform transmitted to a tablet was analyzed in real time to determine the stage of sleep. The patient was turned when he entered the planned stage of sleep. RESULTS: The study analyzed fourteen (14) subjects. Shallow sleep time, deep sleep time, and sleep resumption time after nurse-assisted patient turning were compared among the three groups of non-intervention day, shallow sleep intervention day and deep sleep intervention day. There was no significant difference in the shallow and deep sleep time among the three groups. However, sleep resumption time after nurse-assisted patient turning was significantly shorter on the deep sleep intervention day than on the shallow sleep intervention day (p = textbf 0.033). CONCLUSIONS: This study has novelty in examining the impact of nurse-assisted patient turning performed at different sleep stages on subsequent sleep using objective indicators. The study suggested that a deep sleep state is the optimal timing of nurseassisted patient turning due to the short time to sleep resumption.

Examination of the Effect of Suitable Size of Shoes under the Second Metatarsal Head and Width of Shoes under the Fifth Metatarsal Head for the Prevention of Callus Formation in Healthy Young Women.

Excessive pressure and shear stress while walking cause a risk of callus formation, which eventually causes foot ulcers in patients with diabetes mellitus. Callus under the second metatarsal head (MTH) has been associated with increased shear stress/pressure ratios (SPR). Callus under the fifth MTH has been associated with increased peak shear stress (PSS). The purpose of this study is to examine whether the effect of the suitable size and width of shoes prevents diabetic foot ulcers under the second and fifth MTH. We measured the pressure and shear stress by testing three kinds of sizes and two types of width of shoes. Significant difference was not observed in the SPR under the second MTH among different sizes of shoes. However, the pressure and shear stress were significantly lower when putting on shoes of fit size compared with larger sizes. The PSS under the fifth MTH was significantly smaller when putting on shoes of fit width compared with those of narrow width. Wearing shoes of fit size and width has the potential to prevent callus formation by reducing the pressure and shear stress constituting SPR under the second MTH and PSS under the fifth MTH.