Japanese clinical practice guidelines for aspiration and pharyngeal residual assessment during eating and swallowing for nursing care.

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.

Diagnostic accuracy of ultrasound examination in detecting aspiration and pharyngeal residue in patients with dysphagia: A systematic review and meta-analysis.

AIM: To estimate diagnostic accuracy of ultrasonography for detecting aspiration and pharyngeal residue in patients with dysphagia. METHODS: A systematic search was conducted in MEDLINE (via PubMed), CINAHL, EMBASE, Ichushi-Web, and Cochrane Library databases to identify articles that showed diagnostic accuracy of ultrasonography for detecting aspiration and residue published in English and Japanese until August 2019. Cross-sectional studies, case-control studies, and cohort studies were included. The diagnostic accuracy results were extracted and the pooled estimated sensitivity and specificity were calculated. The risk of bias of the studies was assessed using the Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies 2. The certainty of the evidence was assessed using the Grades of Recommendation Assessment, Development, and Evaluation methodology. RESULTS: Five studies were included in this review. The pooled estimated sensitivity and specificity for detecting aspiration were 0.82 (95% CI: 0.72-0.89) and 0.87 (95% CI: 0.81-0.92), respectively. One study was included that evaluated ultrasound assessments of pharyngeal residue. The sensitivity and specificity were 0.62 (95% CI: 0.32-0.86) and 0.67 (95% CI: 0.22-0.96), respectively. The certainty of the evidence was low and very low for the diagnostic accuracy of aspiration and pharyngeal residue, respectively. CONCLUSION: Ultrasound is a non-invasive method with good sensitivity and specificity in detecting aspiration as well as reference standards. While risk of bias and small number of studies limited the strength of this systematic review, our results suggested that ultrasound examination was useful as a bedside screening tool for detecting aspiration.

Circadian rhythm of heart rate and physical activity in nurses during day and night shifts.

PURPOSE: The study investigates if the circadian rhythm of heart rate is apparent during the working periods of day and night shifts in Swiss and Japanese nurses and if it is influenced by work organization. For a better interpretation of the heart rate, the activity profile over these working periods was monitored. METHODS: Heart rate and activity profile of 18 Swiss and 24 Japanese nurses were measured during one day and one night shift. The day and the night shift data of each subject were combined, resulting in an approximately 18-h working period. RESULTS: A significant time effect of the mean hourly value of the heart rate was found in Swiss nurses (change in amplitude 7.1 bpm) as well as in Japanese nurses (11.8 bpm). These effects could be modeled with cosine curves for the Swiss and Japanese subjects. For the activity level significant time effects, similar to the ones in heart rate, were found in Swiss nurses (87 % of SD) but not in Japanese nurses (26 % of SD). CONCLUSIONS: We found a significant time effect in heart rate similar to the known circadian rhythm under normal sleep-wake conditions while working in the studied shift work schedules. In the Japanese nurses, studied heart rate followed a circadian rhythm independently of the level of physical activity. Therefore, an activity profile following the circadian rhythm, especially a reduced workload from 2 to 4 a.m., is proposed. The proposed activity profile could be reached with an adapted work organization.

Trapezius muscle load, heart rate and time pressure during day and night shift in Swiss and Japanese nurses.

The aim of the present study was to analyze the activity of the trapezius muscle, the heart rate and the time pressure of Swiss and Japanese nurses during day and night shifts. The parameters were measured during a day and a night shift of 17 Swiss and 22 Japanese nurses. The observed rest time of the trapezius muscle was longer for Swiss than for Japanese nurses during both shifts. The 10th and the 50th percentile of the trapezius muscle activity showed a different effect for Swiss than for Japanese nurses. It was higher during the day shift of Swiss nurses and higher during the night shift of Japanese nurses. Heart rate was higher for both Swiss and Japanese nurses during the day. The time pressure was significantly higher for Japanese than for Swiss nurses. Over the duration of the shifts, time pressure increased for Japanese nurses and slightly decreased for those from Switzerland. Considering trapezius muscle activity and time pressure, the nursing profession was more burdening for the examined Japanese nurses than for Swiss nurses. In particular, the night shift for Japanese nurses was characterized by a high trapezius muscle activity and only few rest times for the trapezius muscle.

A programme to encourage participation of haemodialysis patients in an exercise regimen.

Recent research has reinforced the idea that haemodialysis (HD) patients should exercise to maintain their physical functioning and improve their quality of life. Some effective exercise programmes are available for HD patients. However, these programmes are not always completed by the patients who enrol in them, and therefore, these patients do not maintain long-term physical activity. In this study, a support programme based on the concepts of self-monitoring, verbal reinforcement and motivation was developed to encourage continued participation of HD patients in an exercise regimen. Intervention group participants were provided a support programme in addition to the exercise programme, whereas nonintervention group participants were only provided the exercise programme. The two groups were compared for 12 weeks. The intervention group participants showed a significantly higher rate of continuation of independent exercise than the nonintervention group participants.