[Factors related to the physical restriction practiced by nurses in acute care hospitals: An analysis using nurses' self-assessment].

AIM: The purpose of this study was to clarify the relationship between physical restriction as a nursing practice and the perceived extent of person-centered care towards elderly patients with cognitive impairment in acute care hospitals (SSNPEC). RESEARCH METHODS: This study was conducted on ward nurses in 4 hospitals (nursing staff ratio of 7:1; >500 beds) in H city from April 2016 to March 2017. The evaluation of physical restriction in the hospital comprised the following six items: the use of trunk belts, wearing of mitten-type gloves, the use of shoulder harnesses (such as for patients in wheelchairs), wearing care clothes, the use of a bed fence, and psychotropic drugs. In the multiple regression analysis, the total physical restriction score was the dependent variable. Results pertaining to the prediction of physical restriction were as follows: "Care that values psycho-social approaches based on predicted potential problems", "Care that is tailored to the individual and their cognitive function", and "Improvement in the quality of the care" significantly decreased physical restrictions. CONCLUSION: This study showed that nursing practices in acute care hospitals that are based on person-centered care emphasizing clinical ethics decreased the application of physical restrictions. A balance existed between safety management through nursing practices and respect for patients in acute hospitals.

The risk of a second hip fracture in patients after their first hip fracture.

We investigated the incidence of additional fractures and the rate of prescription of osteoporotic pharmacotherapy after an initial hip fracture. We surveyed female patients aged 65 and over who sustained their first hip fracture between January 1, 2006, and December 31, 2007, treated at 25 hospitals in five geographic areas in Japan. Data for 1 year after the first hip fracture were collected from medical records, and questionnaires were mailed to all patients. In total, 2,663 patients were enrolled, and 335 patients were excluded based on exclusion criteria. The analysis was performed on 2,328 patients. During the 1-year follow-up period 160 fractures occurred in 153 patients and 77 subsequent hip fractures occurred in 77 patients. The incidence of all additional fractures among patients who sustained their first hip fracture was 70 (per 1,000 person-year) and that for second hip fracture was 34. In comparison to the general population, women ≥65 years of age who sustained an initial hip fracture were four times as likely to sustain an additional hip fracture. Antiosteoporosis pharmacotherapy was prescribed for 436 patients (18.7%), while 1,240 patients (53.3%) did not receive any treatment during the 1-year period. Patients who have sustained one hip fracture have a higher risk of a second hip fracture compared to the general population, and most of these women receive no pharmaceutical treatment for osteoporosis.

Evaluation of dementia-prevention classes for community-dwelling older adults with mild cognitive impairment.

AIM: The number of elderly people with dementia in Japan is likely to increase as the population ages. In some areas in Tottori Prefecture, dementia-prevention classes have been conducted for several years. In the present study, we evaluated dementia-prevention classes in nine districts of Tottori Prefecture in terms of cognitive function, assessment by the leader and subjective evaluation by participants. METHODS: The study's subjects included 112 community-dwelling elderly residents who were selected after a two-step screening. Data were collected according to the following four factors: (i) evaluation of cognitive function at the beginning and end of classes; (ii) the content of the classes; (iii) observations regarding the state of subjects; and (iv) participants' subjective evaluation obtained via a questionnaire distributed at the final class. RESULTS: In terms of cognitive function among all subjects, scores significantly improved after the dementia-prevention classes. However, there were no significant cognitive improvements in the districts where programmes were biased towards a single category (e.g. systemic exercise, creative activities). Based on class leaders' assessments, subjects showed improved appearance and facial expression in later classes. Participants became more involved in the programmes, and their interests in others increased. In terms of their daily lives, subjects became more involved with others and more active after participating in the classes. CONCLUSIONS: Dementia-prevention classes improved not only cognitive function but also other aspects of daily life, as well. We thought it was important to evaluate both objective and subjective factors related to the classes.

[Utilization of FRAX at orthopedic clinics].

A survey for orthopedic doctors was performed to evaluate the recognition and the usability of FRAX. As a result, a half of them have known FRAX; however, only a few recognized its advantage. Fracture risks were assessed by FRAX for out patients in the orthopedic osteoporosis clinic and also for subjects in the osteoporosis screening. Appropriate threshold of the major osteoporotic fracture for pharmaceutical intervention seemed to be 15% and be applied from 65 to 74 years of age based on the data.