Feasibility of a nursing guide for the oral management of outpatients with diabetes mellitus.

Support for nurses is necessary to enable them to practice the oral management of patients with diabetes; however, no support for nurses in this context has been reported. The objective of this study was to verify the feasibility of a nursing guide for the oral management of outpatients with type 2 diabetes, aimed at giving nurses the ability to independently practice oral management for patients with diabetes in an outpatient department. Questionnaires were administered to 25 certified diabetes educator nurses from 54 medical facilities. The evaluation and degree of understanding of the guide were assessed using items in the nursing guide. In addition, opinions and impressions about the guide in the form of free responses were requested. Descriptive statistics were calculated for all measured variables, and data gathered from the free responses were divided into categories based on their similarities and differences. The feasibility of the nursing guide was confirmed, and nurses confidently provided education regarding oral management to patients with diabetes using the guide. These results suggest that a guide may improve nurses' knowledge, skills, and confidence in providing patient education and improve the overall practice of oral management. Further improvements based on the opinions of nurses, such as the expression of terms, implementation of checklists for oral assessment, and identification of devices that can be utilized in a shorter time, are needed to facilitate the implementation of the guide into practice by nurses. Supplementary Information: The online version contains supplementary material available at 10.1007/s13340-023-00622-4.

Oral symptoms and oral hygiene behaviours among patients with type 2 diabetes at a hospital in Japan: A cross-sectional study.

OBJECTIVES: Effective daily oral hygiene behaviour will prevent periodontal disease. This study aimed to examine the oral symptoms, oral hygiene behaviours and factors contributing to oral hygiene behaviours among patients with type 2 diabetes in a hospital in Japan. METHODS: A cross-sectional survey was conducted with 198 patients with type 2 diabetes. Oral symptoms were assessed using a dichotomous scale based on clinical guidelines. Oral hygiene behaviours were assessed based on the frequency of daily tooth brushing and the use of interdental cleaning aids. Chi-square tests and logistic regression analyses were also performed. RESULTS: Overall, 71.2% of the participants had oral symptoms. Of the participants, 80.3% performed twice daily tooth brushing and 61.1% did not perform interdental cleaning on a daily basis. Logistic regression analysis revealed that tooth brushing behaviour was negatively associated with male patients (odds ratio [OR] = 0.45, 95% confidence interval [CI]: 0.25-0.80), difficulty with mastication (OR = 0.63, CI: 0.43-0.92) and tooth loss (OR = 0.68, CI: 0.46-1.00) and positively associated with periodontal disease (OR = 1.73, CI: 1.10-2.72). There were no significant variables related to the use of interdental cleaning aids. CONCLUSIONS: Patients need to learn about the necessity for regular oral hygiene behaviours and the appropriate way. In particular, support for male patients, those who have difficulty with mastication, those who have experienced natural tooth loss, and those who have not been diagnosed with periodontal disease are needed.

Nurses' knowledge, attitude, and practice regarding oral management for outpatients with type 2 diabetes: a national survey on certified diabetes educators.

The association among certified diabetes educator nurses' knowledge, attitudes, and practices related to oral management has not been well examined. The aim of this study was to examine the association between knowledge and attitude as variables for nurses' practice of oral management as certified diabetes educators at medical facilities in Japan. The questionnaires were administered to 300 certified diabetes educator nurses from 1277 medical facilities. The items regarding knowledge, attitude, and practice of oral management were assessed using items from the guidelines, reports, and books on diabetes and periodontal disease, as well as the exhaustive findings of previous studies. More than 70% of the participants did not practice adequate oral management. Logistic regression analysis revealed that all the items were negatively associated with nurses' confidence in oral management (Factor 1: odds ratio [OR] = 0.55; 95% confidence interval [CI] 0.37-0.83; Factor 2: OR = 0.35; 95% CI 0.18-0.70; Factor 3: OR = 0.38; 95% CI 0.24-0.61; Factor 4: OR = 0.29; 95% CI 0.18-0.49). The practice of oral management coupled with an explanation regarding periodontal disease as a diabetic complication (OR = 2.67; 95% CI 1.01-7.02), and supporting collaboration with multiple medical departments (OR = 2.65; 95% CI 1.24-5.65) were positively associated with nurses' education. These results suggest that more strategies for nurses' education are needed to understand the importance of oral management practices and to improve knowledge, attitudes, and confidence in patient oral management.

Stabilometric analysis of neck orientations during mealtime by a wearable device for dysphagia patients.

Postural changes are commonly used treatment to prevent the elderly from the risk of aspiration pneumonia. However, the evidence-based studies regarding effectiveness of this treatment remains unclear since no systematic method exists to measure constantly changing postures without disturbing usual eating behaviors. In this paper, using IMU system attached to a smart-phone based wearable technology, we analyzed data of the neck orientation angles obtained from the dysphagia patients and healthy adults during their mealtime and attempted to see if the obtained data can show differences regarding the dynamics of the angles.The result shows the possibilities to use the device to monitor neck orientations while the dysphagia patients eating their meals in daily lives.

Development of the Japanese version of the Intensive Care Unit Trigger Tool to detect adverse events in critically ill patients.

AIM: The Intensive Care Unit Trigger Tool (ICUTT) was developed to detect adverse events (AEs) in intensive care unit (ICU) patients. The purpose of this study was to determine the validity and reliability of the Japanese version of the ICUTT (ICUTT-J). METHODS: The translation of ICUTT was carried out based on the guideline for translation of instruments. Subsequently, two review teams independently reviewed 50 patients' medical records using the ICUTT-J, and agreement regarding the presence and number of AEs was evaluated to ensure reliability. RESULTS: The ICUTT-J was submitted to the authors of the original ICUTT, who confirmed it as being equivalent to the original version. The item-content validity index and scale-content validity index were 1.00 and 1.00, respectively. Interrater reliability showed moderate agreement of κ = 0.52 in terms of the presence of AEs and linear weighting of κ = 0.49 (95% confidence interval, 0.28, 0.71) in terms of the number of AEs. CONCLUSION: This study's findings suggest that the ICUTT-J is valid and moderately reliable for use in ICUs.

Factors associated with the practice of periodontal management by diabetes educator nurses for outpatients with diabetes: A nationwide survey in Japan.

AIMS: This study aimed to identify and prioritize factors contributing to the provision of periodontal care by certified diabetes nurse educators to outpatients with diabetes in medical settings in Japan. METHODS: Questionnaires were administered to 321 certified diabetes educator nurses from 1277 institutions. The practice of periodontal care was assessed, with factors contributing to periodontal care through items developed based on the capability, opportunity, and motivation-behavior model. Fisher's exact tests and logistic regression were performed. RESULTS: >70% of certified diabetes educator nurses did not provide periodontal care for diabetes patients. The respondents who assessed people's oral conditions were more likely to engage in individual or group education and consult for oral management professionals than those who did not. Significant factors for such assessment were low psychological capability and reflective motivation, irregular and weak intention to engage in oral management, and working at an institution without an outpatient department specializing in diabetes. CONCLUSIONS: The education for certified diabetes educator nurses who do not work at an institution with an outpatient department specialized in diabetes care should be prioritized. Particularly, education to improve knowledge, skills, and confidence in oral assessments and to make periodontal management regular is needed.

The role of knowledge and self-efficacy on dental consultation behavior of patients with type 2 diabetes.

AIM: This study aimed to examine the association of knowledge and self-efficacy as variables for behavior related to dental consultations among patients with type 2 diabetes, depending on the diagnosis of periodontal disease at a general hospital in Japan. METHODS: A cross-sectional survey was conducted with 198 patients with type 2 diabetes (mean age: 66.1 ± 10.1 years, men: 56.6%, mean glycated hemoglobin: 7.3 ± 1.0%). The self-efficacy of patients with periodontal disease was assessed using the Self-Efficacy Scale for Self-Care. Knowledge was measured using five dichotomous items based on reference to clinical guidelines. Dental consultation behavior was assessed from regular dental checkup behavior. RESULTS: In total, 31.8% of participants attended their regular dental checkup in the last year. Logistic regression analysis revealed that dental consultation behavior was positively associated with self-efficacy among patients diagnosed with periodontal disease (odds ratio [OR] = 1.26, 95% confidence interval [CI]: 1.10-1.45), and positively associated with the knowledge among patients not diagnosed with periodontal disease (OR = 1.54, 95%, CI: 1.09 - 2.16). CONCLUSION: Patients without periodontal disease need to learn about accurate knowledge regarding periodontal disease as a complication of diabetes and its prevention via dental checkups. Supportive consultation to improve self-efficacy with respect to dental consultations should be offered to patients with periodontal disease. Medical professionals will be able to support each patient with type 2 diabetes by changing the educational approach for promoting regular dental checkups at the time of diabetes consultations.

Deep Learning-Based Swallowing Monitor for Realtime Detection of Swallow Duration.

Aspiration pneumonia is a life-threatening disease for the elderly. To prevent its risk, regular swallowing assessment is necessary; however, current screening tools for swallow assessment are not widely available and medical experts are insufficient. As a portable assessment tool, we have been developing a smartphone-based realtime monitoring device (GOKURI) which can evaluate swallowing ability based on swallow sounds. For better detection accuracy of the system, we integrated a deep learning model which was developed based on the swallowing anatomy. In this paper, we provide a detailed analysis to see how the swallow sounds detected by the deep learning-based monitor correspond to the actual swallow activities. Also, as an example of practical application of the system, we analyzed the changes of the swallow abilities over time by recording swallow sounds twice for the same participants at a nursing home. To minimize the risk of aspiration pneumonia, caregivers need to understand the disability levels of the patient's swallows so that safe feeding assistance can be provided. The result of this paper implies the possibility of using GOKURI as a daily swallowing monitor with minimum interventions.

Diabetes self-management education and support for adults with newly diagnosed type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials.

This systematic review aimed to identify the effectiveness of diabetes self-management education and support (DSMES) among adults within 12 months of diagnosis of type 2 diabetes mellitus (T2DM). We searched the Cochrane Library, MEDLINE, CINAHL, PsycINFO, ERIC, and other sources up to March 2019 to detect randomized controlled trials in the last decade based on the global guidelines' definition of DSMES. Data were categorized into biomedical, psychosocial, and behavioral outcomes and synthesized using a random-effects model. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system. We scrutinized 12 studies that enrolled 2,386 adults with newly diagnosed T2DM. Biomedical outcomes presented the pooled effects of HbA1c -0.21% (95% confidence interval, -0.38, -0.04), body weight -2.36 kg (-5.77, 1.05), and waist circumference -1.8 cm (-5.63, 2.04) when the data from the two studies with low risk of bias were combined (N = 1,082). Psychosocial and behavioral effects were inconclusive owing to mixed results from various scales and reporting. The quality of the body of evidence was low. DSMES within 12 months of T2DM diagnosis might affect patient-centered outcomes. Further studies with higher precision using standardized measurement methods are required.

The role of illness schemata in self-care behaviors and glycemic control among patients with type 2 diabetes in Iran.

AIMS: The diabetes illness perception domains outlined by Leventhal's common-sense model may be weakly associated with hemoglobin A1c (HbA1c) and adherence to diabetes self-care behaviors. However, type 2 diabetes patients' illness schemata identified by clustering the illness perception domains remain to be explained. This study aimed to describe type 2 diabetes patients' illness schemata and to examine their association with self-care behaviors and glycemic control in Iran. METHODS: A cross-sectional survey was conducted with 200 patients (mean age 59.5±10.3; 70% female) who attended self-management classes at the Iranian Diabetes Society in Tehran. Illness perceptions and self-care behaviors were assessed using the Persian version of the Illness Perception Questionnaire Revised and the Summary of Diabetes Self-Care Activity. RESULTS: Three clusters of diabetes illness beliefs were identified: "empowered," "self-condemned," and "powerless." "Empowered" participants adhered most rigorously to general diet, fruit and vegetable intake, and exercise, and had the best glycemic control (HbA1c=7.2%, SD=0.2), followed by "self-condemned" and then "powerless" participants, who had the lowest adherence and the worst glycemic control (p<0.0001). CONCLUSIONS: The clustering method for identifying type 2 diabetes patients' illness schemata is useful for selecting patients who need further care and assistance with adhering to self-care behaviors and glycemic control.

Automatic Measurements of Neck Angles toward the Bedside Treatment for the Dysphagia Patients at the Community-Based Health Care.

For the elderly with dysphagiais, postural changes are a popular method to reduce the risk of aspiration pneumonia. Among them, the reclining position, a postural change set by the bed angles, has been widely used in practical settings. However, setting the reclining positions is difficult since all beds do not have a system to measure angles especially at the nursing facilities and patient's homes. Moreover, a anatomically critical angle is the one created by the larynx and the pharynx against the horizontal line, but we cannot check them without a medical equipment, such as X-ray or Videofluoroscopy (VF).We have been developing a smart-phone based wearable technology which can measure the neck angles automatically in realtime. In this research, we conducted a study to compare the IMU measured angles with the larynx and pharynx angles from the VF images, and analyzed if IMU can measure these angles properly. Additionally, we compared three angles with: 1) bed angles, 2) neck angles measured by IMU, and 3) bed angles set by a dysphagia treatment specialist, to show how different neck angles were set in the bedside practice. We will also discuss the IMU's future applications to keep the elderly eat safely in the community.

[Required support・An examination of the subjective quality of life and related factors In elderly people eith a high functional capacity who need mild care].

AIM: We aimed to investigate subjective quality of life (QOL) and related factors in elderly people with a high functional capacity using daycare centers who require support and mild long-term care. METHODS: We collected data on the basic attributes, social background (hobbies, JST-Index of Competence), and subjective QOL (Revision PGC Morale Scale) through interviews with 238 people ≥65 years of age using daycare centers who required support and long-term care (level 1, 2). We conducted a t-test and χ2 test to compare male and female participants and a multiple regression analysis using sex, age, hobbies, eating together, and the JST-Index of Competence (using new devices, collecting information, living management, social participation) as independent variables to predict the subjective QOL (dependent variable). RESULTS: We observed no marked differences in the subjective QOL between men and women, but a significant difference was noted between sexes in the number of people who ate with others. We conducted a multiple regression analysis using the above independent variables with the body mass index and level of care as explanatory variables and subjective QOL as a dependent variable to predict the value of the dependent variable. The subjective QOL tended to be higher in participants with high scores for social participation (standard partial regression coefficient 0.26, 95% confidence interval 0.14-0.38), living management (0.23, 0.09-0.37), and hobbies (0.20, 0.09-0.32). CONCLUSIONS: In elderly subjects with a high functional capacity, living management, social participation, and presence of hobbies were found to be associated with a decreased QOL.

Smartphone-based swallowing monitoring and feedback device for mealtime assistance in nursing homes.

As many of the elderly are prone to dysphagia, preventing aspirations during mealtime assistance is a huge concern, especially for institutions operated with limited staff. Two of the main course of actions that are taken usually to prevent aspiration are the altering of bolus consistency and altering of the swallowing posture. To assist prevention of pneumonia, we have been developing a smartphone-based wearable technology that can evaluate swallowing ability in real-time. In this paper we will introduce modified version of Swallwoscope adding a posture detection system and a remote swallowing activity visualisation system to our previous work. We will evaluate the accuracy of the proposed posture detection system and also evaluate the feasibility of our device to determine bolus consistency. We plan to integrate these components in a network-based framework to share the relevant medical information within the community to enhance safety and pleasure of eating.

Smartphone-Based Real-time Assessment of Swallowing Ability From the Swallowing Sound.

Dysphagia can cause serious challenges to both physical and mental health. Aspiration due to dysphagia is a major health risk that could cause pneumonia and even death. The videofluoroscopic swallow study (VFSS), which is considered the gold standard for the diagnosis of dysphagia, is not widely available, expensive and causes exposure to radiation. The screening tests used for dysphagia need to be carried out by trained staff, and the evaluations are usually non-quantifiable. This paper investigates the development of the Swallowscope, a smartphone-based device and a feasible real-time swallowing sound-processing algorithm for the automatic screening, quantitative evaluation, and the visualisation of swallowing ability. The device can be used during activities of daily life with minimal intervention, making it potentially more capable of capturing aspirations and risky swallow patterns through the continuous monitoring. It also consists of a cloud-based system for the server-side analyzing and automatic sharing of the swallowing sound. The real-time algorithm we developed for the detection of dry and water swallows is based on a template matching approach. We analyzed the wavelet transformation-based spectral characteristics and the temporal characteristics of simultaneous synchronised VFSS and swallowing sound recordings of 25% barium mixed 3-ml water swallows of 70 subjects and the dry or saliva swallowing sound of 15 healthy subjects to establish the parameters of the template. With this algorithm, we achieved an overall detection accuracy of 79.3% (standard error: 4.2%) for the 92 water swallows; and a precision of 83.7% (range: 66.6%-100%) and a recall of 93.9% (range: 72.7%-100%) for the 71 episodes of dry swallows.

[Nourishment of patients with persistent disturbance of consciousness and nutritional markers to simplify evaluation].

AIM: This study was aimed to evaluate the nourishment of patients with a disturbance of consciousness who received tube feeding, and to discuss nutritional markers to simplify evaluation in these patients at home or at facilities for the elderly. METHODS: The nourishment of 46 patients with a disturbance of consciousness who received tube feeding was evaluated by performing 1) physical measurements, 2) blood test, and 3) measurement of resting metabolic rate. Furthermore, the anemia-like symptoms of the palpebral conjunctiva, which were supposed to be related with nourishment, were subjectively evaluated to clarify their relevance to the results of physical measurements and blood test. RESULTS: The average of triceps skinfold thickness (%TSF), which shows relative physical measurement data of patients with a disturbance of consciousness when compared to those of healthy people, was 105.7 +/- 39.8, which was almost equivalent to that of healthy people. The arm muscle circumference (%AMC) and calf circumference (%CC) were 87.5 +/- 11.5 and 73.6 +/- 9.4, respectively. In the blood test, the average Alb value was 3.3 +/- 0.5 g/dl, suggesting that 35 (76.1%) of the 46 patients with disturbance of consciousness had protein energy malnutrition (PEM). Since the relationship between anemia-like symptoms of the palpebral conjunctiva and Hb/Ht (p < 0.01, p < 0.01) and Alb (p < 0.05) was confirmed, there is a high possibility that these markers can be useful for easy evaluation of nourishment. CONCLUSION: Because hypoalimentation is a more serious problem than overnutrition in patients with a disturbance of consciousness, we consider that the calorie count should be adjusted based on the measurement results of resting energy expenditure (REE) in individual patients, although the count for patients with tube feeding was set at individual levels of basal metabolism in the conventional method. Moreover, further discussion is required regarding alternative markers for nutritional evaluation to blood test data.

Comparison of three methods for raising an elderly person from a traditional futon mattress.

The objective of this study was to compare three approaches for a caregiver to raise an elderly person from a Japanese traditional futon mattress placed directly on the floor. These approaches are as follows: raising from behind with the support of the back (method A); straight raising of the trunk (method B), and raising through the use of the caregiver's own rotational motion (method C). The methods were evaluated from the perspective of caregivers and care recipients. The caregivers were 12 nurses and the recipients were 40 elderly persons. Heart rate, surface electromyography and subjective evaluation of physical burden and ease of performance were evaluated in the caregivers, and "stability", "discomfort" and choice of the best method were evaluated subjectively by the elderly persons. The results indicated that method A caused more stress on the lumbar region of caregivers and was more difficult to perform than methods B and C. No significant difference in physical burden was found between methods B and C; however, method C had a lower physical burden and could be performed with ease. For care recipients, the approaches of choice were methods A and C; many preferred method C, while desirable methods of care varied between individuals and lifestyle and mental factors played a role in this decision.