Experiences of dialogue in advance care planning educational programs.

BACKGROUND: Advance care planning (ACP) is a process in which adults engage in an ongoing dialogue about future medical treatment and care. Though ACP is recommended to improve the quality of end-of-life care, the details of the dialogue experience in ACP are unknown. OBJECTIVE: To explore participants' experiences of dialogue in an ACP educational program that encouraged them to discuss the value of a way of life. RESEARCH DESIGN: This qualitative descriptive study used the focus group interview method. Data were analyzed using qualitative content analysis. PARTICIPANTS AND RESEARCH CONTEXT: A dialogue-based ACP educational program was conducted in four regions in Japan for local citizens to discuss the value of their way of life. A total of 66 individuals (mean age = 55.5 ± 17.2 years; 50 women and 16 men) participated in focus group interviews. ETHICAL CONSIDERATIONS: This study was approved by the Ethical Review Committee of Tokyo Women's Medical University (no. 4723) and Kyoto University (no. R2099). FINDINGS: Five main themes were extracted: discussing one's thoughts with others in a considerate manner, reflecting on one's way of life through others, feeling a sense of connection with others through storytelling, realizing the difficulties of talking about "what if" topics, and turning one's eyes toward the future through the dialogue. These themes were interrelated and illustrated the complexity of the experience of discussing values. CONCLUSIONS: The results suggest that dialogue in ACP is useful in clarifying values. They also indicated the need for dealing with the ethical challenges of discussing value and the importance of caring for the interlocutor to have a safe dialogue. In the ACP process, safety in dialogue may improve readiness in ACP, and health practitioners who support ACP need to address the ethical challenges entailing dialogue about values.

Identifying structure and aspects that 'continuing nursing care' used in discharge support from hospital to home care in Japan.

This study investigated nursing practice in continuing nursing care with the aim of identifying the key factors in nursing practice during discharge support. A literature review of papers published in Japanese in 2000 and 2011 was conducted using 'case management', 'care management', 'continuing nursing care', 'discharge support', 'discharge planning' and 'elderly person' as key words. An analysis of 54 papers revealed the following five aspects of continuing nursing care: (i) a cyclical approach aimed at realising the lifestyle desired by the person concerned; (ii) management of medical conditions for lifestyle stability; (iii) support for the patient as someone who can live independently; (iv) support to raise the ability of families to care for themselves; and (v) team approach to achieve implementation of patient-centred care. Understanding these aspects allows nurses to recreate the lifestyle of patients and families and facilitate the implementation of a systematic team approach.

A Survey of Epilepsy-related Knowledge, Attitudes and Practices of Home Healthcare Nurses in the San-in Region of Japan.

BACKGROUND: Comprehensive care is necessary for people with epilepsy (PWE) to lead a fulfilling life at home and in the community. The purpose of this study was to determine the epilepsy-related knowledge, attitudes and practices of home healthcare nurses (HHNs) in the San-in region of Japan. METHODS: A questionnaire survey was conducted by mail of 546 HHNs working in Tottori and Shimane Prefectures. The questionnaire assessed the epilepsy-related knowledge, attitudes and practices of HHNs. For the analysis, simple and cross tabulation of questionnaire responses were conducted, and the chi-squared test was used for statistical testing. RESULTS: A total of 285 HHNs participated in the study. Of the respondents, 43.9% had experience taking care of PWE in a home healthcare nursing setting. Regarding the cause of epilepsy, in descending order the percentage of correct responses were 86.7% for stroke, 85.3% for head injury, and only 13.3% for dementia. Concerning how to respond to an epileptic seizure, almost all respondents answered correctly, but 29.8% gave the incorrect answer of "place something inside the mouth." Regarding the practices of HHNs in relation to caring for PWE, nurses scored 52.0% for collaborating with the attending physician, indicating the need for improvement. The score for "provide information about social resources" was low at 18.4%. Of the respondents, 95.8% answered that epilepsy-related knowledge and technical skills were necessary for home healthcare nursing practice, and 87.7% were interested in participating in a workshop on epilepsy. CONCLUSION: The study revealed an inadequate level of knowledge of epilepsy with dementia and corresponding epileptic seizures, a low awareness of nursing care in collaboration with physicians, and the importance of providing information about social resources. There is a need to offer information and education on the latest knowledge about epilepsy to HHNs.

Analyses of the mechanism of intracellular transport and secretion of pituitary hormone, with an insight of the subcellular localization of pituitary hormone and its mRNA.

Combined in situ hybridization (ISH) and immunohistochemistry (IHC) under electron microscopy (EM-ISH&IHC) has sufficient ultrastructural resolution and provides two-dimensional images of subcellular localization of pituitary hormone and its mRNA in a pituitary cell. The advantages of semiconductor nanocrystals (Quantum dots, Qdots) and confocal laser scanning microscopy (CLSM) enable us to obtain three-dimensional images of subcellular localization of pituitary hormone and its mRNA. Both EM-ISH&IHC and ISH&IHC using Qdots and CLSM are useful for understanding the relation between protein and mRNA simultaneously in two or three dimensions. Another important issue is the intracellular transport and secretion of pituitary hormone. We have developed an experimental pituitary cell line, the GH3 cell, which has growth hormone (GH) linked to enhanced yellow fluorescein protein (EYFP). This stable GH3 cell secretes GH linked to EYFP upon stimulated by Ca2+ influx or Ca2+ release from storage. This GH3 cell is useful for real-time visualization of the intracellular transport and secretion of GH. These three methods enable us to visualize consecutively the process of transcription, translation, transport, and secretion of pituitary hormone.

Trial and evaluation of assertion training involving nursing students.

BACKGROUND: The concept of assertion and conceptual/practical methods of assertion (assertiveness) training were originally developed in the United States and Europe. These principles were embraced and adapted in Japan in 1970's. However, only a few studies relating to assertion (assertiveness) have been undertaken thus far in Japan, especially so in the domain of nursing students in comparison with other countries. The purpose of this study was to design and implement assertion training with nursing students and to clarify its effects. METHODS: The participants were all volunteers, invited from a class of 3rd year nursing students. Ten students (intervention group) participated in the assertion training comprised of five sessions in February 2006. Fifty-six students (control group) were participated only in the questionnaire. Both groups were asked to complete the same questionnaire twice, before and after the assertion training. The questionnaire measured levels of assertiveness, social skills, self-esteem, social support and satisfaction with university life. The results and variances, both before and after assertion training, between the intervention group and the control group were analyzed. The effectiveness of the assertion training was determined by changes in pre and post training questionnaire scores. RESULTS: The scores for social skills in the control group had a tendency to decline while the scores for social skills in the intervention group remained constant. CONCLUSION: Although there were no statistically significant results in the intervention group, the present study highlights areas appropriate for further study.

Mechanism of D(2) agonist-induced inhibition of GH secretion from human GH-secreting adenoma cells.

The mechanism of dopamine D(2) agonist-induced inhibition of GH secretion from GH-secreting adenoma cells was investigated by measurement of intracellular calcium concentration ([Ca(2+)] (i)) and static incubation experiment. Bromocriptine decreased [Ca(2+)](i) in a concentration-dependent manner through D(2) receptor. The inhibition was abolished by pertussis toxin pretreatment. Bromocriptine did not decrease [Ca (2+)](i) after nitrendipine had decreased it. 8Br-cAMP increased [Ca(2+)](i) but application of bromocriptine decreased it, suggesting that bromocriptine-induced inhibition of [Ca(2+)](i) is not dependent on bromocriptine-induced inhibition of adenylyl cyclase. Static incubation experiment revealed that bromocriptine inhibited GH secretion in a concentration-dependent manner. The inhibition was through D(2) receptor and was abolished by pertussis toxin pretreatment. 8Br-cAMP increased GH secretion. Bromocriptine decreased GH secretion even after 8Br-cAMP pretreatment. However, the GH release from cells incubated with bromocriptine alone was significantly less than that from cells incubated with bromocriptine after 8Br-cAMP pretreatment, suggesting a modulatory action of cAMP system in bromocriptine response.