Perspectives of Nursing Students on Hybrid Simulation-Based Learning Clinical Experience: A Text-Mining Analysis.

Given the past limitations on clinical practice training during the COVID-19 pandemic, a hybrid format program was developed, combining a time-lapse unfolding case study and high-fidelity simulation. This study assesses the effectiveness of a new form of clinical training from the perspective of student nurses. A questionnaire was administered to 159 second-year nursing students enrolled in the "Basic Nursing Practice II" course. Text mining was performed using quantitative text analysis for the following items: (1) aspects that were learned more deeply, (2) benefits, and (3) difficulties encountered with the new practice format. The new clinical practice format enhanced participants' learning related to the daily changes required in nursing care and improved their nursing competency through simulated patient interactions. However, the participants faced difficulties dealing with patients accompanied by secular changes. Moreover, they found remote group work challenging. These findings can be applied to the development of new educational strategies.

Post-Migration Changes in Dietary Patterns and Physical Activity among Adult Foreign Residents in Niigata Prefecture, Japan: A Mixed-Methods Study.

The migrant population of Japan is gradually increasing, but it is not well known how and why diet and physical activity (PA) change post-migration. Therefore, this study used a mixed-method approach to investigate the changes in dietary patterns and PA through a web- and paper-based survey (n = 128) and understand the contextual factors for those changes through semi-structured interviews (n = 21). Descriptive and thematic analyses of quantitative and qualitative data were conducted, respectively. The majority of survey (57.8%) and interview (66.7%) participants were female, and the mean duration of stay in Japan was 5 and 3.6 years, respectively. The survey revealed an increased consumption of foods attached to Japanese culture, frozen and microwavable food, and a reduced consumption of fruits. We identified environmental (availability, accessibility, and affordability of foods; food safety and diet-related information; and climate), individual (living status; post-migration lifestyle; and food preferences and limitations), or socio-cultural (relationships with Japanese people; cultural differences; and religious influences) factors that impact diet changes. Language proficiency and the duration of stay shape dietary behaviors. Determinants of PA changes were climate, lifestyle, and the influence of Japanese culture. In conclusion, immigrants in Japan experience post-migration diet and PA changes, and this study adds knowledge about how and why such changes occur.

The role of zinc on nutritional status, sarcopenia, and frailty in older adults: a scoping review.

BACKGROUND: Zinc (Zn) deficiency, malnutrition, sarcopenia, and frailty are prevalent among older adults and are prominent factors contributing to disability and mortality. OBJECTIVE: This scoping review was conducted to aid understanding of the extent and types of research addressing the role of Zn in nutritional status, sarcopenia, and frailty, among older individuals. METHOD: A systematic search was performed in August 2022 of 3 electronic databases (PubMed, Web of Science, and ProQuest) using predefined search terms. The review was conducted referring to the Arksey and O'Malley framework and PRISMA-ScR. RESULTS: The search retrieved 16 018 records, and a total of 49 studies were included in this review after the screening. Of those, 30 were based on dietary Zn intake, 18 on tissue Zn levels, and 1 on both. Most studies were based on cross-sectional data from community-dwelling older adults. Studies addressing the associations between Zn status and individual anthropometric and sarcopenia-related variables reported inconsistent results. However, most studies reported inverse associations between malnutrition, frailty, and Zn status. CONCLUSION: There was more consistent evidence of the relationship of Zn status with malnutrition, sarcopenia, and frailty rather than with individual nutritional parameters. Validated screening and assessment tools and criteria and prospective studies are required to elucidate the relationship of Zn with sarcopenia and frailty in the older population.

Impact of Heavy Snowfall on Emergency Transport and Prognosis of Out-of-Hospital Cardiac Arrest Patients: A Nation-Wide Cohort Study.

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is a significant global cause of mortality, and Emergency Medical Services (EMS) response interval is critical for survival and a neurologically-favorable outcome. Currently, it is unclear whether EMS response interval, neurologically-intact survival, and overall survival differ between snowy and non-snowy periods at heavy snowfall areas. METHODS: A nation-wide population-based cohort of OHCA patients, registered from 2017 through 2019 in the All-Japan Utstein Registry, was divided into four groups according to areas (heavy snowfall area or other area) and seasons (winter or non-winter): heavy snowfall-winter, heavy snowfall-non-winter, other area-winter, and other area-non-winter. The first coprimary outcome was EMS response interval, and the secondary coprimary outcome was one-month survival and a neurologically-favorable outcome at one month. RESULTS: A total of 337,781 OHCA patients were divided into four groups: heavy snowfall-winter (N = 15,627), heavy snowfall-non-winter (N = 97,441), other area-winter (N = 32,955), and other area-non-winter (N = 191,758). Longer EMS response intervals (>13 minutes) were most likely in the heavy snowfall-winter group (OR = 1.86; 95% CI, 1.76 to 1.97), and also more likely in heavy snowfall areas in non-winter (OR = 1.44; 95% CI, 1.38 to 1.50). One-month survival in winter was worse not only in the heavy snowfall area (OR = 0.86; 95% CI, 0.78 to 0.94) but also in other areas (OR = 0.91; 95% CI, 0.87 to 0.94). One-month neurologically-favorable outcomes were also comparable between heavy snowfall-winter and other area-non-winter groups. CONCLUSIONS: This study showed OHCA in heavy snowfall areas in winter resulted in longer EMS response intervals. However, heavy snowfall had little effect on one-month survival or neurologically-favorable outcome at one month.

Deep learning-based classification of adequate sonographic images for self-diagnosing deep vein thrombosis.

BACKGROUND: Pulmonary thromboembolism is a serious disease that often occurs in disaster victims evacuated to shelters. Deep vein thrombosis is the most common reason for pulmonary thromboembolism, and early prevention is important. Medical technicians often perform ultrasonography as part of mobile medical screenings of disaster victims but reaching all isolated and scattered shelters is difficult. Therefore, deep vein thrombosis medical screening methods that can be easily performed by anyone are needed. The purpose of this study was to develop a method to automatically identify cross-sectional images suitable for deep vein thrombosis diagnosis so disaster victims can self-assess their risk of deep vein thrombosis. METHODS: Ultrasonographic images of the popliteal vein were acquired in 20 subjects using stationary and portable ultrasound diagnostic equipment. Images were obtained by frame split from video. Images were classified as "Satisfactory," "Moderately satisfactory," and "Unsatisfactory" according to the level of popliteal vein visualization. Fine-tuning and classification were performed using ResNet101, a deep learning model. RESULTS: Acquiring images with portable ultrasound diagnostic equipment resulted in a classification accuracy of 0.76 and an area under the receiver operating characteristic curve of 0.89. Acquiring images with stationary ultrasound diagnostic equipment resulted in a classification accuracy of 0.73 and an area under the receiver operating characteristic curve of 0.88. CONCLUSION: A method for automatically identifying appropriate diagnostic cross-sectional ultrasonographic images of the popliteal vein was developed. This elemental technology is sufficiently accurate to automatically self-assess the risk of deep vein thrombosis by disaster victims.

Compliance of Static Stretching and the Effect on Blood Pressure and Arteriosclerosis Index in Hypertensive Patients.

Background: Treatment of high blood pressure is a combination of lifestyle changes and medications, and appropriateexercise therapy is recommended as one of the lifestyle-related changes. Recently, stretching, a low-intensity exercise, was reported to be antihypertensive and effective for improving arteriosclerosis, in addition to aerobic exercise. The present study investigated the short-term effects of continuous stretching and rest-induced rebound on vascular endothelial function in hypertensive patients. Methods: This study was conducted as a single-arm prospective interventional study including patients between 30 and 70 years of age undergoing treatment for hypertension from October 2019 until May 2021. The intervention consisted of six months of daily stretching, one month of rest, and another three months of stretching. We measured arteriosclerosis indices such as cardio ankle vascular index (CAVI), ankle brachial pressure index (ABI) and reactive hyperemia index (RHI), and flexibility at the baseline and one, three, six, seven, and ten months from the baseline. Results: We included a total of ten patients (three males and seven females) with an average age of 60.10 ± 6.05 years. The exercise rate for the entire period was 90% or more, and the anteflexion measurement value improved significantly before and after the intervention (p < 0.001). Blood pressure and CAVI/ABI were well controlled throughout the study period. RHI did not show any significant improvement during the initial six months, and only slightly improved by the third month (p = 0.063). Even after the rest phase and resumption of stretching, RHI remained stable. Conclusions: The compliance of the stretching program we used, evaluated by the exercise implementation rate for the entire period, was 90% or more; therefore, easy to perform and continue by hypertensive patients. However, we did not observe a significant positive effect on arteriosclerosis index or blood pressure in this study.

Clinical Sign-Based Rapid Response Team Call Criteria for Identifying Patients Requiring Intensive Care Management in Japan.

Background and Objectives: For effective function of the rapid response system (RRS), prompt identification of patients at a high risk of cardiac arrest and RRS activation without hesitation are important. This study aimed to identify clinical factors that increase the risk of intensive care unit (ICU) transfer and cardiac arrest to identify patients who are likely to develop serious conditions requiring ICU management and appropriate RRS activation in Japan. Materials and Methods: We performed a single-center, case control study among patients requiring a rapid response team (RRT) call from 2017 to 2020. We extracted the demographic data, vital parameters, blood oxygen saturation (SpO2) and the fraction of inspired oxygen (FiO2) from the medical records at the time of RRT call. The patients were divided into two groups to identify clinical signs that correlated with the progression of clinical deterioration. Patient characteristics in the two groups were compared using statistical tests based on the distribution. Receiver operating characteristic (ROC) curve analysis was used to identify the appropriate cut-off values of vital parameters or FiO2 that showed a significant difference between-group. Multivariate logistic regression analysis was used to identify patient factors that were predictive of RRS necessity. Results: We analyzed the data of 65 patients who met our hospital's RRT call criteria. Among the clinical signs in RRT call criteria, respiratory rate (RR) (p < 0.01) and the needed FiO2 were significantly increased (p < 0.01) in patients with severe disease course. ROC curve analysis revealed RR and needed FiO2 cut-off values of 25.5 breaths/min and 30%. The odds ratio for the progression of clinical deterioration was 40.5 times higher with the combination of RR ≥ 26 breaths/min and needed FiO2 ≥ 30%. Conclusions: The combined use of RR ≥ 26 breaths/min and needed FiO2 ≥ 30% might be valid for identifying patients requiring intensive care management.

Quality of Life and Symptom Burden among Chronic Kidney Disease of Uncertain Etiology (CKDu) Patients in Girandurukotte, Sri Lanka.

Symptom burden and health-related quality of life (HRQOL) are important predictors of how a disease affects patients' lives, especially for endemic health problems such as chronic kidney disease of uncertain etiology (CKDu). Our study describes symptom burden, HRQOL, and associated demographic and clinical variables in CKDu patients in the Girandurukotte area, Sri Lanka. A cross-sectional study included 120 CKDu patients attending the renal clinic in the endemic area. The instruments applied were the Kidney Disease Quality of Life-Short Form (KDQOL-SFTM) version 1.3 and CKD Symptom Index-Sri Lanka. Socio-demographic, disease-related, and anthropometric variables were also investigated. The mean age of patients was 61.87 (SD 11.31), while 69.2% were male. The mean glomerular filtration rate was 28.17 (SD 14.03) mL/min/1.73 min2, and 70.8% were anemic. Bone/joint pain was the most experienced symptom while the median number of symptoms reported by patients was 5 (IQR 3-7). The mean symptom burden, physical component summary, mental component summary, and kidney-disease-specific component scores were 12.71 (SD 10.45), 68.63 (SD 19.58), 78.53 (SD 18.78), and 81.57 (SD 5.86), respectively. Age was found to be a significant predictor of HRQOL, while hemoglobin level and being a farmer were significant predictors of symptom burden. Our data indicate that CKDu patients in all stages experience at least one symptom affecting all aspects of HRQOL.

Skeletal Muscle Index at Intensive Care Unit Admission Is a Predictor of Intensive Care Unit-Acquired Weakness in Patients With Sepsis.

BACKGROUND: Intensive care unit-acquired weakness (ICU-AW) can be diagnosed using the Medical Research Council (MRC) score. However, such scoring may not be possible in ICU patients who may be sedated or delirious or have encephalopathy. Currently, a quantitative assessment of the cross-sectional area of the muscle is available to assess changes in skeletal muscle mass using computed tomography (CT) images. This assessment calculates the skeletal muscle index (SMI) (cm2/m2) by dividing the cross-sectional area (cm2) of the skeletal muscle at the level of the third lumbar vertebra by the square of the patient's height (m2) on CT. This study assessed the effectiveness of SMI, as measured by abdominal CT scans, in predicting the onset of ICU-AW in patients with sepsis admitted to the ICU. METHODS: We examined septic ICU patients admitted to the Niigata University Hospital ICU during 2012 - 2017 under mechanical ventilation. Patients were retrospectively divided into two groups by MRC score at ICU discharge: group AW comprised patients with an MRC score < 48, and group non-AW (NAW) comprised the remaining patients. Clinicopathological factors at ICU admission such as age, gender, underlying disease, body mass index, and SMI were compared between the two groups. Statistical analyses were performed using the Mann-Whitney U test, Fisher's exact test, receiver operator characteristic (ROC) analysis and multivariate analysis. RESULTS: A total of 31 septic patients were examined, and 23 patients met the criteria for ICU-AW. The prevalence of women was significantly higher in group AW (P < 0.05). All clinical factors, except for gender, were not significantly different between the two groups. SMI was significantly lower in group AW than in group NAW (P < 0.05). ROC analysis revealed that the cut-off value of SMI for predicting ICU-AW was 44.1, and the multivariate analysis revealed that only low SMI was a significant factor in predicting ICU-AW (P < 0.05). CONCLUSIONS: Our results show that SMI measurement at ICU admission is a valid predictive factor for ICU-AW progression in septic patients.

Assessment of Nutritional Status and Dietary Pattern of a Rural Adult Population in Dry Zone, Sri Lanka.

The objective of this work was to describe average dietary intake, physical activity (PA) and nutritional status of the adult population of Girandurukotte, Sri Lanka. A cross-sectional survey, including one 24-h dietary recall, international physical activity questionnaire and anthropometric measurements was conducted in a representative sample of 120 adults. Mean (SD) for body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR) and waist to height ratio (WHtR) were 23.06(4.20) kg/m2, 85.6(9.5) cm, 0.95(0.05) and 0.55(0.07), respectively. Significant differences were observed in height, body fat %, body muscle %, hip circumference, WHR, WHtR, fat mass index and hand grip strength between men and women (p < 0.05). Among the study group, 35.8% were overweight, 13.3% were obese and 11.7% were underweight. Central obesity was observed in 59.2%, 97.5% and 74.2% of adults by WC, WHR and WHtR, respectively. Mean (SD) dietary diversity score and dietary diversity score with portions were 4.77(1.28) and 4.09(1.32), respectively. Mean daily intake of protein, fruits, vegetables and dairy were well below the national recommendations. Despite the higher PA level, nearly half the population was overweight and obese and the majority was centrally obese. None of the dietary diversity scores met the optimal levels, suggesting poor quality and quantity of the diet.

Micronutrient Status in Sri Lanka: A Review.

Micronutrients include vitamins, minerals and, trace elements that are required in minute quantities but play a vital role in normal human growth, development and physiological functioning. Micronutrient deficiencies, also known as hidden hunger, are a global issue, with particularly high prevalence rates in developing countries. Currently, Sri Lanka is experiencing the double burden of over- and undernutrition. This review describes the micronutrient status of Sri Lanka based on results of national surveys and related articles published from 2000. The available data suggest a higher prevalence of iron, zinc, calcium, folate, and vitamin A deficiencies. The prevalence of iodine deficiency has declined gradually following the implementation of a universal salt iodization program. Iron deficiency is the most common cause of anemia and low red blood cell indices. Females are more vulnerable to micronutrient deficiencies than males. The coexistence of multiple micronutrient deficiencies and concurrent macro- and micronutrient deficiencies is common. Studies have shown an association between micronutrient deficiencies and different demographic, socioeconomic, and dietary factors. Therefore, there is a need for comprehensive studies, nutritional policies, and nationwide intervention programs in Sri Lanka to improve the micronutrient status of the population.

Measurement of muscle activities for evaluating physical burden and pain during mammography positioning.

Mammography has become widespread as a standard method for breast cancer screening. For women undergoing mammography, compression of the breast and special positioning are requested, and they cause the physical burden and pain. However, the reality of the physical burden and subjective pain associated with mammography are not fully understood. We therefore measured the muscle activity of subjects during positioning for mammography screening using surface electromyography to evaluate the physical burden and pain associated with the positioning. The subjects consisted of 15 women (age: 44.4 ± 6.56 years old, height: 160 ± 6.7 cm, weight: 55.08 ± 3.94 kg, and body mass index: 21.4 ± 2.21). Measurements were performed in the mediolateral oblique position, a standard position for mammography. The target muscles were the sternocleidomastoid, biceps, trapezius and gastrocnemius muscles. A portable multi-purpose bio-amplifier was used for the measurements. Visual analogue scale (VAS), which is a tool for self-assessment of subjective pain, was used for pain measurement. The analysis of variance showed the significant difference in the amounts of muscle activities in all the target muscles between the relaxation phase before mammography positioning and the stress phase during mammography positioning. The sites with the increased muscle activities were consistent with the sites of pain measured with the VAS. These results suggest that positioning during mammography affects the muscle activity and that the increased muscle activity could be related to the pain. Understanding muscle activities during mammography is invaluable in making the pain reduction program for the subjects undergoing mammography.

[A preliminary study on measurement of muscle activity during mammography positioning].

This study focused on measuring examinees' muscle activities during mammography positioning using surface electromyography. Muscle activities were measured in three women (40-50s) in two-view mammography (MLO: mediolateral oblique, CC: craniocaudal). The muscles measured were the sternocleidomastoid, biceps, trapezius, and gastrocnemius, selected based on the visual analogue scale reported by Sharp et al. We used a multi-purpose portable bio-amplifier (Polymate AP1000) to assess the muscle activities. The results showed that the trapezius in right MLO and sternocleidomastoid in right CC were active in all three subjects. This suggests that the muscles directly related to mammography positioning are highly active. In addition, the gastrocnemius was active throughout the mammography. The biceps and gastrocnemius were also active in at least one of the three women. We believe that quantitative assessment of muscle activities during mammography positioning will contribute to the improvement of pain-reduction programs in mammography.