Applicability of Nursing Support for Patients With Terminal Cancer and Their Families: A Delphi Study.

BACKGROUND: This report investigates the applicability of nursing support for patients with cancer with a prognosis of months and weeks, and their families. OBJECTIVES: To evaluate the applicability of nursing support for five symptoms (dyspnea, pain, nausea/vomiting, constipation, and delirium) in patients with cancer during the last weeks of life, and the caregiver burden on their families. DESIGN SETTING: A Delphi study was used to determine the applicability of nursing support for patients with terminal cancer and their families. Eight experts in symptom palliation in Japan who have direct care or research experience with these populations were included. The Delphi method was used to assess nursing support types for prognoses of months and weeks. Consensus was defined as ≥70% agreement for either "high applicability" or "low applicability" of each support type. RESULTS: A total of 50 nursing support types for 5 symptoms were evaluated as highly applicable for 92% (n = 46) of patients with cancer with a prognosis of months. For patients with cancer with a prognosis of weeks, 78% (n = 39) of the nursing support was rated as highly applicable. For both prognosis groups, all nursing support (n = 6) for caregiver burden was highly applicable. CONCLUSION: Applicability ratings of nursing support may be influenced by a high degree of invasiveness, accessibility of knowledge and information, and high expectations of effectiveness. Future studies are needed to verify the effectiveness of nursing support evaluated as highly applicable to patients with cancer during the last few months and weeks of life.

Nursing Support for Nausea and Vomiting in Patients With Cancer: A Scoping Review.

Nausea and vomiting are symptoms commonly experienced by patients with advanced cancer and have a wide range of causes, including pharmacological interventions. Additionally, multiple factors often simultaneously cause nausea and vomiting. These highly distressing symptoms may be directly or indirectly related to the disease and can significantly impact both the physical and psychological well-being of patients. This study aims to identify the nursing support provided to reduce nausea and vomiting experienced by patients with cancer. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist and Arksey and O'Malley's framework. We searched the PubMed, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Central Register of Controlled Trials in the Cochrane Library, and the Ichushi-Web of the Japan Medical Abstract Society databases for all content published from the inception of each database through July 31, 2023. A total of 4,625 scientific articles were identified after literature screening. In total, 58 articles were included for full-text review, and 10 articles were finally selected for review. The types of study designs comprised six randomized controlled trials, three prospective observational studies, and one before-after study with no controls. The types of cancers included in the articles were colorectal, breast, lung, pancreatic, gynecological, stomach, and sarcoma. The total sample size of the study population was 793 patients (range = 12-281) for intervention studies and 4,333 patients (range = 20-4,197) for observational studies. Nursing support, extracted from the 10 articles, was classified into the following six types: massage therapy, acupressure, early palliative care, psychosocial support, self-symptom monitoring, and coordinated care. The review yielded six classifications of nursing support for nausea and vomiting in cancer patients. Future research should examine the feasibility of providing nursing support for nausea and vomiting in cancer patients.

Nursing Support for Caregiver Burden in Family Caregivers of Patients With Cancer: A Scoping Review.

Purpose: To identify nursing support for caregiver burden in family caregivers of patients with cancer. Methods: This scoping review was guided by Arksey and O'Malley's six-stage scoping review framework. All available published articles from database inception to July 31, 2023 were systematically searched through PubMed, CINAHL, CENTRAL, and Ichushi-Web of the Japan Medical Abstract Society databases with additional relevant studies from the article list. Each key journal was manually searched. Results: Overall, 502 articles were screened, and 34 were finally included. The results of the qualitative thematic analysis were categorized into 7 components of nursing support: psychological and educational support, psychological and educational support using mainly non-face-to-face (Information and Communication Technology), psychological and educational support mainly using non-face-to-face (telephone) methods, mindfulness to support, support aimed at reducing caregiver stress, support for both patients and caregivers, and others. Of the 34 studies, 23 were randomized controlled trials (RCT), and the remaining 11 were non-RCTs. Conclusion: The results of the scoping review categorized nursing support for caregiver burden in the family caregivers of patients with cancer into 7 components. Future research should examine the feasibility of implementing these components.

Understanding droplet breakup in a post-array device with sheath-flow configuration.

Microfluidic post-array devices have the potential to generate quasi-monodisperse emulsion droplets with high throughput and dispersed phase fractions by splitting droplets with regularly arranged posts. However, the lack of understanding of post-array devices makes it challenging to predict droplet size and quantitatively evaluate the influence of post geometry, hindering their widespread application. Therefore, we investigated the characteristics of droplet breakup through a post array using a series of devices with sheath-flow configurations, in which the dispersed and continuous flow rates could be flexibly tuned. Using a poly(dimethylsiloxane)-glass device fabricated via soft lithography, we found that the volume ratio of the dispersed phase to the continuous phase significantly affects the droplet size, even when the viscosity ratio is close to one. For the first time, we demonstrated that the effective capillary number calculated from the emulsion viscosity and effect of the dispersed phase fraction consistently describes various experimental results. Furthermore, our flow observations and droplet diameter measurement showed two breakup modes: the size-constant obstruction and shear-induced modes with a power-law correlation similar to droplet splitting in a T-junction. Thus, the power-law correlation in microfluidic droplet splitting successfully expresses the droplet generation characteristics in post-array devices. A combination of effective viscosity correction and curve fitting allowed us to evaluate the influence of the material and post-geometry on droplet generation characteristics. This study contributes to the understanding of droplet breakup in post-array devices and extends their unique droplet generation properties to include high-throughput, high-fraction, robust, and continuous emulsification processes.

Nursing support for breathlessness in patients with cancer: a scoping review.

OBJECTIVE: To identify nursing support provided for the relief of breathlessness in patients with cancer. DESIGN: A scoping review following a standard framework proposed by Arksey and O'Malley. STUDY SELECTION: Electronic databases (PubMed, CINAHL, CENTRAL and Ichushi-Web of the Japan Medical Abstract Society Databases) were searched from inception to 31 January 2022. Studies reporting on patients with cancer (aged ≥18 years), intervention for relief from breathlessness, nursing support and quantitatively assessed breathlessness using a scale were included. RESULTS: Overall, 2629 articles were screened, and 27 were finally included. Results of the qualitative thematic analysis were categorised into 12 nursing support components: fan therapy, nurse-led intervention, multidisciplinary intervention, psychoeducational programme, breathing technique, walking therapy, inspiratory muscle training, respiratory rehabilitation, yoga, acupuncture, guided imagery and abdominal massage. CONCLUSIONS: We identified 12 components of nursing support for breathlessness in patients with cancer. The study results may be useful to understand the actual state of nursing support provided for breathlessness in patients with terminal cancer and to consider possible support that can be implemented.

A revision of JPOS/JASCC clinical guidelines for delirium in adult cancer patients: a summary of recommendation statements.

OBJECTIVE: The Japanese Psycho-Oncology Society and the Japanese Association of Supportive Care in Cancer have recently revised the clinical practice guidelines for delirium in adult cancer patients. This article reports the process of developing the revised guidelines and summarizes the recommendations made. METHODS: The guidelines were developed in accordance with the Medical Information Network Distribution Service creation procedures. The guideline development group, consisting of multi-disciplinary members, created three new clinical questions: non-pharmacological intervention and antipsychotics for the prevention of delirium and trazodone for the management of delirium. In addition, systematic reviews of nine existing clinical questions have been updated. Two independent reviewers reviewed the proposed articles. The certainty of evidence and the strength of the recommendations were graded using the grading system developed by the Medical Information Network Distribution Service, following the concept of The Grading of Recommendations Assessment, Development, and Evaluation system. The modified Delphi method was used to validate the recommended statements. RESULTS: This article provides a compendium of the recommendations along with their rationales, as well as a short summary. CONCLUSIONS: These revised guidelines will be useful for the prevention, assessment and management of delirium in adult cancer patients in Japan.

Microfluidic Coupling of Step Emulsification and Deterministic Lateral Displacement for Producing Satellite-Free Droplets and Particles.

Step emulsification, which uses a geometry-dependent mechanism for generating uniformly sized droplets, has recently gained considerable attention because of its robustness against flow fluctuations. However, like shear-based droplet generation, step emulsification is susceptible to impurities caused by satellite droplets. Herein, we demonstrate the integration of deterministic lateral displacement (DLD) to separate the main and satellite droplets produced during step emulsification. Step-emulsification nozzles (16 µm deep) in the upstream region of the proposed device were arrayed on the sidewalls of the main channel (91 µm deep). In the downstream region, the DLD micropillars were arrayed periodically with a critical diameter (cut-off value for size-based separation) of 37 µm. When an acrylate monomer and aqueous polyvinyl alcohol solution were infused as the dispersed and continuous phases, respectively, the nozzles produced monodisperse main droplets in the dripping regime, with an average diameter of ~60 µm, coefficient of variation (CV) value below 3%, and satellite droplets of ~3 µm. Upon entering the DLD region near the sidewall, these main and satellite droplets were gradually separated through the pillars based on their sizes. Finally, off-chip photopolymerization yielded monodisperse polymeric microspheres with an average diameter of 55 µm and a CV value of 2.9% (n = 202).

Nursing support for symptoms in patients with cancer and caregiver burdens: a scoping review protocol.

INTRODUCTION: Terminally ill patients with cancer experience a variety of symptoms, and their families experience certain caregiver burdens. Most studies on this topic have focused on the symptoms experienced by patients with cancer. There is little established evidence to show how nursing support affects these symptoms and burdens. Nurses provide support by extrapolating their clinical experience, practical knowledge and insights gained from the treatment phase of patients with cancer, regardless of the existence or degree of evidence. This study presents a scoping review protocol with the aim of categorising the feasibility of nursing support from the initial to the terminal phases in the trajectory of cancer care. METHOD AND ANALYSIS: This review will be guided by Arksey and O'Malley's five-stage scoping review framework and Levac's extension. Our research project team will focus on the pain, dyspnoea, nausea and vomiting, constipation, delirium, fatigue and skin disorders experienced by patients with cancer as well as the burdens experienced by caregivers of such patients. All available published articles from database inception to 31 January 2022 will be systematically searched using the following electrical databases: PubMed, CINAHL, CENTRAL in the Cochrane Library and Ichushi-Web of the Japan Medical Abstract Society databases. In addition, we will assess relevant studies from the reference list and manually search each key journal. The formula creation phase of the literature search involves working with a librarian to identify relevant keywords. At least two reviewers will independently screen and review articles and extract data using a data chart form. Results will be mapped according to study design and analysed for adaptation in the field of terminal cancer. ETHICS AND DISSEMINATION: This review does not require ethical approval as it is a secondary analysis of pre-existing, published data. The findings will be disseminated through peer-reviewed publications and conference presentations.

Preliminary Effect and Acceptability of an Intervention to Improve End-of-Life Care in Long-Term-Care Facilities: A Feasibility Study.

The number of deaths of older adults in long-term care settings will increase with the aging population. Nurses and care workers in these settings face various challenges in providing end-of-life care, and interventions for quality end-of-life care may be useful. This feasibility study aims to explore the preliminary effect and acceptability of an intervention named the EOL Care Tool to improve end-of-life care in long-term-care facilities. We conducted a single-arm quasi-experimental study using mixed methods. This tool consisted of multiple components: professionalized lectures, newly developed structured documents, regular conferences regarding end-of-life care, and educational support from administrators. Twenty-four nurses and fifty-five care workers employed in a long-term care facility participated. For nurses, improvement in attitudes toward end-of-life care (p < 0.05) and interdisciplinary collaboration (p < 0.05) were shown quantitatively. Regarding acceptability, nurses and care workers evaluated the tool positively except for the difficulty of using the new documents. However, qualitative results showed that care workers felt the reluctance to address the work regarding end-of-life care. Therefore, a good preliminary effect and acceptability for nurses were indicated, while acceptability for care workers was only moderate. Revision to address the mentioned issues and evaluation of the revised tool with a more robust research design are required.

Pain management in community-dwelling older adults with moderate-to-severe dementia.

BACKGROUND: This study explored visiting nurses' knowledge and beliefs regarding pain management in community-dwelling older adults with moderate-to-severe dementia. METHODS: A cross-sectional study design was used to collect data in 2019. A questionnaire was mailed to nursing managers at 1037 home-visiting nursing stations in Japan. FINDINGS: The final analysis included 230 responses. The mean score on the knowledge and belief statements was 14 out of a possible 18, and respondents with more pain management training obtained a higher total score on knowledge than those without such training (p<.001). More than 95% indicated that they needed training on pain management for older adults with dementia. CONCLUSION: Visiting nurses in Japan require training in pain management for older adults with moderate-to-severe dementia. Despite its usefulness, the current pain management training programme should be improved to enable visiting nurses to manage dementia patients' pain more confidently.

Quality of care in hospitalized cancer patients before and after implementation of a systematic prevention program for delirium: the DELTA exploratory trial.

BACKGROUND: We evaluated whether the DELirium Team Approach (DELTA) program-a systematic management program aimed at screening high-risk groups and preventing delirium-would improve quality of care in patients hospitalized with cancer. METHODS: A retrospective before-after study was conducted during a pre-intervention period (between October 2012 and March 2013) and a post-intervention period (between October 2013 and March 2014) at a Japanese hospital providing specialized treatments for cancer. A total of 4180 inpatients were evaluated before the implementation of the DELTA program and 3797 inpatients were evaluated after implementation. RESULTS: After program implementation, the incidence of delirium decreased from 7.1 to 4.3% (odds ratio [OR], 0.52; 95% CI, 0.42-0.64). The incidence of adverse events, including falls or self-extubation, also decreased, from 3.5 to 2.6% (OR, 0.71; 95% CI, 0.54-0.92). There was a significant decrease in the prescription of benzodiazepines (OR, 0.79; 95% CI, 0.71-0.87), increase in the level of independence in activities of daily living at discharge (OR, 1.94; 95% CI, 1.11-3.38), and decrease in the length of stay (risk ratio 0.90; 95% CI, 0.90-0.90). CONCLUSIONS: The systematic management program for delirium decreased the incidence of delirium and improved several clinical outcomes. These data suggest that this simple cost-effective program is feasible and implementable as routine care in busy wards.

Development and Validity of the Nursing Care Scale and Nurse's Difficulty Scale in Caring for Dying Patients With Cancer and Their Families in General Hospitals in Japan.

This study develops and examines the validity and reliability of 2 scales, respectively, for evaluating nursing care and the experience of difficulties providing nursing care for dying patients with cancer and their families. A cross-sectional anonymous questionnaire was administered to nursing staff caring for dying patients with cancer and their families in 4 general hospitals and a university hospital in Japan. The instruments assessed were the Nursing Care Scale for Dying Patients and Their Families (NCD) and the Nurse's Difficulty Scale for Dying Patients and Their Families (NDD). Of the 497 questionnaires sent to nurses, 401 responses (80%) were analyzed. Factor analyses revealed that the NCD and NDD consisted of 12 items with 4 subscales: "symptom management," "reassessment of current treatment and nursing care," "explanation to family," and "respect for the patient and family's dignity before and after death." These scales had sufficient convergent and discriminative validity, sufficient internal consistency (α of subscales: NCD, 0.71-0.87; NDD, 0.74-0.93), and sufficient test-retest reliability (intraclass correlation coefficient of subscales: NCD, 0.59-0.81; NDD, 0.67-0.82) to be used as self-assessments and evaluation tools in education programs to improve the quality of nursing care for the dying patients and their families.

Validity and Reliability of the Dying Care Process and Outcome Scales Before and After Death From the Bereaved Family Members' Perspective.

OBJECTIVE:: There are no instruments evaluating the processes and outcomes of dying care right before and after death. Therefore, we developed and examined the validity and reliability of 2 scales for evaluating dying care processes and outcomes before and after death. METHODS:: A cross-sectional, anonymous questionnaire was administered to bereaved family members of patients with cancer who had died in 5 facilities. We evaluated the Dying Care Process Scale for Bereaved Family Members (DPS-B) and the Dying Care Outcome Scale for Bereaved Family Members (DOS-B) with 345 bereaved family members. RESULTS:: A factor analysis revealed that DPS-B and DOS-B each consisted of 4 subscales. For the DPS-B, they were "symptom management," "respect for the patient's dignity before and after death," "explanation to the family," and "family care." For the DOS-B, they were "peaceful dying process for the patient," "being respected as a person before and after death," "good relationship between the patient and family," and "peaceful dying process for the family." Both DPS-B and DOS-B had sufficient convergent and discriminative validity, sufficient internal consistency (DPS-B: α = 0.91 and subscales' αs = 0.78-0.91; DOS-B: α = 0.91 and subscales' αs = 0.78-0.94), and sufficient test-retest reliability (DPS-B: intraclass correlation coefficient [ICC] of total score = 0.79 and subscales = 0.55-0.79; DOS-B: ICC of total score = 0.88 and subscales = 0.70-0.88). SIGNIFICANCE OF RESULTS:: Both DPS-B and DOS-B are valid and reliable scales for evaluating the dying care processes and outcomes before and after death from the bereaved family members' perspectives.

The Optimal Cutoff Point for Expressing Revised Edmonton Symptom Assessment System Scores as Binary Data Indicating the Presence or Absence of Symptoms.

CONTEXT: Terminally ill patients with cancer experience various physical and emotional symptoms that have a negative impact on quality of life and activities of daily living. Recently, revised Edmonton Symptom Assessment System (ESAS-r) scores have been proposed for assessing symptoms in terminally ill patients with cancer. OBJECTIVE: To determine the optimal cutoff point for expressing ESAS-r scores as binary data, indicating the presence or absence of symptoms. METHODS: We conducted a retrospective study of patients hospitalized in the palliative care unit of our hospital between September 1, 2014 and May 31, 2015. To determine the optimal cutoff point for expressing ESAS-r scores as binary data, indicating the presence or absence of 6 physical symptoms ("pain," "tiredness," "drowsiness," "nausea," "lack of appetite," and "dyspnea"), the sensitivity and specificity of each measurement were calculated. Cutoff points were estimated using receiver operating characteristic curve analysis. RESULTS: Data from 157 patients who performed the self-assessment in ESAS-r scores were analyzed. The mean age was 66.5 years. Approximately 60.0% of patients were male. The optimal cutoff point for pain, tiredness, drowsiness, nausea, lack of appetite, and dyspnea was 4, 4, 4, 2, 5, and 4, respectively. The area under the curve for tiredness, nausea, and dyspnea was >0.70, followed in order by pain, lack of appetite, and drowsiness. The area under the curve for drowsiness was 0.55. CONCLUSION: Our results suggest that physical symptoms other than drowsiness could potentially predict ESAS-r score severity.

Current-induced magnetization switching using an electrically insulating spin-torque generator.

Current-induced magnetization switching through spin-orbit torques is the fundamental building block of spin-orbitronics, which promises high-performance, low-power memory and logic devices. The spin-orbit torques generally arise from spin-orbit coupling of heavy metals. However, even in a heterostructure where a metallic magnet is sandwiched by two different insulators, a nonzero spin-orbit torque is expected because of the broken inversion symmetry; an electrical insulator can be a source of the spin-orbit torques. We demonstrate current-induced magnetization switching using an insulator. We show that oxygen incorporation into the most widely used spintronic material, Pt, turns the heavy metal into an electrically insulating generator of the spin-orbit torques, which enables the electrical switching of perpendicular magnetization in a ferrimagnet sandwiched by insulating oxides. We also show that the spin-orbit torques generated from the Pt oxide can be controlled electrically through voltage-driven oxygen migration. These findings open a route toward energy-efficient, voltage-programmable spin-orbit devices based on insulating metal oxides.

Electrochemicolor Imaging Using an LSI-Based Device for Multiplexed Cell Assays.

Multiplexed bioimaging systems have triggered the development of effective assays, contributing new biological information. Although electrochemical imaging is beneficial for quantitative analysis in real time, monitoring multiple cell functions is difficult. We have developed a novel electrochemical imaging system, herein, using a large-scale integration (LSI)-based amperometric device for detecting multiple biomolecules simultaneously. This system is designated as an electrochemicolor imaging system in which the current signals from two different types of biomolecules are depicted as a multicolor electrochemical image. The mode-selectable function of the 400-electrode device enables the imaging system and two different potentials can be independently applied to the selected electrodes. The imaging system is successfully applied for detecting multiple cell functions of the embryonic stem (ES) cell and the rat pheochromocytoma (PC12) cell aggregates. To the best of our knowledge, this is the first time that a real-time electrochemical mapping technique for multiple electroactive species, simultaneously, has been reported. The imaging system is a promising bioanalytical method for exploring complex biological phenomena.

Electrochemical Motion Tracking of Microorganisms Using a Large-Scale-Integration-Based Amperometric Device.

Motion tracking of microorganisms is useful to investigate the effects of chemical or physical stimulation on their biological functions. Herein, we describe a novel electrochemical imaging method for motion tracking of microorganisms using a large-scale integration (LSI)-based amperometric device. The device consists of 400 electrochemical sensors with a pitch of 250 µm. A convection flow caused by the motion of microorganisms supplies redox species to the sensors and increases their electrochemical responses. Thus, the flow is converted to electrochemical signals, enabling the electrochemical motion tracking of the microorganisms. As a proof of concept, capillary vibration was monitored. Finally, the method was applied to monitoring the motion of Daphnia magna. The motions of these microorganisms were clearly tracked based on the electrochemical oxidation of [Fe(CN)6 ]4- and reduction of O2 .

CCR3 Is Associated with the Death of a Photoreceptor Cell-line Induced by Light Exposure.

The C-C chemokine receptor type 3 (CCR3) is the receptor for eotaxins (CCL-11, 24, 26), RANTES (CCL-5) and MCP-3 (CCL-7). It was reported that an inhibition of CCR3 by antagonists or antibodies reduces the degree of laser-induced choroidal neovascularization in mice, a model for wet age-related macular degeneration (AMD). Although several chemokine receptors have the potential of reducing the degree of the chronic inflammation in experimental dry AMD, the association of CCR3 remains unknown. The purpose of this study was to determine the role played by CCR3 in the death of 661W cells which are cells of a murine photoreceptor-derived cell line as an in vitro model of dry AMD. The expression of CCR3 was increased in the 661W cells after light exposure. Inhibition of CCR3 reduced the rate of cell death induced by light exposure. A blockade of CCR3 signaling by CCR3 silencing and two kinds of CCR3 antagonists, SB 328437 and SB 297006, reduced the rate of light-induced cell death. In addition, CCR3 inhibition decreased the level of reactive oxygen species and the activation of caspase-3/7 induced by light exposure. These findings indicated that the CCR3 blockade should be considered for the treatment of the dry AMD.

Spin-torque generator engineered by natural oxidation of Cu.

The spin Hall effect is a spin-orbit coupling phenomenon, which enables electric generation and detection of spin currents. This relativistic effect provides a way for realizing efficient spintronic devices based on electric manipulation of magnetization through spin torque. However, it has been believed that heavy metals are indispensable for the spin-torque generation. Here we show that the spin Hall effect in Cu, a light metal with weak spin-orbit coupling, is significantly enhanced through natural oxidation. We demonstrate that the spin-torque generation efficiency of a Cu/Ni81Fe19 bilayer is enhanced by over two orders of magnitude by tuning the surface oxidation, reaching the efficiency of Pt/ferromagnetic metal bilayers. This finding illustrates a crucial role of oxidation in the spin Hall effect, opening a route for engineering the spin-torque generator by oxygen control and manipulating magnetization without using heavy metals.