Advance Care Planning for Intensive Care Patients During the Perioperative Period: A Qualitative Study.

INTRODUCTION: Patients in intensive care units (ICUs) may transition into an end-of-life phase during treatment. Advance care planning (ACP) for this population has not been studied comprehensively, and support for its implementation is insufficient. OBJECTIVE: This study aims to clarify the ACP support needs among critical perioperative patients. METHODS: In this qualitative descriptive study, semistructured interviews were conducted with patients previously admitted to the ICU. The survey was conducted from September to November 2019. Participants comprised 13 individuals, who were admitted to the ICU for a period of 3 months to 2 years after surgery. RESULTS: The average age of the participants was 63.8 years. The average mechanical ventilation duration following surgery was 24.5 h. The interviews focused on the ACP needs from the preoperative period to discharge. About 90% of the patients thought about the possibility of death before surgery and considered giving advance orders (e.g., "I don't want life-sustaining treatment"). The participants discussed inheritance, work-related matters, and household issues with their families but rarely spoke about treatment and care. Although they examined the content of the advance directives, the medical staff was not informed about them. Patients revealed that they wanted to understand the distinction between life-prolonging and life-saving treatments and discuss it with the medical staff, apart from being educated on ACP. Many patients previously admitted to the ICU are unclear about the difference between life-prolonging and life-saving treatments; this is also true for medical staff. CONCLUSION: Patients who had been admitted to the ICU after high-risk surgery thought they needed help with ACP before surgery. Therefore, patients have the right to know about treatment risks; however, medical staff believes that this is difficult to communicate. Thus, medical staff should consider ways to communicate clearly with patients, including discussing the risks associated with surgery.

Intervention and efficacy of advance care planning for patients in intensive care units and their families: a scoping review protocol.

AIM: This scoping review aims to elucidate the effectiveness of advance care planning interventions for patients entering the intensive care unit and their families. DESIGN: Scoping review of relevant literature from January 2000-March 2020. METHODS: This review includes studies undertaken in intensive care units that focus on patients older than 18 years or their families. The review will be conducted in accordance with the PRISMA-P guideline. The PubMed, EMBASE, CINAHL, BNI, PsycINFO and ICHUSHI databases and the Cochrane Library will be searched for both published and unpublished articles. Two independent reviewers will examine the list of remaining titles and summarize and identify articles that meet the inclusion criteria. RESULTS: It has long been taboo to consider end-of-life care when in intensive care unit. However, promoting advance care planning, even in patients who are in the intensive care unit, is important and it may help support the patient's need for autonomy.

Evaluation of the Remote-controlled Drone System using an Eye-tracking device through the Internet for patients in bedridden conditions

In many countries, the rate of aging in their population is rapidly increasing. It is expected that this increasing trend influences the number of patients in bedridden states who have difficulty moving their extremities, such as those patients with amyotrophic lateral sclerosis (ALS). The patients are limited in many aspects of their daily lives; this includes not seeing what is outside of their rooms, affecting their quality of life (QOL). Thus, this study aims to evaluate the Remote-controlled Drone System using the Eye-tracking device through the Internet (RDSEI) to improve QOL for patients in bedridden conditions. The novel RDSEI is proposed and developed by the Kai laboratory. The RDSEI consists of a drone, a transmitter, a control screen, an eye-tracking device, a video capture device, a server computer, and a client computer. The subjects of this experimental evaluation of the RDSEI were five healthy male adults (average age: 20.6 years old). Experimental results indicated that all the subjects could control the drone easily by using this system, although there were delays, blurriness, and freezing of the video. Therefore, it was concluded that by using this system, the subjects could control the drone by only their eye movements, thereby enabling them to see the outside world through the drone's camera. In the future, the patients will be able to control the RDSEI from remote locations and converse with persons in remote locations

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A brief parental education for shaping sleep habits in 4-month-old infants.

OBJECTIVE: To examine the effectiveness of a simple behavioral intervention with an educational booklet on the modification of parenting behaviors and the prevention of sleep disturbance in 4-month-old infants. DESIGN: A prospective cohort design with cluster sampling controls in a primary care setting. PARTICIPANTS: A total of 136 mothers with 4-month-old infants who visited a local health check-up clinic and responded to the 3-month follow-up survey. METHODS: At the health check-up, an intervention group was provided with 10 minutes of group guidance and a simple educational booklet designed to encourage parents to promote favorable sleep patterns in their infants. A control group was provided with standard education alone. The two groups were questioned 3 months later through a survey sent by mail. Main measurements were parenting behaviors of parents and night waking of infants. RESULTS: Two undesirable maternal behaviors that reinforce night waking in infants exhibited a significantly greater improvement in the intervention group than in the control group. "Feed or check diaper promptly" behavior and "hold and soothe immediately" behavior after "night waking" in the infant were significantly decreased in the intervention group. CONCLUSIONS: Our findings suggest that increased night waking in infants was prevented in the intervention group. Our results indicate that the proportion of infant night waking was significantly higher in the control group, and there was also a tendency toward an increase in the proportion of infants who woke frequently and cried. These infant behaviors were not changed in the intervention group at the 3-month follow-up stage.

[Impact of parenting behavior relevant to infant's sleep on maternal sleep and health].

BACKGROUND: Maternal health is affected by infant's sleep problems like night awakening or bedtime difficulties. Previous studies indicated that infant's sleep problems are affected by particular parenting behaviour (hereinafter referred to as parenting). However, the relation between maternal sleep and infant's sleep has been unclear and there is only limited information on the interaction between parenting, infant's sleep, maternal sleep, and maternal health. The purpose of this study was: 1. to examine the relationship between infant's sleep problems and maternal sleep and health; and 2. to investigate comprehensive relations of four parameters; maternal sleep, maternal health, infant's sleep, and parenting. METHODS: The subjects were 194 mothers who attended health checkup for 4month old infants. The questionnaire consisted of 3 components: 1) infant's and mother's sleep habits and sleep problems; 2) maternal health; 3) parenting. There were 15 items for parenting, divided into desirable and undesirable behavior. Subjects were classified into Problem Group (n = 40) or Control Group (n = 142) according to the infants' sleep problems. Maternal sleep, maternal health, parenting were compared between two groups. In addition, we examined relationships among the four parameters using path analysis. RESULTS: Over 60% of mothers experienced some sleep problems and about 30% were suspected of being at high risk of insomnia. The most common mother's sleep problem was "poor sleep quality". Over 80% of mothers had some health problems, that most frequently observed being "Shoulder stiffness". Desirable parenting like "Feed fully and checking the diaper before bedtime" was observed in 80% of mothers, while undesirable parenting like "Feeding or checking a diaper immediately" was seen in 71% of mothers. Maternal sleep problems, maternal health problems, and undesirable parenting were more frequent in the Problem Group than the Control Group. As a result of path analysis, the following relations were found: undesirable parenting affected infant's sleep problems, infant's sleep problems influenced maternal sleep, and mother's sleep influenced maternal health. CONCLUSIONS: Thirty percent of mothers were suspected of having sleep disorder and more than half practiced undesirable parenting. Undesirable parenting affected infant's sleep problems which in turn directly affected mothers' sleep and indirectly affected mother's health.

[Preparation and effect of a behavioral science-based education program for sleep improvement among medical students].

OBJECTIVE: The present study aimed to investigate a simple education program that is effective for sleep improvement among medical students who will be medical doctors in the future. The education program applied in the present study was developed for sleep improvement based on behavioral science and changes in knowledge and sleeping habits were observed. METHODS: Subjects were 6th-year medical students of 2002 and 2003. Students of 2002 attended a program including a 90-minute lecture and a 2-week practice learning session, and students of 2003 attended only the lecture. In the lecture, behavior therapy for chronic insomnia was explained using a booklet. In the practice learning session, students set a target behavior for improvement and conducted self-monitoring of their sleep and the targeted behavior. Changes in knowledge about sleep, attitude toward the therapy, sleep, and sleep-related habits were observed and compared between the 2 groups of subjects immediately and 2-weeks after the lecture. RESULTS: It was found that after both programs subjects had more knowledge about sleep than before. In the program including practice learning session, subjects' attitude for managing patients changed from before the lecture to after the lecture, and after the practice learning session. It was found that more than half of the students thought that they could provide sleep guidance based on the behavior therapy. Regarding the subjects' sleep, significant improvements were observed for "having nightmares upon falling asleep," "sleepiness during daytime," "sense of getting a sound sleep," and "mood upon waking up." Regarding sleep-related habits, significant improvements were observed for "taking a nap," "dozing off," and "eating breakfast." On the other hand, only the lecture subjects improved irregularity of bedtime and sleeping time. Although an increase in knowledge and improvement of sleep were observed among students who attended only the lecture, a further increase in knowledge and improvement of sleeping habits were observed among students who also attended the practice learning session. CONCLUSION: The results described herein suggest developing and providing a simple and convenient education program for sleep improvement was effective for increasing students' knowledge about sleep, developing improved coping methods regarding sleep, and improving sleep. It is also suggested that behavioral scientific instructive methods, including practice learning, are effective for medical education.

[Sleep of 4-month-old infants: bedtime, night waking and sleep problems].

BACKGROUND AND OBJECTIVES: Recently, Japanese infant's bedtime has become late and it is reported that this might have a bad influence on infant's growth. The purpose of the present study was to investigate the actual situation and interrelationships between night waking and other sleep problems in Japanese 4-month -old infant. METHODS: The subjects were 194 mothers and infants who participated in health checkups at four months after delivery in Fukuoka City. The questionnaire consisted of 3 components: 1) infant's and mother's sleep practices and sleep problems; 2) coping behavior for infant's sleep; 3) perceptions of child-care and maternal health. Their responses were linked to health checkup's results. The subjects were divided into two groups; Waking Group (n = 111) who was wakening one or more times from 0-6 a.m. and Sleeping Group (n = 83) who was sleeping throughout the night. The proportion of Waking Group was constituted 57.2% in all infants. Infant's growth, sleep, and sleep problems were compared between two groups. RESULTS: The mean infant's bedtime was 10:28 p.m., and the proportion of infants reported to go to bed at 10 p.m. or later was 69.4%. The proportion of infants with irregular bedtimes was 16.5%. Twenty-eight point six percent of infants had sleep problems like difficulty settling, severe night waking and were suspected to be high risk of sleep disorders. Infants in the Waking Group were found to have more numbers of sleep problems than in the Sleeping Group. The proportion with difficulty settling was higher in the Waking Group. Additionally, the proportion with irregular bedtimes was higher in the Waking Group. However, infant's height and weight did not significantly differ between two groups. CONCLUSIONS: Late bedtime and high proportion of night waking in 4-month-old infants were found to be characteristic in Fukuoka city. There is a possibility that night waking reflects delayed development of circadian rhythms.