Factors affecting the duration required for meal intake among postgastrectomy patients.

BACKGROUND & AIMS: Patients who had undergone gastrectomy often feel tired during meals as it takes longer for them to consume their meals, as compared to the length preoperatively. We aimed to clarify the factors affecting the duration required for food intake in this population. METHODS: Participants enrolled in the study were patients who underwent total gastrectomy (TG) or distal gastrectomy (DG) within the past 5 years. We provided them with questionnaire using the mailing method. The following items were included in the questionnaire: demographics, treatment, total duration taken for three meals, meal contents, nutritional status, and Dysfunction After Upper Gastrointestinal Surgery 20 (DAUGS20) score. The participants were divided into the long duration group (LG) and short duration group (SG) of total meal duration. To compare the groups, a binomial logistic regression analysis was performed. RESULTS: Among the 316 participants identified, those in the middle meal intake duration group and the outlier group of over 180 min were excluded. A total of 57 and 95 participants were enrolled in the LG (101-180 min, mean: 125.4 min [SD 16.1 min]) and SG (30-60 min, mean: 52.7 min [SD 8.9 min]), respectively. Age (odds ratio [OR]: 1.092; 95% confidence interval [CI]: 1.042; 1.145; p < 0.001), BMI (OR: 0.783; 95% CI: 0.675; 0.908; p = 0.001), and surgical type (TG/DG) (OR: 0.423; 95% CI: 0.190; 0.945; p = 0.036) were determined to be factors affecting the duration required for food intake. CONCLUSIONS: The major factors for longer food intake duration were older age, lower BMI, and surgical type. Older people and individuals with a lower presurgery BMI were more likely to be included in the LG, which suggests that these factors could be associated with physical weakness, such as sarcopenia. Moreover, TG surgical type was more likely to cause a narrower gastrointestinal tract, especially in the area of anastomosis, which prolongs the food passage duration. For better QOL, postgastrectomy patients must be provided with knowledge on not only diet and nutrition but also efficient meal-taking, focusing on the physical decline associated with older age and lower BMI.

Factors Affecting the Risk of Diabetes Development among Brazilian Residents in Japan.

This study aimed to uncover the risk of diabetes and its associated factors among Brazilian residents in Japan. An anonymous questionnaire survey was conducted among Brazilians living in Japan who were aged >40 years. The questionnaire collected data on the participants' Finnish Diabetes Risk Score (FINDRISC), basic demographics, and health conditions. The analysis was based on the FINDRISC to assess factors affecting the risk of diabetes. Among the 181 participants (mean age, 52.9 years), 77 and 104 were men and women, respectively; 26 (14.3%) people were diagnosed with diabetes. The participants were categorized into high- and low-risk groups based on a FINDRISC value of ≥12 and ≤11, respectively. The high-risk group, 26 [17.7%] patients, contained a significantly higher proportion whose education level was less than elementary school, who were unable to speak Japanese, and whose diets contained little feijoa than the low-risk group. Feijoa is a local Brazilian bean dish that is low in fat and calories but contains high protein content, which helps prevent diabetes. Our findings suggest that increased health literacy is important for controlling chronic diseases, including diabetes.

Comparison of unpalatable meal contents between patients who underwent total and distal gastrectomies.

BACKGROUND: Unpalatable meal contents have several impacts on the dietary life of patients who undergo gastrectomy. However, few studies have focused on the unpalatable meal contents according to surgical procedure. This study aims to clarify the differences in the unpalatable meal contents between the patients who underwent total and distal gastrectomies (TG and DG, respectively). METHODS: This study involved patients (n = 341) who underwent TG or DG within 5 years, and a questionnaire of unpalatable meal contents was used. The data on the demographics, operation types, Dysfunction After Upper Gastrointestinal Surgery 20 (DAUGS20) scoring system, and nutrition conditions were confirmed. Furthermore, these were analyzed using descriptive statistics and compared between TG (n = 180) and DG (n = 161) groups. RESULTS: The unpalatable meal contents that were significantly different between two groups were big in size (p = 0.013), solid (p = 0.040), rough (p = 0.041), and dry (p = 0.045), which were more difficulty in the TG group. Furthermore, the strong sour taste was more difficulty in the DG group (p = 0.031). DISCUSSION: The meals which the TG group had difficulty eating were characteristic of sticking or stagnating in the digestive tract, making the passage of food more difficult in the TG patients. This was because they had a smaller storage for foods and a narrower space at the anastomotic region than those who underwent DG. CONCLUSION: The meal contents were assumed to have been influenced by the surgical procedure. We conclude that the patients in the TG group felt more difficulty in eating the meal contents that could stagnate at the anastomotic region than those in the DG group.

Psychometric evaluation of the Nurse Competence Scale: A cross-sectional study.

Measuring nurses' competence for practice is critical for quality and safety improvement in nursing care and patient outcomes. While the Nurse Competence Scale is a widely used international measure of the generic nursing competence of nurses in various career stages, it has not been used in Thailand. This study involved the forward-backward translation of the scale into Thai and evaluation of its psychometric properties with 571 nurses at one public and one private hospital in Chiang Mai, Thailand. Participants also completed a demographic form. The content validity analysis revealed that the item-level content validity index (I-CVI) was .90, and the scale-level content validity index (S-CVI/Average) was .91. The principal component analysis with varimax rotation demonstrated that the six factor structure accounted for 58.45% of the total variance. The Mann-Whitney U-test showed a significant difference between low and high work experience groups for all six factors, providing further support for the scale's construct validity. The reliability analysis showed an acceptable level of Cronbach's alphas in six factors ranging from .82 to .88. In conclusion, the Thai version demonstrated promising psychometric properties, but requires further testing with nurses in different settings before use in practice.

Exercise Therapy Interventions in Patients With Hip Osteoarthritis: Comparison of the Effects of DVD and Website-Based Interventions.

BACKGROUND: Prevalence of developmental hip dysplasia is high in Japan. Exercise therapy has been proven effective to treat certain aspects of hip osteoarthritis. Moreover, therapy provided via digital video discs (DVDs) and websites allows patients to exercise in the comfort of their own homes. However, no studies have evaluated the effectiveness of visual instructions in patients with hip disorders. OBJECTIVE: This study aimed to compare the effectiveness of exercise therapy administered via DVD and that administered via a website. METHODS: We developed a six-step progressive exercise therapy program for patients with hip osteoarthritis, which included three kinds each of open kinetic chain and closed kinetic chain exercises. Once the program was developed, exercise DVDs were produced. In addition to the six-step exercise program, our website was enabled to count the number of exercises performed by each patient and was accessible via the Internet at any time. Patients with hip osteoarthritis for whom surgery was not advised were enrolled by one university hospital in the Kansai area in Japan. Clinical symptoms and hip function were quantified using the Japanese Orthopedic Association Hip Disease Evaluation Questionnaire (JHEQ) and the Oxford Hip Score (OHS). Quality of life was measured using the SF-8 Health Survey, and self-efficacy for continued exercise was measured using the General Self-Efficacy Scale (GSES). Questionnaires were completed preintervention and after 6 months. RESULTS: At 6-month follow-up, 10 DVD users (1 male, 9 female; mean age 51.3, SD 16.1 years) and 18 website users (2 male, 16 female; mean age 52.4, SD 10.4 years) were reachable. The change in each parameter could not be confirmed a significant improvement. However, most items tended to reflect overall improvement during the 6 months of intervention (P=.05-.94; paired t test). Regarding effect size, we considered a small effect to be greater than 0.2. Little effect was observed for JHEQ pain, SF-8 physical component summary (PCS), and SF-8 mental component summary in the DVD group, as well as OHS, SF-8 (PCS), and GSES in the website group. CONCLUSIONS: When comparing the effectiveness of exercise therapy between our DVD and website, we found that although both groups tended to improve in physical function, only the website group showed tendency of enhanced self-efficacy.

Quality of life of patients with osteonecrosis of the femoral head: a multicentre study.

PURPOSE: Quality-of-life (QOL) assessments in patients with osteonecrosis of the femoral head (ONFH) have rarely been reported. This multicentre study aimed to elucidate the relationship between disease severity, including necrotic lesion type and radiological staging, and QOL, as well as between patients' characteristics and QOL. METHODS: Two hundred seventy-four patients with ONFH (108 females, 166 males; median age, 46 years) were asked to complete self-assessment QOL questionnaires including the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire, Oxford Hip Score, and SF-12v2. RESULTS: Patients with large necrotic lesion type or collapsed ONFH had low QOL scores. Among patients with non-collapsed lesions, patients with alcohol-associated ONFH had lower QOL scores than those with steroid-associated ONFH, those with bilateral ONFH had lower mental scores, and male patients had worse social condition scores. Among patients with collapsed lesions, middle-aged patients exhibited lower mental QOL, and a strong correlation was observed between social activity and mental health. CONCLUSION: Collapsed ONFH was associated with low QOL scores. Among patients with non-collapsed lesions, alcohol-associated ONFH, bilateral disease, and male sex were linked to low QOL scores.

[Cell-Free Ascites Reinfusion Therapy(CART)Modified by Keisuke Matsusaki(KM-CART)at Our Hospital].

Refractory ascites causes distress in patients with cancer. Cell-free and concentrated ascites reinfusion therapy(CART)is an option for the treatment of ascites. Conventional CART had drawbacks in terms of the volume of ascites it could treat and the complications it caused. As a result, a modified form of CART(KM-CART)was developed. The current study retrospectively examined the effectiveness and safety of KM-CART in patients with cancer. Nineteen patients with cancer underwent KMCART a total of 30 times between March 2017 and January 2018. The volume of the collected ascitic fluid was 7.0±2.6 L, and the albumin(Alb)concentration in the reinfused ascitic fluid was 52.6±31.4 g. Serum Alb level after KM-CART did not decrease from the pretreatment level, while serum creatinine(Cr)level decreased significantly. Abdominal girth and bilateral thigh circumference decreased significantly, and appetite improved. Adverse events were noted in the form of liver dysfunction( noted once)and postrenal failure(noted once), but both patients recovered with subsequent treatment. A decrease in the blood pressure was noted duringparacentesis and reinfusion of ascitic fluid, but blood pressure remained within an acceptable range, and a fever was not noted. KM-CART can treat a large volume of ascites and facilitates the treatment while causingfew adverse events. KM-CART is useful for ascites and greatly improves the quality of life(QOL)for patients with cancer.

Validity and responsiveness of the Oxford hip score in a prospective study with Japanese total hip arthroplasty patients.

BACKGROUND: With the increasing need for disease-specific health outcome measurements, the Oxford hip score was developed to measure health-related quality of life of total hip arthroplasty (THA) patients in the United Kingdom. The Oxford hip score comprises 12 items pertaining to pain and physical function, which are increasingly used to measure health outcomes of patients who have undergone THA. The purpose of this study was to establish the validity and responsiveness of the Oxford hip score in a prospective study of Japanese patients. METHODS: The study was conducted at two hospitals. The eligibility criterion for the study was consenting adult patients who underwent primary unilateral THA between April 2005 and October 2007. Three scales were self-administered at the preoperative stage and 6 months after THA. These scales were the Oxford hip score, the Short Form-36 (SF-36) version 2, and three activities requiring deep flexion of the hip (i.e., clipping one's toenails; use of a Japanese squat toilet; "seiza"--sitting on one's legs on the floor, a common posture while eating in Japan. RESULTS: A total of 224 consenting adult patients were recruited. Among them, 125 (61.9%) participated in pre- and postoperative surveys. Altogether, 108 (22 men, 86 women; mean age, 58.4 +/- 12.5 years) of the 125 patients answered all the items. A significant improvement in the mean scores was observed in all scales. Correlation coefficients between the Oxford hip score and the SF-36 version 2 (physical functioning, role physical, bodily pain) ranged from 0.60 to 0.76 preoperatively and postoperatively. Effect size was 1.7 for pain and 1.3 for physical function. The effect size for seiza was small (0.3). CONCLUSIONS: This study demonstrated the validity and responsiveness of the Oxford hip score in a prospective study. However, it does not measure activities requiring deep flexion of the hip joint, and the use of additional items is suggested.

In vivo observations of a case of chlorpromazine deposits in the cornea using an HRT II Rostock corneal module.

PURPOSE: In vivo study of corneal deposits in a patient receiving chlorpromazine therapy was done by using a confocal microscope, the HRT II Rostock corneal module (RCM). METHODS: A 23-year-old woman who had been on chlorpromazine therapy for 5 years complained of bilateral photophobia and was referred to our clinic. She had suffered from light sensitivity for 4 years. RESULTS: Slit-lamp microscopy revealed white deposits, particularly in the layers of the endothelium and Descemet membrane, which were concentrated in the center of both corneas. Deposition of many white granules was observed in the superficial subepithelial stroma of the cornea by HRT II RCM. Granular deposits were observed at the center of most cells in the corneal endothelium. CONCLUSIONS: The HRT II RCM could clearly detect deposits in the corneal endothelium, as well as in other regions such as the corneal epithelium and stroma.

Long-term follow-up for bullous keratopathy after sato-type anterior-posterior corneal refractive surgery.

PURPOSE: To evaluate cases of bullous keratopathy resulting from anterior-posterior radial corneal keratotomy (Sato-type operation) performed from 1951 to 1959. DESIGN: Observational case series. METHODS: Records for a total of 220 eyes of 139 patients with follow-up examinations were examined. The age at operation vs time to occurrence of bullous keratopathy after the original operation was evaluated in four age groups. Endothelial cell density was measured in 11 long-term postoperative eyes. RESULTS: The mean time to development of bullous keratopathy after surgery was 26.9 +/- 8.8 years (mean +/- SD; n = 173 eyes). The length of this period was not affected by the age of the patient at the time of the original surgery. Average endothelial cell density in 11 eyes of 11 patients 28.5 +/- 3.7 years after surgery was 639 +/- 135 cells/mm(2). CONCLUSIONS: Although some corneas remained clear more than 26 years after anterior-posterior radial keratotomy, the risk of late corneal decompensation continues to exist for these patients.