JMA journal最新文献

Introduction: Clinical judgment is crucial for nurses because it directly impacts patient safety and outcomes. Simulation is an effective strategy for teaching clinical reasoning and judgment. This study investigated the relationship between simulation performance and foundational knowledge from previous academic subjects, as measured by clinical judgment performance on the Lasater Clinical Judgment Rubric (LCJR). This study aimed to determine the impact of simulation-based learning and previous academic achievement on LCJR scores among nursing students.

Methods: In this cross-sectional quantitative study, a questionnaire was administered to second-year undergraduate nursing students (n = 85) after they completed simulation-based learning. The questionnaire captured self-assessed achievement levels related to the simulation's learning objectives and previous academic subjects. Statistical analysis included normality tests, Cronbach's α, Spearman's correlation, and multiple regression, with simulation and subject achievement as independent variables and LCJR scores as the dependent variable.

Results: Achievement of learning objective 3 (the "expectation to initial grasp") within the simulation, along with self-reported achievement in physical assessment, critical thinking, and nursing processes from previous academic subjects, significantly affected the LCJR total score and the "Interpreting" dimension. Physical assessment, critical thinking, and nursing processes also significantly impacted the LCJR "Noticing" dimension. Achievement of learning objective 1 ("Gathering information from electronic medical records") and learning objective 3 affected the LCJR "Responding."

Conclusions: The achievement of physical assessment, critical thinking, and nursing process in the previous academic subjects affected the total LCJR scores and the scores of Noticing and Interpreting. Emphasizing these areas of nursing education may enhance the students' clinical judgment skills.

Japan's aging population and declining public transportation have reduced healthcare access, particularly for older adults in rural areas. Currently, innovative mobility services such as ridesharing, mixed cargo/passenger transport, and medical "Mobility as a Service" are being implemented or piloted alongside existing services for older adults, such as home-visit medical care and transportation subsidies. This letter highlights ongoing initiatives in Japan and their potential to improve healthcare access. It also explores opportunities to enhance these efforts by leveraging public infrastructure, such as the nationwide post office network.

Background: Since the increased interest in post-intensive care syndrome (PICS) and PICS-family, many studies have been conducted. However, the longitudinal changes in PICS symptoms are not clearly understood. This study aimed to summarize the longitudinal symptom changes in each PICS domain, including physical, cognitive, mental health, quality of life, and family.

Methods: In this secondary analysis study, we identified the studies that conducted longitudinal PICS assessments published between 2014 and 2022. The most frequently used assessment tools in each domain were defined as representative methods, and results of included studies were summarized by each PICS domain. The collected data were grouped by the following: within 3 months (baseline), at 3 months, 6 months, and annually thereafter. The Wilcoxon rank-sum test was used to compare changes from baseline.

Results: Of the 5,160 studies screened, 76 studies were selected in this study. The percentage predicted value of the 6-minute walk test as an indicator of physical function significantly improved from baseline to 6 months (median [interquartile range], from 45.9 [32.0-63.0] to 65.0 [57.8-72.8], p = 0.04), and continued to improve during the 5-year follow-up period. Montreal Cognitive Assessment for cognitive assessment and Impact of Event Scale-Revised for mental health assessment did not show statistically significant change. The anxiety score of the Hospital Anxiety and Depression Scale (HADS) improved from baseline to the 12-month follow-up (from 6.8 [4.0-8.5] to 4.3 [3.3-5.3], p = 0.04). The anxiety and depression scores of the HADS in family members did not show statistically significant change. The physical component summary of the Short Form-36 for quality of life assessment increased from baseline to the 12-month follow-up (from 31.3 [25.5-37.1] to 40.6 [36.9-50.0], p = 0.03); however, the mental component summary of the Short Form-36 was not changed with statistical significance.

Conclusions: Although the physical and mental domains showed significant longitudinal improvements, PICS symptoms were long-lasting in all domains with varying severity.

Primary dural lymphoma is a rare subtype of primary central nervous system lymphoma that arises from the dura mater. The majority of primary dural lymphomas are histologically mucosa-associated lymphoid tissue lymphoma. We present a rare case of a 78-year-old woman with primary dural lymphoma diagnosed as diffuse large B-cell lymphoma. She was admitted with status epilepticus. Magnetic resonance imaging showed an extra-axial mass lesion in the right parieto-occipital region, which enhanced homogeneously with contrast medium. To obtain a histopathological diagnosis, resection of the lesion involving the dura mater was performed. Based on histopathological and immunohistochemical examinations, the patient was diagnosed with diffuse large B-cell lymphoma. We summarize the clinical characteristics of this unusual disease.

Introduction: Atherosclerotic cardiovascular disease (ASCVD) risk profiles vary among populations. In Japan, a prediction model for the 10-year estimate of ASCVD risk, integrating coronary artery disease and atherothrombotic cerebral infarct risk assessments, has been developed based on the Hisayama Study. While hyperuricemia can promote atherosclerosis, serum uric acid levels are not included as a risk factor in the 10-year ASCVD prediction model.

Methods: We investigated the association between serum uric acid levels and 10-year ASCVD risk in 5,984 Japanese adults (3,285 males, 2,699 females) aged 40-79 years who underwent health check-ups between 2020 and 2022. The 10-year ASCVD risk scores were calculated using the aforementioned prediction model.

Results: Participants in the lowest quartile of serum uric acid levels (3.8 ± 0.6 mg/dL) had a mean 10-year ASCVD risk of 2.1 ± 3.2%, while those in the highest quartile (7.2 ± 0.7 mg/dL) had a mean risk of 4.3 ± 4.6% (p < 0.001). A significant positive correlation was observed between serum uric acid levels and 10-year ASCVD risk scores (r = 0.34, p < 0.001). Multiple linear regression analysis also revealed that serum uric acid levels remained an independent predictor of 10-year ASCVD risk after adjusting for other risk factors (β = 0.02, p < 0.001).

Conclusions: This study indicates that serum uric acid levels may serve as a useful marker for ASCVD risk assessment, particularly in the Japanese population.

Introduction: Residents who use multifunctional wheelchairs before nursing home admission often face discontinuation of such devices after nursing home admission. However, basic data on this issue remain limited. Therefore, in this study, we aimed to provide preliminary data by investigating the occurrence of fall-related fractures after nursing home admission, stratified by the type of wheelchair used before nursing home admission.

Methods: We used linked long-term care claims data, care-need certification survey data, and medical claims data from Ibaraki Prefecture, Japan. Participants were older adults who were newly admitted to nursing homes directly from home between July 2018 and February 2019 and had used wheelchair rental services before nursing home admission. We divided the wheelchairs into two types using long-term care claims data: multifunctional and standard wheelchairs. The outcomes of interest were newly occurring fall-related fractures within the first month of nursing home admission, identified from medical claims data. Fracture incidence was compared between the two wheelchair types, and information of residents with fracture were described.

Results: The study included 215 participants. The participants' median age was 88 years (interquartile range, 83-93); 153 (71.2%) were female, and 96 (44.7%) used a multifunctional wheelchair before nursing home admission. There are no fall-related fractures occurred among standard wheelchair users, whereas five fractures were observed among multifunctional wheelchair users.

Conclusions: Residents who used multifunctional wheelchairs experienced more fall-related fractures after admission than those who used standard wheelchairs before nursing home admission. Further research is needed to better understand the issue of service continuity by investigating wheelchair use after nursing home admission and the circumstances of fall-related fractures.

Introduction: Balancing preventive and symptomatic medications is crucial to minimizing polypharmacy in older adults with limited life expectancy. This study examined end-of-life medications among older adults with advanced-stage cancer receiving home medical care.

Methods: We conducted a retrospective cohort study using Japan's national claims database between October 2017 and September 2019 and selected adults aged ≥75 years who received comprehensive home medical care services for patients with advanced-stage cancer. We compared prescriptions for preventive and symptomatic medications during two periods: (1) within 180 days before the first claim for the service issued (index date) and (2) within 180 days after the index date or until death.

Results: Overall, the study included 8,463 participants, of whom 47% were women and 46% were aged ≥85 years. The median observation period after the index date was 57 days (interquartile range: 30-131 days). Among preventive drugs, antihypertensives were the most frequently prescribed before the index date (60.3%), followed by lipid-lowering drugs (25.4%) and antiplatelets (21.7%). Prescription of lipid-lowering drugs, vitamins, and drugs for osteoporosis decreased by approximately 70%-80% after the index date. In contrast, prescription of oral anticoagulants, antidiabetic drugs, and antidementia drugs declined by approximately 40%. Symptomatic drug prescriptions also decreased after the index date, except for opioids (from 42.2% to 51.9%).

Conclusions: This is the first nationwide study to examine the prescriptions of preventive and symptomatic drugs among older adults with advanced-stage cancer receiving end-of-life home medical care.