The Preventive Home Visit Practicum is a nursing training program where students, grouped in teams of four or five (comprising a freshman, sophomore, junior, and senior), regularly visit a community-dwelling older adult. Due to the COVID-19 pandemic, the practicum was conducted with various infection control measures, and alternative activities were attempted when home visits were suspended. The experience of responding to the pandemic highlighted the importance of this practicum, which transcends the school year and underscores the necessity of cooperation of the community.

BACKGROUND/AIMS: There is a controversy about the availability of invasive treatment for esophageal/gastric varices in patients with Child-Pugh class C (CP-C) end-stage liver cirrhosis (LC). We have evaluated the validity of invasive treatment with CP-C end-stage LC patients. METHODS: The study enrolled 51 patients with CP-C end-stage LC who had undergone invasive treatment. The treatment modalities included endoscopic variceal ligation in 22 patients, endoscopic injection sclerotherapy in 17 patients, and balloon-occluded retrograde transvenous obliteration (BRTO) in 12 patients. We have investigated the overall survival (OS) rates and risk factors that contributed to death within one year after treatment. RESULTS: The OS rate in all patients at one, three, and five years was 72.6%, 30.2%, and 15.1%, respectively. The OS rate in patients who received endoscopic treatment and the BRTO group at one, three, and five years was 67.6%, 28.2% and 14.1% and 90.0%, 36.0% and 18.0%, respectively. The average of Child-Pugh scores (CPS) from before treatment to one month after variceal treatment significantly improved from 10.53 to 10.02 (P=0.003). Three significant factors that contributed to death within one year after treatment included the presence of bleeding varices, high CPS (≥11), and high serum total bilirubin levels (≥4.0 mg/dL). CONCLUSIONS: The study demonstrated that patients with a CPS of up to 10 and less than 4.0 mg/dL of serum total bilirubin levels may not have a negative impact on prognosis after invasive treatment for esophageal/gastric varices despite their CP-C end-stage LC.
Balloon Occlusion ; Bilirubin ; Endoscopy ; Esophageal and Gastric Varices ; Hemorrhage ; Humans ; Hypertension, Portal ; Ligation ; Liver Cirrhosis ; Liver ; Prognosis ; Risk Factors ; Sclerotherapy ; Varicose Veins

Background/Aims: The frequency and details of nonalcoholic fatty liver disease (NAFLD) complications in patients with inflammatory bowel disease (IBD) remain unclear. This study aimed to clarify characteristics of NAFLD in patients with IBD. Methods: We retrospectively identified and enrolled patients with IBD diagnosed with or without NAFLD by undergoing abdominal computed tomography (CT) at our institution between 2005 and 2020. The primary endpoint was the complication rate of NAFLD in patients with IBD. Secondary endpoints were the clinical characteristics of nonobese patients with IBD and comorbid NAFLD and their association with nutritional and inflammatory parameters. Results: Twenty-one (21.9%) of 96 eligible patients with IBD also had NAFLD. In nonobese patients (defined as patients with a body mass index <25 kg/m2), C-reactive protein (CRP; P<0.001) and alanine aminotransferase (P=0.018) levels were higher and the albumin level (P=0.005) and prognostic nutritional index (PNI; P=0.002) values were lower in patients with NAFLD than in those without NAFLD. The PNI value was positively correlated (P<0.001) and the CRP level was negatively correlated (P=0.001) with the hepatosplenic ratio. However, in the NAFLD combined group, PNI (P<0.05) and CRP values (P<0.001) were improved over time after CT imaging by continuing IBD treatment. Conclusions Worsening nutritional and inflammatory status in IBD patients is associated with complications of NAFLD. Diagnosis of NAFLD in IBD patients using CT imaging might be useful not only for early detection of NAFLD but also in assessing the need for therapeutic intervention for IBD.

Objective: Nurse executives (NEs) working at rural medical facilities encounter challenges, including nursing quality and management, due to a shortage of nurses; this requires them to develop their competencies. A previous study reported that managers working in rural medical institutions gather nearby to learn about management. However, no research has focused on NEs working in rural areas or clarified their experiences in developing competency through learning networks. This study focused on the learning networks of NEs working in rural medical facilities and aimed to clarify their experiences with competency development.Patients/Materials and Methods: In this study, we conducted competency development for NEs through the learning networks in Japan. An ethnographic qualitative study design was used. Twenty NEs participated in the study. Data were collected through participant observation and ethnographic interviews, and analyzed using thematic analysis.Results: This study revealed the following three themes: (1) aiming to provide medical care that contributes to the rural community; (2) work efficiency by a small number of staff; and (3) development as NEs. The NEs in this study improved as NEs by promoting efficiency in their work with a small group, while aiming to provide medical care that contributes to the rural community through participation in a learning network.Conclusion: A learning network of NEs develops their competencies by helping them improve their practice through dialogue and reflection on their nursing management. Therefore, even in an environment with limited resources, NEs might be able to improve the services of their organization through the learning network.