Our ward encounters many cases (approximately 80 every year) requiring end-of-life care. The experiences of nurses, as well as of patients’ families and friends, vary widely and nurses appear to be anxious about providing mortuary care, known as Angel care. There is no standardized manual, and therefore medical care professionals need to optimize good Angel care practices in order to alleviate nurses’ anxiety around the issue. We administered a questionnaire regarding the situation of Angel care to 208 ward nurses in our hospital and extracted difficulties in providing Angel care reported by the 173 respondents. Less than 5% of nurses, regardless of length of nursing experience, experienced no anxiety. Nurses found it difficult to conduct basic technical procedures: 51.7% had difficulties in closing the deceased patient’s mouth and 40.2% had difficulties judging whether the results of mortuary makeup resemble antemortem appearance. Ninety-five percent of nurses wished to study Angel care in the future should learning materials be available. In conclusion, more than half of nurses were anxious about providing Angel care regardless of length of their nursing experience and number of cases handled. Nurses are greatly interested in Angel care and wish to learn more if learning materials are made available.

The accuracy of a uniaxial accelerometer for assessing physical activity in preschool-aged children was assessed by using an indirect calorimeter which provides the physical activity ratio (PAR) for free living activities. Subjects were 5- to 6-yr-old Japanese girls and boys (n=24, 6.1±0.3 years). PAR was assessed for nine activities (lying down, watching a video while sitting and standing, line drawing for coloring-in, playing with blocks, walking, stair climbing, ball toss, and running) using the Douglas bag method. “Exercise intensities” were recorded with the uniaxial accelerometer (Lifecorder EX ; Suzuken Co. Ltd, Nagoya, Japan). PARs were also predicted by using the equations presented by Higuchi et al. (2003) and Kumahara et al. (2004). Significant correlation was observed between “exercise intensities” as measured by the uniaxial accelerometer and PAR for all activities (r=0.827). Predicted PAR values for walking and running were overestimated according to the equations. On the other hand, PAR values for stair climbing and ball toss were underestimated. These findings indicate that although the uniaxial accelerometer may help in evaluating daily physical activity in preschool-aged children, its use as a proxy measure of PAR based on the above equations may be limited.

A survey was conducted by mailing two questionnaires to 80 medical schools to obtain information about their utilization of information technology (IT)-based teaching methods. We found that more than 80% of schools are using ITbased teaching materials and that some 95% have lecture rooms where IT-based teaching is possible. However, only 10% of schools had a specific section that systematically supports the creation of IT-based materials.

Purpose: This study investigated the current state of critical hemorrhage during home palliative care for terminally ill cancer patients. Methods: We conducted a retrospective medical chart review of 7 cancer patients (1.4%) who received home palliative care from our clinic and died of critical hemorrhage at home from October 2007 to December 2014. Results: Four patients were male, the mean age was 70±11 years, and underlying diseases were different. None of the patients were accompanied by medical staff at the onset of bleeding. Six patients died at home and one patient was admitted to hospital for hemostasis. Six patients had a pre-hemorrhage episode more than 24 hours before critical hemorrhage occurred from the same site. One patient was administered a hemostatic agent, hemostasis was attempted in one, and one was given sedation. Six patients wanted to die at home, and did die at home. Discussion: If terminally ill cancer patients have critical hemorrhage at home, our options are limited. The results of this study suggest the importance of hemorrhage risk assessment and advance care planning.

Exercise therapy as well as diet therapy, is fundamental in the treatment of diabetes mellitus, however, its methods and effects of long term physical exercise therapy has not yet been clarified.
The present study has been designed to evaluate the effects of physical exercise therapy in diabetic patients with fasting hyperglycemia. Ten non-insulin dependent diabetic patients participated in a 6-month physical exercise program consisting of 30 min, of jogging performed 3 times per week (Exercise group) . The exercise intensity represented 40% of estimated Vo₂max.
The following results were obtained:
1. More significant improvement of glucose tolerance and plasma insulin response to glucose load was observed in exercise group as compared with the patients treated with mild caloric restriction alone (Diet group, N=15) .
2. The significant increase in plasma HDL-cholesterol and HDL-cholesterol/total cholesterol ratio was observed only in exercise group.
3. The reduction of body weight in exercise group was significantly greater than that in diet group.
4. The physical exercise also resulted in an improvement of cardiovascular adaptaion to exercise.
5. Improvement of symptoms in daily life activity was also found after physical exercise therapy. However, some medical troubles such as hypoglycemia, muscle pain and arthralgia were found during observation period.
In conclusion, physical exercise therapy is useful as an adjunct to diet to improve metabolic control in patients with diabetes mellitus. And for effective exercise therapy, exercise program must be individualized, and motivation is stimulated by team including physician, trainer, nurse and dietitian.

Introduction: The present study was conducted to identify the influence of self-efficacy score and having an action plan on “stages of change” for exercise after one year.
Methods: Physical functions and psychological factors at baseline and after one year in 105 elderly individuals who participated in a preventive care program. The subjects were classified into four groups by using the stages of change scale for physical activity.
The cause related to impact on physical activity and action stage change (stage) after one year later with having or not having action plan for preventive care program in elderly at home in community as well as sense of self efficacy was investigated.
Results: Self-efficacy scored significantly higher in the usual activity group with continuity of stage activity both at baseline and one year later. The relative risk of having an action plan at baseline for exercise after one year was 2 . 90 (95% CI: 1.52-5.55). This value significantly influenced the maintenance of physical activity after one year.
Conclusion: The results of this study suggest that showing an action plan was effective in maintenance of physical activity.

Fall-related factors (FRFs) are classified into intrinsic factors and extrinsic factors. Intervention programs, which focused on modifiable factors (MFs) among FRFs have been designed to prevent falls. The purpose of this study was to identify easily-measurable intrinsic MFs for falls and recurrent falls. Cross-sectional analysis was carried out on the data from 483 community-dwelling older adults, aged 65-92 years (73.7 ± 5.9 yr, 138 men, 345 women). We measured history of falls in the past year and 7 domains of FRFs. Of these, 20 items were selected as MFs. Analyses of FRFs and MFs were conducted by comparing (separated by sex) those who did not report a fall with those who reported any number of falls, and those who reported no falls or one fall with those who reported recurrent falls. Using the significant items as independent variables, multiple logistic regression analysis with forward selection method was performed. The prevalence of falls and recurrent falls was: in men, 24.6% and 14.5%; in women, 26.7% and 12.5%. There were no significant differences in prevalence of falls or recurrent falls between genders. The following items were selected as the MFs most strongly associated with falls: climbing 10 steps with difficulty and tandem walk; and associated with recurrent falls: climbing 10 steps with difficulty, sit and reach, and tandem walk. These results are useful in determining the focus of fall prevention programs to be used in future community-based interventions.

OBJECTIVES: Sarcopenia, decreased muscle volume and muscle weakness in the elderly is a serious risk of various adverse outcomes. Current diagnostic procedure for sarcopenia includes gait speed, grip strength, and percentage of skeletal muscle volume. However, lower leg muscle strength decreases much faster than grasp power, and we have evaluated the usefulness of its measurement using a recently developed instrument (Locomoscan). METHODS: Forty-three institutionalized elderly subjects were evaluated for their anthropometrical parameters, body composition, grasp and lower leg muscle strength, and gait speed. They were categorized into 2 groups; gait speed equal to or higher than 0.8 m/s and that below 0.8 m/s. RESULTS: Leg muscle strength per body weight was significantly greater in those with their gait speed equal to or higher than 0.8 m/s, whereas there was no significant difference in other parameters. Receiver operator characteristics analysis has shown that leg muscle alone significantly predicted the greater gait speed. CONCLUSIONS: Lower leg muscle strength can be useful for predicting gait speed.
Aged* ; Body Composition ; Body Weight ; Gait* ; Hand Strength* ; Humans ; Leg* ; Muscle Strength* ; Muscle Weakness ; Muscle, Skeletal ; Sarcopenia

Background/Aims: While Helicobacter pylori (HP)-negative gastric cancer is frequently reported, little is known about the predictors for detecting HP-negative early gastric cancer (EGC). We aimed to evaluate the predictors for the detection of HP-negative EGC. Methods: We retrospectively reviewed 13,477 consecutive asymptomatic cases where upper endoscopy was performed by nine physicians from April 2017 to March 2019 and analyzed the detection rate of high-risk lesions (HRLs), including EGC, tubular adenoma, and lymphoma, according to the status of HP infection. The observation time was corrected for multiple regression analyses. Results: For all physicians, the average observation time for screening HP-eradicated and -naïve patients was shorter than that for screening HP-positive patients (p<0.05). Multiple regression analyses revealed that the observation time in the three groups was an independent predictor for detecting HRLs in HP-eradicated patients (p=0.03106, 0.01263, and 0.02485, respectively), while experience of endoscopy was an independent predictor for detecting HRLs in HP-naïve patients (p=0.02638). Conclusions While observation time during screening endoscopy was a quality indicator for detecting HRLs in HP-eradicated patients, experience of endoscopy was a quality indicator for detecting HRLs in HP-naïve patients.