Background: Lumbar spinal stenosis (LSS) impairs activities of daily living (ADL) in older adults. Factors associated with ADL impairment in LSS have not been identified. This study aimed to ascertain the pre-admission living conditions in older adults with LSS and investigate the factors associated with impairment in ADL. Methods: A total of 261 community-dwelling older adults aged ≥65 years with LSS, scheduled for surgery were included. The Oswestry Disability Index (ODI) was used to assess ADL impairment. The Life-Space Assessment was used to assess the extent and frequency of outings. Pain, numbness, continuous walking distance, and health-related quality of life as psychosomatic functions. Falls self-efficacy and the degree of social isolation were assessed as social life status. Factors associated with ADL impairment were examined using multiple logistic regression analysis. Results: Significant differences were found in psychosomatic functioning, living space, and falls self-efficacy depending on the presence or absence of ADL impairment. The ODI sub-components showed a stronger degree of impairment in pain intensity, walking, standing, and social life. There were significant differences in the frequency of going outside the home and inside the neighborhood, ADL impairment was shown to affect the frequency of outings within close proximity to their lives. Numbness was associated with ADL impairment (odds ratio=1.2; 95% confidence interval 1.1–1.4). Conclusion Assessing the degree of numbness is important in predicting ADL impairment in older adults with LSS. Additionally, assessing the living conditions and taking an appropriate approach before admission can help prevent ADL impairment.

Background: Lumbar spinal stenosis (LSS) impairs activities of daily living (ADL) in older adults. Factors associated with ADL impairment in LSS have not been identified. This study aimed to ascertain the pre-admission living conditions in older adults with LSS and investigate the factors associated with impairment in ADL. Methods: A total of 261 community-dwelling older adults aged ≥65 years with LSS, scheduled for surgery were included. The Oswestry Disability Index (ODI) was used to assess ADL impairment. The Life-Space Assessment was used to assess the extent and frequency of outings. Pain, numbness, continuous walking distance, and health-related quality of life as psychosomatic functions. Falls self-efficacy and the degree of social isolation were assessed as social life status. Factors associated with ADL impairment were examined using multiple logistic regression analysis. Results: Significant differences were found in psychosomatic functioning, living space, and falls self-efficacy depending on the presence or absence of ADL impairment. The ODI sub-components showed a stronger degree of impairment in pain intensity, walking, standing, and social life. There were significant differences in the frequency of going outside the home and inside the neighborhood, ADL impairment was shown to affect the frequency of outings within close proximity to their lives. Numbness was associated with ADL impairment (odds ratio=1.2; 95% confidence interval 1.1–1.4). Conclusion Assessing the degree of numbness is important in predicting ADL impairment in older adults with LSS. Additionally, assessing the living conditions and taking an appropriate approach before admission can help prevent ADL impairment.

Background: Lumbar spinal stenosis (LSS) impairs activities of daily living (ADL) in older adults. Factors associated with ADL impairment in LSS have not been identified. This study aimed to ascertain the pre-admission living conditions in older adults with LSS and investigate the factors associated with impairment in ADL. Methods: A total of 261 community-dwelling older adults aged ≥65 years with LSS, scheduled for surgery were included. The Oswestry Disability Index (ODI) was used to assess ADL impairment. The Life-Space Assessment was used to assess the extent and frequency of outings. Pain, numbness, continuous walking distance, and health-related quality of life as psychosomatic functions. Falls self-efficacy and the degree of social isolation were assessed as social life status. Factors associated with ADL impairment were examined using multiple logistic regression analysis. Results: Significant differences were found in psychosomatic functioning, living space, and falls self-efficacy depending on the presence or absence of ADL impairment. The ODI sub-components showed a stronger degree of impairment in pain intensity, walking, standing, and social life. There were significant differences in the frequency of going outside the home and inside the neighborhood, ADL impairment was shown to affect the frequency of outings within close proximity to their lives. Numbness was associated with ADL impairment (odds ratio=1.2; 95% confidence interval 1.1–1.4). Conclusion Assessing the degree of numbness is important in predicting ADL impairment in older adults with LSS. Additionally, assessing the living conditions and taking an appropriate approach before admission can help prevent ADL impairment.

Surrogate decision-making support in the critical care field is a highly challenging form of support owing to its urgency and the fact that families are in crisis situations. Given this context, the diversification of families as a feature of modern society is thought to bring further difficulties to nurses who are involved in surrogate decision-making support. Therefore, this study sought to clarify the content of such support for diverse families that skilled nurses provided in the critical care field. We conducted semi-structured interviews with nine skilled nurses and a qualitative and inductive analysis of the obtained data. We extracted the following five categories of surrogate decision-making support. Even when there was no spare time in the critical care field, skilled nurses operated on the premise that family relationships and values are diverse while (1) “creating a foundation for surrogate decision-making that satisfied families” and (2) “making decisions based on a broad view of family relationships without being bound by preconceptions”, and they realized individualized support by (3) “adjusting the role of surrogate decision-makers based on family characteristics”. In cases where responses were difficult, it became clear that support was provided while (4) “responding to families in accordance with social norms” and demonstrating the ability to (5) “involve medical teams and finds solutions in difficult cases”.[[Please check that this conveys your intended meaning]]

We herein report a patient who complained persistent exudate at navel in spite of adequate antibiotics therapy after laparoscopic cholecystectomy was successfully treated with Kampo therapy. The pharmacological effect of this Kampo formulation i.e. senkinnaitakusan is still unknown, but this formulation has been used for persistent infectious diseases. According to the description in the classic textbook, this formulation is suggested to encourage metabolic function and exhibit anti-inflammatory function. There have been no reports of Kampo therapy for the superficial incisional site infection associated with laparoscopic surgery. The authors propose that Kampo medicine is another promising option in the management of surgical site infection (SSI).

Background/Aims: Image-enhanced endoscopy can detect superficial oro-hypopharyngeal squamous cell carcinoma; however, reliable endoscopy of the pharyngeal region is challenging. Endoscopy under general anesthesia during transoral surgery occasionally reveals multiple synchronous lesions that remained undetected on preoperative endoscopy. Therefore, we aimed to determine the lesion detection capability of endoscopy under general anesthesia for superficial oro-hypopharyngeal squamous cell carcinoma. Methods: This retrospective study included 63 patients who underwent transoral surgery for superficial oropharyngeal squamous cell carcinoma between April 2005 and December 2020. The primary endpoint was to compare the lesion detection capabilities of preoperative endoscopy and endoscopy under general anesthesia. Other endpoints included the comparison of clinicopathological findings between lesions detected using preoperative endoscopy and those newly detected using endoscopy under general anesthesia. Results: Fifty-eight patients (85 lesions) were analyzed. The mean number of lesions per patient detected was 1.17 for preoperative endoscopy and 1.47 for endoscopy under general anesthesia. Endoscopy under general anesthesia helped detect more lesions than preoperative endoscopy did (p<0.001). The lesions that were newly detected on endoscopy under general anesthesia were small and characterized by few changes in color and surface ruggedness. Conclusions Endoscopy under general anesthesia for superficial squamous cell carcinoma is helpful for detecting multiple synchronous lesions.