Intervention program to promote self-management for prevention of lymphedema after gynecological cancer surgery ― Evaluation of the effectiveness at 12 months after the intervention –

In Japan cancer has been the most common cause of deaths since 1981, and effort has been made to provide countermeasure for cancers. The key to countermeasures is for the general population including cancer patients to know about and overcome cancer. Because the development of cancer is related to lifestyle, it is necessary to work at preventing cancer with attention to the conduct of daily life. The five-year relative survival rate registered in the community from 2006 to 2008 was 62.1%, and this illustrates that there are many cancer survivors leading daily lives after contracting cancer. Uterine cancer was the fifth most common in cancer in 2013. However, it is an important object of the treatment to prevent postoperative complications in gynecologic cancer patients, such as development of lymphedema, because it is reported that the survival rate of uterine cancer is high. The incidence of lymphedema is reported to be between 27.2% and 42% in Japan. Once lymphedema develops, it is difficult to cure, making prevention of the onset an important issue.As a result of the multiple logistic regression analysis performed here using patients where the right femoral circumference increased 2 cm or more as an objective variable, there were differences between the groups analyzed (intervention and control). Compared to the intervention group, 4.46 times more patients in the control group had increases in the right femoral circumference by 2 cm or more. We conducted a randomized controlled trial of an intervention program to promote self-management to prevent lymphedema development after gynecological cancer surgery, and examined the effectiveness at 12 months after the surgery. From the results it can be inferred that observing the lymphedema symptoms including measuring and recording of femoral circumferences and body weight by patients themselves influenced the promotion of self-management. Six months after the surgery, there were significantly more patients who developed lymphedema in the control group, but there were no differences between the groups at 12 months after the surgery. Lymphedema development after gynecological cancer surgery appears about 2.6 months after surgery and chronic lymphedema often appears around 9.7 months after surgery. It can be inferred that this difference is due to the temporary improvement of lymphatic reflux after the improvement of edema. The difference in femoral circumferences is sometimes used as one diagnostic tool for the determination of lymphedema. In this study, we compared the right femoral circumferences before discharge and 12 months after the surgery. Mild lymphedema is defined as larger than 10 mm but smaller than 20 mm in any dimension. In severe cases, a dimension may be larger than 20 mm]. In this study, we performed a multiple logistic regression analysis by defining the patients with lymphedema as patients whose right femoral circumference is increased more than 2 cm. The analysis showed the following as factors influencing the increase in the right femoral circumference by more than 2 cm: group (intervention and control), aerobic exercise, and self-efficacy. Compared to the intervention group, 4.46 times more patients in the control group had increases in the right femoral circumference of more than 2 cm, and this suggests that the intervention program to promote self-management to prevent lymphedema after gynecological cancer surgery is effective at 12 months after the surgery

Causal Model of Work Engagement among Registered Nurses and Licensed Practical Nurses Working in Long-Term Care Contexts in Japan

The objective of this study was to determine a causal process underlying work engagement, in which individual resources (i.e., resilience) and job resources influence work performance, mediated by work engagement in different types of nurses working in long-term care contexts. We investigated a work engagement causal model in which individual and job resources were set as antecedent factors, work engagement as a mediating factor, and work performance as the outcome, to clarify differences between registered nurses (RNs) and licensed practical nurses (LPNs) working in long-term care contexts. We conducted a questionnaire-based survey with 1,786 Japanese nurses working in long-term care contexts in the Tohoku region. Using 1,269 respondents, we examined the causal model using structural equation modeling (SEM) and multiple population analysis to compare between RNs and LPNs. The results revealed a process whereby individual and job resources influenced work performance, mediated by work engagement, in RNs. In other words, greater individual and job resources enhance pride in work and positive emotion (i.e., work engagement), and greater positive emotion improves work performance. This process was not equivalent in LPNs. In LPNs, the most significant factor affecting work performance was the direct effect of job resources; moreover, the mediating effect of work engagement was not supported. The results demonstrated that in order to improve performance among LPNs working in long-term care contexts, it is important to provide job resource support, as well as to facilitate positive emotion through pride in one’s work

National trends in the outcomes of subarachnoid haemorrhage and the prognostic influence of stroke centre capability in Japan: retrospective cohort study

Objectives To examine the national, 6-year trends in in-hospital clinical outcomes of patients with subarachnoid haemorrhage (SAH) who underwent clipping or coiling and the prognostic influence of temporal trends in the Comprehensive Stroke Center (CSC) capabilities on patient outcomes in Japan.Design Retrospective study.Setting Six hundred and thirty-one primary care institutions in Japan.Participants Forty-five thousand and eleven patients with SAH who were urgently hospitalised, identified using the J-ASPECT Diagnosis Procedure Combination database.Primary and secondary outcome measures Annual number of patients with SAH who remained untreated, or who received clipping or coiling, in-hospital mortality and poor functional outcomes (modified Rankin Scale: 3–6) at discharge. Each CSC was assessed using a validated scoring system (CSC score: 1–25 points).Results In the overall cohort, in-hospital mortality decreased (year for trend, OR (95% CI): 0.97 (0.96 to 0.99)), while the proportion of poor functional outcomes remained unchanged (1.00 (0.98 to 1.02)). The proportion of patients who underwent clipping gradually decreased from 46.6% to 38.5%, while that of those who received coiling and those left untreated gradually increased from 16.9% to 22.6% and 35.4% to 38%, respectively. In-hospital mortality of coiled (0.94 (0.89 to 0.98)) and untreated (0.93 (0.90 to 0.96)) patients decreased, whereas that of clipped patients remained stable. CSC score improvement was associated with increased use of coiling (per 1-point increase, 1.14 (1.08 to 1.20)) but not with short-term patient outcomes regardless of treatment modality.Conclusions The 6-year trends indicated lower in-hospital mortality for patients with SAH (attributable to better outcomes), increased use of coiling and multidisciplinary care for untreated patients. Further increasing CSC capabilities may improve overall outcomes, mainly by increasing the use of coiling. Additional studies are necessary to determine the effect of confounders such as aneurysm complexity on outcomes of clipped patients in the modern endovascular era