Preconditions for successful guideline implementation: perceptions of oncology nurses

Abstract Background Although evidence-based guidelines are important for improving the quality of patient care, implementation in practice is below expectations. With the recent focus on team care, guidelines are intended to promote the integration of care across multiple disciplines. We conducted an exploratory study to understand oncology nurses' perceptions of guideline implementation and to learn their views on how their experiences affected the implementation. Methods A qualitative study was used with focus group interviews. We collected data from 11 nurses with more than 5 years of oncology nursing experience in Japan. The data were analyzed using grounded theory. Results Results of the analysis identified "preconditions for successful guideline implementation" as a core category. There were 4 categories (goal congruence, equal partnership, professional self-development and user-friendliness) and 11 subcategories related to organizational, multidisciplinary, individual, and guideline levels. Conclusions Although the guidelines were viewed as important, they were not fully implemented in practice. There are preconditions at the organizational, multidisciplinary, individual, and guideline levels that must be met if an organization is to successfully implement the guideline in clinical settings. Prioritizing strategies by focusing on these preconditions will help to facilitate successful guideline implementation.</p

Attachment and amae: a comparative study of mother-child close relationships in Japan and Britain

Attachment theory addresses the young child’s biological and psychological need to elicit their mother’s protection and care, and seeks to explain the emotional bond that forms between them in the early years of life. Several researchers have pointed out that the Western concept of attachment might be less relevant for Japanese parent-child dyads because Japanese child-rearing ideals are based on the concept of ‘amae’ (emotional one-ness between mother and child), whereas attachment theory emphasises the link between attachment and independence/autonomy. Research to date, however, has not yet directly addressed the possible association between maternal amae attitudes and attachment patterns in Japanese mother-child dyads. This is, in part, due to the current lack of any assessment tool to measure mothers’ responses to their child’s amae behaviours. Japanese attachment patterns have also not yet been investigated using the Manchester Child Attachment Story Task (MCAST: Green et al., 2000), a doll-play attachment measurement for children aged between 4 and 8 years old which has been used in Western contexts. This doctoral thesis consists of three cross-cultural empirical studies which address this gap in the current literature. In the first study, a 39-item prototype amae attitude scale (AAS) was constructed based on responses from Japanese focus groups and an earlier study of amae behaviours (Vereijken et al., 1997). The scale was subsequently completed by Japanese and British mothers. Japanese mothers were found to be more tolerant in general than British mothers of their child’s amae behaviours, in all 4 sub-categories explored (pure, asking, frustrated, and anxious amae), with cultural differences most marked in maternal attitudes towards their children’s anxious-amae behaviour. The second study addressed two questions: whether attachment behaviours differ in Japanese and British 4-5 year olds (measured with the MCAST) and whether there is a relationship between children’s MCAST attachment classifications and maternal attitudes towards children’s amae behaviours (measured with the AAS) in Japanese and British dyads. Contrary to what has been found in some of the previous Japanese Strange Situation studies, the distribution of MCAST attachment classifications was similar in the two countries. As predicted from the results of study 1, the AAS scores of Japanese mothers also indicated that they were significantly more tolerant of their child’s amae behaviours than their British counterparts. This was true for both mothers of securely and insecurely attached children. A tendency for mothers of securely attached children to have less tolerant attitudes towards children’s amae behaviours than those of insecurely attached children was found in both countries. A cultural difference also emerged in the way children expressed the maternal needs of the child doll during the mildly stressful scenarios in the MCAST. The third study examined actual mother-child interaction in both countries, measuring the mother’s emotional availability to the child (using the Emotional Availability Scale: Biringen, 2000) and relating this to both maternal AAS and child MCAST data. The results showed that emotional availability scores and attachment classification patterns did not differ across cultures. Analysis of the home observations also indicated that children from both cultures who were classified as insecurely attached (ambivalent and disorganised type) in the MCAST tended to show more amae behaviours towards their mothers than children classified as securely attached. Together, these three studies suggest that children in both counties show similar attachment patterns and that it is not only Japanese children who express amae behaviours towards their mothers. In fact, amae relates to attachment security in both cultures, although the way it is expressed and maternal attitudes towards such behaviours differ across cultures

Current nursing practice for patients on oral chemotherapy: a multicenter survey in Japan

BACKGROUND: With a paradigm shift toward a chronic care model in cancer, the issue of adherence is becoming increasingly important in oncology. METHODS: We mailed two self-reported surveys on current nursing practices for patients on oral chemotherapy to all 309 designated cancer centers and 141 large general hospitals in Japan. The first survey was based on a nurse-based questionnaire containing 40 items concerning nurse’s characteristics, nurse staffing at workplace, general nursing care for new patients on oral chemotherapy and those with refilled prescriptions, follow-up, and system-based approach. The second survey was based on a patient-based questionnaire containing 10 items about patient characteristics and adherence-related nursing practice for 249 patients taking oral chemotherapy of 903 systematically sampled. We used multivariate logistic regression to identify factors that were associated with adherence-related nursing practices. RESULTS: A total of 62 nurses (mean age: 41.5 years) from 62 hospitals who consented participated in the both nurse-based survey and patient-based survey about 249 patients. The results of nurse-based survey indicated that practices varied, but nurses were less likely to ask adherence-related questions of patients with refilled prescriptions than of new patients. The results of patient-based survey found that questions on side effects, discussions about barriers to achieving balance between treatment and daily life activities, and medication management were all significantly related to the question about unused medicines. Logistic regression revealed that adherence-related nursing practices were associated with the nurse’s background, type of treatment, and healthcare system-related factors. Patient orientation on oral chemotherapy, interdisciplinary learning, and having a system-based approach for detecting prescription errors were identified as healthcare system-related factors. CONCLUSIONS: A more systematic approach must be developed to ensure patients receive safe and effective oral chemotherapy, while nurses should play significant roles in patient education and monitoring

Defect of oral tolerance in NC/Nga mice

The NC/Nga mouse is a model animal for human atopic dermatitis. In this study, we investigated oral tolerance induction in NC/Nga mice. In BALB/c mice, oral administration of ovalbumin (OVA) resulted in suppression of both OVA-specific T and B cell responses induced by OVA immunization. In NC/Nga mice, OVA-induced antigen (Ag) -specific T and B cell responses were significantly less than those in BALB/c mice. Furthermore, oral administration of OVA did not suppress OVA-specific immunoresponses in NC/Nga mice. We further examined antibody (Ab) response against food Ag by feeding mice an experimental diet that contained OVA or casein as a protein source. The level of serum OVA or casein-specific IgG was significantly higher in NC/Nga mice than in BALB/c mice. These results indicate that NC/Nga mice have a defect in the induction of oral tolerance. NC/Nga mice can therefore be used as a model for investigating the mechanism of oral tolerance

Curated genome annotation of Oryza sativa ssp. japonica and comparative genome analysis with Arabidopsis thaliana

We present here the annotation of the complete genome of rice Oryza sativa L. ssp. japonica cultivar Nipponbare. All functional annotations for proteins and non-protein-coding RNA (npRNA) candidates were manually curated. Functions were identified or inferred in 19,969 (70%) of the proteins, and 131 possible npRNAs (including 58 antisense transcripts) were found. Almost 5000 annotated protein-coding genes were found to be disrupted in insertional mutant lines, which will accelerate future experimental validation of the annotations. The rice loci were determined by using cDNA sequences obtained from rice and other representative cereals. Our conservative estimate based on these loci and an extrapolation suggested that the gene number of rice is ~32,000, which is smaller than previous estimates. We conducted comparative analyses between rice and Arabidopsis thaliana and found that both genomes possessed several lineage-specific genes, which might account for the observed differences between these species, while they had similar sets of predicted functional domains among the protein sequences. A system to control translational efficiency seems to be conserved across large evolutionary distances. Moreover, the evolutionary process of protein-coding genes was examined. Our results suggest that natural selection may have played a role for duplicated genes in both species, so that duplication was suppressed or favored in a manner that depended on the function of a gene

Seismicity controlled by resistivity structure : the 2016 Kumamoto earthquakes, Kyushu Island, Japan

The M JMA 7.3 Kumamoto earthquake that occurred at 1:25 JST on April 16, 2016, not only triggered aftershocks in the vicinity of the epicenter, but also triggered earthquakes that were 50–100 km away from the epicenter of the main shock. The active seismicity can be divided into three regions: (1) the vicinity of the main faults, (2) the northern region of Aso volcano (50 km northeast of the mainshock epicenter), and (3) the regions around three volcanoes, Yufu, Tsurumi, and Garan (100 km northeast of the mainshock epicenter). Notably, the zones between these regions are distinctively seismically inactive. The electric resistivity structure estimated from one-dimensional analysis of the 247 broadband (0.005–3000 s) magnetotelluric and telluric observation sites clearly shows that the earthquakes occurred in resistive regions adjacent to conductive zones or resistive-conductive transition zones. In contrast, seismicity is quite low in electrically conductive zones, which are interpreted as regions of connected fluids. We suggest that the series of the earthquakes was induced by a local accumulated stress and/or fluid supply from conductive zones. Because the relationship between the earthquakes and the resistivity structure is consistent with previous studies, seismic hazard assessment generally can be improved by taking into account the resistivity structure. Following on from the 2016 Kumamoto earthquake series, we suggest that there are two zones that have a relatively high potential of earthquake generation along the western extension of the MTL