Patients with advanced hepatocellular carcinoma (HCC) undergoing molecular targeted therapy often experience non-negligible adverse events (AEs). Paradoxically, certain AEs are reportedly associated with a good prognosis. We aimed to identify factors predictive of treatment duration and overall survival (OS) in patients with HCC undergoing lenvatinib therapy. Forty-six consecutive patients with advanced HCC who received lenvatinib therapy from April 2018 to November 2019 were prospectively followed until November 2019. Treatment efficacy was assessed according to the modified Response Evaluation Criteria in Solid Tumors for 2–3 months after therapy initiation. The disease control rate (DCR) was defined as the percentage of patients with a complete response, partial response, or stable disease. The DCR was 65.2%, with a median survival of 10.2 months. Grade 2/3 hypoalbuminemia resulted in shorter treatment duration. Factors predictive of longer OS were a Child-Pugh score of 5 at baseline and the occurrence of Grade 2/3 hypothyroidism. Conversely, Grade 2/3 hypoalbuminemia was associated with a poorer prognosis. An AE of Grade 2/3 hypothyroidism was associated with a better prognosis in patients receiving lenvatinib treatment for advanced HCC. Continuing anticancer therapy with appropriate thyroid hormone replacement may contribute to longer OS.

BackgroundThis study aimed to identify the health-related quality of life (HRQOL) domains associated with prognosis by assessing longitudinal alterations in HRQOL in patients with advanced hepatocellular carcinoma receiving sorafenib.MethodsWe prospectively assessed HRQOL by administering the SF-36 questionnaire 3-monthly to consecutive patients with advanced hepatocellular carcinoma receiving sorafenib. We evaluated the impact of HRQOL on their overall survival and duration of treatment with sorafenib using Cox's proportional hazards model.ResultsThere were 54 participants: 42 (78 %) were male, the median age was 71 years, 24 (44 %) had hepatitis C virus infection, 33 (61 %) had Child-Pugh scores of 5, and 30 (56 %) had TNM stage IV hepatocellular carcinoma. The median overall survival and treatment duration were 9 and 5 months, respectively, and 40 patients (74 %) died. Thirteen patients receiving sorafenib over a 1-year period maintained all domain scores >40, without a significant decline during the treatment period. In contrast, physical functioning, physical role, and vitality scores declined continuously and significantly in the year before death (in the 40 patients who died). Previous curative treatment and physical functioning scores ≥40 at baseline were significantly associated with longer overall survival by multivariate analysis. Social functioning scores ≥40, absence of vascular invasion, and lower DCP value were significant predictors of longer treatment duration.ConclusionsHRQOL was not significantly impaired in those patients who were able to complete a 1-year course of sorafenib treatment. Baseline physical functioning scores ≥40 and social functioning scores ≥40 were significantly associated with longer overall survival and longer treatment duration, respectively. Thus, HRQOL could be a valuable marker to predict the clinical course of patients with advanced hepatocellular carcinoma receiving sorafenib.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-2908-7) contains supplementary material, which is available to authorized users.

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The purpose of this study was to clarify how Japanese nurse managers (i.e., “shunin”) or higher-ranked positions self-rate their nursing management competencies and to identify factors associated with their ability to develop staff. Data were collected using a questionnaire based on the 41-item Management Index for Nurses. This index assesses the competencies related to six components of nursing management: planning, motivating staff, developing staff, communication, organization, and ensuring safety. The total possible score is 205 points. The mean percentage score for each component was calculated based on the responses from 118 participants (107 women; mean age = 44.1 ± 7.0 years). Results showed that the mean percentage score for competencies related to ensuring safety was, by far, the highest (71.8%), and the lowest was for competencies related to organization (47.6%). Principal factors found to be associated with participants’ ability to develop staff were “gathering and using information” (a subscale of “educational background and interests”) and “supportiveness of the work environment”. These results suggest that, to improve nurse managers’ competencies related to their ability to develop staff, hospitals need to establish continuing education systems that offer nurse managers convenient educational opportunities in management science, either on-site or at a higher education institution; and develop an in-house support system that enables managers to obtain counseling when practical management concerns cause them stress.

Background: Patients undergoing major surgery often experience "post-operative dysfunction", which may affect their physical strength and mental activity for a significant period post-operatively. We aimed to clarify the post-operative changes in physical activity, quality of life, and self-efficacy in patients with gastric cancer. Methods: Physical activity, health-related quality of life, and self-efficacy were assessed in subjects using self-administered questionnaires before surgery, at discharge, and 1, 3, and 6 months after discharge. Post-operative parameters were compared to baseline data using the Friedman test with Bonferroni correction, as well as the Wilcoxon two-sample test. Results: Seventeen subjects were included. Dietary intake and number of steps walked significantly decreased for up to 1 month after discharge, whereas physical activity of ≥3 metabolic equivalents of task and exercise-expended energy were lowest at discharge. These differences were all statistically significant. Importantly, the patients did subsequently improve. Body mass index did not differ significantly at discharge, but showed a gradual, significant decrease at 1 and 3 months after discharge. With respect to health-related quality of life, the physical, role, and social functions decreased significantly for a month after surgery, whereas symptoms of fatigue, anorexia, and diarrhea were significantly severe during the first month after discharge. Self-efficacy in terms of symptoms, activities of daily living, and disease status significantly decreased at discharge, but subsequently improved. Conclusions: Patients with gastric cancer showed lower dietary intake and body mass index up to 1 and 3 months after discharge, respectively. Physical activity and self-efficacy were lowest at discharge but improved subsequently. It is necessary, both preoperatively and in the first month following discharge, to provide patients with support that encourages self-management of physical changes and symptoms, and a return to normal levels of physical activity.

With a view toward developing Simulated Patient Exercises (SPE) together with local residents, we aimed to ascertain the role that instructors should play, and the coordination they should undertake to achieve this goal. We interviewed local residents in their 60s and 70s who participated in the participatory SPE program of Tokai University's Adult Nursing Department. We asked the residents about what they gained from, and how they felt about, their experience in the program, and about the kind of support they need to play their role effectively. From the interview data and qualitative inductive analysis, we derived four themes describing the residents' experiences: "Self-encouragement and growth", "hardships as a Simulated Patient", "efforts to improve the training of simulated patients" and "wishes for nursing students". Many of the statements described hardships the residents faced as Simulated Patients, including their nervousness and the burden of learning their role. On the other hand, we also heard many positive statements about how the residents felt encouraged and achieved growth through the experience. For example, in serving as simulated patients, the residents were encouraged by a sense of pride at how they were helping to train nursing students who will in the future help them and their family members, and they felt inspired by the students' earnestness and their cordial learning attitudes, as well as by the camaraderie with fellow Simulated Patients. These positive statements illustrate the value of local residents participating in the program, and they explain why the residents continued to participate.

Objective: In this study, we analyzed a sample of nursing students, focusing on their self-directed learning experiences as they completed a program comprising specialized exercises and examinations and clinical training. Through this, we aimed to identify means of improving nurses' self-directed learning skills during nursing education. Methods: Sixty-six third-year university students underwent a six-week adult-nursing training involving participatory-type simulated-patient (SP) exercises and objective structured clinical examinations (OSCEs), during which they maintained portfolios in which they noted their experiences and thoughts as they engaged in this education. We analyzed, through qualitative induction, the written data in these portfolios. We followed this by cross-sectionally integrating, using a chronological perspective, experiences reported by the same sample in previous research, consequently clarifying the structure of the students' self-directed learning. Results: The students' self-directed learning experiences during the adult-nursing training were divided into six classifications. Comparison of self-directed learning in participatory-type SP exercises, OSCE, and training, respectively, showed that few students applied their experience of the SP and OCSE exercises in training. However, during training they showed a strong ability to independently perform reviews of challenges that arose in actual practice and to engage in collaboration. They also showed increased desire to perform nursing. Conclusions: As the exercises and practice were not conducted consecutively, external experiences may have affected the continuity of the education, and hindered the students' ability to maintain a sense of continuous development. Thus, encouraging students to regularly review their education may enhance their self-directed learning skills.

Center, neurosurgery ward, and neurology ward, and conducting early rehabilitation from the acute phase. Recently, in A Very Early Rehabilitation Trial for acute stroke, the placement of full-time physiotherapists facilitated easier cooperation between doctors and nurses in situations where the condition of acute patients changed significantly; the greatest advantage of this is that early rehabilitation can be performed frequently, thereby improving the prognosis of patients with stroke [9]. Moreover, the placement of a dedicated rehabilitation therapist in the ward increased the patients' training time, shortened the hospitalization of patients, and accelerated activities of daily living (ADL) acquisition by cooperation with nurses [10]. Resident rehabilitation staff has been assigned to the neurosurgery and neurology wards of our hospital, which makes it easier to collaborate with the Department of Rehabilitation Services. Thus, we have been providing interventions from the viewpoint of rehabilitation. However, it has not yet been clarified how the placement of resident rehabilitation staff in the general ward affects the early rehabilitation of patients and strengthens the collaboration between nurses and the rehabilitation staff. Therefore, it is necessary to clarify the effect of the placement of resident rehabilitation staff on the medical personnel and patients. In this study, "pre-resident rehabilitation staffing" is defined as the absence of resident rehabilitation staff in the general neurosurgery unit; therefore, the therapists visited the neurosurgery ward from the general rehabilitation center only when the physicians required an intervention for patients with stroke.