Impact of nurse-assisted patient turning at different sleep stages on the quality of subsequent sleep

BACKGROUND

Nursing care performed during sleep, including nurse-assisted patient turning, is one of the factors that deteriorates sleep quality but is necessary for pressure ulcer prevention. Thus, it is important to determine when nurseassisted patient turning has the least impact on sleep quality.

AIM

The aim of this study was to clarify the impact of nurseassisted patient turning at different sleep stages and to determine the optimal timing of this aspect during sleep.

METHODS

The experiment, which consisted of healthy men in their 20s and 30s, was performed over four successive nights per subject. The first night was dedicated to environment adaptation, and the 2nd to the 4th nights were randomly assigned for shallow sleep intervention, deep sleep intervention, and non-intervention. On the intervention day, nurse-assisted patient turning was conducted twice. Overnight sleep conditions were measured by polysomnography (PSG). The PSG waveform transmitted to a tablet was analyzed in real time to determine the stage of sleep. The patient was turned when he entered the planned stage of sleep.

RESULTS

The study analyzed fourteen (14) subjects. Shallow sleep time, deep sleep time, and sleep resumption time after nurse-assisted patient turning were compared among the three groups of non-intervention day, shallow sleep intervention day and deep sleep intervention day. There was no significant difference in the shallow and deep sleep time among the three groups. However, sleep resumption time after nurse-assisted patient turning was significantly shorter on the deep sleep intervention day than on the shallow sleep intervention day (p = textbf 0.033).

CONCLUSIONS

This study has novelty in examining the impact of nurse-assisted patient turning performed at different sleep stages on subsequent sleep using objective indicators. The study suggested that a deep sleep state is the optimal timing of nurseassisted patient turning due to the short time to sleep resumption.

Examination of the Effect of Suitable Size of Shoes under the Second Metatarsal Head and Width of Shoes under the Fifth Metatarsal Head for the Prevention of Callus Formation in Healthy Young Women

Excessive pressure and shear stress while walking cause a risk of callus formation, which eventually causes foot ulcers in patients with diabetes mellitus. Callus under the second metatarsal head (MTH) has been associated with increased shear stress/pressure ratios (SPR). Callus under the fifth MTH has been associated with increased peak shear stress (PSS). The purpose of this study is to examine whether the effect of the suitable size and width of shoes prevents diabetic foot ulcers under the second and fifth MTH. We measured the pressure and shear stress by testing three kinds of sizes and two types of width of shoes. Significant difference was not observed in the SPR under the second MTH among different sizes of shoes. However, the pressure and shear stress were significantly lower when putting on shoes of fit size compared with larger sizes. The PSS under the fifth MTH was significantly smaller when putting on shoes of fit width compared with those of narrow width. Wearing shoes of fit size and width has the potential to prevent callus formation by reducing the pressure and shear stress constituting SPR under the second MTH and PSS under the fifth MTH.

The external force associated with callus formation under the first metatarsal head is reduced by wearing rocker sole shoes

INTRODUCTION

Callus is one of the main causes of diabetic foot ulcers. Therefore, preventing callus formation is very important. In a previous study, it was clarified that callus formation under the first metatarsal head (MTH) is associated with high shear stress time integral/pressure time integral (SPR-i). another study, it was clarified that rocker sole shoes are effective in reducing peak pressure under the first MTH. Therefore, we hypothesized that rocker sole shoes reduce SPR-i under the first MTH. This study aimed to clarify the effect of rocker sole shoes for external forces and leg motions in comparison with that of the normal sole shoes.

METHODS

In-shoe external forces and leg motions were measured during walking wearing the normal sole shoes or the rocker sole shoes in healthy participants. As the external forces, the peak plantar pressure (PP), pressure time integral (PI), peak shear stress (PSS), and shear stress integral (SSI) of each gait cycle were calculated. Additionally, shear stress-pressure ratios (SPR) were calculated by dividing shear stress by pressure; concretely, peak values (SPR-p) and time integral values (SPR-i). As the leg motion, hip and knee joint motions were analyzed for the axis of flexion- extension. Three axes of ankle joint motion (inversion-eversion, plantar flexion-dorsiflexion, and adduction-abduction) were analyzed.

RESULTS AND DISCUSSION

Six participants attended, and twelve feet were analyzed. When wearing the rocker sole shoes, the SPR-i under the first MTH was significantly smaller than when wearing the normal sole shoes. The SPR-i higher than 0.60 is associated with callus formation under the first MTH. In three of five feet with callus, SPR-i exceeded 0.60 in the normal sole shoes. The SPR-i of all three feet became smaller than 0.60 when wearing the rocker sole shoes. Although the knee (flexion-extension) and ankle (plantar flexion-dorsiflexion) joint motion became smaller when wearing the rocker sole shoes, there was no significant difference in walking speed. It is considered that propulsion was maintained by the push-off support provided by rocker sole shoes.

CONCLUSION

It was suggested that rocker sole shoes are effective preventing callus formation under the first MTH.

Effects of familiar voices on brain activity

This study aimed to examine the extent to which a familiar voice influences brain activity. Participants were nine healthy female volunteers aged 21-34 years old (with a mean age of 25.78 ± 4.04 years). Brain activity was recorded during periods of silence, familiar and unfamiliar voices. Electroencephalographic data were collected and analyzed using a frequency rate set at 5 min. To account for emotional influences imbedded into the contents of the voice stimuli, both the voice of a familiar family member and the voice of a stranger were used to record a well-known Japanese fairy tale, 'Momotaro'. Results revealed that listening to familiar voices increased the rate of the β band (13-30 Hz) in all four brain areas (F3, F4, C3 and C4). In particular, increased activity was observed at F4 and C4. Findings revealed that in study, participants' familiar voices activated cerebral functioning more than unfamiliar voices.

Effects of changing illuminance on somatosensory function

Artificial sources of illumination can be easily used, regardless of the time and place, to improve visibility at night and in dark places. Illuminance and color temperature are particularly important factors since they are known to elicit physiological effects. However, the relationship between changes in illuminance and somatosensory function has not been sufficiently clarified. Thus, the purpose of this study was to construct a laboratorial model to examine the effects of lowering or raising illuminance on somatosensory function. Three illuminance levels (200 lx, 50 lx, and 0 lx), which were changed using all combinations, and an artificial sensory stimulus maintained at a constant intensity were presented to the subjects of this study. Objective sensory function in response to the sensory stimulus was investigated by somatosensory evoked potential (SEP), and subjective sensory evaluation in response to the stimulus was investigated using a visual analogue scale (VAS) and by interview. In many cases, the SEP amplitude and VAS value tended to decrease when illuminance was lowered and tended to increase when illuminance was raised. However, in a few cases, SEP amplitude and VAS value tended to increase in spite of the low illuminance. The occurrence of attention responses and unpleasant emotional responses caused by lowering the illuminance seems to be related to this study finding.

Context-dependent place-selective responses of the neurons in the medial parietal region of macaque monkeys

To investigate the role of the medial parietal region (MPR), comprising area 7 m and the retrosplenial and posterior cingulate cortices, in spatial navigation, we analyzed the spatial aspect of the responses of the MPR neurons in monkeys while they actively performed a navigation task in a virtual environment. One-third of the analyzed MPR neurons were activated depending on the location of the monkeys in the environment, that is, showed place-selective responses. Some neurons showed varying responses based on the starting point (SP) or destination. We further investigated the responses of the place-selective neurons when the monkeys were shown animations of the entire navigation route, including the preferred field, and a segment of the route, including an area around the preferred field, and a still image of the preferred field. We observed that the responses of some place-selective neurons reduced when the monkeys viewed the preferred field in the segmented animation or in the still image compared with when they viewed the entire animation. These results suggested that the knowledge about the SP or destination, that is, context, is necessary to activate place-selective neurons. The effect of such contextual information suggests that the MPR plays decisive roles in spatial processing such as navigation.

Navigation-associated medial parietal neurons in monkeys

To examine the neural basis of route knowledge by which one can reach one's destination, we recorded the activity of 580 neurons in the monkey medial parietal region (MPR) while monkeys actively navigated through a virtual environment. One hundred eighty of these neurons (31%) showed significant responses to the monkeys' movements in the virtual environment. Of these responsive neurons, 77% (139/180) showed responses associated with a specific movement at a specific location (navigation neurons), 8% (14/180) showed responses associated with a specific movement (movement-selective neurons), and the remaining 27 neurons (15%) were nonselective. We found navigation neurons whose responses to the same movement at the same location were modulated depending on the route that the monkey was currently taking, that is, in a route-selective manner (32 of 59 tested neurons among 139 navigation neurons, route-selective navigation neurons). The reversible inactivation of MPR neurons by muscimol resulted in a monkey becoming lost during the navigation task trial. These results suggest that MPR plays a critical role in route-based navigation by integrating location information and self-movement information.

Anterior cingulate activity during routine and non-routine sequential behaviors in macaques

Anterior cingulate cortex is important in monitoring action for new challenges. We recorded neuron activity in the anterior cingulate sulcus of macaques while they performed a sequential problem-solving task. By trial and error, animals determined the correct sequence for touching three fixed spatial targets. After the sequence was repeated three times, we then changed the correct solution order, requiring a new search. Irrespective of component movements or their kinematics, task-related neurons encoded the serial order of the sequence. Neurons activated with sequence components (68%) differed in activity between search and repetition. Search-related activity occurred when behavioral flexibility was required and ended as soon as the animal accumulated enough information to infer the solution, but had not yet tested it. Repetition-related activity occurred in a regime of memory-based motor performance in which attention to action is less necessary.