with among the highest numbers of patients with COVID-19 in the country. We selected HCWs, including physicians, nurses, laboratory medical technologists, radiological technologists, and pharmacists, who worked in departments in which they had contact with patients with COVID-19, including emergency departments, general internal medicine departments, respiratory medicine departments, infectious disease departments, general wards, and intensive care units. An explanation of the sample size calculation appears in the eAppendix in the Supplement. This study was approved by the institutional review board of St Luke's International Hospital in Tokyo, Japan. A letter of informed consent was distributed to the participants via email, and completion of the questionnaire implied their consent. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.The web-based survey was generated using SurveyMonkey, a cloud-based survey development application. The survey solicited responses regarding participants' demographic characteristics (age and gender), professional history (job category and years of experience), working environment characteristics (mean weekly working hours, days off per month, and hours of sleep per day), types of anxiety perceived, changes compared with before the pandemic, and types of support needed.The primary outcome was the prevalence of burnout among frontline HCWs in departments with direct contact with patients with COVID-19, using the validated Japanese version of the Maslach Burnout Inventory-General Survey, 3 which is currently considered the criterion standard for measuring burnout. This 16-item questionnaire contains 3 subscales that evaluate what are considered the 3 major domains of burnout, ie, emotional exhaustion, cynicism (ie, depersonalization), and professional efficacy (ie, personal accomplishment). High levels of exhaustion (>3.5) plus either high cynicism (>3.5) or low professional efficacy (<2.5) were selected as the primary criteria for burnout.We first compared the baseline characteristics of those who did and did not have burnout by using the χ 2 difference test for categorical variables and the Mann-Whitney U test for continuous variables. Given the limited information available on confounding by potential risk factors for burnout, we used logistic regression analyses to evaluate whether any factors, such as types of anxiety perceived, changes compared with the prepandemic period, and types of support needed, were significant by integrating data on the participants' backgrounds into the model. All analyses

In recent years, a concept of renal rehabilitation has become widely known among nephrology specialists, dialysis specialists, kidney transplantation specialists, rehabilitation specialists, nutrition specialists, guideline specialists, nurses, physiotherapists, and representatives of patients. Therefore, in order to make it clear the definition, methods, and effectiveness of renal rehabilitation in Japan, we launched Renal Rehabilitation Guideline Preparation Committee in 2016 as a part of works in the Japanese Society of Renal Rehabilitation, and created a guideline in accordance to the "Minds Handbook for Clinical Practice Guideline Development 2014". Here, we report systematic reviews and recommendations of exercise therapies in patients with kidney diseases based on the guideline preparation committee works. Six recommendations for the condition of each kidney disorder, groups addressing nephritis/nephrosis, chronic kidney diseases, dialysis therapy, and kidney transplantation were created. All the recommendation grades were determined by a consensus conference participated in by representatives of patients and various professionals. The purpose of this report is to provide an evidence-based, best practice summary to optimize the quality, safety and efficacy, and availability of renal rehabilitation service, and to provide care for maximum patient prognosis, quality of life, and satisfaction.

Objectives To determine the prevalence of burnout according to job category after the first wave of COVID‐19 in Japan and to explore its association with certain factors. Methods An online cross‐sectional survey of health care workers (HCWs) from June 15 to July 6, 2020, was conducted at a tertiary hospital in Tokyo, Japan. Demographic characteristics, results of the Japanese version of the Maslach Burnout Inventory‐General Survey, types of anxiety and stress, changes in life and work after the peak of the pandemic, and types of support aimed at reducing the physical or mental burden, were determined. Results Of 672 HCWs, 149 (22.6%) met the overall burnout criteria. Burnout was more prevalent in women (OR, 3.11; 95% CI, 1.45‐6.67, P = .003), anxiety due to unfamiliarity with personal protective equipment (PPE) (OR, 1.98; 95% CI, 1.20‐3.27, P = .007), and decreased sleep duration (OR, 1.96; 95% CI, 1.20‐3.20, P = .008). Conversely, participants who felt that the delivery of COVID‐19‐related information (OR, .608; 95% CI, .371‐.996, P = .048) and PPE education opportunities (OR, .484; 95% CI, .236‐.993, P = .048) and messages of encouragement at the workplace (OR, .584; 95% CI, .352‐.969; p = .037) was helpful experienced less burnout. Conclusions There is a need to focus on the above factors to maintain the mental health of HCWs. The delivery of COVID‐19‐related information and educational interventions for PPE and messages of encouragement at the workplace may be needed to reduce the mental burden.

BackgroundEven with abundant evidence for osmotic demyelination in patients with hyponatremia, the risk factors for overcorrection have not been fully investigated. Therefore the purpose of this study is to clarify the risks for overcorrection during the treatment of chronic profound hyponatremia.MethodsThis is a single-center retrospective observational study. We enrolled 56 adult patients with a serum sodium (SNa) concentration of ≤125 mEq/L who were treated in an intensive care unit by nephrologists using a locally developed, fixed treatment algorithm between February 2012 and April 2014. The impact of patient parameters on the incidence of overcorrection was estimated using univariable and multivariable logistic regression models. Overcorrection was defined as an increase of SNa by >10 mEq/L and >18 mEq/L during the first 24 and 48 h, respectively.ResultsThe median age was 78 years, 48.2% were male, and 94.6% of the patients presented with symptoms associated with hyponatremia. The initial median SNa was 115 mEq/L (quartile, 111–119 mEq/L). A total of 11 (19.6%) patients met the criteria for overcorrection with 9 (16.0%) occurring at 24 h, 6 (10.7%) at 48 h, and 4 (7.1%) at both 24 and 48 h. However, none of these patients developed osmotic demyelination. Primary polydipsia, initial SNa, and early urine output were the significant risk factors for overcorrection on univariable analysis. Multivariable analysis revealed that the initial SNa had a statistically significant impact on the incidence of overcorrection with an adjusted odds ratio of 0.84 (95% confidence interval, 0.70–0.98; p = 0.037) for every 1 mEq/L increase. Additionaly, the increase in SNa during the first 4 h and early urine output were significantly higher in patients with overcorrection than in those without (p = 0.001 and 0.005, respectively).ConclusionsAn initial low level of SNa was associated with an increased risk of overcorrection in patients with profound hyponatremia. In this regard, the rapid increase in SNa during the first 4 h may play an important role.

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