It was found that plantar shear stress adjusted for weight during the push-off phase was increased in patients with callus compared with those without callus by using the newly developed measurement system. These results suggest that reduction of plantar shear stress during the push-off phase can prevent callus formation in neuropathic patients with diabetes.

Plantar foot ulceration is one diabetic complication shown to be associated with both pressure and shear force. There are plantar pressure measurement systems, but it is still difficult to measure plantar shear force while walking. The aim of this study is to establish a simultaneous in-shoe measurement system of plantar pressure and shear force during a gait. The design of the measurement system is based on F-scan pressure-distribution-sensor sheets and shear-sensor sheets. An insole with a shear-sensor sheet was arranged to be applicable for measurement of diabetic having neuropathy patients without damaging their skin. It was found that the system gets proper different shear force data in response to gait patterns, such as shuffle walking and flat-floored walking. We confirmed, moreover, the repeatability of the system for 5 healthy individuals. Experimental results show that weight-adjusted plantar shear stress during the pushoff phase of a gait increases in diabetic patients with calluses more than in patients without calluses. After a clinical study of diabetic patients, the system can be applied not only for the prevention of diabetic foot but also for the broad evaluation of gait posture.

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Objective: To clarify the education and training-related factors associated with provision of endof-life care by home-visit nursing agencies that did not calculate the medical expenses for functionenhanced home nursing management.Methods: An anonymous questionnaire was administered to 2,000 randomly selected home-visit nursing agencies throughout Japan. It asked about the facility structure, training/education factors among nurses and managers, regional and cultural difficulties in implementing end-of-life care at home, and provision of end-of-life care at home.Results: A total of 242 responses were analyzed. Logistic regression analysis was carried out, adjusting for the number of full-time equivalent nurses, the presence of an additional 24-hour response system and regional and cultural difficulties in implementing end-of-life care at home. It showed that the provision of end-of-life care at home was associated with end-of-life care training for managers (odds ratio: 4.17, 95% confidence intervals: 1.76-9.90), and support to increase the frequency of accompanied visits for nurses practicing end-of-life care at home for the first time (3.12, 1.33-7.29).Conclusion: End-of-life care at home may be promoted by providing specific training for managers and ensuring that nurses who are practicing end-of-life care at home for the first time are accompanied.受付日：2022 年 4 月 22 日 受理日：2022 年 9 月 5 日 1) 公益財団法人日本訪問看護財団 Japan Visiting Nursing Foundation 2) 東京大学大学院医学系研究科健康科学・看護学専攻高齢者在宅長期ケ