Background: This study aimed to identify the structure of stress factors during fundamental clinical training and the relationships between stress factors and coping behaviors in nursing students. Methods: The participants in this descriptive cross-sectional study were 158 first-year undergraduate nursing students from a university nursing department. A self-administered questionnaire study was conducted before and after fundamental clinical training. Results: Exploratory factor analysis on stressors related to clinical training revealed the following seven factors: (1) "relationships with teachers and clinical instructors, " (2) "lack of knowledge and skills, " (3) "reflecting on patient-care experiences, " (4) "relationships with patients, families, and healthcare staff, " (5) "conferences, " (6) "peer relationships, " and (7) "daily planning in clinical practice. " Students with higher scores for stress factor such as "relationships with teachers and clinical instructors" were less likely to engage in the coping behavior "changing mood. " Moreover, three stress factors, "lack of knowledge and skills, " "reflecting on patient-care experiences, " and "conferences, " negatively correlated with the coping behavior "seeking help to solve problems. " Conclusion: We identified seven stress factors in nursing students during fundamental clinical training. Faculty teachers and clinical instructors need to actively engage with students by providing adequate debriefing or guidance and having them reflect on their daily actions. Furthermore, orientations before clinical training should be redesigned to address conference procedures and reflection on patient care.

An important consideration in the quality of end-of-life care is whether the patient's place of death matches his or her hopes. We aimed to identify topics related to patients' home death by comparing the occurrence frequency of topics explained by doctors for family caregivers between the home death cases and the hospital death cases. The method of integrating qualitative and quantitative data was adopted in this study. Primary participants were 24 home doctors who specialized home medical care. Enrolled 18 patients received periodical medical care by cooperated doctors, understood their own health situation, and lived with family caregivers. Doctors recorded all their speech during every visit with voice-recorder until the patient died at home or was re-hospitalized. Doctors' speech was transcribed and converted to the number of occurrences based on number of visits. The occurrence frequency was compared with a χ2 test (Yates' correction). Speaking records of 227 visits to 18 patients by doctors were collected. Finally, 16 patients died at home and two died at hospital. We measured the occurrence frequency of topics during maximum 26 visits on 16 home death cases and maximum 13 visits on two hospital death cases. The topics of patients' death, helping daily burden using public insurance, and financial application were more frequently appeared with home death cases than hospital death cases. In conclusion, doctors should explain to family caregivers the topics of patients' death process and specific measures or procedures for reduction in care burden.

Primary hyperparathyroidism was investigated using the presence of basic fibroblast growth factor (bFGF) from the immunohistochemical viewpoint with an anti-bFGF antibody in hyperplastic parathyroid glands of patients with multiple endocrine neoplasia type I (MEN-I) and of patients with non-MEN. The results corresponded well with the data from the DNA analysis. Twenty-five hyperplastic parathyroid glands from 11 patients with MEN-I and 38 glands from 20 patients with non-MEN primary hyperparathyroidism were stained immunohistochemically according to the avidin-biotin-peroxidase complex procedure. When 50% or more of the cells appeared uniformly stained, it was judged positively stained. In addition, 18 hyperplastic parathyroid glands from patients with MEN-I patients and 24 hyperplastic parathyroid glands from non-MEN patients were also analyzed for DNA using flow cytometry. The ratio of positively stained hyperplastic parathyroid glands was 72% in MEN-I patients and 18% in non-MEN patients. The difference between the two groups was significant (p < 0.01). The nodules consisted of oxyphilic cells in 7 of 25 hyperplastic parathyroid glands from MEN-I patients and in 10 of 38 hyperplastic parathyroid glands from non-MEN patients, and all the cells were positive for bFGF. There was no significant correlation between bFGF staining and the DNA ploidy pattern. bFGF possibly plays a role in the development of parathyroid gland hyperplasia, especially in MEN-I patients. The increase of oxyphilic cells may be correlated with the expression of bFGF.

Objective: As stroke mortality rates decline in Japan, a large proportion of disabled stroke survivors living in their homes are supported by informal caregivers or formal healthcare services. To evaluate the impact of healthcare provision on outcome of stroke patients living at home, this study investigated the associations of long-term care and health-related quality of life (HRQOL) in patients 1 year after stroke onset. Methods: Data on patient and caregiver characteristics, HRQOL of patients, and healthcare services for those living at home were prospectively collected from 426 patients with stroke at baseline and 12 months. Using general measures of HRQOL, namely, Short Form-36 (SF-36) and EuroQOL 5 dimension (EQ-5D), multivariate regression models were used to determine the contribution of variables to changes in HRQOL scores from discharge to the first year after stroke. Results: Five domains of SF-36-role-physical, vitality, social functioning, roleemotional, and mental health-were significantly improved 1 year after stroke. Factors affecting changes in the five domains of HRQOL were age, independence in activities of daily living, and cognitive function. Home care service was positively associated with role-physical, social functioning, and role-emotional. In addition, home rehabilitation and home bathing services were positively associated with social functioning. Conclusion: This study clarified that improvements of HRQOL 1 year after stroke were associated with use of home-based services involving home care service, home rehabilitation, and home bathing services. The use of home-based services contributed to the improved welfare of patients living at home.

The aim of this study was to reveal the level of ethical competence acquired through basic nursing education, to report on the present state of ethics education, and to consider future directions for ethics education. The medical databases ICHUSHI, MEDLINE, and CINAHL were searched using the search terms "nursing ethics," "nursing practice," "ethics education," and "nursing students." Of the total results, 25 research articles (original papers, research reports, practical reports, documents) were used for this study. Ethical competence covered in basic nursing education corresponded to points 1-11 of the Code of Ethics, and the competencies acquired included cognizance and judgement. Ethics education included methods such as case studies in Japan and blended learning in other countries. At present, ethical competence education does not comprehensively cover the Code of Ethics, and the judgement level of competence is not acquired during basic nursing education. It is thus necessary henceforth to progressively put an educational program in place to develop ethics education that persists from basic nursing education through to continuing nursing education.