Enhancing intercultural sensitivity in Japanese nursing students through international online nursing courses: A quasi-experimental study.

BACKGROUND: Globalization has highlighted the importance of being competent in communicating with people of various cultural backgrounds. PURPOSE: To evaluate the effect of international courses for nursing students through online education in terms of intercultural sensitivity and perceived English proficiency. DESIGN: A one-group pretest-posttest quasi-experimental design with an online self-reported questionnaire was conducted. PARTICIPANTS AND SETTINGS: Participants were second-, third-, and fourth-year nursing students at a medical university in Tokyo in the spring term of 2021. METHOD: Measurements were performed before and after the international nursing courses, which consisted of 1) nursing communication English, taught by native English instructors to second- and third-year students; and 2) international health nursing, taught by overseas-experienced faculty members to fourth-year students. Furthermore, there is an elective Collaborative Online International Learning course, where students discuss, collaborate, and complete common assignments with students from a university in the United States. Intercultural sensitivity was measured using the Japanese version of the Intercultural Sensitivity Scale. The pre- and post-test intercultural sensitivity were compared using a paired t-test. Content analysis was employed to analyze the open-ended questions. RESULTS: A total of 104 students' data were analyzed. Students' intercultural sensitivity mean improved significantly from 79.88 ± 8.47 (pre) to 83.04 ± 8.63 (post). Participants in the elective course (n = 7) showed significantly higher intercultural sensitivity levels than non-participants. The self-evaluated English proficiency of second- and third-year students who took English courses significantly improved after the courses. Themes extracted by elective course participants revealed students' perceptions toward learning about diverse cultures, resilience, and intercultural communication skills, which they can utilize for nursing practice in the future. CONCLUSION: Taking international nursing courses can increase nursing students' intercultural sensitivity. Universities are encouraged to provide international nursing courses to help enhance their cultural sensitivity and competency for their future nursing careers.

A Comparison of Spinopelvic Alignment and Quality of Life between Farmers and Non-Farmers: A Cross-Sectional Population-Based Study in a Japanese Rural Area.

BACKGROUND: It may be difficult to define what would constitute an abnormal spinal sagittal alignment. The same degree of malalignment may be found both in patients with pain and disability and in asymptomatic individuals. This study focuses on elderly farmers who characteristically have a kyphotic spine, in addition to local residents. It questions whether these patients experience cervical and lower back symptoms, respectively, more often than elderly people who never worked on a farm and do not have a kyphotic deformity. Previous research could have been biased by sampling patients who came to a spine clinic for treatment, whereas this study sampled asymptomatic elderly who may or may not have had kyphosis. METHODS: We studied 100 local residents at their annual health checkup (22 farmers and 78 non-farmers) with a median age of 71 years (range 65-84 years). Spinal radiographs were used to measure sagittal vertical axis, lumbar lordosis, thoracic kyphosis and other measurements of sagittal malalignment. Back symptoms were measured using Oswestry Disability Index (ODI) and Neck Disability Index (NDI). The association between alignment measures and back symptoms were calculated by bivariate comparison between patient groups and by Pearson's correlation. RESULTS: About 55% of farmers and 35% of non-farmers had abnormal radiographs (i.e., vertebral fracture). Farmers had higher measurements of sagittal vertical axis (SVA), compared to non-farmers, when measured from C7 (median 24.4 mm vs. 9.15 mm, p = 0.04) and from C2 (47.65 vs. 25.3, p = 0.03). Lumbar lordosis (LL) and thoracic kyphosis (TK) were significantly decreased in farmers vs. non-farmers (37.5 vs. 43.5, p = 0.04 and 32.5 vs. 39, p = 0.02, respectively). The ODI was likely to be higher among farmers compared to non-farmers while NDI scores showed no significant difference between farmers and non-farmers (median 11.7 vs. 6.0, p = 0.06 and median 13 vs. 12, p = 0.82, respectively). In terms of correlation among spinal parameters, LL had a higher correlation with SVA, but TK had less correlation with SVA among farmers compared to non-farmers. There was no significant correlation between disability scores and measurements of sagittal alignment. CONCLUSIONS: Farmers had higher measurements of sagittal malalignment, characterized by loss of LL, decreased TK and an increased forward translation of cervical vertebrae relative to sacrum. ODI was likely to higher in farmers compared to non-farmers although the association did not reach a significant level. These results probably indicate that the gradual development of spinal malalignment in agricultural workers does not result in excess morbidity compared to controls.

Fostering globally competent dental students through virtual team-working, problem-solving and person-centred multi-disciplinary care planning.

Background/purpose: : Development and acquisition of communication, logical thinking, team-building, critical appraisal, critical thinking and person-centred multi-disciplinary care planning must be considered as skill sets and global core competencies for a dental professional. Therefore, an international online study course to foster undergraduate dental students' skill sets in these areas was established and this study aimed to report the perceptions of participants. Materials and methods: An international online course consisting of three levels pertaining to the school year was delivered to dental undergraduates of Japan and Thailand from September to December in 2021. An online questionnaire survey was conducted to obtain feedback from the participants and assess the implementation of the course. Results: In total, 64 responses were obtained from students who participated in all the assigned online sessions and completed the questionnaire (a response rate of 88%). More than 95% of students from each level felt that the programme increased their motivation to study clinical dentistry, and was beneficial for their future and made them appreciate the importance of participating in international exchange. The ratio of favourable respondents was more than 90% with a 95% confidence interval. Conclusion: Fostering globally competent dental students is important and the acquisition of necessary skill sets could be enhanced through international virtual team-working, problem-solving and person-centred multi-disciplinary care planning activities. These are beneficial for undergraduate dental student training so that they graduate with a broader global perspective and an appreciation of the importance of delivering person-centred culturally sensitive dental care.

Impact of orthogeriatric care management by orthopedic surgeons and physicians on in-hospital clinical outcomes: A difference-in-difference analysis.

AIM: The orthopedic surgery unit in our suburb serves a large elderly trauma population in addition to providing elective surgeries. As patients with hip fractures have become older and at higher risk of medical complications, our hospital has initiated integrated co-management of these patients by orthopedic surgeons and geriatricians from the point of hospital admission. The aim of this study was to evaluate the impact of the hospital policy change on hip fracture management and clinical outcome indicators. METHODS: Using the difference-in-difference approach, in total, 288 consecutive patients with hip fractures treated during the 1 year before and 2 years after transition to orthogeriatric care from a geriatric consultation model to integrated orthogeriatric care model were compared with 576 patients from other local hospitals. RESULTS: Despite a seasonal trend toward increased length of hospital stay in winter, the intervention significantly reduced the change in mean length of stay (mean difference [95% confidence interval], -12.9 days [-21.5 to -4.3]; P = 0.007) and discharge to home tended to change less frequently (-12.6%; P = 0.10). There was no significant reduction in mean time to surgery (-0.2 days; P = 0.83), mortality (-0.8%; P = 0.62), or complications (-1.0%; P = 0.85). CONCLUSIONS: Changing our hip fracture service from a geriatric consultation model of care to an integrated orthogeriatric model significantly reduced length of hospital stay probably due to a lower chance of discharge to home. To our knowledge, this is the first study in Japan to compare two orthogeriatric care models considering the nationwide improvement in hip fracture management. Geriatr Gerontol Int 2022; 22: 138-144.

Evaluating e-learning on an international scale: An audit of computer simulation learning materials in the field of dentistry.

BACKGROUND/PURPOSE: Global networking and e-learning courses are an effective strategy for sharing educational content and there is potential scope to use e-learning technology in dental education. Therefore, this study aimed to explicate the challenges encountered in international e-learning use and decipher optimum solutions for disseminating course/systems on an international scale. MATERIALS AND METHODS: An e-learning course with four computer-assisted simulation materials developed among international faculties was provided to dental undergraduates at dental schools in Japan and Vietnam in 2020. A post-questionnaire survey plus pre- and post-tests were conducted to obtain learners' feedback and assess the success of the course's implementation. RESULTS: Altogether, 41 students participated, with a response rate of 78.8%. The mean post-test score was significantly higher than that of the pre-test (p < 0.001). Students from both groups felt that e-learning was beneficial, useful for their future, and should be continued. CONCLUSION: This study showed that e-learning/course provision could be achieved at an international level by using a common online system, which is beneficial for students to gain a wider perspective and global dental education. Learners indicated that they learned without any major problems in learning operations. This type of educational material creation and course implementation is extremely important in global networking and dental education in the present era; and communication and cooperation between the faculties was important for course provision. More countries should be included in future studies to ensure that it has global application.

Early recovery of basic mobility under femoral nerve block after hip fracture surgery - A propensity score matched pilot study.

BACKGROUND: Previous studies have shown better pain reduction utilizing femoral nerve block (FNB) in patients who underwent hip fracture surgery. However, few studies have focused on the recovery of physical function after FNB, and most studies excluded patients with dementia. We investigated the association between FNB performed in the operating room and the recovery of physical function after hip fracture surgery, including patients with dementia. METHODS: A total of 103 patients with a mean age of 87.4 years who underwent hip fracture surgery under spinal anesthesia between July 2015 and December 2017 (46 patients receiving a single injection of FNB and 57 standard care) were enrolled. Patients with FNB versus standard care were matched by a propensity score to adjust for patient characteristics. An anesthesiologist performed FNB with 20ml of 0.2% ropivacaine, and the standard care group received intravenous 1000 mg acetaminophen or 50mg flurbiprofen once after surgery. After matching, 78 patients were analyzed. Our primary outcome was 3-day cumulated ambulation score (CAS, 0-18 points) and secondary outcomes were 1-day CAS on postoperative day 1-3 and length of hospital stay. We also stratified patient groups based on the presence of dementia and fracture type. RESULTS: Patients undergoing FNB had significantly better 3-day CAS compared to standard care (mean [SD], 8.72 [3.42] vs 7.33 [2.62]; mean difference, 1.38 [95%CI; 0.03 - 2.74]; p = 0.048) and 1-day CAS on postoperative day two (mean [SD], 3.10 [1.39] vs 2.56 [0.94]; mean difference, 0.54 [0.01 - 1.07]; p = 0.049). Length of hospital stay did not significantly differ among the two groups (p = 0.65). Larger positive effect was likely to be seen for patients with a femoral neck fractures and for those without dementia. CONCLUSIONS: Patients who underwent surgery with spinal anesthesia plus FNB had better ambulatory status early after hip fracture surgery compared to patients not offered FNB. The beneficial association between FNB and ambulatory status was likely to be observed especially in patients with femoral neck fracture and without dementia.

Translation, Inter-rater Reliability, Agreement, and Internal Consistency of the Japanese Version of the Cumulated Ambulation Score in Patients after Hip Fracture Surgery.

OBJECTIVES: The aim of this study was to translate the Cumulated Ambulation Score (CAS) from English into Japanese in cooperation with different types of healthcare providers and to investigate its inter-rater reliability and internal consistency. METHODS: Two physical therapists at each of three general hospitals in Japan measured the mobility of 50 consecutive post-operative hip fracture patients on two occasions between 2 and 6 days after surgery using the Japanese version of the CAS (CAS-JP). We analyzed the inter-rater reliability and agreement using both the linear weighted kappa and the interclass correlation coefficient; we also analyzed the internal consistency using Cronbach's alpha coefficient. RESULTS: The mean age of patients was 81 (SD: 11.6) years and 82% were women. Approximately half of the patients had severe cognitive impairment. Kappa was ≥ 0.93 for the three mobility activities and for the total CAS-JP score, the percentage agreement was ≥ 0.98, the ICC was ≥ 0.95, and Cronbach's alpha coefficient was 0.85. CONCLUSIONS: We found that the CAS-JP possessed good inter-rater reliability, agreement, and internal consistency. The CAS-JP is a reliable and easy-to-use evaluation tool suitable for daily clinical practice across different healthcare providers to monitor mobility in older hip fracture patients in Japan. We suggest that CAS-JP be evaluated in future studies for use in younger patients and in other patient groups with mobility problems.

Dental Hygiene Learning Outcomes Obtained Through Computer-Assisted Simulation Modules.

Purpose: Education reflecting current knowledge is required for competent health care providers but the number of educators and/or lecture/clinical contact hours are often limited. The purpose of this study was to evaluate the learning outcomes and practicality of interactive simulation modules developed for a computerized learning system in dental hygiene education.Methods: Twenty-nine Japanese fourth-year dental hygiene undergraduates were given access to five interactive modules, delivered via a learning management system (LMS), for one month. The modules provided virtual clinical settings to take learners through decision-making processes for explaining procedures and treatments, and making appointments in English. Pre- and post-tests and a questionnaire were used to evaluate the knowledge gained and to receive learner's feedback. Participants were classified into two groups (study group and non-study group), based on their use/non-use of modules made available during the five-week period for statistical analysis.Results: Post-test scores were significantly higher in the study group (n = 22) than in the non-study group (n = 6), (p = 0.024). Post-test scores were also significantly higher than the pre-test scores in the study group (p = 0.001). No significant differences in the post- versus pre-test scores were found in the non-study group. The questionnaire response rate of 100% (n = 29) indicated that participants considered the interactive modules, including the system operation, as convenient and beneficial.Conclusion: Modules made available via a LMS for self-study were beneficial for Japanese undergraduate dental hygiene students in the acquisition of knowledge and skills for clinical decision-making in English.

English education for healthcare professionals in Japan.

In a global environment, education for healthcare professionals should include cultivating human resources who have the necessary skills to work in an international arena. This article will review the current status of English education for dental healthcare professionals in Japan. After conducting a literature search using the keywords: English education, Japan, and dental, only a few studies were found that investigated and proposed suggestions for dental professional English education. Even so, these were still in the early stages with outcomes yet to be fully evaluated. Even though English is thought indispensable for global professionals, and that increasing chances for communication skills is necessary, little attention has been addressed to English education for dental professionals or the implementation of such education in the Japanese undergraduate dental curricula. With the current reality of field expansion in dentistry, the need for not only improved English communication skills for Japanese dentists, but also the acquisition of essential expertise, psychomotor, teambuilding, critical thinking, and creative thinking skills in English as well as Japanese, is a definite probability. In order to reach this level of knowledge, further efforts and research would be necessary for the advancement and development of dental professional English education in Japan.

Evaluation of simulation learning materials use to fill the gap in Japanese dental English education.

Even though English is most frequently the common language when the patient's native language differs from that of a dentist, the opportunities for Japanese undergraduate dental students to learn dental English are now quite limited. The purposes of our study were to investigate: the effectiveness and feasibility of the computer-assisted simulation materials as one solution strategy for dental English education in Japan, and the needs and demands for dental English from the learners' side. Interactive simulation materials for medical interviews in English and clinical cases which were translated to English, were delivered via Learning Management System (LMS) to nineteen trainee residents of dentistry (residents). Evaluation for the materials, learners' knowledge and interests in the contents, and ease of operation were obtained by post-questionnaire (response rates were 100% and 95%, respectively). Both questionnaire-surveys received positive feedback toward the materials, yet 47% answered that they lacked the level of knowledge about contents of the medical interview in English. Results were sufficient to suggest that the residents would like to have the opportunity to study or practice medical interview in English, or English related to dentistry, and that the simulation materials could be one of the solution strategies for opportunity provision.