Amane Tateno

Objectives: Communication with intensive care unit (ICU) staff is a key determinant of psychological distress among the families of ICU patients. An important component of ICU communication is to provide information for families’ informational needs. This study examined the differences in unmet informational needs of the families of ICU patients, based on patient survival status.,Methods: This single-center, cross-sectional survey study was conducted in the emergency ICU of a university hospital in Japan. ICU patients’ family members were invited to complete a 21-item, validated questionnaire assessing informational needs. Data were analyzed using generalized estimating equations to examine the differences in unmet informational needs between the families, along with item-level analyses.,Results: 194 family members participated (160 members of ICU survivor families and 34 of non-survivor families). Unmet needs were more frequently reported among families of ICU survivors. Significant differences were found in 7 of 21 items, particularly regarding condition changes, expected clinical course, and information timing and delivery.,Conclusion: Families of ICU survivors were more likely to report unmet informational needs than those of ICU non-survivors. This potential communication gap among families of ICU survivors implies a need for greater attention to informational needs during the recovery phase of critical illnesses.,Implications for practice: ICU clinicians should maintain structured, proactive communication not only during end-of-life care but also as patients stabilize and enter the recovery phase. Regular updates on changes in the patient’s condition and expected clinical course, together with clear guidance on when and how information will be provided, may help address families’ unmet informational needs.

The serotonin 1B receptor can be studied in vivo with PET using [ ¹¹ C]AZ10419369, and has been linked to both the pathophysiology and treatment of major depressive disorder (MDD). Ketamine and electroconvulsive therapy (ECT) both exert rapid and potent antidepressive effects, and although these treatments may not act directly on the serotonin system, they both cause dose-dependent increases in serotonin levels, and there is convergent evidence suggesting that the serotonin system may be important for their mechanisms of action. In this study, we re-analysed a multi-centre dataset of 222 [ ¹¹ C]AZ10419369 PET measurements from three centres, including MDD patients examined with PET both before and after treatment with ketamine ( n = 19 completers), saline placebo ( n = 10), or ECT ( n = 13 completers). Using a hierarchical Bayesian approach (SiMBA) that takes advantage of the full dataset to improve parameter estimation and enable data harmonisation across centres, we demonstrate large increases in 5-HT _1B R binding following both ketamine (6.4%, 95% CI: 3.1–9.6%) and ECT (9.3%, 95% CI: 4.3–14.2%). Ketamine-induced changes were statistically distinguishable from placebo, and an exploratory cross-centre comparison enabled by the data harmonisation within the combined modelling framework, suggests that ECT-induced changes are also distinguishable from placebo. These changes were not associated with individual symptom improvement. These findings suggest that despite differences in the pri-mary target of these rapid acting treatments for depression, they may converge on similar downstream changes to the serotonin system.

Electroconvulsive therapy (ECT) is a very valuable treatment for mood disorders. While previous studies have examined predictors of ECT responsiveness, there is a scarcity of neuroimaging studies examining these predictors. In previous studies, it has been reported that epilepsy is significantly more common in patients with Alzheimer’s disease, and it has been suggested that tau accumulation is related to the susceptibility to seizures. Positron emission tomography (PET) with florzolotau (18 F) ([¹⁸F]PM-PBB3) allows accurate quantification of tau in the brain cortex. We therefore performed tau PET with florzolotau (18 F) in 14 patients with mood disorders undergoing ECT to determine whether there is a relationship between tau accumulation and susceptibility to ECT. As a result, we found that the more tau accumulates, the more likely it is to produce effective seizures in ECT. Although our study has some limitations, it is suggested that ECT would be the first choice for treatment of depression associated with degenerative pathology such as Alzheimer’s disease because tau accumulation might enhance the therapeutic efficacy of ECT.

Background: Evidence regarding the relationship between empathy and burnout among nurses remains inconsistent. Moral distress may help explain this complexity. Given the associations of moral distress and burnout with turnover intention, it remains insufficiently understood how empathy is linked to these outcomes through multidimensional moral distress, which is a critical concern for nursing management. Aim: This study examined how empathy relates to burnout and turnover intention among nurses, focusing on indirect associations involving multidimensional moral distress and burnout. Methods: A cross‐sectional web‐based survey was conducted among Japanese nurses ( n = 412). Empathy was assessed using the Jefferson Scale of Empathy, burnout using the Burnout Assessment Tool, and moral distress using the Measure of Moral Distress for Healthcare Professionals, which captures multiple dimensions of moral distress. Turnover intention was measured using a single‐item scale. Mediation and moderation analyses were performed. Results: In the primary parallel mediation analysis, with all four moral distress domains considered simultaneously, positive indirect associations involving system‐level moral distress were statistically significant for burnout and turnover intention using 95% bootstrap confidence intervals. Supplementary separate‐domain sensitivity analyses also identified indirect associations involving clinical‐/patient‐level moral distress. The interaction between empathy and burnout in relation to turnover intention was significant. The negative indirect association of empathy with turnover intention through burnout and the positive serial indirect association through system‐level moral distress and burnout were both conditional on empathy level. Conclusions: The opposing indirect associations suggest that empathy should not be viewed as a uniformly protective resource in relation to turnover intention. System‐level moral distress showed the most consistent domain‐specific pattern across the analyses. The cross‐sectional design does not establish temporal or causal relationships. Implications for Nursing Management: Nursing managers may consider staffing adequacy, ethical climate, decision‐making autonomy, and organizational support alongside individual‐focused approaches to empathy and resilience.

PET analysis is conventionally performed as a two-stage process of quantification followed by analysis. We recently introduced SiMBA (Simultaneous Multifactor Bayesian Analysis), a hierarchical model that performs quantification and analysis for all brain regions of all individuals at once, and in so doing improves both the accuracy of parameter estimation and inferential efficiency. However until now, SiMBA has only been implemented for the two-tissue compartment model. We have now extended this general approach to also allow a non-invasive reference tissue implementation that includes both the full reference tissue model (FRTM) and the simplified reference tissue model (SRTM). Although the FRTM did not successfully converge and gave rise to unlikely parameter estimates for this application, the SRTM described the data well. In simulated data, SiMBA improves quantitative parameter estimation accuracy, reducing error by, on average, 57% for binding potential (BPND) using SRTM. In considerations of statistical power, our simulation studies indicate that the efficiency of SiMBA modeling approximately corresponds to improvements that would require doubling the sample size if using conventional methods, with no increase in the false-positive rate. We applied the model to PET data measured with [11C]AZ10419369, which binds selectively to the serotonin 1B receptor, in datasets collected at three different PET centres (n = 139, n = 44 and n = 39). We show that SiMBA yields replicable inferences by comparing associations between PET parameters and age in the different datasets. Moreover, we show that time activity curve data from different centres can be combined in a single SiMBA model using covariates to control between-centre parameter differences, in order to harmonise data between centres. In summary, we present a novel approach for non-invasive quantification and analysis of PET time activity curve data which improves quantification and inferences, enables effective between-centre data harmonisation, and also yields replicable outcomes. This method has the potential to significantly expand the range of research questions which can be meaningfully tested using conventional sample sizes with PET imaging.

Electroconvulsive therapy (ECT) is a very valuable treatment for mood disorders. However, there are no a priori indicators to predict the effect of ECT on the elderly, and we sometimes wonder whether we should administer ECT to the elderly. In previous studies, there are reported that epilepsy is significantly more common in patients with Alzheimer's disease, and it has been suggested that tau accumulation is related to the susceptibility to seizures. Positron emission tomography (PET) with florzolotau (18F) ([18F]PM-PBB3) allows accurate quantification of tau in the brain cortex. We therefore performed tau PET with florzolotau (18F) in patients with mood disorders undergoing ECT to determine whether there is a relationship between tau accumulation and susceptibility to ECT. As the result, we found that the more tau accumulates, the more likely it is to produce effective seizures in ECT. Although our study has some limitations, it is suggested that ECT would be the first choice for treatment of depression associated with degenerative pathology such as Alzheimer's disease because tau accumulation might enhance the therapeutic efficacy of ECT.

Background: It has been reported that forest bathing significantly reduced negative emotions and increased the positive feelings in both healthy males and females, as well as increasing blood serotonin in healthy males, indicating the potential for a beneficial effect on depressive status. However, an improvement effect of forest bathing on participants with depression has not been reported so far. Therefore, in order to fill this gap, this study examined the effect of forest bathing on depression in female participants with depression/depressive tendencies. Methods: Thirty-one females aged 40.1 ± 2.4 years with depression/depressive tendencies were recruited after obtaining informed consent. The study employed a randomized crossover design to compare forest bathing with city walking. They participated in day trips to a Japanese cypress forest park and to a city area of Nagano Prefecture as a control in June 2023. On both trips, they walked 2.5 km (for 90 min) in the morning and afternoon, respectively, for a total of 5.0 km per day. Blood samples were taken at 4 pm for the measurements before forest bathing on the first day and after the walking in forest and unban sites on the second and third days, at the same hospital. Concentrations of oxytocin, IGF-1, serotonin and lactic acid in blood were measured. SDS scores were calculated and the POMS test and questionnaires for subjective fatigue symptoms and sleep quality were administered before and after each trip. Temperature, humidity and illuminance were also measured in the forest and urban environments. The Nippon Medical School Central Ethics Committee approved this study. Results: Forest bathing significantly decreased SDS scores compared to city walk and the baseline, and the effect lasted for one week after forest bathing. Forest bathing also significantly increased the concentrations of blood serotonin in participants who were not taking antidepressants, significantly increased the levels of oxytocin and IGF-1 in blood, significantly increased the scores for positive feelings, and reduced the scores for negative emotions compared with city walking in the POMS test. In addition, forest bathing reduced subjective fatigue symptoms and improved sleep quality. Conclusions: These findings provided scientific evidence to contribute to understanding forest bathing as a potential intervention for preventing depression, and future research on males should further explore these effects.

PET analysis is conventionally performed as a two-stage process of quantification followed by analysis. We recently introduced SiMBA (Simultaneous Multifactor Bayesian Analysis), a hierarchical model that performs quantification and analysis for all brain regions of all individuals at once, and in so doing improves both the accuracy of parameter estimation as well as inferential efficiency. However until now, SiMBA has only been implemented for the two-tissue compartment model. We have now extended this general approach to also allow a non-invasive reference tissue implementation that includes both the full reference tissue model and the simplified reference tissue model. In simulated data, SiMBA improves quantitative parameter estimation accuracy, reducing error by, on average, 57% for binding potential ( BP _ND ). In considerations of statistical power, our simulation studies indicate that the efficiency of SiMBA modeling approximately corresponds to improvements that would require doubling the sample size if using conventional methods, with no increase in the false positive rate. We applied the model to PET data measured with [ ¹¹ C]AZ10419369, which binds selectively to the serotonin 1B receptor, in datasets collected at three different PET centres (n=139, n=44 and n=39). We show that SiMBA yields replicable inferences by comparing associations between PET parameters and age in the different datasets. Moreover, we show that time activity curve data from different centres can be combined in a single SiMBA model using covariates to control between-centre parameter differences, in order to harmonise data between centres. In summary, we present a novel approach for noninvasive quantification and analysis of PET time activity curve data which improves quantification and inferences, enables effective between-centre data harmonisation, and also yields replicable outcomes. This method has the potential to significantly expand the range of research questions which can be meaningfully tested using conventional sample sizes with PET imaging.