訪問看護サービスを利用していた在宅高齢者の表在性浮腫に対するケアの実態

本研究の目的は在宅高齢者の浮腫に対するケアの実態を明らかにすることである。対象は浮腫のある在宅高齢者にケアを行った訪問看護師で、2011年9～10月に郵送での自記式質問紙調査を実施した。回収数は281人、回収率は18.0％であった。浮腫は局所が259人（92.2％）、全身が22人（7.8％）で、局所浮腫は長期慢性疾患罹患者に、また全身浮腫は悪性新生物罹患者に多かった（p < 0.01）。局所浮腫は維持期にある者、また全身浮腫は終末期にある者に多く (p < 0.001）、ケアは局所浮腫では圧迫を緩めるが少なく、全身浮腫では圧迫を緩めるが多かった (p < 0.05）。看護実践による結果で改善傾向は局所浮腫、悪化傾向は全身浮腫に多かった (p < 0.05）。長期慢性疾患の維持期における局所浮腫への訪問看護師によるケアは、身体的苦痛の回避、二次的合併症予防、医療処置の削減に寄与するものと考える。The purpose of this study was to clarify the actual condition of care for edema in elderly patients receiving home nursing care. The subjects were visiting nurses who provided home care for elderly patients with edema. A self-reported questionnaire was sent by mail to these nurses from September to October 2011. The number of responses was 281 and the response rate was 18.0%. Edema was localized in 259 patients (92.2%) and was generalized in 22 patients (7.8%). The incidence of localized edema was higher in patients with long-term chronic diseases, while that of generalized edema was higher in patients with malignant neoplasms (p < 0.01). The incidence of localized edema was higher among patients receiving maintenance care, while that of generalized edema was higher among patients receiving terminal care (p < 0.001). As the type of management provided, loosening pressure was not common for localized edema, but was common for generalized edema (p < 0.05). As a result of nursing care, edema tended to resolve in the patients with localized edema, while it tended to progress in the patients with generalized edema (p ＜ 0.05). Management of localized edema in patients receiving maintenance care for long-term chronic diseases by visiting nurses helps to avoid physical pain, prevents secondary complications, and decreases the need for medical treatment

A Comparative Study of Face-to-Face and Online Interprofessional Education Models for Nursing Students in Japan: A Cross-Sectional Survey

This study investigated the effects of an online interprofessional education (IPE) program on nursing students at a university in Japan. It conducted a comparative analysis between traditional face-to-face and online interventions. All students who enrolled in the “Team Medical Practice” course in both 2019 and 2020 were invited to participate. After team-based learning with different healthcare professions, we quantitatively analyzed pre- and post-intervention outcomes using two measures: the Readiness for Interprofessional Learning Scale (RIPLS) and the IPE Questionnaire TSUKUBA model (IPET). We compared the results of 153 nursing students. The RIPLS results demonstrate significant pre- and post-intervention score differences in the teamwork and collaboration subscale for the online group only. The post-IPE score analysis revealed that scores were significantly higher in the online group in all subscales: Teamwork and collaboration, Opportunities for IPE, and Uniqueness of profession. Based on the IPET results, there were no significant differences in pre- and post-intervention scores. However, the online group showed a significant increase in post-intervention scores in participation in group work, thoughts about the team in health and welfare, and thoughts about interprofessional collaboration. These findings indicate that the online IPE program improved nursing students’ readiness for interprofessional learning, demonstrating practical efficacy

Alcohol consumption and the risk of heart failure: the Suita Study and meta-analysis of prospective cohort studies

Background: Alcohol consumption is a modifiable lifestyle, but its role in heart failure (HF) development is controversial. Herein, we investigated the prospective association between alcohol consumption and HF risk. Methods: A total of 2,712 participants (1,149 men and 1,563 women) from the Suita Study were followed up every two years. Cox regression was applied to calculate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) of HF risk for heavy drinking (≥46 g/day in men or ≥23 g/day in women) and never drinking compared to light drinking (<23 g/day in men or <11.5 g/day in women). Then, we combined the results of the Suita Study with those from other eligible prospective cohort studies in a meta-analysis using the random-effects model. Results: In the Suita Study, within a median follow-up period of 8 years, 319 HF cases (162 in men and 157 in women) were detected. In men, but not women, never and heavy drinking carried a higher risk of HF than light drinking: HRs (95% CIs) = 1.65 (1.00, 2.73) and 2.14 (1.26, 3.66), respectively. Alike, the meta-analysis showed a higher risk of HF among heavy drinkers: HR (95% CI) = 1.37 (1.15, 1.62) and abstainers: HR (95% CI) = 1.18 (1.02, 1.37). Conclusion: We indicated a J-shaped association between alcohol consumption and HF risk among Japanese men. The results of the meta-analysis came in line with the Suita Study. Heavy-drinking men should be targeted for lifestyle modification interventions

A Fulminant Case of Granulomatosis with Polyangiitis with Meningeal and Parenchymal Involvement

Central nervous system (CNS) involvement, such as pachymeningitis and/or cerebrovascular events, is rare in patients with granulomatosis with polyangiitis (GPA). Furthermore, the details of pathological examinations of cases have rarely been described. We describe a case of GPA that manifested as an isolated paranasal sinus disease that invaded the subarachnoid space and caused a hemorrhagic venous infarction. We also describe the pathological characteristics of the biopsied brain material from the successful decompressive craniectomy. In particular, granulomatous inflammation with geographic necrosis and multinucleated giant cells were observed in the perivascular area of the thickened dura mater and leptomeninges. Small vessels in the meninges were involved in the granulomatous lesions, and the lumens of the veins were often occluded. In the cerebral cortices and white matter in these areas, hemorrhagic infarction was widely observed. We suggest that our findings represent a novel mechanism of CNS involvement in GPA. Moreover, we believe that the emergency decompressive craniectomy and partial lobectomy for the cerebral infarction in this patient with GPA likely contributed to his survival

Late-onset anti-NMDA receptor encephalitis

OBJECTIVE: To describe the clinical features and outcome of anti–NMDA receptor (NMDAR) encephalitis in patients ≥45 years old. METHOD: Observational cohort study. RESULTS: In a cohort of 661 patients with anti-NMDAR encephalitis, we identified 31 patients ≥45 years old. Compared with younger adults (18–44 years), older patients were more often male (45% vs 12%, p < 0.0001), had lower frequency of tumors (23% vs 51%, p = 0.002; rarely teratomas), had longer median time to diagnosis (8 vs 4 weeks, p = 0.009) and treatment (7 vs 4 weeks, p = 0.039), and had less favorable outcome (modified Rankin Scale score 0–2 at 2 years, 60% vs 80%, p < 0.026). In multivariable analysis, younger age (odds ratio [OR] 0.15, confidence interval [CI] 0.05–0.39, p = 0.0001), early treatment (OR 0.60, CI 0.47–0.78, p < 0.0001), no need for intensive care (OR 0.09, CI 0.04–0.22, p < 0.0001), and longer follow-up (p < 0.0001) were associated with good outcome. Rituximab and cyclophosphamide were effective when first-line immunotherapies failed (OR 2.93, CI 1.10–7.76, p = 0.031). Overall, 60% of patients older than 45 years had full or substantial recovery at 24 months follow-up. CONCLUSIONS: Anti-NMDAR encephalitis is less severe in patients ≥45 years old than in young adults, but the outcome is poorer in older patients. In this age group, delays in diagnosis and treatment are more frequent than in younger patients. The frequency of underlying tumors is low, but if present they are usually carcinomas instead of teratomas in younger patients. Early and aggressive immunotherapy will likely improve the clinical outcome

Non-functioning parathyroid carcinoma: a case report

Abstract Background Non-functioning parathyroid carcinoma is a rare disease that is difficult to distinguish from other diseases based on the lack of hyperparathyroidism. This is a report of non-functioning parathyroid carcinoma diagnosed by reverse transcription polymerase chain reaction (RT-PCR) targeting parathyroid hormone (PTH) messenger RNA. Case Presentation The patient is a 67-year-old male who visited our hospital for the chief complaint of hoarseness. A 5-cm mass was observed in the right lobe of the thyroid gland, and poorly differentiated thyroid carcinoma was suspected according to the fine-needle biopsy results. The laboratory data for thyroid functions, thyroglobulin, anti-thyroglobulin antibodies, calcium, phosphorus, and intact-PTH were all within the normal range. Right recurrent nerve paralysis was observed preoperatively. The patient was diagnosed with poorly differentiated thyroid carcinoma, and total thyroidectomy and central node dissection with partial resection of the right recurrent nerve and esophageal muscle were performed. The pathological findings revealed atypical cells containing clear cells in solid and alveolar structures with broad fibrosis. Mitosis, focal coagulative necrosis, and vascular and capsular invasions were observed. A slightly positive PTH immunohistochemical stain was noted, whereas the RT-PCR results were positive. We finally diagnosed this tumor as non-functioning PTC. No distant metastasis occurred, and the patient is still alive. Conclusions This is a report of a patient with non-functioning parathyroid carcinoma, which is clinically very rare. We diagnosed this tumor as non-functioning parathyroid carcinoma using RT-PCR for PTH mRNA