Sleep-wake rhythm and its association with lifestyle, health-related quality of life and academic performance among Japanese nursing students: a cross-sectional studys

journal articl

精神科における多職種連携の取り組み

精神科においては精神障害者の生活の質の向上のために退院促進が求められている．そのためにはチームアプローチが不可欠であり，それを実践するためには，各専門職者の持っている能力を統合した活動を展開しなければならない．学際的連携チームケアモデルInterdisciplinary collaborative teamcare model （ICTCM）とは，チームケアを実践するための具体的な方法（教育，理論，実践，研究）を示すものである．そこで，ICTCMを使用して，チームケアサービスの質の改善活動の一環として，看護サービスをレベルアップすることを目的とした多職種参加による看護診断学習会を行ってきた．その結果，チームケア運営体制の整備，職種間の役割理解及び職種間で積極的に情報を共有しようとする姿勢が改善したと考えられた．This article describes workshop on nursing diagnosis that aimed improving an interdisciplinary collaboration in the psychiatric hospital. Psychiatric hospitals are required the promotion of discharge a patients with chronic mental disorders in order to enhance the quality of life of the people with mental disorders. For that purpose, team approach is absolutely imperative. In order to practice team approach, we have to unify the competency of each professional. Interdisciplinary Collaborative Team Care Model （ICTCM）shows the concrete method（education, theory, practice, research）for practicing team care. Our hospitals’ staffs are working based on this model in order to assure continuous improvement of providing efficient and high-quality of team care services. Nursing diagnosis workshop based on this model has been performed which aims to improve nursing services involve the participation of various health care professional. The overall conclusion of the report was that the management system of the team care is well-organized, also understanding of the role of other professions, the active and positive attitude for sharing information between inter-health care providers have improved

チュウオウ ザイリョウシツ ニ オケル QC カツドウ ノ コウカ : ギョウム ノ ミナオシ ニ ヨル カイゼン ト コスト サクゲン

The purpose of this study was to clarify whether QC activities performed by employees responsible for the central supply room in small groups to identify problems and voluntarily help with improvements could actually improve the performance and reduce costs. Regarding the methods, problems extracted from free discussions were reorganized according to the 4 Ms (men, machines, materials, and methods) of the QC technique, and regarded as "causes" in the central supply room. Then, a "characteristic" was derived from these causes to create a characteristic diagram. Finally, goals per cause were established based on the characteristic, measures to achieve the goals were planned and implemented, and the results were evaluated for the effects of QC activities in terms of improving performance and cost reduction. The study identified four causes, including "equipment / allocation," "supply systems," "sterilization technologies," and "human resource management," and a characteristic : "What are performance problems in the central supply room?" This demonstrated that setting goals per cause based on the characteristic and taking measures to achieve the goals had resulted in improvements in performance and cost reduction. QC activities were found to be effective in appropriately modifying the working environment, realizing performance improvements and cost reduction, and enhancing employees\u27 motivation

Impact of newly developed, next-generation artificial endocrine pancreas

Background : Recent studies have shown that strict perioperative blood glucose management may reduce mortality and morbidity in critically ill adult patients. The purpose of this study was to assess the accuracy and efficacy of the intraoperative application of a newly developed, next-generation artificial endocrine pancreas (STG-55, Nikkiso Co., Ltd., Tokyo, Japan). Methods : Twenty patients scheduled to undergo surgery were enrolled in this study. The STG-55 is designed to be more user-friendly than its conventional counterpart (STG-22) while maintaining the latter’s fundamental functions, such as a closed-loop system using algorithms for insulin and glucose infusion. After anesthetic induction, a 20G intravenous catheter was inserted into a peripheral forearm vein and connected to a continuous blood glucose monitor. The resultant 105 scores for paired blood glucose values were compared by Bland-Altman analysis. Results : Stable blood glucose values were maintained automatically, and there were no complications related to use of the STG-55. A close correlation (r=0.96) was observed between continuous glucose measurements using the STG-55 and conventional intermittent glucose measurements. The difficulty of manipulation using this system was decreased by improved preparation procedures. Conclusion : The glycemic control system using the STG-55 could provide an alternative way to achieve effective and safe perioperative glycemic control

Usefulness of central venous oxygen saturation monitoring during bidirectional Glenn shunt

A PediaSat(TM) oximetry catheter (PediaSat : Edwards Lifesciences Co., Ltd., Irvine, CA, U.S.A.), which facilitates continuous measurement of central venous oxygen saturation (ScvO2), may be useful for surgery for pediatric congenital heart disease. We used PediaSat during a bidirectional Glenn shunt. The patient was a 13-month-old boy. Under a diagnosis of left single ventricle (pulmonary atresia, right ventricular hypoplasia, atrial septal defect) and residual left aortic arch/left superior vena cava, a modified right Blalock- Taussig shunt was performed. Cyanosis deteriorated, so a bidirectional Glenn shunt was scheduled. After anesthesia induction, a 4.5 Fr double-lumen (8 cm) PediaSat was inserted through the right internal jugular vein for continuous ScvO2 monitoring. Furthermore, the probe of a near-infrared, mixed blood oxygen saturation-measuring monitor was attached to the forehead for continuous monitoring of the regional brain tissue mixed blood oxygen saturation (rSO2) (INVOS(TM) 5100C, Covidien ; Boulder, CO, U.S.A.). Blockage of the right pulmonary artery and right superior vena cava decreased the oxygen saturation, ScvO2, and rSO2, but increased the central venous pressure. Although changes in ScvO2 were parallel to those in rSO2, the former showed more marked changes. A combination of ScvO2 and rSO2 for monitoring during Glenn shunt may be safer

Recent Less-invasive Circulatory Monitoring during Renal Transplantation

For anesthetic management during renal transplantation, it is necessary to maintain the blood flow and function of the transplanted kidney by performing massive fluid management and stabilizing blood pressure. We report anesthetic management for renal transplantation with a less-invasive circulatory monitoring system (Edwards Life Sciences Co., Ltd., Irvine, California, U.S.A.). In November 2010, renal transplantation was started in our hospital, and performed in 6 patients. In the first patient, fluid/circulatory management was conducted by connecting a standard arterial line and a standard central venous (CV) line. In the second patient, a FloTracTM system and a standard CV line were used. In the third patient, a standard arterial line and a PreSepTM CV Oximetry Catheter were used. In the fourth and fifth patients, a FloTracTM and a PreSepTM were used. In the latest patient, FloTracTM and PreSepTM were connected to an EV1000TM Clinical Platform for fluid/circulatory management. The establishment of high-visibility monitors was useful for evaluating the condition and confirming the effects. As there are marked changes in hemodynamics, the CV pressure, which has been used as a parameter of fluid management, is not reliable in renal failure patients with a high incidence of cardiovascular complications. Advances in noninvasive circulatory monitoring with dynamic indices may improve the safety of anesthetic management during renal transplantation

Usefulness of artificial endocrine pancreas during resection of insulinoma

A 71-year-old woman had an episode of syncope due to hypoglycemia of 27 mg/dl. She was diagnosed with insulinoma and scheduled for laparoscopic enucleation along with the use of an artificial endocrine pancreas (STG-22, Nikkiso Co., Ltd., Tokyo, Japan). Anesthesia was maintained with sevoflurane and remifentanil. Her blood glucose level was controlled using the artificial endocrine pancreas, which enabled continuous blood glucose monitoring and computer-operated glucose and insulin infusion to maintain the blood glucose level at a steady state. The target concentration of blood glucose was set at 80-120 mg/dl during surgery. Until removal of the tumor, the blood glucose level was kept at around 80-100 mg/dl. After removal of the tumor, the blood glucose level gradually increased, but it was kept in the normal range by the artificial endocrine pancreas. The artificial endocrine pancreas was useful to monitor and maintain blood glucose levels during and after the removal of insulinoma, without any hyper- or hypoglycemia

Plasma Corticosterone Activates SGK1 and Induces Morphological Changes in Oligodendrocytes in Corpus Callosum

Repeated stressful events are known to be associated with onset of depression. Further, stress activates the hypothalamic–pituitary–adrenocortical (HPA) system by elevating plasma cortisol levels. However, little is known about the related downstream molecular pathway. In this study, by using repeated water-immersion and restraint stress (WIRS) as a stressor for mice, we attempted to elucidate the molecular pathway induced by elevated plasma corticosterone levels. We observed the following effects both, in vivo and in vitro: (1) repeated exposure to WIRS activates the 3-phosphoinositide-dependent protein kinase (PDK1)–serum glucocorticoid regulated kinase (SGK1)–N-myc downstream-regulated gene 1 (NDRG1)–adhesion molecule (i.e., N-cadherin, α-catenin, and β-catenin) stabilization pathway via an increase in plasma corticosterone levels; (2) the activation of this signaling pathway induces morphological changes in oligodendrocytes; and (3) after recovery from chronic stress, the abnormal arborization of oligodendrocytes and depression-like symptoms return to the control levels. Our data strongly suggest that these abnornalities of oligodendrocytes are possibly related to depression-like symptoms

Characteristics of Child-Rearing Environments Related to Social Development in Early Childhood

This study aimed to determine the characteristics of childrearing environments related to social development in early childhood. A questionnaire survey was conducted with the caregivers of children attending an urban preschool to identify the characteristics of the childrearing environment in relation to social development in early childhood. The TK Infant Development Test was used to assess social development. The Index of Child Care Environment (13 items in four domains) was used to assess the childrearing environment. Six of the items were used to assess parent–child interaction at home. The correlation coefficients between the social development and childrearing environment items were calculated. Multiple regression analysis was conducted with social development (DQ) as the dependent variable and the childcare environment items as the independent variables. Two types of analyses were conducted: forced entry (model 1) and stepwise (model 2). The results of our univariate and multivariate analyses showed a significant association between the social development items and childrearing environment items after adjusting for the target attributes. This finding suggests that an appropriate childrearing environment promotes social development in early childhood