急性期脳卒中ユニットにおける脳卒中ケアの看護師の認識と実際の看護実践状況 : 日本の横断的Webベースのアンケート調査

The awareness of care provided by stroke care unit (SCU) nurses in Japan to patients with an acute cerebrovascular accident (CVA) and the characteristic differences in their actual nursing practice were evaluated. A cross-sectional web-based questionnaire survey was administered to 1040 SCU nurses. Data collection and reporting procedures followed the STROBE Statement Checklist for cross-sectional studies. Exploratory factor analysis, using 52 observation items, identified eight factors with a factor loading > 0.4. For all factors, the actual practice was significantly lower than the awareness of the importance of nursing care for patients with acute CVA. Awareness and actual practice of recognition of patients’ physical changes (RPPCs) were high. The actual practice of RPPCs and preventing the worsening of acute stroke and related symptoms varied, depending on years of experience in acute phase stroke care. RPPCs in actual practice had a significantly higher score among certified nurses or certified nurse specialists. Their awareness of the importance of collaborating with therapists was low. On-the-job training can improve nurses’ competence and prevent worsening conditions in patients with CVA. An emphasis on enhancing practice experience toward patients with acute CVA and facilitating the deployment of certified nurses in SCUs can improve nursing care practice

ノウシュッケツ ト クモマクカ シュッケツ ノ チリョウ

We reviewed recent advances in the treatment of hypertensive intracerebral hemorrhage(HIH) and subarachnoid hemorrhage (SAH). The mortality rate of patients with HIH, approximately50% in McKissock’s time (around 1960), was reduced to 20% due to the disseminationof improved diagnostic imaging technologies, advances in medical and surgical treatmentregimens, and an increase in the detection rate of mild cases of HIH. On the otherhand, the mortality rate of SAH patients remained unchanged (approximately 50%) becausepatients experiencing the insult were often of advanced age and because the number ofpatients graded as poor has increased.To treat patients with HIH, we developed a new surgical approach that we call “CT-guidedstereotactic aspiration surgery (SAS)”. We also devised an ultrasonic hematoma aspirator.SAS is beginning to supplant conventional open surgery. SAS may be indicated for patientswith putaminal hemorrhage where the hematoma volume is greater than 30ml, and forpatients with cerebellar hemorrhage with a hematoma volume greater than 15ml. On theother hand, open surgery may be indicated for patients with subcortical hemorrhage wherethe hematoma volume is greater than 40ml. It is not indicated for patients with pontine andthalamic hemorrhage. The efficacy and safety of SAS in patients with pontine and thalamichemorrhage remain to be determined and to our knowledge, no randomized study of role ofSAS in patients with HIH has been reported. Such a study (Surgical Trial in IntracerebralHemorrhage, STICH) is planned in the UK to ascertain operative indications.There have been some advances with respect to diagnostic equipment and the managementof SAH. Three-dimensional CT angiography (3D-CTA), using a helical CT scan, andmagnetic resonance imaging angiography (MRA) have yielded superior images of cerebralaneurysms when compared with digital subtraction angiography (DSA). The titanium clipmarkedly reduces metallic artifacts on CT images. The complete clipping of aneurysms withtitanium clips can be ascertained by postopertive 3D-CTA. A recent Japanese cooperativestudy revealed a decrease in the mortality rate of SAH patients graded as poor. However,grade V patients (World Federation of Neurological Surgery) continue to have a poor outcome.Mild hypothermia induced with indomethacine, an antagonist of cyclooxygenase,may improve the treatment outcome. The cumulative rate of rupture of cerebral aneurysmswas estimated at approximately 1 - 2% per year, however a recent paper shows it tobe 0.05% per year. An unruptured cerebral aneurysms study (UCAS Japan) will start nextyear in Japan. It will reveal ruptre risk and the risks inherent in surgical intervention inpatients with unruptured cerebral aneurysms

Examining Factors Associated with Dynapenia/Sarcopenia in Patients with Schizophrenia : A Pilot Case-Control Study

Sedentary behavior in patients with schizophrenia causes muscle weakness, is associated with a higher risk of metabolic syndrome, and contributes to mortality risk. This pilot case-control study aims to examine the associated factors for dynapenia/sarcopenia in patients with schizophrenia. The participants were 30 healthy individuals (healthy group) and 30 patients with schizophrenia (patient group), who were matched for age and sex. Descriptive statistics, Welch’s t-test, cross-tabulations, adjusted residuals, Fisher’s exact probability test (extended), and/or odds ratios (ORs) were calculated. In this study, dynapenia was significantly more prevalent in patients with schizophrenia than in healthy individuals. Regarding body water, Pearson’s chi-square value was 4.41 (p = 0.04), and significantly more patients with dynapenia were below the normal range. In particular, body water and dynapenia showed a significant association, with an OR = 3.42 and 95% confidence interval [1.06, 11.09]. Notably, compared with participants of the healthy group, patients with schizophrenia were overweight, had less body water, and were at a higher risk for dynapenia. The impedance method and the digital grip dynamometer used in this study were simple and useful tools for evaluating muscle quality. To improve health conditions for patients with schizophrenia, additional attention should be paid to muscle weakness, nutritional status, and physical rehabilitation

Key Points of Nursing Care for Patients with Acute Stroke

In patients with stroke, it has been proven that management by a specialized medical team for stroke treatment for several days immediately after stroke onset significantly reduces mortality, improves return-to-home rates, and positively impacts activities of daily living and quality of life after discharge. This chapter describes the key points of nursing care for patients with acute stroke, which include “Recognition of patients’ physical changes,” “Prevention of the worsening of acute stroke and related Symptoms,” “Reduction of patients’ physical distress,” “Appropriate management of patients’ physical conditions,” “Reacquisition of activities of daily living,” “Collaboration with rehabilitation therapists,” “Reduction of mental and social distress in patients and their families,” and “Reduction of the risk of recurrence and requirement of discharge support.” These points will have a positive impact on patients with stroke by improving the nurses’ competence to practice nursing and enhancing the quality of team care

2D Video Analysis for Active shoulder ROM

Aging and its associated problems related to movement impacts the care of people with psychiatric disorders. This study sought to clarify the usefulness of 2D video analysis for evaluating shoulder range of motion (ROM) during upper limb exercises in patients with psychiatric disorders. Subjects (N=54) were patients with psychiatric disorders categorized as the following : having either a high or low activities of daily living (ADL) score using the Barthel Index ; experiencing shoulder ROM limitation, and whether or not compensatory movements were exhibited. Compensatory movement was also considered in patients with Parkinsonism, cerebrovascular disease, and cognitive dysfunction. Shoulder joint ROM was measured using a goniometer and active ROM was captured using ImageJ. No significant difference between passive ROM measured by a goniometer and active ROM measured by ImageJ considering disease groups, ADL level, and shoulder ROM limitation was found. Factoring in compensatory movements, however, significant differences were found between passive and active ROM : existence compensatory movement group, left side (z=-2.30, p=0.02) ; nonexistence compensatory movement group, right side (z=-2.63, p<0.001). Image-evaluating devices help assess ROM in patients with psychiatric disorders, enhancing the development of physical rehabilitation programs to regain critical ADL, sustaining self-care capabilities

Using ultrasonography in evaluating the intramuscular injection techniques used for administering drug treatments to schizophrenic patients in Japan

This study was conducted with six patients with schizophrenia, four of whom received the atypical antipsychotic risperidone long-acting injectable (RLAI), and two patients receiving the typical depot injection (TDI). The purpose of this study was to determine the location (gluteus medius or maximus ; deltoid muscles) and diffusion of typical and atypical antipsychotic medications administered intramuscularly using ultrasonography. When using the standardized depth of needle insertion, in some cases, the drug was injected into the gluteus maximus instead of the gluteus medius. Similarly, in some cases the TDI was not visible in the ultrasonographic images until sixteen days after the injection. This verifies how hard the injection site becomes when microspheres of RLAI is injected as compared to other muscle areas. These results confirmed that the gluteus muscle structure was the ideal muscle for depot injection as evidenced by the injection solution being dispersed and rendered not visible immediately after intramuscular injection (IM). With the use of ultrasonography, injection sites and drug dispersions were evaluated under a direct visual guidance, suggesting that ultrasonography is a useful method for establishing evidence for determining correct insertion of IM injection, diffusion of medications, and the effective administration of IM injections

Preparation of NASICON-Based Ceramic Thick-Film with Electrophoretic Deposition for Solid-State Photoluminescence Device

Electrophoretic deposition method was applied to prepare some solid-electrolyte thick-films of Na1+xZr2SixP3-xO12 (x = 2, 3; NASICON) and Na5DySi4O12 (NDSO) on Au-coated alumina substrates. With the ethanol-based medium, the deposition process was investigated under constant voltage mode. The concentration of the suspension and applied voltage were optimized with respect to the rate of deposition and quality of the deposit. The NASICON (Na3Zr2Si2PO12) -based solid-state ionic conductor thick-film as a host ceramic with a guest Cu+ ion has been produced as a noble phosphor thick-film by using an electrochemical ion doping method. The photoluminescence (PL) device of the NASICON:Cu+ film showed good photo-luminescent peaks near 450-500nm depending on the host materials

Nurses&rsquo; Awareness and Actual Nursing Practice Situation of Stroke Care in Acute Stroke Units: A Japanese Cross-Sectional Web-Based Questionnaire Survey

The awareness of care provided by stroke care unit (SCU) nurses in Japan to patients with an acute cerebrovascular accident (CVA) and the characteristic differences in their actual nursing practice were evaluated. A cross-sectional web-based questionnaire survey was administered to 1040 SCU nurses. Data collection and reporting procedures followed the STROBE Statement Checklist for cross-sectional studies. Exploratory factor analysis, using 52 observation items, identified eight factors with a factor loading &gt; 0.4. For all factors, the actual practice was significantly lower than the awareness of the importance of nursing care for patients with acute CVA. Awareness and actual practice of recognition of patients&rsquo; physical changes (RPPCs) were high. The actual practice of RPPCs and preventing the worsening of acute stroke and related symptoms varied, depending on years of experience in acute phase stroke care. RPPCs in actual practice had a significantly higher score among certified nurses or certified nurse specialists. Their awareness of the importance of collaborating with therapists was low. On-the-job training can improve nurses&rsquo; competence and prevent worsening conditions in patients with CVA. An emphasis on enhancing practice experience toward patients with acute CVA and facilitating the deployment of certified nurses in SCUs can improve nursing care practice