胃がん術後患者の身体症状とセルフケア能力の関連

本研究は，胃切除術後患者の身体症状とセルフケア能力との関係を明らかにすることを目的とした．Ａ大学病院外来通院中の胃切除術後患者57名を対象に，上部消化管がん患者の術後機能障害を査定する尺度及びセルフケア能力尺度を用いた無記名の自記式質問紙調査を実施した．有効回答は51部であった．術後に頻繁に生じていた身体症状は下痢障害19名（37.0％），活動力障害18名（35.0％）の順に多かった．セルフケア能力は，健康に関心を向ける能力，体調を整える能力が高かった．セルフケア能力と術後身体症状との関連は，健康のために選択する能力（rs ＝－ .34；p ＜ .05），生活を続ける能力（rs ＝－ .32；p ＜ .05），支援してくれる人をもつ能力（rs ＝－ .42；p ＜ .01）の得点がそれぞれ高いほど，活動力障害の得点は有意に低かった．胃がん術後患者が困難を抱える身体症状を軽減するためには，患者が自身のライフスタイルに合った健康管理方法を見つけ，それを選択し，継続して実施していけるようにセルフケア支援を行う必要性が示唆された．そのためには，患者個々の背景をふまえ，術後予測される症状を早期から説明し，入院前外来から退院後にかけて長期間にわたり継続したセルフケア支援を行うことが必要である．The objective of this study was to clarify the relationship between physical symptoms and self-care ability of postgastrectomy patients. Fifty-seven post-gastrectomy patients attending the outpatient clinic of the Department of General Surgery at the A University Hospital underwent an anonymous self-administered questionnaire survey regarding postoperative physical symptoms and self-care abilities. The number of valid responses was 51. In postoperative physical symptoms, frequency of diarrhea disorder and activity disorder were high. In self-care ability, “ability to pay attention to health” and “ability to regulate physical condition” were high. In order to alleviate the physical symptoms that patients have after gastric cancer surgery, it may be necessary to provide self-care support so that patients themselves can find a health management method that suits their lifestyle, and continue to implement it. To that end, based on the patient's background, the symptoms predicted after surgery should be explained to them from an early stage. It is necessary to provide continuous self-care support for a long period from pre-admission outpatient to after discharge

Enhanced Auditory Brainstem Response and Parental Bonding Style in Children with Gastrointestinal Symptoms

The electrophysiological properties of the brain and influence of parental bonding in childhood irritable bowel syndrome (IBS) are unclear. We hypothesized that children with chronic gastrointestinal (GI) symptoms like IBS may show exaggerated brainstem auditory evoked potential (BAEP) responses and receive more inadequate parental bonding. = 0.024). Multiple regression analysis in females also supported these findings.It is suggested that children with chronic GI symptoms have exaggerated brainstem responses to environmental stimuli and inadequate parental behaviors aggravate these symptoms

Use of the index of pulmonary vascular disease for predicting long-term outcome of pulmonary arterial hypertension associated with congenital heart disease

AimsLimited data exist on risk factors for the long-term outcome of pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD-PAH). We focused on the index of pulmonary vascular disease (IPVD), an assessment system for pulmonary artery pathology specimens. The IPVD classifies pulmonary vascular lesions into four categories based on severity: (1) no intimal thickening, (2) cellular thickening of the intima, (3) fibrous thickening of the intima, and (4) destruction of the tunica media, with the overall grade expressed as an additive mean of these scores. This study aimed to investigate the relationship between IPVD and the long-term outcome of CHD-PAH.MethodsThis retrospective study examined lung pathology images of 764 patients with CHD-PAH aged <20 years whose lung specimens were submitted to the Japanese Research Institute of Pulmonary Vasculature for pulmonary pathological review between 2001 and 2020. Clinical information was collected retrospectively by each attending physician. The primary endpoint was cardiovascular death.ResultsThe 5-year, 10-year, 15-year, and 20-year cardiovascular death-free survival rates for all patients were 92.0%, 90.4%, 87.3%, and 86.1%, respectively. The group with an IPVD of ≥2.0 had significantly poorer survival than the group with an IPVD <2.0 (P = .037). The Cox proportional hazards model adjusted for the presence of congenital anomaly syndromes associated with pulmonary hypertension, and age at lung biopsy showed similar results (hazard ratio 4.46; 95% confidence interval: 1.45–13.73; P = .009).ConclusionsThe IPVD scoring system is useful for predicting the long-term outcome of CHD-PAH. For patients with an IPVD of ≥2.0, treatment strategies, including choosing palliative procedures such as pulmonary artery banding to restrict pulmonary blood flow and postponement of intracardiac repair, should be more carefully considered

The Cardiac Sympathetic Nerve Activity in the Elderly Is Attenuated in the Right Lateral Decubitus Position

Objectives: The aim of this study was to evaluate the effect of the supine, left lateral decubitus, and right lateral decubitus positions on autonomic nervous activity in elderly adults by using spectral analysis of heart rate variability (HRV). Method: Forty-five adults aged 73.6 ± 5.7 years were enrolled. After lying in the supine position, all participants moved to the lateral decubitus positions in a random order and maintained the positions for 10 min, while electrocardiographic data were recorded to measure HRV. Results: The lowest heart rate continued for 10 min when participants were in the left lateral decubitus position compared with the other two positions ( p < .001), while the HRV indexes remained unchanged. The low-frequency HRV to high-frequency HRV ratio (LF/HF) for the right lateral decubitus position was significantly lower than that for the other positions. Discussion: The right lateral decubitus position may attenuate sympathetic nerve activity in elderly adults

手術前患者の不安と術後せん妄発症との関連性：システマティックレビュー

本研究は手術予定患者が抱く術前不安と術後せん妄発症の関連性を，系統的レビューおよびメタアナリシスで評価することを目的とした．医中誌Web，PubMed，Scopus を用い，術前不安，せん妄，preoperative anxiety，preoperative uneasiness，delirium をキーワードに，1985年から2021年8月までの文献を検索した結果，358文献のうち6件が分析対象となった．3件は術前不安と術後せん妄に関連がない，3件は関連があると報告していた．対象手術疾患は心臓，癌，整形で，術後せん妄発症率は17.8％～41.1％であった．メタアナリシスでは，術前不安の評価尺度の違いによって，術前不安と術後せん妄発症の関連性の有無に関する結果が相反するものとなった．術前不安の評価尺度の種類が結果に影響をおよぼす可能性が示唆されたが，文献数が少ないため，さらなる研究の蓄積が必要である．Objective: Whether preoperative anxiety is associated with the development of postoperative delirium remains controversial. The aim of this study was to clarify the relationship between preoperative anxiety and the onset of postoperative delirium in patients undergoing surgery through a systematic review and meta-analysis. Methods: Using Ichushi Web, MEDLINE/PubMed, and Scopus, we extracted literature published from January 1985 to August 2021 with keywords such as preoperative anxiety, preoperative uneasiness, and delirium. Meta-analysis and sensitivity analyses were also performed to determine whether preoperative anxiety was a risk factor for postoperative delirium. Result: Of the 358 original articles retrieved in our search, only six research articles were selected. Three research articles did not demonstrate an association between preoperative anxiety and postoperative delirium, while the other three did. In each study, surgery was performed for cardiac, cancer, and orthopedic diseases, and the incidence of postoperative delirium ranged from 17.8% to 41.1%. Depending on the type of preoperative anxiety rating scale, the meta-analysis and sensitivity analyses showed inconsistent results regarding the association between preoperative anxiety and the development of postoperative delirium. Conclusion: Whether or not preoperative anxiety is a risk factor for postoperative delirium may be influenced by the type of preoperative anxiety rating scale. However, further prospective studies are warranted to re-evaluate this hypothesis due to the small number of references included in this analysis

Six underlying health conditions strongly influence mortality based on pneumonia severity in an ageing population of Japan: a prospective cohort study

Abstract Background Mortality prediction of pneumonia by severity scores in patients with multiple underlying health conditions has not fully been investigated. This prospective cohort study is to identify mortality-associated underlying health conditions and to analyse their influence on severity-based pneumonia mortality prediction. Methods Adult patients with community-acquired pneumonia or healthcare-associated pneumonia (HCAP) who visited four community hospitals between September 2011 and January 2013 were enrolled. Candidate underlying health conditions, including demographic and clinical characteristics, were incorporated into the logistic regression models, along with CURB (confusion, elevated urea nitrogen, tachypnoea, and hypotension) score as a measure of disease severity. The areas under the receiver operating characteristic curves (AUROC) of the predictive index based on significant underlying health conditions was compared to that of CURB65 (CURB and age ≥ 65) score or Pneumonia severity index (PSI). Mortality association between disease severity and the number of underlying health conditions was analysed. Results In total 1772 patients were eligible for analysis, of which 140 (7.9%) died within 30 days. Six underlying health conditions were independently associated: home care (adjusted odds ratio, 5.84; 95% confidence interval, CI, 2.28–14.99), recent hospitalization (2.21; 1.36–3.60), age ≥ 85 years (2.15; 1.08–4.28), low body mass index (1.99, 1.25–3.16), neoplastic disease (1.82; 1.17–2.85), and male gender (1.78; 1.16–2.75). The predictive index based on these conditions alone had a significantly or marginally higher AUROC than that based on CURB65 score (0.78 vs 0.66, p = 0.02) or PSI (0.78 vs 0.71, p = 0.05), respectively. Compared to this index, the AUROC of the total score consisting of six underlying health conditions and CURB score (range 0–10) did not improve mortality predictions (p = 0.3). In patients with one or less underlying health conditions, the mortality was discretely associated with severe pneumonia (CURB65 ≥ 3) (risk ratio: 7.24, 95%CI: 3.08–25.13), whereas in patients with 2 or more underlying health conditions, the mortality association with severe pneumonia was not detected (risk ratio: 1.53, 95% CI: 0.94–2.50). Conclusions Mortality prediction based on pneumonia severity scores is highly influenced by the accumulating number of underlying health conditions in an ageing society. The validation using a different cohort is necessary to generalise the conclusion

Multiple regression analysis for total sample.

<p>GI symptoms as dependent variable and CSI (except GI) score, parental care, over-protection, and latencies of BAEP as independent variables. R² = 0.699, <i>p</i> = 0.0001.</p