The research on the problems of health care and living of the aged (Pursuing the cases of home treatment given to the elderly patients for one year after their discharge)

退院後の生活に目を向けた適切な退院指導がなされることは、高齢患者が安心して在宅療養を送る上で、重要な意味を持つ。そこで病院から在宅療養に移行した70歳以上の高齢者の抱える問題を4回に渡って1年間調査し、これまでに退院時、3ヵ月後、6ヵ月後の調査結果を報告した。本稿では1年を通じて回答のあった53名について健康と生活上の問題の変化を分析し、考察した。在宅療養に移行した高齢者の健康状態と生活上の問題は、ほぼ一致して退院後6ヵ月から1年後までに変化を認め、特に日常生活上の問題は著しく増加した。その原因として病状の悪化との関連が考えられた。また、高齢者の問題についての意識は、研究者の専門的な問題意識に比べて低かった。従って入院中に退院後の生活を予測することには限界があり、今後は退院指導の充実と伴に在宅サービスとの連携が重要であることを認めた。We planned to make emerge the problems felt by the elderly patients of 70 years and over given home treatment. As a means of our research, four times a year we sent a questinnaire to the aged who had been discharged. After collecting the answers of the questionnaires, we decided to focus on the 53 elderly patients who answered all four questionnaires, and then tried to make their problems emerge. The contents of the questionnaires were about their health care in a year and how their daily life changed. We can see that the condition of the elderly patients under home treatment and their living problems have changed almost without exceptions six months to a year after their discharge. Especially the number of the problems in their daily life increased remarkably. These results might be considered to be caused by the aggravation of their diseases. In addition, the elderly patients are not as conscious of their own problems as a specialist with a critical mind. Therefore, there is a limit to estimating the change in lifestyle of a discharged patient while they remain hospitalized. We consider it essential to get full discharge-care closely connected with home service for elderly patients

The relation of Ikigai (the meaning of one's life) to one's behavioral pattern and belief, researched through the elderly persons at their discharge from hospital

退院を控えた老人が,どの程度生きがいを持って退院していくのか,老人自身のどのような生き方が生きがいに影響しているのかについて知るため,それまでの健康状態や,生活信条,生活行動について,退院許可の出た70歳以上の患者92名を対象として,独自の調査用紙に基づき面接調査を行った｡生きが いとこれまでの健康度,生活信条,生活行動の関連性を,分散分析及びt検定により解析した｡生きがいの平均得点が高かった生活行動は｢ボランティア｣で,続いて｢植物｣であった。生きがいの平均得点が高かった生活信条は｢その日を楽しく生きる｣と回答した人が,回答しなかった人との間に有意差があり,老人の退院時の生きがいの得点が高い傾向を示すことが明らかとなった｡There have been few researches about Ikigai of the elderly at the time of leaving the hospital and about the ways of their home nursing care. The purpose of this study is to clarify the relation of Ikigai to one's behavioral pattern and belief. In three national university hospitals and a general hospital in Chugoku region and Shikoku region, ninety-two patients above the age of 70, ready to discharge, were interviewed and given a questionnaire. The questions were about their body condition, behavioral pattern, and belief, and their Ikigai. More than eighty percent of them seem to lead a life worth living at the time of leaving the hospital. The behavioral pattern scores on the "working as a volunteer" and "growing plants" are on a high level of Ikigai. The belief scores on the "enjoy every day" is also on a high level of Ikigai. In this paper the result of this interview is reported and a better nursing care for them is discussed

The effective nursing educational plan for the elderly at hospital discharge. - through the questionnaires for the nurses and the elderly patients -

近年の急速な高齢化社会にともない複数の疾病や種々の障害をもちながら自宅で療養する高齢者が増加してきている。このような状況でいったん入院療養した高齢者が自宅へ帰り生活をしていくにはかなりの困難が予測される。高齢者が退院し自宅での生活にスムーズに適応できるか否かは看護婦の退院指導の良否に関わってくる。そこで指導側の看護婦の指導計画や指導方法、内容について調査すると共に受け手の患者の指導希望内容との比較を行い有効な退院指導のあり方を検討した。患者の心配事や援助や相談の希望内容と看護婦の重要とする指導内容はほぼ同様の内容であった。その内容は日常生活に関すること、病気や健康に関することが多かった。看護婦の退院指導の計画でカンファレンスをしている看護婦はしていない看護婦に比べ指導内容の経済的なこと、趣味や生きがいに関する事、生活環境、家族の協力に関することを重要とすると回答したものが有意に多かった。The elderly with chronic disease or handicaps who receive nursing home care is currently increasing. They may have some difficulties in their daily life after hospital discharge. The proper nursing educational plan may determine their post-hospital life without anxiety. The purpose of this study is to find out the effective nursing educational plan for them. Therefore, we investigated the contents of the nursing educational plan for their hospital discharge and what elderly patients need in their post-hospital life. As a result, both contents were similar. Those were about their daily life, disease, health. And there were significantly defferences between well-discussed plan and no discussed plan in the items of economy, hobbies, purpose of life, home environment, family cooperation. Results from this study suggest that more detailed discussion among nurses at hospital discharge is necessary to determine the individual nursing educational plan of elderly patients in their post-hospital life

Selective Elimination of NG2-Expressing Hair Follicle Stem Cells Exacerbates the Sensitization Phase of Contact Dermatitis in a Transgenic Rat Model

The hair cycle consists of three different phases: anagen (growth), catagen (regression), and telogen (resting). During the anagen phase, hair follicle stem cells (HFSCs) in the bulge and the secondary hair germ proliferate and generate the outer and inner root sheath cells and the hair shafts. We previously identified NG2-immunoreactive (NG2+) cells as HFSCs in both regions of the hair follicles. Recently, the interaction between the hair cycle and the cutaneous immune system has been re-examined under physiological and pathological conditions. However, the roles of NG2+ HFSCs in the skin’s immune system remain completely elucidated. In the present study, we investigated whether the elimination of NG2+ HFSCs affects the induction of allergic contact dermatitis, using a herpes simplex virus thymidine kinase (HSVtk)/ganciclovir (GCV) suicide gene system. When the GCV solution was applied to the skin of NG2-HSVtk transgenic (Tg) rats during the depilation-induced anagen phase, NG2+ HFSCs in the Tg rat skin induced apoptotic cell death. Under exposure of a hapten, the selective ablation of NG2+ HFSCs during the anagen phase aggravated the sensitization phase of allergic contact dermatitis. These findings suggest that NG2+ HFSCs and their progeny have immunosuppressive abilities during the anagen phase

Effects of Multimodal Analgesic Protocol, with Buprenorphine and Meloxicam, on Mice Well-Being: A Dose Finding Study

The anesthetic or analgesic agent of choice, route and frequency of anesthetic or analgesic administration, and stressors induce distress during the perioperative period. We evaluated a multimodal analgesic protocol using buprenorphine and meloxicam on the well-being of mice. Twenty-four Slc:ICR male mice were divided into control, anesthesia + analgesia, and surgery + anesthesia + analgesia groups. Tap water (orally: PO) and water for injection (subcutaneous: SC) were administered to the control group. Buprenorphine was administered twice (SC, 0.1 mg/kg/8 h) and meloxicam was administered thrice (PO, 5 mg/kg/24 h) to the anesthesia + analgesia and surgery + anesthesia + analgesia groups. The mice were subjected to laparotomy and assessed for several parameters. Even in absence of surgical pain, the anesthesia + analgesia group presented the same negative effects as the surgery + anesthesia + analgesia group. This multimodal analgesic protocol for mice was expected to have an analgesic effect on pain associated with laparotomy but was not sufficient to prevent food intake and weight decrease. This does not negate the need to administer analgesics, but suggests the need to focus on and care not only about the approach to relieve pain associated with surgery, but also other types of distresses to minimize negative side effects that may interfere with postoperative recovery in mice

A case of focal nodular hyperplasia-like lesion presenting unusual signal intensity on the hepatobiliary phase of gadoxetic acid-enhanced magnetic resonance image

Focal nodular hyperplasia (FNH) or FNH-like lesions of the liver are benign lesions that can be mostly diagnosed by hepatobiliary phase gadoxetic acid-enhanced magnetic resonance imaging (MRI). Accurate imaging diagnosis is based on the fact that most FNHs or FNH-like lesions show characteristic hyper- or isointensity on hepatobiliary phase images. We report a case of an FNH-like lesion in a 73-year-old woman that mimicked a malignant tumor. Dynamic contrast-enhanced computed tomography (CT) and MRI using gadoxetic-acid revealed an ill-defined nodule showing early enhancement in the arterial phase and gradual and prolonged enhancement in the portal and equilibrium/transitional phases. Hepatobiliary phase imaging revealed inhomogeneous hypointensity, accompanied by a slightly isointense area compared to the background liver. Angiography-assisted CT showed a portal perfusion defect of the nodule, inhomogeneous arterial blood supply in the early phase, and less internal enhancement in the late phase, accompanied by irregularly shaped peritumoral enhancement. No central stellate scar was identified in any of the images. Imaging findings could not exclude the possibility of hepatocellular carcinoma, but the nodule was pathologically diagnosed as an FNH-like lesion by partial hepatectomy. In the present case, an unusual inhomogeneous hypointensity on hepatobiliary phase imaging made it difficult to diagnose the FNH-like lesions