Self-Management Awareness in Patients on Maintenance Dialysis

The present study characterizes selfmanagement awareness in patients on maintenance dialysis. We conducted interviews with 9 patients on maintenance dialysis which were then analyzed by comparative content analysis. This was done in order to gather information to support future self-management. Seven categories emerged as a result of this analysis. Patients on maintenance dialysis were aware of a continuation and the need for dialysis treatment, perceived that they were handling self-management successfully, and were aware that they were proper managers able to carry out daily living. In addition, they sought support for their self-management through family and understanding people willing to assist them. Furthermore, these patients, now given the opportunity to reflect on their past selves, adopted the attitude, when I was not limited, and now that I am. Lastly, after comparing themselves to others, these patients perceived that each person's way of managing determined their future. We observed that patients on maintenance dialysis had unique self-management practices, and each was in search for their own “way of life, a way of being and dying in the future. The findings in this study suggest that in order for patients on maintenance dialysis to achieve selfmanagement and proper daily living, caregivers must provide support for the development of such self-management. This would allow relationships with other patients to develop, including relationships with family

看護学生の緩和ケアにおける がん性疼痛コントロールに対する初期体験

[Study design]. Inductive / exploratory study of qualitative factors.[Purpose]. To clarify how nursing students understand cancer pain control in palliative care.[Materials and methods]. As the first stage, we extracted learning experiences from 59 nursing students at College A. Inductive and exploratory analyses were performed from their reports submitted following a clinical practicum in palliative care. [Results]. Nursing student\u27s experiences with cancer pain control in palliative care was classified into three groups: 1）physical characteristics of "presence of continuous pain due to cancer", 2 psychological characteristics of "loss of ability brought about by cancer", and 3） family / social characteristics such as "lifestyle changes", "role changes", and "social isolation". From our analysis, "trying to understand the patient\u27s pain" and "reaching to understand the impact of cancer pain" were most important factors.[Conclusions]. Experiences of nursing student\u27s learning to understand pain control in palliative care contained two factors: "trying to understand the patient\u27s pain" and "reaching to understand the impact of cancer pain".【目的】本研究の目的は看護学生の緩和ケアおける，がん性疼痛コントロールをどの体験に基づき，どのように理解するのかを検討した。【方法】A大学看護学生59名に対する緩和ケアの臨地実習後レポートについて，がん性疼痛コントロールにおける理解の初期段階として，学生の体験を抽出し，帰納的・探索的に分析した。【結果】看護学生の緩和ケアにおけるがん性疼痛コントロールに対する体験は，「がんによる慢性的な疼痛が存在する」の身体的特徴であり，対象者の理解につながる体験では，「がんがもたらす能力の喪失」の心理的な特徴，「生活スタイルの変更」，「役割の変更」，「社会的孤立」の家庭・社会生活上の特徴の3つに分類ができた。さらに我々の分析から「その人の痛みを理解しようとすること」，「がんの痛みが及ぼす影響などを理解しようと少しでも歩み寄ること」が重要は因子であることがわかった。【結論】看護学生の緩和ケアにおける疼痛コントロールを理解する体験は，がんに対する疼痛緩和のプロセスに，学生が人間を尊重する姿勢として「その人の痛みを理解しようとすること」，「がんの痛みが及ぼす影響などを理解しようと少しでも歩み寄ること」であった。この2つの体験が，緩和ケアにおける疼痛コントロールを理解する初期段階と示唆できた

Relationships between Composition of Major Fatty Acids and Fat Distribution and Insulin Resistance in Japanese

Objective. The aim of this study was to evaluate the relationships between the composition of free fatty acids (FFAs) and metabolic parameters, including body fat distribution, in Japanese. Methods. The study subjects were 111 Japanese patients (54 males, 57 females). Metabolic parameters and visceral and subcutaneous fat areas as determined by CT scanning at the umbilical level were measured. Glucose tolerance test (GTT) was performed by administering 75 g glucose orally. Results. The percentage of linoleic acid (C18:2), the greatest constituent among FFAs, was negatively correlated with visceral fat area (r = −0 411, p < 0 0001), fasting glucose (r = −0 330, p < 0 0001), HbA1c (r = −0 231, p = 0 0146), and systolic blood pressure (r = −0 224, p = 0 0184). Linoleic acid percentage was also significantly negatively correlated with HOMA-IR (r = −0 416, p < 0 0001) by simple correlation. Based on the findings of OGTT, the 111 subjects were classified into three groups: 33 with normal glucose tolerance, 71 with impaired glucose tolerance (IGT), and 7 diabetic subjects. The percentage of serum linoleic acid in diabetic subjects was significantly lower than that in normal subjects. Conclusion. We conclude that serum linoleic acid level is negatively correlated with the accumulation of visceral fat in relation to a reduction of insulin resistance in Japanese subjects

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension