Efficacy of shared decision making on treatment satisfaction for patients with first-admission schizophrenia: study protocol for a randomised controlled trial

BACKGROUND: Shared decision making is a promising model for patient-centred medicine, resulting in better clinical outcomes overall. In the mental health field, interventions that consider the patient-centred perspective—such as patient quality of life, involvement in the treatment, treatment satisfaction, and working alliance—have increased and better clinical outcomes discovered for patients with schizophrenia. However, few studies have examined the efficacy of shared decision making for schizophrenia treatment. The objective of this study is to evaluate the effect of a shared decision making intervention compared to treatment as usual on patient satisfaction at discharge for first-admission patients with schizophrenia. METHODS/DESIGN: This is a randomised, parallel-group, two-arm, open-label, single-centre study currently being conducted in an acute psychiatric ward of Numazu Chuo Hospital, Japan. We are recruiting patients between 16 and 65 years old who are admitted to the ward with a diagnosis of schizophrenia without prior experience of psychiatric admission. Fifty-eight participants are being randomised into a shared decision making intervention group or a treatment as usual control group in a 1:1 ratio. The intervention program was developed based on a shared decision making model and is presented as a weekly course lasting the duration of the patients’ acute psychiatric ward stay. The primary outcome measure is patient satisfaction at discharge as assessed by the Client Satisfaction Questionnaire. Due to the study’s nature, neither the patient nor staff can be blinded. DISCUSSION: This is the first randomised controlled trial to evaluate the efficacy of shared decision making for patients with early-treatment-stage schizophrenia. The intervention program in this study is innovative in that it includes both of the patient and staff who are involved in the treatment. TRIAL REGISTRATION: The study has been registered with ClinicalTrials.gov as NCT01869660

Reduction of Behavioral Psychological Symptoms of Dementia by Multimodal Comprehensive Care for Vulnerable Geriatric Patients in an Acute Care Hospital: A Case Series

Management of Behavioral and Psychological Symptoms of Dementia (BPSD) is a key challenge in geriatric dementia care. A multimodal comprehensive care methodology, Humanitude, with eye contact, verbal communication, and touch as its elements, was provided to three geriatric dementia patients for whom conventional nursing care failed in an acute care hospital. Each episode was evaluated by video analysis. All patients had advanced dementia with BPSD. Failure of care was identified by patient’s shouting, screaming, or abrupt movements of limbs. In this case series, conventional care failed for all three patients. Each element of care communication was much shorter than in Humanitude care, which was accepted by the patients. The average of the elements performed during the care was eye contact 0.6%, verbal communication 15.7%, and touch 0.1% in conventional care and 12.5%, 54.8%, and 44.5% in Humanitude care, respectively. The duration of aggressive behavior of each patient during care was 25.0%, 25.4%, and 66.3% in conventional care and 0%, 0%, and 0.3% in Humanitude, respectively. In our case series, conventional care was provided by less eye contact, verbal communication, and touch. The multimodal comprehensive care approach, Humanitude, decreased BPSD and showed success by patients’ acceptance of care

Irregular atrial flutter following pulmonary vein isolation for persistent atrial fibrillation

AbstractA 65-year-old man with a history of refractory paroxysmal atrial fibrillation (AF) underwent catheter ablation for persistent AF lasting 2 months. AF was not terminated after complete isolation of the 4 pulmonary veins (PV). Instead, it was transformed to a sustained atrial tachyarrhythmia with beat-to-beat variability in the atrial cycle length. A 12-lead electrocardiogram during tachycardia showed negative flutter-like waves in the inferior leads. Entrainment pacing along the tricuspid annulus confirmed the diagnosis of irregular cavotricuspid isthmus (CTI)-dependent typical atrial flutter (AFL). Linear ablation of the CTI terminated AFL and restored sinus rhythm

Attitudes of nurses and student nurses towards working with older people and to gerontological nursing as a career in Germany, Scotland, Slovenia, Sweden, Japan and the United States.

The aim of this study was to describe attitudes towards caring for older people among nurses and student nurses in six participating countries. Working with older people has historically had a negative profile and, with a global rise in the numbers of older people and a global shortage of nurses, it is essential to recruit nurses into this area. This study gathered data from six countries to explore nurses' and student nurses' attitudes to nursing older people and to gerontological nursing as a career. A convenience sample of 1064 nursing students and 2585 nurses in six countries answered the Multifactorial Attitudes Questionnaire (MAQ), designed to elicit attitudes towards caring for older people and to the esteem that comes with working in this field. The MAQ consists of seven positive and thirteen negative statements, and uses a Likert scale. A higher total score indicates a more positive attitude. Differences in attitudes among the six counties was observed for both nursing students and for nurses ( < 0.001). Nursing students in Scotland and the USA had the highest mean scores, and Slovenia and Sweden were the countries with the lowest mean scores. The highest scores for nurses were reported in Scotland and Sweden, and the lowest scores in Germany and Japan. From the findings, it is suggested that formal nursing education to students between 18 and 29 years of age has high importance for positive attitudes towards working with older people

Typical atrial flutter with atypical flutter wave morphology due to abnormal interatrial conduction

We report a case of typical counterclockwise atrial flutter (AFL) with conduction block from right to left atrium along the coronary sinus (CS) musculature, confirmed by discontinuous CS activation sequence during pacing near the ostium and differential right atrial pacing. AFL was associated with an atypical flutter wave morphology, due to the detour of the activation wavefront from right to left atrium via alternate interatrial electrical connections, such as Bachmann&#8217;s bundle, the interatrial septum, or both. (Cardiol J 2011; 18, 4: 450&#8211;453

Molecular and isotopic investigations of pottery and “charred remains” from Sannai Maruyama and Sannai Maruyama No. 9, Aomori Prefecture.

This paper presents a preliminary study of the analysis of organic residues of Early and Middle Jomon pottery and ‘charred remains.’ Samples are taken from the Sannai Maruyama site and the Sannai Maruyama No. 9 site in Aomori City, Aomori Prefecture in northern Japan. The following questions are addressed in this study: (i) Do organic residues survive in association with pottery vessels and charred remains? (ii) Can the residues be identified based on molecular and isotopic criteria applied in other investigations? (iii) Are the residues associated with the charred remains common to the residues associated with the pottery vessels? (iv) How do these residues contribute to our understanding of food processing and consumption? Results of our analysis indicate that the lipid composition of the pottery extracts is remarkably similar although some of the sherds exhibited better preservation and a wider range of molecules were detected albeit in lower abundance. There is a marked contrast with the composition of the lipid extracts of the ‘charred remains.’ The lipid compositions of sample sets from Sannai Maruyama and Sannai Maruyama No. 9 suggest aquatic resources in the pottery but with a plant contribution. The ‘charred remains’ from Sannai Maruyama contain plant tissues most likely with a high starch composition such as nuts. Lipids were recovered from the majority of the samples

How Yogo Teachers of attached schools get involved in student teaching

　子どもの多様な健康課題に対応して，学校における安全・安心な環境の確保や子どもの心身の健康を守り，は ぐくむことのできる体制構築が求められる今日，教育実習等においては，実習生を学校保健に対する関心・理解 を高め，子どもの健康・安全な学校生活を考慮した教育活動を展開できる教員として育成することが重要となる。 そこで，教育実習等の機会に附属学校園養護教諭が，学校保健活動を遂行できる教員養成を目的とした講義・演 習を実施した。その結果，実習生は学校保健に対する認識を高めることができた。附属学校園養護教諭が教員養 成に積極的に参画することは，学校保健活動を遂行できる教員養成に果たす役割が大きいといえる

Pegfilgrastim-Induced Aortitis in a Patient with Small-Cell Lung Cancer Who Received Immunotherapy Combined with Chemotherapy

Introduction: Granulocyte colony-stimulating factor (G-CSF), including pegfilgrastim, increases the peripheral blood leukocyte count and is widely used in clinical practice in combination with cytotoxic chemotherapy. The most frequent side effects of G-CSF are pain and fever; aortitis, in contrast, is a rare and serious side effect. Case Presentation: A 73-year-old man with small-cell lung cancer was treated with a full dose of a combination of carboplatin/etoposide/durvalumab and pegfilgrastim. The patient developed fever and right ear pain 12 days after pegfilgrastim administration and was diagnosed with aortitis by contrast-enhanced computed tomography 5 days later. Because the patient had already been administered the immune checkpoint inhibitor and had a history of hepatitis B, the patient was followed up without corticosteroid administration, and the patient’s symptoms resolved spontaneously. Conclusion: In situations where immunosuppression should be avoided, we believe that follow-up without corticosteroids for G-CSF-induced aortitis is a promising option

Interpreting the functional role of a novel interaction motif in prokaryotic sodium channels

Voltage-gated sodium channels enable the translocation of sodium ions across cell membranes and play crucial roles in electrical signaling by initiating the action potential. In humans, mutations in sodium channels give rise to several neurological and cardiovascular diseases, and hence they are targets for pharmaceutical drug developments. Prokaryotic sodium channel crystal structures have provided detailed views of sodium channels, which by homology have suggested potentially important functionally related structural features in human sodium channels. A new crystal structure of a full-length prokaryotic channel, NavMs, in a conformation we proposed to represent the open, activated state, has revealed a novel interaction motif associated with channel opening. This motif is associated with disease when mutated in human sodium channels and plays an important and dynamic role in our new model for channel activation

Enantioselective disposition of clenbuterol in rats

Clenbuterol is a long-acting β2-adrenoceptor agonist and bronchodilator that is used for the treatment of asthma, but the desired activities reside almost exclusively in the (-)-R-enantiomer. This study examined enantioselectivity in the disposition of clenbuterol following administration of clenbuterol racemate to rats. Concentrations of clenbuterol enantiomers in plasma, urine and bile were determined by LC-MS/MS assay with a Chirobiotic T column. This method was confirmed to show high sensitivity, specificity and precision, and clenbuterol enantiomers in 0.1ml volumes of plasma were precisely quantified at concentrations as low as 0.25ng/ml. The pharmacokinetic profiles of clenbuterol enantiomers following intravenous and intraduodenal administration of clenbuterol racemate (2mg/kg) in rats were significantly different. The distribution volume of (-)-R-clenbuterol (9.17l/kg) was significantly higher than that of (+)-S-clenbuterol (4.14l/kg). The total body clearance of (-)-R-clenbuterol (13.5ml/min/kg) was significantly higher than that of the (+)-S-enantiomer (11.5ml/min/kg). An in situ absorption study in jejunal loops showed no difference in the residual amount between the (-)-R- and (+)-S-enantiomers. Urinary clearance was the same for the two enantiomers, but biliary excretion of (-)-R-clenbuterol was higher than that of the (+)-S-enantiomer. The fractions of free (non-protein-bound) (-)-R- and (+)-S-clenbuterol in rat plasma were 48.8% and 33.1%, respectively. These results indicated that there are differences in the distribution and excretion of the clenbuterol enantiomers, and these may be predominantly due to enantioselective protein binding. © 2013 John Wiley & Sons, Ltd.発行後1年より全文公