Questionnaire survey on the continuity of home oxygen therapy after a disaster with power outages

AbstractBackgroundAfter the Great East Japan Earthquake, oxygen-dependent patients in areas experiencing power outages could not continue home oxygen therapy (HOT) without oxygen cylinders. The purpose of this study was to examine use of oxygen cylinders in areas experiencing power outages and the effects of HOT interruption on patients' health.MethodsQuestionnaires were mailed to 1106 oxygen-dependent patients and HOT-prescribing physicians in Akita, near the disaster-stricken area. We investigated patients' actions when unable to use an oxygen concentrator and classified the patients based on oxygen cylinder use. Patients who experienced an interruption of or reduction in oxygen flow rate by their own judgment were assigned to the “interruption” and “reduction” groups, respectively; those who maintained their usual flow rate were assigned to the “continuation” group. Differences were tested using analysis of variance and the χ2 tests.ResultsIn total, 599 patients responded to the questionnaire. Oxygen cylinders were supplied to 574 patients (95.8%) before their oxygen cylinders were depleted. Comparison of the continuation (n=356), reduction (n=64), and interruption (n=154) groups showed significant differences in family structure (p=0.004), underlying disease (p=0.014), oxygen flow rate (p<0.001), situation regarding use (p<0.001), knowledge of HOT (p<0.001), and anxiety about oxygen supply (p<0.001). There were no differences in changes in physical condition.ConclusionsMost patients could receive oxygen cylinders after the disaster. Some patients discontinued their usual oxygen therapy, but their overall health status was not affected

Placebo effect and dental treatment

舌痛症や口腔異常感症など口腔内に器質的異常所見を認めないにも関わらず，痛み，違和感など生じる症状をMedically Unexplained Oral Symptoms (MUOS) と呼ぶ。当科では年間500～600人のMUOSに苦しむ患者が受診しており，多くの患者がMUOSに苦しんでいることがわかる。MUOSを訴える患者の多くが歯科治療を経験しており，歯科治療に対する不平，不満を訴えることが多い。患者にとって歯科治療が自身の期待していたものと異なっていたことがMUOSを生じさせる一つの要因であると推測される。 プラセボ（偽薬）は，薬理作用が期待できないにも関わらず症状を改善させることが知られている。最近プラセボ効果を説明する概念としてBayesian brainというものが提唱されている。 本総説ではMUOSおよび近年のプラセボ研究を紹介し，MUOSを生じさせない歯科治療のあり方について考察する

Factors Contributing to Erythropoietin Hyporesponsiveness in Patients on Long-Term Continuous Ambulatory Peritoneal Dialysis: A Cross-Sectional Study

Background: Factors contributing to erythropoietin (EPO) hyporesponsiveness in patients on long-term continuous ambulatory peritoneal dialysis are not well understood. Therefore, we investigated the factors contributing to EPO hyporesponsiveness using the EPO resistance index (ERI). Methods: A total of 14 patients (7 males and 7 females, age 65.0 ± 11.9 years) were selected for this study. We defined ERI as the weekly dose of EPO per body weight divided by hemoglobin (U/kg/g/dl/week). Bioelectrical impedance analysis was used to assess the patients' body composition and fluid status. We examined associations between ERI and clinical parameters, such as physiological, chemical and nutrition status, by correlation and multiple linear regression analyses. Results: Peritoneal dialysis duration was 95 ± 23 months, and all patients underwent peritoneal dialysis for >5 years. Hemoglobin, blood pressure and ultrafiltration volume of peritoneal dialysis were 11.5 ± 1.2 g/dl, 123 ± 14/72 ± 8 mm Hg and 834 ± 317 ml/day, respectively. Renal Kt/V and peritoneal Kt/V, which are indices of dialysis adequacy, were 0.32 ± 0.31 and 1.70 ± 0.31, respectively. Age and extracellular water/total body water (ECW/TBW) ratio had significant positive correlations with ERI (both p Conclusions: This study demonstrates that ECW/TBW was a factor contributing to ERI and that appropriate maintenance of body fluid volume could contribute to low EPO dosing