ガクサイテキ タショクシュ レンケイ ニヨル チーム ケア ケンキュウ ノ ドウコウ

In order to perform “professional missions for care”, each professional group actively engagedin health and social care today needs to examine and recognize “what should bechanged for a better outcome” from the dimensions of both clinical practice and education ineach discipline. The results shall lead us to practice more effective InterdisciplinaryCollaborative Team Care (ICTC).In this paper, we explain the historical development of the ICTC, the several teamworkmodels, as well as the trend of research on the ICTC, all of which can be helpful for the professionalsto facilitate an interdisciplinary working and a further research

The changes of Auditory Evoked Potential (AEP) and EEG in the patients undergoing hemodialysis

AEP (Auditory Evoked Potential) and EEG were studied with 20 patients undergoing hemodialysis (dialyzed group, 41~65 y. o.), consisted of non-diabetic group (13 with chronic glomerulonephritis) and diabetic group (7 with diabetic nephropathy), comparing with those of 20 healthy subjects (normal group, 38~66 y. o.). EEGs containing AEPs evoked by click stimulation were recorded with 1024 msec of analysis time through the two derivations (3 CH : Cz→A1+2 and 6CH : Cz→T5). The group-mean AEPs were obtained with each group, and compared with each other, and then the differences of latencies and peak-to-peak amplitudes of the components were tested statistically between the groups. The EEGs were subjected to the quantitative frequency analysis. Correlation coefficients were tested statistically between the latencies, peak-to-peak amplitudes of AEP components and EEG power %, and between those and blood data. The following results were obtained. 1. The waveforms of group-mean AEP of normal group had hexaphasic contour, consisted of components P1~8 and N1~8, including the prominent negative peak N4 and positive peak P5, within 600 msec of latency. 2. The group-mean AEP of non-diabetic group had similar contour to that of normal group. Latencies of the components were significantly longer except for that of P5, and peak-to-peak amplitudes were mostly larger, than those of normal group. 3. The group-mean AEP of diabetic group had also similar contour to that of normal group, but the prominent negative peak was N3. Latencies of the components were significantly longer except for that of P5, and peak-to-peak amplitudes were smaller, than those of normal group. 4. The latencies of the diabetic group were significantly shorter, and the peak-to-peak amplitudes were also smaller, than those of non-diabetic group. 5. Quantitative frequency analysis of EEG resulted in significant decrease of α2 power% and increase of β1 power % in non-diabetic group, and significant decrease of β1 power % in diabetic group. 6. Positive correlation was found between δ power % of EEG and the latencies of long-latency components of AEP, and negative correlation between α1, α2, β2 power % and the latencies of middle-long-latency components. Between peak-to-peak amplitudes of AEP, negative correlation was found with δ power %, and positive correlation with β1 power %. 7. Between AEP-latencies, the positive correlation was found with Cr (creatinine) and K (potassium), negative correlation with P (phosphorus). Between AEP-amplitudes, positive correlation was found with BUN and P, and negative correlation with Cr and calcium. These results were considered to be attributed to the more prominent inhibition of GABA-inhibitory system in gray matter in non-diabetics, and to severe disturbances in both white and gray matter in diabetics, reflecting antagonistic influences from pathological condition between non-diabetics (uremia) and diabetic nephropathy

Somatosensory Evoked Potential (SEP) and EEG of patients undergoing hemodialysis

The SEP (Somatosensory Evoked Potential) and EEG were studied with 19 patients undergoing hemodialysis (dialyzed group, 41~65 y. o.), consisted of non-diabetic group (13 patients with chronic gromerulonephritis) and diabetic group (6 patients with diabetic nephropathy), comparing with those of 20 healthy subjects (normal group, 38~66 y. o.). EEGs containing SEPs evoked by median nerve stimulation were recorded with 1024 msec of analysis time through the two derivations (1CH : C3'→F3' and 4CH : C3'→A1+2). The group-mean SEPs were obtained with each group, and compared with each other, and then the differences of latencies and peak-to-peak amplitudes of the components were tested statistically between the groups. The EEGs were subjected to the quantitative frequency analysis. Correlation coefficients were tested between the latencies, peak-to-peak amplitudes and EEG power %, and between the latencies, peak-to-peak amplitudes and blood data. The following results were obtained. 1. The waveforms of group-mean SEP of normal group and non-diabetic group had hexaphasic contour, consisted of the components Pl~8, N1~8. But, in that of diabetic group the contour deteriorated at around the long latency components. 2. The latencies were longer in the ascending order normal group, non-diabetic group and diabetic group, and peak-to-peak amplitudes were larger in the ascending order diabetic group, normal group and non-diabetic group. 3. In the SEP of non-diabetic group, latencies were increased and amplitudes were decreased. 4. In the SEP of diabetic group, latencies were increased more than those of non-diabetic group, and amplitudes were decreased. 5. Quantitative frequency analysis of EEG, indicated decreased peak frequency of α waves in non-diabetic group, and decreased peak frequency of α waves and increased δ, θ waves in diabetic group, more than those in normal group. 6. The correlation coefficients of EEG power % between SEP-latencies indicated increased latencies due to decreased fast waves and increased slow waves, and those between SEP peak-to-peak amplitudes indicated increased amplitudes due to increased fast waves and decreased slow waves. 7. Between SEP-latencies, negative correlation was found with blood K, Ca, BUN, and positive correlation with dialyzed period (years), and between SEP-amplitudes, negative correlation with creatinin, Ca, hemogrobin, and positive correlation with BUN. These results were attributed to more marked disturbances of GABA-inhibitory system in gray matter together with white matter in non-diabetics, and to severe disturbances of the central nervous system in both of gray and white matter in diabetics

コウイ ショウガイ : ショウレイ ト コウサツ

Conduct disorder is characterized by repeated and continual antisocial behavior by children and adolescents. In this article we report a patient of this disorder who was referred to our hospital for psychiatric evaluation and briefly summarize the present understanding of the cause, treatment and prognosis of this disorder. The cause of conduct disorder consists of three major factors ; biological, environmental and mental factors. Conduct disorder may have a relation to attention deficit/hyperactivity disorder (AD/HD). Children with AD/HD tend to develop oppositional defiant disorder or conduct disorder in adolescents stage and then antisocial personality in adult stage. It is often difficult to improve symptoms of conduct disorder only with psychological treatment. Pharmacological treatment must be considered in some cases to ameliorate impulsiveness and aggression that may have organic origin. Early psychiatric intervention may be helpful in the treatment of conduct disorder

Visual Evoked Potential (VEP) and EEG in patients undergoing hemodialysis

The CNS (Central Nervous System) of 20 patients undergoing hemodialysis (dialyzed group, 38~65 y. o.) were studied by VEP (Visual Evoked Potential) comparing with 20 healthy subjects (normal group, 38~66 y. o.). The 20 patients were divided into non-diabetic group of 14 with chronic gromerulonephritis and diabetic group of 6 with diabetic nephropathy. EEGs containing VEPs evoked by flash stimuli once every 5 second were recorded by 100 sweeps with 1024 msec of analysis time, simultaneously through the two derivations (2CH : O1→A1+2 and 5CH : O1→Cz). The EEGs were subjected to the quantitative frequency analysis. These data of VEP were examined between these subject groups, with reference to the EEG and the blood data. The following results were obtained. 1 The waveforms of group mean VEP of normal group, dialyzed group and non-diabetic group had triphasic contour containing dominant components of N3, P6, N8 (2CH) or N3, P5, N8 (5CH), but that of diabetic group severely deteriorated and lost the contour. 2 In dialyzed group and non-diabetic group, latencies of early components (P1-P3) were longer and peak-to-peak amplitudes of late components were larger than those of normal group significantly. 3 Latencies of early components were longer in the ascending order normal group, non-diabetic group and diabetic group, and peak-to-peak amplitudes were smaller in the ascending order non-diabetic group, normal group and diabetic group. 4 Quantitative frequency analysis of EEG indicated that the peak frequency of α waves of dialyzed group and non-diabetic group were smaller, and θ power % of diabetic group were smaller than that of normal group. 5 From the correlation coefficients between the EEG power% and the latencies or the amplitudes of each compenent of VEP, δ power % correlated significantly with the latencies of middle and long latency components in 2CH and those of long latency in 5CH positively. β1 power % correlated significantly with peak-to-peak amplitude of long latency components in 5CH positively. 6 BUN and potassium correlated positively with latencies of early components. BUN correlated positively with peak-to-peak amplitudes. Hemoglobin correlated negatively with latencies. 7 These results indicte that the CNS of diabetic group was disturbed more severely than dialyzed group and non-diabetic group in VEP and EEG, and the inhibitory system (GABA) of optic center cortex related to late components was disturbed first

Neither gynecomastia nor galactorrhea is a common side effect of neuroleptics in male patients

Gynecomastia is known to be a side effect of neuroleptics. The authors investigated the prevalence of gynecomastia and galactorrhea in a group of regularly neuroleptic-treated male patients. Methods : Gynecomastia was defined as a palpable, discrete button of firm subareolar tissue measuring at least 2 cm in diameter. The subjects were 100 male patients who were taking neuroleptic-treatment regularly. Each patient gave informed consent for the research involved in this study. Results : (1) Palpable gynecomastia was present in 2% of the patient group, but not at all in the normal group. (2) Galactorrhea was not present in either patient or normal group. (3) The mean level of the serum prolactin in the group of patients without gynecomastia was significantly higher than that in the normal group, but there was no significant difference in blood luteinizing hormone, follicle-stimulating hormone, testosterone (T), estradiol (E 2) or T/E2 ratio between the groups. (4) The mean level of the T/E2 ratio in the patients with gynecomastia was tended to be higher than that in the group of patients without gynecomastia. Conclusions : Overall, theseresults seem to indicate that (i) gynecomastia is not popular in the Japanese population, and (ii) in male patients, neither palpable gynecomastia nor galactorrhea is a common side effect of neuroleptics. To clarify the relation between gynecomastia and neuroleptic treatment, large prospective studies are required

Study of life satisfaction and quality of life of patients receiving home oxygen therapy

An investigation was conducted by mail using a questionnaire regarding the life satisfaction and quality of life (QOL) of patients receiving home oxygen therapy (HOT) to evaluate their support. QOL was evaluated according to 4 scales : (1) activities, (2) state of health and quality of living, (3) physical symptoms, and (4) economic state. The answers of 90 patients (recovery rate : 60%) who responded to the investigation were analyzed, and the following points were clarified. 1. Most of the subjects visited the hospital regularly, and about half the subjects (50.6%) had been treated by hospitalization during the 3 years prior to the investigation. 2. A large majority of the subjects (77.4%) answered they were satisfied with life. 3. Life satisfaction was closely related to the patients’ roles and hobbies, and their activities in their communities and families. 4. The quality of living and the state of health were closely related to mental activity. 5. The economic state was closely related to all items of life satisfaction, quality of living, and state of health. From these results, expansion of the range of activities of patients receiving HOT and providing an economic basis for their living as well as preventing exacerbation of the disease are considered to be important for improving their life satisfaction

Home nursing skills of the registered visiting nursing stations

本研究の目的は，T県内の訪問看護ステーション（以下ステーション）に所属する看護師が実施している看護技術の実態を明らかにすることである．研究対象は，T県において登録されているステーション５７ヵ所の管理者であった．調査票の郵送により４段階の選択肢による回答を求め，以下のことが明らかになった． １）回答のあった４１ヵ所のステーションで１ヵ月に１度以上実施していた項目は「日常生活援助技術」では，関節可動域訓練，歩行介助，移動の介助，寝衣交換などの衣生活援助であった．「適切な医療ケアを支援する技術」ではバイタルサインの観察であった．「安全・安楽援助技術」では適切な体位の保持であった． ２）「日常生活援助技術」では，回答のあったステーションの９０％以上が１ヵ月に１度以上実施していた項目は，療養生活環境調整，排便を促す援助，オムツ交換，体位変換，移乗の介助，部分浴，入浴介助，清拭，陰部ケア，整容，洗髪，口腔ケアであった． ３）「適切な医療ケアを支援する技術」では，８０％以上のステーションが１ヵ月に１度以上実施していた項目は褥瘡ケア（予防も含む），創傷処置，経口薬の服薬方法の説明，外用薬の使用方法の説明，パルスオキシメータであった． ４）「安全・安楽援助技術」では，８０％以上のステーションが１ヵ月に１度以上実施していた項目は療養生活の安全確保，転倒・転落・外傷予防，マッサージであった． ５）救命・救急に関する項目については実施頻度が低かった． 教育上の課題としては，実施頻度が高い項目においては，訪問先の状況に応じた実施ができるように学内演習を進める必要がある．また，臨地での経験が困難と予測される項目や救急時の技術，高度な医療技術項目については視聴覚機器を活用し，知識面での理解を深める必要があると考えられた．Purpose : The purpose of this study was to investigate the study items of home nursing skills of the registered Visiting Nursing Stations（VNS）. Method : The questionnaire survey was mailed to fifty seven managers of registered VNS in T prefecture. Results : The effective answer rate was ７１．９％（n＝４１）．The nursing skills in the three domains that were carried out at least once or more in a month by nurses who belong to all VNS are as follows : １）In the domain of daily life support skills, four items of “range of motion exercises”，“walking assistance”， “assistance of transferring”, and “changing night clothes” were identified. ２）In the domain of skills for helping effective medical care，“check-up of vital signs” was identified. ３）In the domain of skills for safety/ comfort， “maintaining comfortable positions” was identified. And nursing skills that were required in emergency medical care/treatments were observed in a very low frequency in the same domain. Discussion : The nursing faculty should provide exercises in the university settings for the students to acquire these fundamental nursing skills, so that they can perform adequate nursing care at the time of home visits. In addition, it might be necessary for the faculty to utilize an audiovisual aid effectively in order to promote a better understanding of the students on the nursing skills/knowledge that would be rarely experienced during their clinical training, such as emergency clinical care and advanced therapeutic technologies. In order to build the effective study support system for the nursing students, we need to develop a collaborative education system between the University and the VNS