The health and daily-life problem of the aged at homes for three months after discharge from the hospital

今後の継続看護・在宅看護を考えてゆく際の参考にするために、医療施設から自宅へ退院した高齢患者が3カ月経過後に、どのような健康上や日常生活上の問題点をもち、家庭や地域でどのような援助や支援を受けて生活しているかについて報告をする。総合病院に入院していた70歳以上の高齢者で自宅に退院する患者92名のうち、退院後3カ月経過後の時点で回答を得た70名（76.0％）について分析を行った。病状については約8割の者は特に問題を持っていない、しかし約2割の者は病状に悪化が見られた。現在困っていることは「健康上の問題」とした者は約3割であった。日常生活の自立状況では「仕事もできる」とする者が退院時の18.6％より、3カ月後は40.0％に増加しており、「生きがいがかなりある」とする者は退院時の34.3％より、3カ月後は45.7％に増加していた。しかし、回答が得られなかった22名（24.0％）の高齢者は、より重要な問題を包含している可能性があり、追跡をする必要がある。We report that for the guidance to consider future continuing-nursing and home-nursing, the elderly patient who living in homes for three months after discharged from the hospital, have what problems in their health and daily lives and what sort of supports they are receiving in their homes and from the vicinities. Analysis was done on the health and daily-life problems of 70 elderly who responded to a survey which was mailed, three months after discharged from the hospital, among 92 elderly more than 70 years old. 80% of them had no problems in their conditions, but in 20% conditions got worse. About 30% of them complained of the problem of health with respect to independence of daily life. Patients who were able to work increased from 18.6% to 40.0%, and the ptients who felt worth living increased from 34.3% to 45.7%. 22 elderly who hadn't answer seemed to have more severe problems however, further surveys are needed

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

Research of the problems on the elderly patients at discharge from the hospital concerning their health and daily life at home

高齢者の退院指導及び在宅看護の在り方を検討した研究は少ない。そこで、高齢者の自宅院時に持つ健康上及び生活上の問題を明らかにすることを目的に、面接調査を行った。対象は、中・四国の3国立大学付属病院と1総合病院で退院許可のあった70歳以上の患者78名とした。調査内容は、退院時の患者の身体状態・日常生活動作・退院時の患者の状況・家族の状況・健康に対する意識や取り組みについてとした。その結果、(1)高齢の自宅退院患者の23.1％は、身体状態上継続看護が必要であった。(2)退院患者の20.5％が、退院後生活を自立する為に介助が必要であるとしていた。(3)退院患者の57.7％は心配事を持ち、50％は相談・指導を希望していた。(4)患者の世話人の42.3％は職業を持ち、27.3％は健康を害していた。(5)退院患者の73.1％は何らかの健康管理がなされ、84.7％は生きがいを持っていた。Now there are few researehes into the guidance which be done for the elderly patients at the time of leaving the hospital and into the ways of their home nursing care. Therefore, we did interview the elderly patients in order to make it clear what problems they have about their health and their life. In the three national university hospitals in Chugoku District and Shikoku District and one general hospial, we focussed on the 78 patients more than seventy years old who were allowed to leave the hospital. The purpose of our research is to know body condition and the situation of the patients leaving the hospital, activities of their daily life, the situation of their family and their consciousness and care about their health. After having done this research we conclude as follows, (1) 23.1 percent of all the patients need continuing nursing care from the viewpoint of their body condition after leaving the hospital. (2) 20.5 percent of all the patients need help from their family or others to support themselves at home. (3) 57.7 percent of all the patients have worries and 50 percent of them have a wish to consult with the doctors or the nurses and to be guided by them. (4) 42.3 percent of people who take care of patients have their own job and suffer from poor health. (5) 73.1 percent of all the patients who leaves the hospital were given some health care before entering the hospital and 84.7 percent of them seem to lead a life worth living

Study for self-efficacy of intensive care unit nursing

ICU看護婦の看護ケアの自信（以下ICU看護ケアの自己効力とする）の程度を知り，ICU看護ケアの自己効力に影響する要因を明らかにすると同時に，ICU経験3年以上の15名の看護婦についてはICU看護ケアの自己効力とリーダーとしての自信（以後リーダーシップの自己効力とする）との関係を明らかにすることを目的する。ICU看護ケアの自己効力とリーダーシップの自己効力について尺度を作成し，ICU勤務の看護婦48名を対象として調査を行った。有効回答数は45で，平均年齢は27.8±5.0歳であった。その結果，以下の3点が明らかとなった。1．年齢，看護婦経験年数，ICUでの経験年数が増すごとにICU看護ケアの自己効力も上昇していた（年齢：r(s)＝0.35，pく0.05，看護婦経験年数：r(s)＝0.35，pく0.05，ICUでの経験年数：r(s)＝0.56，P＜0.01）。2．配属の希望の有無，職場に満足しているか否か，看護ケアが患者の回復に影響すると考えているか否かについては，ICU看護ケアの自己効力への影響を認めなかった。3．リーダー役割をとっている看護婦のICU看護ケアの自己効力とリーダーシップの自己効力の間には，有意な相関はみられなかった。The purposes of this study were; (1) to examine the self-efficacy of ICU nursing, and (2) to clear the factors related to the self-efficacy of ICU nursing, (3) to investigate between the self-efficacy of ICU nursing and the self-efficacy of leadership for 15 nurses who had experience more than 3 years in the ICU section. Subjects were 45 ICU working nurses whose average age was 27.8±5.0. Using originally designed scales of self-efficacy of ICU nursing and the self-efficacy of leadership, we found following results; (1) the self-efficacy of ICU nursing was significantly related to age (r(s)=0.35, p<0.05), duration of experience as a nurse (r(s)=0.35, p<0.05) and that of ICU (r(s)=0.56, p<0.01). (2) there were no significant relation between the self-efficacy of ICU nursing and desire to be ICU nurse, job satisfaction and belief in positive effect of her nursing care for patient's recovery. (3) the self-efficacy of ICU nursing didn't have significant relationship to the self-efficacy of leadership

Hydrogen Permeation into a Carbon Steel Sheet Observed by a Micro-capillary Combined with a Devanathan-Stachurski Cell

A micro-capillary technique was applied to a Devanathan-Stachurski electrochemical cell for local measurement of hydrogen permeation into a steel sheet. An electrolyte-flowing design for the hydrogen entry side of the Devanathan-Stachurski cell successfully allowed the detection of hydrogen permeation response on hydrogen exit side electrode in a micro-capillary cell with a diameter of 250 µm. Phase shift of the detected permeation current from a sinusoidal perturbation of the electrolyte flow rate in the hydrogen entry cell was strongly dependent on the metallographic structure of the steel sheet. A local structure, in which two single grains form grain boundaries, led to hydrogen permeation more frequently than did a local structure of single grains. The results suggested that the diffusion coefficient of the boundaries was at least two-times larger than that of the grains

Cataract Surgery for Tilted Lens in Peters' Anomaly Type 2

Background: Cases of cataract surgery without penetrating keratoplasty in patients with Peters' anomaly are very rare. We report a case of Peters' anomaly type 2 with tilted lens due to synechia between the lens and iris that was treated with cataract surgery without penetrating keratoplasty. Case Presentation: A 16-year-old girl had Peters' anomaly in both eyes. Corneal opacity was severe in the left eye due to high-grade dysgenesis of the anterior segment. In the right eye, corneal opacity had spread from the center of the cornea to the inferotemporal side, and there was synechia between the iris and corneal endothelium from the inferonasal side to the inferotemporal side. Opacity was observed in the anterior pole of the lens, and there was synechia between the anterior iris and the lens. Ultrasound biomicroscopy (UBM) revealed that the lens was tilted because of synechia. The tilted lens induced astigmatism, which reduced visual acuity to 20/250, in conjunction with a cataract. Cataract surgery was performed; the synechia between the lens capsule and the iris was severed, an intraocular lens was inserted, and the tilt was repaired. UBM was used postoperatively to confirm that the lens capsule synechia had been corrected and that the intraocular lens was not tilted. As a result, visual acuity improved to 20/100; glaucoma and expansion of corneal opacity were not observed. Conclusions: Severing of the synechia between the cataract and iris, during cataract surgery, in a patient with Peters' anomaly type 2 resulted in favorable postoperative visual acuity

Disruption of Mouse CD46 Causes an Accelerated Spontaneous Acrosome Reaction in Sperm

Human membrane cofactor protein (MCP, CD46) is a ubiquitously expressed protein known to protect cells from complement attack. Interestingly, when we examined the expression of mouse CD46, which we recently cloned, the message was found only in testis and the protein was found on the inner acrosomal membrane of sperm. In order to elucidate the function of CD46, we produced mice carrying a null mutation in the CD46 gene by using homologous recombination. Despite the absence of CD46, the mice were healthy and both sexes were fertile. However, to our surprise, the fertilizing ability of males appeared to be facilitated by disruption of the CD46 gene, as the average number of pups born from CD46(−/−) males was significantly greater than that of wild-type males. It was also revealed that the incidence of the spontaneous acrosome reaction doubled in CD46(−/−) sperm compared to that in wild-type sperm. It was assumed that this increase caused the heightened fertilizing ability found in CD46(−/−) sperm. These data suggest that CD46 may have some role in regulating sperm acrosome reaction