点眼瓶センサーとDeep Learningによる緑内障患者点眼アドヒアランス自動把握能力の評価

内容の要旨, 審査の要旨広島大学(Hiroshima University)博士(医学)Doctor of Philosophy in Medical Sciencedoctora

Stress coping pattern among pre-operative patients and relations to their background

術前訪問のストレス状態を軽減するための一手段として，手術室の看護者により術前訪問が行われている。患者自身のストレスの状態とその対処法が異なっていることは従来の研究より明らかであるが，このような個々の術前患者の対処状況に応じた術前訪問については，充分に行えていないのが現状である。患者のストレス状態は患者背景と関係しており，さらにはその対処行為をパターン化できるものと考え，この対処行為のパターンと，背景因子との関わりを明らかにし，それらを考慮した術前訪問のあり方を考えることを目的として本研究を行った。対象は1週間以内に手術予定の患者20名とした。データは面接による半構成的な質問に対する対象者の自由な回答を記録して収集した。質問内容は，1．対象者の背景要因としての「経験」「自己認知」「環境要因」2．対象者の心理状態・ストレス認知・対処について，「病気を発見した時」、「入院の必要性の説明を受けた時」「手術の必要性の説明を受けた時」「現在」の4つの時点についての心理状態，ストレスの認知，対処法について回想法によるものとした。対象者は男性11名，女性9名で，平均年齢は57.7±15.9歳であった。各事例における4時点での対処行為をパターン化したところ，A ：「積極的対処」B：「回避」C：「おまかせ」D：「積極的対処」→「おまかせ」E：「回避」→「積極的対処」F：「回避」→「積極的対処」→「おまかせ」G：「回避」→「おまかせ」の7パターンに分類された。患者背景要因と対処法の関係については，次の2点が明らかとなった。1）ストレス対処に「問題状況の再認知」または「おまかせ」を用いていた患者は，癌告知を受けており，ストレス状態の軽減傾向が特徴的であった。それに対して，「回避」を主に用いていた患者は，未告知事例や疾患について曖昧な解釈の事例が集中しており，ストレス状態が特徴的であった。2）性格を「神経質」「辛抱強い」と自己評価した患者の対処行為として，「積極的対処」が共通して用いられていた。Operating room nurses visit the pre-operating patients before the operation. This visit is designed to inform the patients and reduce their stress. But the stress level of each patient and their ability for dealing with stress may vary. The purpose of this study is to investigate stress-coping patterns of pre-operative patients. Twenty patients at the University Hospital of Chugoku Region in Japan volunteered for this study. Subjects consisted of 11 males and 9 females with average of 57.7 years old. An interviewer obtained data using an original semi-structured questionnaire after getting informed consent. Items of questionnaire were patient's background, his/her psychological status, stress recognition. The patients' coping mechanisms were evaluated using the recollection method at 4 different time points: a) when the patient's disease was diagnosed, b) when the patient was informed of the need for hospitalization, c) when the patient was informed of the need for operation, and d) at the time of the operation. We found common patterns of coping among them, which were classified into 7 categories: A) positive action at any situations, B) evasion, C) leaving, D) positive action and leaving, E) evasion and positive action, F) evasion, positive action and leaving, G) evasion and leaving. The following 2 points were noted between the patients' background and coping mechanisms: 1) Patients using "re-acknowledgment or leaving" pattern were informed well about their disease and did not feel stress from their situation. 2) Patients taking positive actions recognized their character as "nervous about their situation" or "patient"

Cardiovascular events in Japanese asymptomatic patients with type 2 diabetes: a 1-year interim report of a J-ACCESS 2 investigation using myocardial perfusion imaging

金沢大学医薬保健研究域医学系Purpose Diabetic patients have a high risk for cardiovascular events. The role of myocardial perfusion imaging was investigated in asymptomatic diabetic patients to evaluate short-term prognosis in a Japanese population. Methods A total of 506 asymptomatic patients ≥50 years of age who had carotid artery maximum intima-media thickness ≥1.1 mm, urinary albumin excretion of ≥30 mg/g creatinine, with additional criteria of abdominal obesity, low HDL cholesterol, high triglyceride level, and hypertension were enrolled and followed up over a 3-year period. Gated SPECT with stress-rest protocol was performed and analyzed by summed defect scores and QGS software. One-year cardiovascular events were analyzed. Results Myocardial ischemia was observed in 17% of patients, and abnormal perfusion findings of ischemia and/or scar were observed in 32% of patients. By the end of the 1-year follow-up, 33 (6.5%) cardiovascular events occurred including 6 all-cause deaths. Patients with summed stress score (SSS) >8 had a higher incidence of either death or cardiovascular events. Event-free survival rates for SSS 0–3, 4–8, 9–13, and ≥14 were 0.96, 0.95, 0.82, and 0.76, respectively. Multivariate Cox regression analysis showed that significant variables were SSS, history of cerebrovascular accident, and electrocardiographic abnormality at rest. Conclusion The 1-year interim summary showed that cardiovascular events were significantly higher in patients with SPECT abnormality, although hard cardiac event rate was relatively low. Targeted treatment strategy is required for asymptomatic but potentially high-risk diabetic patients

Safety analysis of two different regimens of uracil–tegafur plus leucovorin as adjuvant chemotherapy for high-risk stage II and III colon cancer in a phase III trial comparing 6 with 18 months of treatment: JFMC33-0502 trial

PURPOSE: The JFMC33-0502 trial is a phase III clinical study designed to determine the most appropriate duration of postoperative adjuvant chemotherapy with uracil–tegafur (UFT) plus leucovorin in patients with stage IIB or III colon cancer. We report the interim results of preplanned safety analyses. METHODS: Patients with stage IIB or III colon cancer who had undergone curative resection were randomly assigned to receive UFT (300 mg/m(2)) plus leucovorin (75 mg/day) for 6 months (control group, 4 weeks of treatment followed by a 1-week rest, five courses) or for 18 months (study group, 5 days of treatment followed by a 2-day rest, 15 courses). Treatment status and safety were evaluated. RESULTS: A total of 1,071 patients were enrolled, and 1,063 were included in safety analyses. Treatment completion rate at 6 months was 74.0 % in the control group and 76.7 % in the study group. Treatment completion rate in the study group at 18 months was 56.0 %. The overall incidence of adverse events (AEs) was 75.3 % in the control group and 77.6 % in the study group. The incidences of grade 3 or higher AEs were low in both groups. During the first 6 months, the incidences of the subjective AEs were significantly lower in the study group. CONCLUSIONS: Oral UFT plus leucovorin given by either dosage schedule is a very safe regimen for adjuvant chemotherapy. In particular, 5 days of treatment followed by a 2-day rest was a useful treatment option from the viewpoint of toxicity even when given for longer than 6 months. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00280-014-2461-5) contains supplementary material, which is available to authorized users

Precise Measurement of Cosmic-Ray Proton and Helium Spectra with the BESS Spectrometer

We report cosmic-ray proton and helium spectra in energy ranges of 1 to 120 GeV and 1 to 54 GeV/nucleon, respectively, measured by a balloon flight of the BESS spectrometer in 1998. The magnetic-rigidity of the cosmic-rays was reliably determined by highly precise measurement of the circular track in a uniform solenoidal magnetic field of 1 Tesla. Those spectra were determined within overall uncertainties of +-5 % for protons and +- 10 % for helium nuclei including statistical and systematic errors.Comment: 12 pages, 4 figure