What Are Effective Program Characteristics of Self-Management Interventions in Patients With Heart Failure? An Individual Patient Data Meta-analysis

To identify those characteristics of self-management interventions in patients with heart failure (HF) that are effective in influencing health-related quality of life, mortality, and hospitalizations

慢性心不全の疾病管理に関する研究

広島大学(Hiroshima University)博士(看護学)Nursingdoctora

The realities regarding self-management of chronic heart failure and the relationship between self-management and a clinical indicator of chronic heart disease

本研究の目的は, 外来通院中の慢性心不全患者の疾病の自己管理の実態について明らかにし, 心不全の臨床指標である脳性(B型)ナトリウム利尿ペプチド(BNP)との関連について検討すること, そして, 本研究から得られた結果を急性増悪予防のための疾病管理プログラムを作成するための基礎資料とすることである. A県内の医療機関3施設に通院する慢性心不全患者を対象に他記式構成的質問紙を用いた個別面接法を行った. その結果, 回答者109名中, 心不全の病識が認められたのはわずか7.3%であった. 塩分・水分摂取についても同様に有識者は20%以下であった. また, 対象者は7割以上が糖尿病や高血圧症を合併していた. さらに, 89名において, 疾病の自己管理要因と心不全の臨床指標であるBNPとの関連を検討した結果, 89名中21名のBNP値が観察期間中の3ヵ月で悪化しており, 塩分制限を行っていない対象者においてBNP値の悪化が認められた. 以上より, 疾病管理プログラムには, 心不全の病態や疾病の自己管理に関する適切な知識の提供及び基礎疾患の管理も内容に入れる必要があることがわかった.The purpose of this study is to clarify the realities regarding self-management relating to chronic heart failure and to investigate relationships between factors of self-management and Brain natriuretic peptide (BNP), which is one of the clinical indicators of heart disease. The results of this study will be used for the development of a chronic heart failure (CHF) management program. The interview test was given to 109 outpatients at one clinic and two hospitals. Results indicated that only 7.3% of participants had knowledge of CHF, and fewer than 20% had knowledge of a lowsodium diet and fluid intake. More than 70% of participants had diabetes and hypertension. Moreover, analyzing the data of 89 participants, BNP among 21 of 89 participants, in the selfmanagement factors, deteriorated significantly. In addition, the relationship between the results of selfmanagement factors and BNP among 89 participants showed that participants who did not carry out a low-sodium diet deteriorated more than participants who did. Therefore, as these results indicate, proper knowledge of CHF and self-management, as well as management of CHF factors, need to be included in CHF disease management programs

Wandering Behavior in Elderly People with Alzheimer's Disease

This study investigated the relationship between feelings and opinions, non-wandering patterns, and types of wandering in wanderers with Alzheimer's Disease, with the ultimate aim of exploring methods of nursing care appropriate to their feelings while wandering. There were basically two types of wandering, purposeful and non-purposeful. The former could be categorized into four types, work, going home, interaction, and physiological. Regardless of the degree of impaired cognitive function, two or more wandering types were exhibited by all participants, and the combination of types differed from individual to individual. Feelings were broadly classified into positive and negative in investigating the relationship between feelings during wandering and types of wandering. In three purposeful types of wandering (except for going home) - work, interaction, physiological - feelings were positive in the case of accomplishing their purposes but negative in the reverse case, and were also negative in the non-purposeful type. Four patterns in the non-wandering situations - concentrating, peace of mind, relating to others, and physiological needs - were identified. The best pattern for discontinuing wandering was peace of mind, which was effective for all five wandering types. In particular, for the going home wandering type, this was the only way to discontinue wandering. On the other hand, work and physiological types were available in all four patterns as an effective way to discontinue wandering.本研究では,認知症高齢者の徘徊時の気持ちや徘徊中断について聴取,および観察を行なった。認知症高齢者の徘徊の目的および理由と徘徊時の気持ちや徘徊を中断するときの関連から,徘徊者の気持ちを踏まえたより効果的な援助方法を探ることが目的である。徘徊には大きく分けて,有目的と無目的の二つのパターンがあり,前者は,さらに「勤勉性」「帰宅願望性」「親密性」「生理的要因性」の四つのタイプに分類された。個人を主体とした徘徊行動では,全ての対象者のタイプは単一ではなく,認知レベルにかかわらず,二ないし五タイプであり,個人における組み合わせも異なっていた。また,徘徊時には,肯定的及び否定的な感情があり,非徘徊時のパターンには,「集中する」「精神的安寧が得られる」「他者と関わる」「生理的欲求がある」があった。そして,「精神的安寧が得られる」ことは全ての徘徊行動パターンに有効な徘徊中断への対応方法であった。原著Original Article国立情報学研究所で電子