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

Present status of home health nursing in a Japanese hospital-based home health care agency

病院を基盤とした在宅看護提供機関における在宅看護の現状を調査し,在宅看護の現在の問題点を明らかにするとともに,在宅看護に携わる看護婦の役割について検討した｡本調査の結果,一人暮らしの患者は,家族に介護者のいる患者に比べ明らかにADLが高い場合も訪問看護を受けていることが分かった｡また,高齢者夫婦二人暮らしの患者と2世代以上家族の患者のADLに差はなく,このことは,高齢の介護者に相当の負担がかかっていると言える｡訪問看護内容としては, 日常生活自立度の低い患者への日常生活援助の実施率は高く,精神的支援や指導的看護技術の実施率は低かった｡在宅看護に携わる看護婦は, 日常生活援助に追われがちであるが,一次予防に焦点を当てたケア,患者や介護者の精神的支援,指導,ケアマネジメントを行うことは緊急の課題である｡We investigated the present status of home health nursing in a Japanese hospital-based home health care agency, to clarify present problems in home health nursing and to assess the roles of home health nurses. Based on our results, ADL of care recipients who lived alone were clearly independent compared with care recipients who lived with family care-givers. The level of ADL of both care recipients who lived with their spouses and those who lived with more than 2 family members were not different. It indicates that aged family care-givers assume great responsibility. In cases of bedridden recipients,daily life care was performed at a high rate, but mental care or teaching care was performed at a low rate. Home health nurses should focus on primary preventive care, mental care for recipients and care-givers, and teaching care or management of a care plan

患者による受け持ち学生の技術に対する評価と期待

学生が実習で受け持った入院患者が，学生の実習態度や看護技術をどう評価しているのか，学生にどのような態度や技術を期待しているのかを明らかにする目的で調査を行った．対象は，慢性期看護実習で学生が５週間継続して受け持った患者のうち，研究への同意が得られた１９名の患者である．本稿では，看護技術のうち，コミュニケーション技術および観察技術について報告する．調査の結果，学生のコミュニケーション技術および観察技術に対する患者の評価はおおむね良好であり，それらの技術に対する患者の期待は高いことが明らかになった．しかし，少数ではあるものの否定的な評価や学生には全く期待しない患者もおり，看護者としての姿勢に対する教育，受け持ち患者決定における条件などについては，今後さらに検討の必要性があることが示唆された．As part of the clinical nursing experience, nursing students were assigned to take care of patients requiring treatment for chronic health conditions for five consecutive weeks. The study was conducted to ascertain how １９ consenting patients assessed the attitudes and communication and observation skills of nursing students. Patients were also asked about their expectations of the students. Results showed that patients expected nursing students to demonstrate a high level of skills ; the communication and observation skills of the nursing students were generally assessed favorably. However, a few patients gave negative assessments of the students' attitudes and skills and stated that they did not expect anything from them. Our results suggest that it is necessary to further investigate the attitudes of nursing students and the conditions for their clinical assignments

Daily physical activity in patients with chronic glomerulonephritis

腎炎患者の日常生活活動強度と持久性体力を明らかにするため、本研究を行った。被検者は20歳から61歳の腎炎患者7名である。日常生活活動強度の指標として、連続心拍計を用いて24時間心拍数を測定した。また、持久性体力を評価するため、換気性閾値（Ventilatory Threshold : VT）を測定した。各被験者のVTは、同性、同年齢の健常者の値に対する相対値（％VT）で評価した。被検者の％VTの平均は、93.4±18.6％で、健常者に比べて低下していた。24時間心拍数の平均は、82±8拍／分であった。24時間心拍数のうち、VT時の心拍数を越えるものは、多くても2％でしかなく、腎炎患者の日常生活の大部分は、有酸素運動であった。We examined the intensity of daily physical activityand cardiorespiratory endurance in 7 patients with chronic glomerulonephritis between 20 and 61 years old. To determine the intensity of daily physical activity, the 24-hour heart rate was measured. To evaluate cardiorespiratory endurance, ventilatory threshold oxygen uptake (VT) was measured. VT of each patient was presented as the percentage of the value in sex and age-matched healthy subjects (% VT). The mean % VT was 93.4±18.6% lower than that in the healthy subjects. The mean 24-hour heart rate was 82±8 beats/min. The heart rate over the VT in 24-hour heart rate was at most 2%. In conclusion, metabolism was aerobic in the greater part of their daily lives

Improvement and Evaluation of an Individual Identification System Using High Frequency Electrocardiogram

Biometric identication techniques are widely used as individual identification methods in ecurity systems. We have studied the high frequency component of electrocardiogram (HFECG) as a new biometric modality. In this technique, a HFECG segment containing individual characteristics is extracted and used for identification. Identi_cation performance depends greatly on extraction accuracy, but the current extraction method using the peak point on R waves as fiducial points can result in unsatisfactory performance. In this study, we propose a new ducial point determination technique utilizing waveforms transformed from ECGs. The algorithm is based on differential calculus and produces sufficient performance despite having less complexity than other signal detection techniques. Comparative evaluation established that identification performance was improved using the new method

The Efficacy of Software to Help Patients Understand Drug for Adjuvant Treatment for Breast Cancer: A Pilot Randomized Controlled Trial

We assessed the usefulness of ChemoCalc, a software package for calculating drug costs, in helping patients understand these costs. We randomly assigned, in a 1 : 1 ratio, 20 women who had undergone surgery for early breast cancer to a group that discussed adjuvant treatment with their physicians using the ChemoCalc software (ChemoCalc group) or a group that discussed adjuvant treatment without ChemoCalc (Usual Explanation group). The participants completed a five-grade evaluation questionnaire after these discussions. The primary endpoint was the intergroup comparison of the questionnaire scores regarding participants’ understanding of their treatment-associated drug costs. Median age was not significantly different between the ChemoCalc group and Usual Explanation group (57 vs. 50, respectively; p=0.27). Patients in the ChemoCalc group had a significantly higher perceived level of understanding of the drug cost than those in the Usual Explanation group (5 [4-5] vs. 2.5 [1-5], respectively; p=0.002). Scores related to the patients’ perception that understanding drug costs is an important part of breast cancer treatment were also higher in the ChemoCalc group than the Usual Explanation group (5 [2-5] vs. 3 [1-5], respectively; p=0.049). ChemoCalc was found to be useful for understanding drug costs

The effective nursing educational plan for the elderly at hospital discharge. - through the questionnaires for the nurses and the elderly patients -

近年の急速な高齢化社会にともない複数の疾病や種々の障害をもちながら自宅で療養する高齢者が増加してきている。このような状況でいったん入院療養した高齢者が自宅へ帰り生活をしていくにはかなりの困難が予測される。高齢者が退院し自宅での生活にスムーズに適応できるか否かは看護婦の退院指導の良否に関わってくる。そこで指導側の看護婦の指導計画や指導方法、内容について調査すると共に受け手の患者の指導希望内容との比較を行い有効な退院指導のあり方を検討した。患者の心配事や援助や相談の希望内容と看護婦の重要とする指導内容はほぼ同様の内容であった。その内容は日常生活に関すること、病気や健康に関することが多かった。看護婦の退院指導の計画でカンファレンスをしている看護婦はしていない看護婦に比べ指導内容の経済的なこと、趣味や生きがいに関する事、生活環境、家族の協力に関することを重要とすると回答したものが有意に多かった。The elderly with chronic disease or handicaps who receive nursing home care is currently increasing. They may have some difficulties in their daily life after hospital discharge. The proper nursing educational plan may determine their post-hospital life without anxiety. The purpose of this study is to find out the effective nursing educational plan for them. Therefore, we investigated the contents of the nursing educational plan for their hospital discharge and what elderly patients need in their post-hospital life. As a result, both contents were similar. Those were about their daily life, disease, health. And there were significantly defferences between well-discussed plan and no discussed plan in the items of economy, hobbies, purpose of life, home environment, family cooperation. Results from this study suggest that more detailed discussion among nurses at hospital discharge is necessary to determine the individual nursing educational plan of elderly patients in their post-hospital life

The Effect of p38 Mitogen-Activated Protein Kinase Activation on Inflammatory Liver Damage following Hemorrhagic Shock in Rats

Hemorrhagic shock is a frequent cause of liver failure and often leads to a fatal outcome. Several studies have revealed that p38 MAPK is a key mediator in hemorrhagic damage of the primary organs through the activation of proinflammatory cytokines such as tumor necrosis factor (TNF)-α and interleukin (IL)-1β. However, the precise role of these factors in liver damage following hemorrhagic shock is unclear. In this study, we used FR167653, a specific inhibitor of p38 MAPK phosphorylation, to examine the role of p38 MAPK in liver damage occurring up to 5 hours after a hemorrhagic episode in a rat model. Activation of p38 MAPK in the liver as well as an increase in hepatic mRNA expression and serum concentrations of TNF-α and IL-1β occurred during the early phase after hemorrhage. Increased serum levels of hepatic enzymes, as well as histological damage and activated neutrophil accumulation in the liver, were observed in the late phase following hemorrhagic shock. FR167653 inhibited the inflammation-related hepatic injury following hemorrhagic shock. Bacterial lipopolysaccharide (LPS) derived from the gut appeared to have little effects on the hepatic damage. These results demonstrate that p38 MAPK activation is induced by hepatic ischemia during hemorrhagic shock and plays an important role both in the hepatic expression of proinflammatory cytokines and in the development of inflammation-related liver damage