Lived experience in patients with recurrent glioblastoma in Japan: A narrative study

Glioblastoma (GBM) is well known to have one of the poorest prognoses among all cancers. Patients with GBM in progression-free survival (PFS) may be relatively stable and can often maintain their quality of life. Thus, PFS is a desirable goal. In Japan, the median PFS is 11 months. It is difficult to grasp a patient\u27s thoughts and hopes when, after PFS, they are readmitted due to recurrence or acute deterioration. Therefore, this study aimed to describe the lived experience of illness in patients with recurrent GBM, focusing on PFS. We enrolled five patients into the study; however, only four patients completed data collection. Data were collected using semi-structured interviews. We also conducted a thematic narrative analysis. As a result, we generated one overall theme: Even in vulnerable and constrained daily lives, the aim was gaining a sense of stability—and maintaining it steadily—as far as possible, on their own. That sense of stability is fragile so that maintaining equilibrium is a precarious enterprise. Moreover, in PFS, participants were trying to maintain equilibrium by reevaluating themselves and sometimes giving up something, although they received support from people around them. We infer that it is important for nurses to assess and understand the fluctuations in that sense of stability through continuous involvement with patients. An interdisciplinary approach and lateral integration of care are important to meet the needs of GBM patients. This understanding will lead to nursing supports that help patients live with stability, pride, and dignity

Effects of trunk lean and foot lift exercises in sitting position on abdominal muscle activity and the contribution rate of transversus abdominis

Purpose: Abdominal hollowing exercise has been recommended to improve trunk stability. Trunk lean and foot lift exercises while sitting may easily promote abdominal muscle activity even in people who cannot perform abdominal hollowing consciously. The purpose of the present study was to examine the changes in abdominal muscle activity and contribution rate of the transversus abdominis muscle (TrA) when leaning the trunk and lifting the foot during sitting. Methods: The muscle stiffnesses (indicators of muscle activity) of the right rectus abdominis, external oblique, internal oblique, and TrA of 14 healthy men were measured during abdominal hollowing and the following nine sitting tasks: reference posture, 15° and maximal posterior trunk lean, 20° and maximal ipsilateral and contralateral trunk lean, and ipsilateral and contralateral foot lift. The TrA contribution rate was calculated by dividing the TrA stiffness by the sum of the abdominal muscles’ stiffnesses. Results: The TrA stiffness was significantly higher in abdominal hollowing than in reference posture, posterior and ipsilateral trunk lean, and ipsilateral foot lift, but not higher than in contralateral trunk lean and contralateral foot lift. There was no significant difference in the TrA contribution rates between abdominal hollowing and ipsilateral or contralateral foot lift. Conclusion: The contralateral trunk lean or contralateral foot lift could enhance TrA activity for people who cannot perform abdominal hollowing consciously. The contralateral foot lift could particularly be beneficial to obtain selective activity of TrA

Qualitative Simulation for Early-Stage Service Design

Currently, the importance of services is widely accepted in various industries. Given this background, fundamental research on service engineering is carried out quite actively. Service engineering seeks to provide design methodology for services from an engineering perspective. In product and service design, designers are generally forced to spend a lot of redesign works if design changes occur at a late stage of the design process. Thus, it is important for designers to validate design solutions in the early stage(s) of the design process by using simulation methods. However, simulation models in the existing methods are built with quantitative information. In the early stages of the service design process, most of the information about a design solution is still not defined; therefore, it is difficult to obtain sufficient quantitative information. For obtaining such quantitative information, service providers need to offer a designed service to their customers as a trial, which impose much effort for building quantitative simulation models. In order to reduce such risks, this research applies a qualitative simulation method, which can be used to analyze the behavior of systems with fuzzy qualitative information. In this paper, we propose a method to build a qualitative simulation model with the design information available at the early stage(s) of the service design process. This method would enable designers to evaluate a design solution in the early stage of a service design process and would increases quality of the service design.サービス学会主催 The 3rd International Conference on Serviceology (ICServ 2015) July 7-9, 2015 in San Jose, CA, USA

Rasとカルシウムのシグナルは、Raf1においてShoc2を介して合流する

京都大学0048新制・論文博士博士(医学)乙第12541号論医博第2022号新制||医||987(附属図書館)28839(主査)教授 野田 亮, 教授 成宮 周, 教授 楠見 明弘学位規則第4条第2項該当Doctor of Medical ScienceKyoto UniversityDA

A descriptive analysis of end-of-life discussions for high-grade glioma patients

[Background] End-of-life discussions (EOLDs) in patients with high-grade glioma (HGG) have not been well described. Therefore, this study examined the appropriateness of timing and the extent of patient involvement in EOLDs and their impact on HGG patients. [Methods] A cross-sectional survey was conducted among 105 bereaved families of HGG patients at a university hospital in Japan between July and August 2019. Fisher’s exact test and the Wilcoxon rank-sum test were used to assess the association between patient participation in EOLDs and their outcomes. [Results] In total, 77 questionnaires were returned (response rate 73%), of which 20 respondents replied with refusal documents. Overall, 31/57 (54%) participated in EOLDs at least once in acute hospital settings, and a significant difference was observed between participating and nonparticipating groups in communicating the patient’s wishes for EOL care to the family (48% vs 8%, P = .001). Moreover, >80% of respondents indicated that the initiation of EOLDs during the early diagnosis period with patients and families was appropriate. Most EOLDs were provided by neurosurgeons (96%), and other health care providers rarely participated. Additionally, patient goals and priorities were discussed in only 28% of the EOLDs. Patient participation in EOLDs was not associated with the quality of EOL care and a good death. [Conclusions] Although participation in EOLDs is relatively challenging for HGG patients, this study showed that participation in EOLDs may enable patients to express their wishes regarding EOL care. It is important to initiate EOLDs early on through an interdisciplinary team approach while respecting patient goals and priorities

Effect of static stretching with different rest intervals on muscle stiffness.

The aim of the study was to investigate the effect of static stretching (SS) with different rest intervals on muscle stiffness. Fifteen healthy males participated in the study. Four bouts of thirty-second SS for the gastrocnemii were performed at the maximal dorsiflexion using dynamometer with two different rest intervals between stretches, namely 0 s (R0) and 30 s (R30). Each participant underwent both stretching protocols at least 48 h apart in a random order. Between each bout of SS, the ankle was moved to 20°-plantar-flexion in 3 s, held for each rest interval time, and then returned to the stretching position in 3 s. The shear elastic modulus of the medial gastrocnemius was measured before (PRE) and immediately after (POST) four bouts of SS to assess muscle stiffness of the medial gastrocnemius. Two-way repeated measures analysis of variance (protocol × time) indicated a significant interaction effect on the shear elastic modulus. The shear elastic modulus significantly decreased after SS in both protocols [R0, PRE: 11.5 ± 3.3 kPa, POST: 10.0 ± 2.6 kPa, amount of change: 1.6 ± 0.9 kPa (13.0 ± 5.2%); R30, PRE: 11.0 ± 2.8 kPa, POST: 10.2 ± 2.1 kPa, amount of change: 0.8 ± 1.3 kPa (6.0 ± 10.4%)]. Furthermore, the SS with 0-s rest interval induced greater decrease in shear elastic modulus when compared to SS with 30-s rest interval (p = 0.023). Thus, when performing SS to decrease muscle stiffness, rest intervals between stretches should be minimized

Acute effects of low-intensity isometric exercise at long and short muscle-tendon unit lengths

Low-intensity training at long muscle-tendon unit lengths with a greater passive force may cause muscle swelling, which may be related to hypertrophy, even if the active force production is lower than that at short muscle-tendon unit lengths. This study compared muscle swelling after low-intensity torque-matched isometric exercises at long and short muscle-tendon unit lengths. Twenty-six volunteers performed isometric knee flexion exercises (30% of maximal voluntary contraction × 5 seconds × 10 repetitions × 9 sets) either at long or short lengths of the hamstrings (90° hip flexion and 30° knee flexion, or 90° hip and knee flexion, respectively). Active torque was calculated by subtracting passive torque from the total torque generated during exercise. Swelling-induced changes in cross-sectional area was assessed before and after exercise using ultrasonography. There was no between-group difference in the total torque during exercise; however, the active torque was significantly lower in the group trained at long than in the group trained at short muscle-tendon unit lengths. Muscle swelling occurred in both groups. The results suggest that exercise at long muscle-tendon unit lengths can cause similar muscle swelling as exercise at short muscle-tendon unit lengths, even in cases where active torque production is lower than that at short lengths