浜松市リハビリテーション病院における臨地実習指導マニュアルの作成(その他)

浜松市リハビリテーション病院は平成11年12月に旧国立病院より移管、開設された、病床数180床、4病棟を有するリハビリテーション専門の病院である。平成17年度より聖隷クリストファー大学の基礎看護実習を受け入れることになった。臨地実習の受け入れは初めての経験である。そこで、実習指導者会を立ち上げ各病棟から実習指導者を選出し、実習指導者マニュアルの作成、基礎看護実習の実習指導案の作成、実習に必要な物品の整備などを行った。その経過と実習指導の実際、実習指導者の振り返りを報告する

Prognostic Value of Coronary Sinus Flow Quantification by Cardiac Magnetic Resonance Imaging in Patients With Acute Myocardial Infarction

Background This study aimed to evaluate the prognostic value of hyperemic coronary sinus flow (h‐CSF) and global coronary flow reserve (g‐CFR) obtained by phase‐contrast cine‐magnetic resonance imaging in patients with acute myocardial infarction (MI). Methods and Results This retrospective study analyzed patients with acute MI (n=523) who underwent primary (ST‐segment–elevation MI) or urgent (non–ST‐segment–elevation MI) percutaneous coronary intervention. Absolute coronary sinus blood flow (CSF) at rest and during vasodilator stress hyperemia was quantified at 30 days (24–36 days) after the index infarct‐related lesion percutaneous coronary intervention and revascularization of functionally significant non–infarct‐related lesions. We used Cox proportional hazards regression modeling to examine the association between h‐CSF, g‐CFR, and major adverse cardiac events defined as all‐cause death, nonfatal MI, hospitalization for congestive heart failure, and stroke. Finally, 325 patients with ST‐segment–elevation MI (62.1%) and 198 patients with non–ST‐segment–elevation MI (37.9%) were studied over a median follow‐up of 2.5 years. The rest CSF, h‐CSF, and g‐CFR were 0.94 (0.68–1.26) mL/min per g, 2.05 (1.42–2.73) mL/min per g, and 2.17 (1.54–3.03), respectively. Major adverse cardiac events occurred in 62 patients, and Cox proportional hazards analysis showed that h‐CSF and g‐CFR were independent predictors of major adverse cardiac events (h‐CSF: hazard ratio [HR], 0.64; 95% CI, 0.47–0.88; P=0.005; g‐CFR: HR, 0.62; 95% CI, 0.47–0.82; P=0.001). When stratified by h‐CSF and g‐CFR, cardiac event‐free survival was the worst in patients with concordantly impaired h‐CSF (<1.6 mL/min per g) and g‐CFR (<1.7) (P<0.001). Conclusions Global coronary sinus flow quantification using phase‐contrast cine‐magnetic resonance imaging provided significant prognostic information independent of infarction size and conventional risk factors in patients with acute MI undergoing revascularization