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当院ICU における意思決定支援の変化～公認心理師が入院時重症患者対応メディエーターの役割を担って～
Get PDF市立函館病院集中治療部において，公認心理師が入院時重症患者対応メディエーターとして１年間に介入した患者57例について検討した．患者・家族の心理的動揺が大きいために，重篤な病状の受容支援が中心となったが，１/３は意志決定支援まで行うことができた．支援を重ねる過程で，意思決定支援の中心的な役割は，病棟看護師へと移行していった．重症患者支援の中でも特に意思決定支援については，病院全体で取り組むことが望ましく，公認心理師は支援者支援や悲嘆ケアなど専門性を活かした役割を担うべきである．We examined 57 severely ill patients who were supported by Certified Public Psychologists as Critical Care Mediator in the intensive care unit of Hakodate Municipal Hospital over a year. Because of the great psychological turmoil experienced by patients and their families, the primary focus was on support for acceptance of serious medical conditions. However, one third of the patients were able to receive support for decision-making.Gradually the central role of decision-making support shifted to ward nurses. Specifically, in the support for critically ill patients, decision-making support should be addressed by the hospital. Additionally, Certified Public Psychologists should utilize their expertise in areas such as person support and grief care.journal articl
Japan’s health care policy in the near future and its implication for medical education
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Adverse plasma branched-chain amino acid profile mirrors fatty muscle degeneration in diabetic heart failure patients
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Elevated plasma branched-chain amino acids (BCAAs) are tightly linked to incident diabetes and its complications, while lower BCAAs are associated with adverse outcomes in the elderly and heart failure (HF) patients. The interplay between body compositions and plasma BCAAs, especially under the influence of co-morbid diabetes in HF patients, is not well understood. Here, we examined the impact of diabetes on the prognostic value of plasma BCAA and its association with body compositions in HF patients.
Methods and results
We retrospectively examined 301 HF patients (70 ± 15 years old; 59% male), among which 36% had diabetes. Blood samples for plasma BCAA measurements were collected in a fasting state after stabilization of HF and analysed using ultraperformance liquid chromatography. A dual-energy X-ray absorptiometry scan assessed regional body compositions, and muscle wasting was defined as appendicular skeletal muscle mass index (ASMI) < 7.00 and <5.40 kg/m2 for males and females, respectively, according to the criteria of the Asian Working Group for Sarcopenia. Although analyses of covariance revealed that plasma BCAAs were significantly higher in diabetic patients, low valine (<222.1 nmol/mL) similarly predicted adverse events defined by HF hospitalization, lethal arrhythmia, or all-cause death in both diabetic and non-diabetic patients independently of age, sex, and NT-proBNP (adjusted hazard ratio [HR] 3.1, 95% confidence interval [CI] of 1.1–8.6 and adjusted HR 2.67, 95% CI 1.1–6.5, respectively; P for interaction 0.88). In multivariate linear regression analyses comprising age, sex, and regional body compositions as explanatory variables, plasma BCAAs were positively correlated with visceral adipose tissue area in non-diabetic patients (standardized β coefficients [β] = 0.44, P < 0.001). In contrast, in diabetic patients, plasma BCAAs were correlated positively with ASMI (β = 0.49, P = 0.001) and negatively with appendicular fat mass index (AFMI; β = −0.42, P = 0.004). Co-morbid diabetes was independently associated with muscle wasting (adjusted odds ratio 2.1, 95% CI 1.1–4.0) and significantly higher plasma 3-methylhistidine level, a marker of myofibrillar degradation. In diabetic patients, ASMI uniquely showed a J-shaped relationship with AFMI, and in a subgroup of HF patients with muscle wasting, diabetic patients showed 12% higher AFMI than non-diabetic patients despite comparable ASMI reductions.
Conclusions
Despite higher plasma BCAA levels in HF patients with diabetes, the prognostic value of low valine remained consistent regardless of diabetes status. However, low BCAAs were distinctly associated with fatty muscle degeneration in the extremities in diabetic patients, suggesting the importance of targeted interventions to prevent such tissue remodelling in this population.journal articl
Fatty acid metabolism is involved in both retinal physiology and the pathology of retinal vascular diseases
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The Roles and Regulatory Mechanisms of Tight Junction Protein Cingulin and Transcription Factor Forkhead Box Protein O1 in Human Lung Adenocarcinoma A549 Cells and Normal Lung Epithelial Cells
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Gap junction beta-4 accelerates cell-cycle progression and metastasis through MET–AKT activation in pancreatic cancer
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Psychological impact and genetic counseling in patients with multiple endocrine neoplasia type 1（MEN1）: addressing quality of life concerns
Get PDFMultiple endocrine neoplasia type 1（MEN1）is an autosomal dominantly inherited disease that causes tumors in various endocrine and non-endocrine organs and requires cross-sectional and long-term healthcare management.In patients with MEN1, anxiety affects quality of life（QOL）, not only because of concerns about health care, but also due to the hereditary nature of the disease. In this study, we examined the psychological impact of MEN1 on patients and the influence of genetic counseling（GC）. After conducting a preliminary survey, a questionnaire battery was sent to MEN1 patients recruited from 3 medical institutions and a patient association in Japan. Responses from 76 patients were analyzed（response rate 54%）. High correlation coefficients were found between the Mental health subscale of the 36-Item Short Form Health Survey version 2 as a standardized QOL scale and two anxiety scales, the Hospital Anxiety and Depression Scale and State-Trait Anxiety Inventory. The highest component of anxiety concerned “transmission to children and grandchildren”, which was significantly higher in the group that received GC. Low QOL has been reported in patients with MEN1. Although GC provides psychological support, the information provided additional to genetic information may increase anxiety. Thus, while the usefulness of GC in hereditary diseases is widely recognized, to ensure its value for individuals, it is necessary to consider each person’s background and emotional state and bear in mind its possible risks.departmental bulletin pape