Morinomiya University of Medical Sciences Academic Repository / 森ノ宮医療大学学術リポジトリ
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The association between ultrafiltration rate and mortality in a co- hort of chronic hemodialysis patients with and without diabetes mellitus: a 7-year retrospective observational study.
Get PDFBackground: The ultrafiltration rate (UFR) is one of the important factors involved in long-term mortality in hemodialysis (HD) patients. Presence of diabetes mellitus often affects UFR due to abrupt hypotension during dialysis. In this study, we aimed to find the optimal UFR to improve the mortality in this population with and without diabetes mellitus (DM).
Methods: The effect of the UFR on mortality was retrospectively evaluated in 707 patients un- dergoing regular HD from 1 June 2010 to 30 June 2017. The relationship between the UFR and mortality in patients in the non-DM group and those in the DM group was evaluated. Logistic regression analyses were used to select the determinants of mortality. Receiver operating char- acteristic (ROC) curve analyses and survival analysis were used to determine the optimal cutoff points of UFR for mortality.
Results: The cutoff UFR values of the non-DM and DM groups were 12.07 ml/hr/kg and 9.66 ml/ hr/kg, respectively. A survival curve showed that in the non-DM group, the 7-year survival rate of patients with a UFR <12.07 ml/hr/kg was 72.6% and that in those with a UFR ≥12.07 ml/hr/kg was 19.6% (p<0.0001). In the DM group, the 7-year survival rate of those with a UFR <9.66 ml/ hr/kg was 66.7%, and it was 33.4% in those with a UFR ≥9.66 ml/hr/kg (p<0.0001).
Conclusion: Lower UFR is essential for the long-term mortality of HD patients, and optimal UFR would be different between patients with and without DM.departmental bulletin pape
A questionnaire survey on nursing situations for pediatric patients with respiratory diseases and the status of use of severity scales
Get PDF呼吸器疾患罹患患児に対する看護の現状把握を目的とし、特に重症度スコア使用状況に着目しつつ、 医療機関検索サイトより抽出した小児科を標榜し、二次救急受け入れ可能な病院 629 施設にアンケー ト調査を実施した。小児病棟設置施設は 41.3% にとどまり、また重症化による高次病院搬送は 69.6% であり、少子高齢化社会における小児入院可能施設減少状況や救急医療体制の問題が反映された結果と なった。呼吸器疾患罹患患児に対する看護(複数回答)では、観察項目として努力性呼吸(76.1%)・ SpO2 値(69.6%)・呼吸数(32.6%)が重要視され、この3項目を選択しない施設は 2.2% のみであっ た。呼吸の状態悪化と判断した場合の看護(複数回答)では酸素投与、薬剤の吸入、鼻汁・痰の吸引が 90%以上の施設で実施され、SpO2 値 94%~ 95%で酸素投与を開始する施設が 43.4% で最多であった が、酸素投与開始基準については小児医療の中で統一されていない現状であった。重症度スコア利用に よる総合的判断を看護アセスメントに活用している施設は 17.4% と低い現状であった。In this study, a questionnaire survey was performed to reveal nursing situation for pediatric patients with respiratory diseases and to investigate status of use of severity scales for respiratory diseases. Only 41.3% of hospitals that answered the questionnaire secured a pediatric ward, and 69.6% were forced to transfer to other hospitals for severe cases, suggesting shrinking pediatric medical environment in an aged society. Concerning survey about observation parameters in nursing for pediatric patients with respiratory diseases, effort breathing, degree of oxygen saturation and respiratory rate were regarded as important parameters. Although almost hospitals performed oxygen administration for severe cases, our questionnaire survey showed that oxygen start criteria was not unified. Hospitals that use severity scales for respiratory diseases in nursing assessment were only 17.4%, and there was no difference in use rate between a pediatric ward and a mixed ward. Also, expertise, hospital scale and medical standards of hospital did not affect to use rate of the severity scales.
This questionnaire survey suggested decline of pediatric medical care. Although comprehensive observation should be essential in nursing for early detection of respiratory disorder of pediatric patients, this survey revealed limited use of severity scores which could contribute to improve the quality of nursing assessment. It is expected to evaluate usefulness of severity scales in nursing field, and to spread the use of scores.departmental bulletin pape
Ingenuity and achievements of Theme-oriented Practicum(Basic Nursing) in COVID-19
Get PDF本稿では、COVID-19(新型コロナウイルス感染症)の世界的な感染拡大を受け、本学の臨地実習の 中止、遠隔授業への転換の中で取り組んだ主題実習I(基礎看護学)を振り返り、「with コロナ」とい われる今後の多様な臨地実習の可能性について考察した。
基礎看護学領域においては 15 名の学生が、「患者の夜間のニーズ」「チーム医療」「外来看護」とい う 3 サブカテゴリーにおいて、各学生が掲げたテーマのもと学修活動を進めた。グループ活動等では Microsoft Teams、Zoom といった Web 会議システムを活用した。
実習では ICT を活用しながら模擬夜勤、他学科教員へのインタビュー、映像教材を用いた事例検討 を行った。ディスカッションには、外来看護、チーム医療、退院支援、夜勤経験等を持ち、どのカテゴ リーにも対応できる看護師 3 名を招聘した。
本実習では、4 年次生の経験と能力に基づく学修レディネスに基づき、発想の転換や学修教材を工夫 したことにより一定の成果が得られたが、看護学の学修には臨地での実践が不可欠であることも再認識 できた。今後、臨地実習においても ICT を活用した多様な学修形態や教材についてもさらに検討して いく必要があるといえる。departmental bulletin pape
Effect of the technique taught in acupuncture practice on muscle hardness: Comparison in fascia and muscle
Get PDF【目的】はり師・きゅう師養成校において、学生に指導する基本的な刺鍼中の手技である雀啄術を筋膜 および筋中に実施し、筋硬度の変化を観察した。
【方法】研究内容について同意が得られた森ノ宮医療大学教職員で、刺激部位に問題を有さない 8 名を 対象とした。被験者に安静仰臥位を指示した後、左右の前脛骨筋に筋膜刺激(Fascia: F 群)およ び筋中刺激(Muscle: M 群)のいずれかを実施した。介入順序は PC で作成した乱数に従ってラ ンダム化した。前脛骨筋における刺入部位は、筋硬度が高い部位とした。使用した鍼はセイリン 株式会社製ディスポーザブル鍼 50mm 20 号鍼で、超音波診断装置で鍼尖部の位置を確認しながら 刺入した。目的の深度に達した後、1 秒間に 5mm以内の上下 1 往復を行う雀啄術を 10 回実施した。 筋硬度の評価は、超音波診断装置 ( キャノンメディカル社製 Aplio500) を用いたエラストグラフィ 法で測定した。測定は刺鍼前、切皮後、雀啄刺激後、置鍼 5 分、10 分時点、抜鍼直後、抜鍼後 5 分、10 分時点の計 8 回とした。
【結果】両群ともに鍼刺入前値と比較して有意な筋硬度変化は認められなかった。F 群では置鍼中に筋 硬度の低下傾向を示した。M 群では筋硬度の上昇傾向を示した。両群の刺入前値に対する変化量 を算出して群間比較を行った結果、置鍼 10 分後に有意(p<0.01)に F 群の方が低値を示し、そ の傾向は抜鍼 10 分後まで継続した(p<0.05)。
【考察】学生に指導する基本的な刺鍼中の手技である雀啄術では、筋硬度の低下は認められなかった。 しかし、F 群と M 群で異なる経時的変化を示し、群間に有意差が認められたことから、F 群の方 が筋硬度を低下させる可能性が考えられた。養成校教育では、鍼刺入時に深部組織の硬度変化を 鍼抵抗感覚から理解するように指導することが多い。しかし、本研究で用いた手法では明確な筋 硬度変化は認められなかった。一方、刺激組織の違いによる差は検討の余地があった。以上の結 果から、学生への技術指導について再考の必要があると考える。[Purpose] In acupuncturist or moxibustionist training schools, we teach students the sparrow pecking technique, a basic acupuncture technique, to stimulate muscles and fascia and observe the changes in muscle hardness.
[Method] Eight faculty members and students from the Morinomiya University of Medical Sciences, who consented to the study content and had no issues at the stimulation site, were included in the study. After instructing the participant to rest in the supine position, the left and right tibialis anterior muscles were stimulated with either fascial stimulation (Fascia: Group F) or intramuscular stimulation (Muscle: Group M). The intervention order was randomized according to random numbers created by a computer. The insertion site in the tibialis anterior muscle was the site of muscle tension found via palpation. The acupuncture needle used for the procedure was a 0.20 × 50 mm disposable acupuncture needle manufactured by Seirin Corporation, and the muscle or fascia was needled while positioning the acupuncture tip using ultrasonic diagnostic equipment. After reaching the target depth, the sparrow pecking technique was performed 10 times, moving the needle up and down within a range of 5 mm, once per second. The muscle hardness was measured with shear wave elastography (SWE) using ultrasonic diagnostic equipment (Aplio500, Canon Medical Systems Corporation). Measurements were recorded eight times in total: before acupuncture, after skin penetration, after stimulation with the sparrow pecking technique, 5 minutes after retaining the needle, 10 minutes after retaining the needle, immediately after removing the needle, 5 minutes after removing the needle, and 10 minutes after removing the needle.
[Results] Neither group showed any significant change in SWE when compared to the pre-acupuncture values. Group F showed a decreasing trend in SWE during needle retention, while Group M showed an increasing trend. The results of calculating the amount of change from the pre-insertion value in both groups and comparing the values of the groups showed that the value was significantly lower in Group F 10 minutes after retaining the needle (p < 0.01), and this tendency persisted for up to 10 minutes after removal of the needle (p < 0.05).
[Discussion] There was no decrease in the SWE values with the sparrow pecking technique, a basic acupuncture technique used to train students. However, Group F and Group M exhibited different changes over time. There was a significant difference between the groups, suggesting that Group F may have had a greater reduction in muscle hardness. In acupuncture training schools, students are often instructed to ascertain the change in the hardness of deep tissue from the sensation of resistance felt via the acupuncture needle when it is inserted. However, there was no clear change in SWE with the technique used in this study. The differences could be due to variations in the stimulated tissue. The above results suggest the necessity of reconsidering the technique guidance taught to students.departmental bulletin pape
Frailty and Nursing- From the perspective of nutrition and oral frailty -
Get PDF平均寿命の延びとともに健康寿命も伸びている現状の中で、高齢者がどのように最後まで自立した生 活を送るかということが、多くの人の課題となっている。そのため、加齢とともに心身が衰える「フレ イル(Frailty)」について知識を深め、成人期から健康対策を行っていくことは、介護予防や高齢者の QOL 向上の観点からも重要である。また、運動面のみでなく、栄養面やオーラルフレイル、さらには 社会面での支援が重要であることがわかった。As healthy life expectancy in Japanese society becomes longer with the increase in mean life expectancy, the means for older adults to continue living autonomously in their last years is an important challenge for many people. We thus hypothesized that increased knowledge on frailty, which refers to physical weakening associated with age, together with the implementation of healthy lifestyle changes while people are still young and healthy, are important to boost the quality of life of older adults and prevent them from requiring long-term care. Moreover, this study revealed that in addition to encouraging exercise, ensuring good nutrition, preventing oral frailty, and providing social support are also important aspects as well.departmental bulletin pape
A Survey on Students’ Sleep during Chronic Practicum in Adult Nursing
Get PDF〔目的〕看護学科 3 年次の成人看護学慢性期の臨地実習における看護学生の睡眠時間と睡眠の質を明ら かにし、今後の教育的介入の方向性について示唆を得ることである。
〔方法〕成人看護学慢性の実習を終了した 3 年生 74 名を対象に、調査用紙を配布し有効回答数 68 名の 分析を行った。
〔結果〕実習中の睡眠時間は、5 時間で他の看護系大学より 30 分〜 1 時間長かった。しかし、睡眠の質 は 61.3%の半数以上の学生に睡眠障害がみられた。その要因には、実習記録の記載にかける時間や翌 日の実習に寝坊しないかなどの不安が上がった。
〔考察〕睡眠の質の悪化は、集中力の低下や学習意欲の低下に繋がる可能性がある。このことから今後は、 個々に合わせた対応や記録内容等の改善の必要性があると示唆された。Purpose
The purpose of this study was to understand the sleep problems that occur amongst students
during their practice in the chronic phase of adult nursing. Methods
The test was performed on 74 third-year students who completed their chronic adult nursing practice, of which 68 were analyzed.
Results
The average sleep time was 30 minutes to 1hour longer than other nursing colleges at five
hours, but the quality of sleep was 61.3%, with more than half of the students having sleep
disorders. The case was anxiety about the time for training records and whether to oversleep. Discussion
Factors such as recording time and knowledge, and anxiety about being late for the next day's practice, could have increased the results. In the future, it was suggested that there is a need for improvement, such as individual guidance and changes in the contents of records.departmental bulletin pape
Postural control changes with pseudo-cataract glasses
Get PDF【目的】白内障疑似体験ゴーグル装着による視覚の変化が、静的姿勢制御に与える影響を検討した。
【方法】健常若年者 24 名を対象に、3 つの異なる視覚条件での重心動揺軌跡を比較した。視覚条件 は開眼、白内障疑似体験ゴーグル装着(以下、疑似白内障)、視覚遮断ゴーグル装着(以下、視覚遮断) とした。比較項目は総軌跡長、外周面積、実効値面積、重心動揺軌跡の概形分類とした。
【結果】総軌跡長、外周面積、実効値面積はいずれも開眼、疑似白内障、視覚遮断の順で有意に増加した。 重心動揺軌跡の概形分類では、開眼では求心型が多く、びまん型が少なかった。また、視覚遮断では求 心型が少なく、びまん型が多かった。
【結論】白内障疑似体験ゴーグル装着による急性の視覚変化は重心動揺を増加させた。[Purpose] This study aims to investigate the effects of the variations in vision due to pseudo- cataract, on the parameters that cause the center of pressure (COP) to move.
[Methods] The subjects were 24 young and healthy adults. We measured the parameters that cause the COP to move, under three visual conditions: without glasses, glasses with pseudo- cataract (with PC glasses), and glasses with visual deprivation (with VD glasses).
[Results] The total length of COP sway, envelope area, and root mean square area increases in the order of 'without glasses', 'with PC glasses', and 'with VD glasses'. In case of 'without glasses' fixed center type patterns are often observed in a stabilogram, while diffuse type patterns are observed in case of 'with VD glasses'.
[Conclusion] The variations in visual conditions affect the movement of the COP.departmental bulletin pape