Showa University Academic Resource Repository / 昭和大学学術業績リポジトリ
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歯科診療における新型コロナウイルスのエアロゾル感染リスク評価について
Get PDF新型コロナウイルス感染症2019（COVID-19）の世界的流行により，歯科治療におけるエアロゾル感染のリスクに関する懸念が高まった．歯科分野においては，エアロゾルの発生や患者の口腔粘膜および唾液との直接的な接触が避けられないため，感染流行当初はエアロゾルを発生させる歯科治療を極力控えるよう，WHOなどの行政機関からアナウンスがなされた．その後，歯科におけるCOVID-19感染リスクの研究が進み，具体的なガイドラインが提供されたが，過去3年間にわたりCOVID-19によるエアロゾル感染に関する研究者間の見解は一致しなかった．本総説では歯科診療時の感染リスクやその測定手法を中心に概説し，今後の歯科における感染制御のあり方についても考察を行う．COVID-19を含めたさまざまな感染症に対し，本稿を用いて，歯科医療現場で最大限の予防策を講じる一助としたい．departmental bulletin pape
リンクナースが活き活きと働く上で求められる支援について ―ワークエンゲージメントと周囲からのサポートとの関係から―
Get PDFリンクナースには，専門家と自部署をつなぎ，自部署の問題意識を高めて実践を改善することが期待されており，病棟全体に影響を与えることのできる看護師が役割を担う．しかし，リンクナースにはやりがいより負担感が強いとの報告もある．本研究では，リンクナースが活き活きと働く上で求められる支援について，ワークエンゲージメント（以下WE）と周囲からのサポートとの関係から明らかにすることを目的とした．対象は急性期病棟に勤務し，リンクナース経験がある看護職とし，調査内容は周囲からのサポート14項目および，邦訳版ユトレヒトワークエンゲージメント尺度とした．94名から回答が得られ，回収率は28.7％であった．全体のWE平均値は2.43であった．WEを周囲からのサポート別に比較したところ，「同僚からの協力」，「専門家からのサポート」，「キャリア形成への影響」，「上司からの権限委譲」，「上司からの進捗確認」，「上司からのフィードバック」の項目において，サポートを受けていた方がWEが高いという結果が得られた．リンクナースに対し上司が，権限を委譲するとともに，その活動過程を細やかに確認し，成果をフィードバックすることがWE向上に繋がると思われた．また，専門看護師や認定看護師などの専門家がリンクナースに対して，就任前もしくは就任直後から，個々のレディネスに合わせた専門的知識や技術・技術を教育することが，WEを高めることにつながると推察された．さらに上司がリンクナースを任命するにあたり，該当領域への興味・関心が高いことをリーダーシップよりも優先することも検討が必要である．departmental bulletin pape
Simple classification system for predicting the difficulty level of laparoscopic cholecystectomy
Get PDFThis cohort study examined the validity of our new classification system in predicting the difficulty level of laparoscopic cholecystectomy （LC）. We enrolled consecutive patients who underwent cholecystectomy at the Division of Gastroenterological and General Surgery in Showa University Hospital, Japan. Severe-grade LC was classified according to cholecystitis severity according to the 2013 Tokyo Guidelines, preoperative imaging findings, cystic duct depiction, and anatomical anomalies of the bile duct. Cases were categorized according to the degree of difficulty as follows: E （easy）, C （moderate）, and D （difficult）. Moreover, preoperative prediction accuracy was evaluated by determining the degree of inflammation and presence of anatomical variation based on operative data. Operative variables and morbidity were retrospectively evaluated. LC was performed in 534 patients, 424 of whom were assessed. The accuracy of the correlation between the classification system and intraoperative findings was as follows: E, 77%, C, 61%, and D, 76%. The average operative time was 109±44, 134±43, and 172±58 min for E, C, and D levels, respectively （P＝0.0022; E/C, P＜0.0001; C/D, P＜0.0001; E/D, P＝0.00017）. The average blood loss was 17±31, 43±61, and 71±53ml for E, C, and D levels, respectively （P＝0.0020; E/C, P＜0.0001; C/D, P＝0.0201; E/D, P＜0.0001）. The surgical outcomes significantly differed between the levels; however, the conversion and morbidity rates did not. In conclusion, our classification system was correlated with intraoperative findings and surgical outcomes, thereby contributing to improved LC outcomes.departmental bulletin pape
Rehabilitation from the acute to the recovery phase of severe pneumonia with persistent cognitive dysfunction due to intensive care unit-acquired delirium: a case report
Get PDFIntensive care unit-acquired delirium can lead to persistent cognitive dysfunction. Although it impedes independent mobilization at hospital discharge, the effects in intensive rehabilitation in the recovery phase remain unclear. An 84-year-old male was admitted to our intensive care unit with dyspnea. He was diagnosed with influenza-related pneumonia and sepsis and was placed on a mechanical ventilator for complete respiratory support. On day 14 （D14） of illness, rehabilitation was initiated. On D33, reductions in physical and cognitive functions were observed through Medical Research Council and Mini-Mental Statement Examination scores of 34 and 11 points, respectively. During his intensive care unit stay, he showed signs of delirium for 27 consecutive days. On D47, he was admitted to a postacute rehabilitation hospital where he underwent physical （strength training; basic movement, balance, and gait exercises; and endurance training）, occupational （activities of daily living training）, and speech （cognitive training, primarily higher-order tasks） therapies for 90 min daily. On D115, his physical function was markedly improved （Medical Research Council score, 57 points）; however, his cognitive impairments persisted. On D124, he was transferred to a long-term care facility. Seamless rehabilitation from the acute to the convalescent phase was performed; however, the improvement in cognitive impairment following intensive care unit-acquired delirium was less than the improvement in physical function. Even after discharge from recovery hospitals, rehabilitation should be continued in addition to interventions in the intensive care unit aimed at preventing delirium and cognitive impairment and hastening recovery.departmental bulletin pape
Mood and anxiety symptoms in adults with ADHD: An investigation of individuals without comorbid mental disorders
Get PDFPrior research has consistently documented elevated rates of comorbid mood and anxiety disorders in individuals with attention deficit hyperactivity disorder （ADHD）. However, there remains a limited body of literature examining the manifestation of mood and anxiety symptoms in adults with ADHD who do not have comorbid mental disorders. This study aims to explore the potential vulnerability of adults with ADHD, unburdened by comorbid mental conditions, to the development of mood and anxiety disorders. We conducted a comprehensive evaluation of mood and anxiety disorder symptoms in a cohort comprising 61 adults diagnosed with ADHD, who did not exhibit comorbid mental disorders, and matched them for age and gender with 64 neurotypical control participants. This investigation involved scrutinizing the interplay between emotional symptoms and those characteristic of ADHD. Substantial disparities emerged across all symptom rating scales when comparing the ADHD group to the control group. Regarding gender distinctions within the ADHD cohort, females exhibited a heightened susceptibility, demonstrating a propensity to manifest more severe symptoms compared to their male counterparts. Notably, the ADHD group displayed more pronounced correlations among emotional symptoms and those associated with ADHD. The most marked differences between the two groups were observed in the scores of Bipolar Spectrum Diagnostic Scale （BSDS） and state anxiety assessments. The findings from this study provide compelling evidence that adults with ADHD, unencumbered by comorbid mental disorders, exhibit significantly more pronounced mood and anxiety symptoms when compared to their mentally healthy counterparts. These results underscore a noteworthy vulnerability among this population to the eventual development of mood and anxiety disorders, emphasizing the importance of targeted interventions and vigilant monitoring in clinical practice.departmental bulletin pape
腰椎椎間板ヘルニアに対する椎間板内酵素注入療法における椎間板の水分含有量評価の有用性について～MRI検査画像から求められるT2 mappingの有用性～
Get PDF昭和大学博士(保健医療学)2023年度doctoral thesi
Bleeding risk factors and real-world antithrombotic therapies in elderly patients with atrial fibrillation undergoing percutaneous coronary intervention:a retrospective study
Get PDF昭和大学博士(薬学)2023年度doctoral thesi
Risk Factors for Thromboembolic and Bleeding Events in Patients After the Fontan Operation (Insights from the National Database of Health Insurance Claims of Japan)
Get PDF昭和大学博士(薬学)2023年度doctoral thesi
