論文

パーキンソン病患者について自己効力感を指標として、患者の行動を支援するための因子を分析し、報告した。患者会の活動についても考察した。

パーキンソン病患者の生活調査、社会資源の活用と、自己効力感について報告した。難病制度の中の特に、長期にわたり介護が必要な点、QOLの向上が重要であることへの支援について考察した。

難病ケアシステムの変遷をまとめた。その上で、患者の主観的満足について調査し、患者のQOLを高めるための心理・社会的支援の必要性を考察した。

Parkinson's disease (PD) is characterized by major alterations of neurotransmitter activity due to damage of the substantia nigra. Changes in neuropeptide concentration within the basal ganglia may play an important role in the putative dopaminergic-peptidergic interactions associated with the disease. Cholecystokinin (CCK) modulates the release of dopamine in the mesolimbic pathway and affects dopamine-related behavior. We analyzed genetic variations in the CCK gene, in both the coding and promoter region, in order to investigate the role of polymorphism in idiopathic PD. Four polymorphic sites of the CCK gene (-196G/A, -45C/T, 1270C/G, 6662C/T) were found in PD patients and controls. Complete linkage disequilibrium was observed between the -45 locus and the 1270 locus, and also a possible linkage disequilibrium was found between the -45 and -196 loci. A significant difference was found in the distributions of three identified genotypes at the -45 locus between 116 PD patients and 95 age-matched control subjects (χ2 = 7.95, p = 0.018, Bonferroni correction p = 0.054). In addition, a significant difference was obtained amongst the three genotypic groups at the -45 locus when compared between PD patients who experienced hallucinations (n = 23) and those (n = 93) who did not (χ2 = 8.08, p = 0.018, Bonferroni correction; p = 0.126). Our data suggested that mutations at the -45 locus in the promoter region of the CCK gene may influence vulnerability to hallucinations in PD patients treated with L-dopa.

アルコール依存症と関係を示唆する遺伝子との相関について分析した。

Recent studies suggest that Parkinson's disease (PD) is associated with particular personality traits. Using Cloningers's Tridimensional Personality Questionnaire (TPQ), Menza and colleagues [1993: Neurology 43: 505-508] reported a possible association between PD and a reduced score in the novelty seeking (NS) dimension of the TPQ. We sought to determine whether this association, which was found in a study conducted in the United States, could also be found among Japanese PD patients. We performed personality assessments of 67 Japanese PD patients, using the TPQ test. The results suggest that Japanese PD patients have significantly lower scores in the NS dimension of the TPQ, as well as significantly higher harm avoidance (HA) scores, compared with matched control subjects. Furthermore, the PD patients undergoing treatment for depression using antidepressant drugs scored significantly higher in the HA dimension than PD patients who did not receive antidepressant drug treatment. Our results suggest that the high HA score, and the low NS score in the TPQ test observed in patients with PD, is a cross-cultural phenomenon, although the influence of depression, long-term treatment, and premorbid gene/environmental interactions may also affect these personality traits. (C) 2000 Wiley-Liss, Inc.

パーキンソン病患者からの面接調査を行った原著論文。患者の病前のライフスタイルや、タイプA行動を分析した。その結果、敵意など攻撃性はないが、タイプA特性があった、同年代の対照群と比較し、平均睡眠時間には差がなかったが、睡眠充足感がないという答えが多かった。

ナイチンゲール看護覚え書をもとにして、住環境とその快適性について概説した。

Background: Complications resulting from venipuncture include vein and nerve damage, hematoma, and neuropathic pain. Although the basic procedures are understood, few analyses of actual data exist. It is important to improve the safety standards of this technique during venipuncture. This study aimed to obtain data on actual needle movement during vacuum venipuncture in order to develop appropriate educational procedures. Methods: Six experienced nurses were recruited to collect blood samples from 64 subjects. These procedures were recorded using a digital camera. Software was then used to track and analyze motion without the use of a marker in order to maintain the sterility of the needle. Movement along the X-and Y-axes during blood sampling was examined. Results: Approximately 2.5 cm of the needle was inserted into the body, of which 6 mm resulted from advancing or moving the needle following puncture. The mean calculated puncture angle was 15.2°. Given the hazards posed by attaching and removing the blood collection tube, as well as by manipulating the needle to fix its position, the needle became unstable whether it was fixed or not fixed. Conclusion: This study examined venipuncture procedures and showed that the method was influenced by increased needle movement. Focusing on skills for puncturing the skin, inserting the needle into the vein, and changing hands while being conscious of needle-tip stability may be essential for improving the safety of venipuncture. © 2013 Fujii, publisher and licensee Dove Medical Press Ltd.

Background: The purpose of this study was to assess specific vacuum-venipuncture skills and the influence of the time involved in skin puncture and blood collection. Methods: Thirty subjects undergoing venipuncture in which video analysis was possible were included. These procedures were carried out by four nurses and recorded with a digital camera. Venipuncture skills classified by our observations were delineated on the basis of frame-by-frame video images, and a graph of x and y coordinates was created. Results: With the first blood-collection tube, strong blood flow required the practitioner to push the tube back in to compensate for the strong repulsive force in approximately 46% of cases. By the third blood-collection tube, the blood flow had weakened; therefore, the tube was moved up and down. In cases that required a second venipuncture, the tube was already pierced, so the time required to fill it to 5 mL was significantly longer. Conclusion: Hand movement of the practitioner is adjusted according to blood flow. Reflex movement in response to strong blood flow may increase the risk of pushing the needle through the vein with excessive force. The time required to fill the tube varies among nurses, tube order, and level of venipuncture skills. © 2013 Fujii.

The purpose of this study was to determine safe techniques of performing blood collection using an evacuated tube system, particularly with regard to manipulation of the equipment and at the puncture site. Careful observation of the procedure was used to collect data for evaluating the various venepuncture techniques. Nurses were digitally videotaped performing simulated venepuncture. A self-administered questionnaire and unstructured observation of a videotaped recording were evaluated, and valid responses were analyzed from participants who performed venepuncture using various techniques. The participants who changed hands during the procedure were older than those who did not change hands. Needle movements during puncture and insertion, including rotation and insertion in a wave-like trajectory, were observed. Appropriate training, including recommendations for maintaining the stability of the needle tip, is important to ensure safety when performing venepuncture. Movement of the needle should not place too much pressure on the puncture site. © 2013 Wiley Publishing Asia Pty Ltd.

Purpose: Falls are a major problem and cause poor quality of life and reduced life expectancy in people affected by Parkinson's disease (PD). The timed up-and-go (TUG) test is the most popular test of walking ability in patients with PD. However, it carries a risk of falls because patients are told to walk as quickly as possible. The purpose of this study was to characterise issues of safety and reproducibility arising in TUG tests. Methods: Our population was 7 hospitalised patients (4 men, 3 women) with PD and 1 healthy control. We used video capture, Motion Analyser software, and an innovative Yorisoi (snuggling nursing robot) robot. Results: We found the same movements when patients walked in time to a verbal rhythm provided by the physiotherapist and when they used the robot in walking. The TUG times were longest when the therapist provided no intervention. The typical PD patient experienced freezing of gait when rounding the reflective cone marker in the TUG test, and after turning, experienced gait festination. The patient thus encountered difficulty in using the reflective marker. Moreover, because of the characteristic PD shuffling gait, the patient’s steps were difficult to count automatically. After the turn, the patient's body leaned heavily; however, if the physiotherapist or the robot applied a light force in the direction of the positive axis, it was possible to prevent a fall. Conclusions: When applied to patients with PD, the TUG test requires modifications for safety and more accurate step counting to improve reproducibility.IMPLICATIONS FOR REHABILITATION The presence of a sense of security with the attendant or the robot is related to walking speed. The TUG test must be reproducible in patients with PD, regardless of whether there is a rhythm or an attendant, and must be able to count the steps in a shuffling gait. The TUG test must consider safety in patients with PD, because it is easier to fall after a turn and when sitting on a chair, and it is instructed to be in hurry walk. After making a turn, a patient's body may lean heavily; however, if a physiotherapist or a Yorisoi (snuggling nursing robot) robot applies a light force in the direction of the positive axis, it is possible to prevent a fall. Assertive technology, such as the Yorisoi robot, may be used to improve the safety TUG test in patients with PD.

Aim: This integrative review aimed to clarify the nature of horizontal and lateral violence among nurses and assess how such violence affects patient safety. Background: Bullying and violence among nurses have been examined in numerous reports, yet their impact on patient safety remains unclear. Definitions of horizontal and lateral violence vary, complicating our understanding of their distinctions. Methods: The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. We systematically searched Web of Science for articles published between 1991 and 2023 on 27 August 2022 and 4 October 2024. We also searched PubMed and CINAHL to identify papers using the keywords ‘patient safety’, ‘nursing’, ‘horizontal violence’, and ‘lateral violence’. Results: Of the initial 105 studies, 29 were ultimately extracted, with 27 indicating a link between horizontal and/or lateral violence and patient safety. We identified studies showing that nursing, horizontal violence, and lateral violence are related to patient safety. However, distinguishing between horizontal and lateral violence was challenging, and both could be considered peer violence. Discussion: Horizontal and/or lateral violence encompasses repetitive physical, mental and emotional mistreatment by co-workers, including verbal and nonverbal abuse. These behaviours are characterised by sabotaging, humiliating, excluding and isolating others to alleviate the perpetrator's anxiety and insecurity. They have become systemic issues within healthcare facilities and in the nursing profession. Peer violence also occurs at the expense of the safety of others, including patients. Conclusion: This review shows links between horizontal and/or lateral violence. It highlights that a culture of incivility, job stress, disruptive peer relationships and organisational silence in healthcare facilities all impact patient safety. Moreover, these problems affect nurses who care for the same patients, creating a vicious cycle of peer violence. Implications for nursing, health, and social policy: Four solutions for improving patient safety are proposed: showing professional and civil conduct, promoting a safety culture, cultivating constructive peer relationships and creating a healthy organisational environment.