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Life Adjustments of Elderly Hemodialysis Patients for Continuing to Attend Dialysis Facility

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Open Journal of Nursing 2015年第10期5卷 878-884页

作者： utako shimizu Momoe Sakagami Mieko Uchiyama Hagiko Aoki School of Sciences Faculty of Medicine Niigata University Niigata Japan

This study aimed to elucidate elderly patients’ recognition of and life adjustment to attending dialysis facilities, and then to discuss factors for enabling such patients to continue attending dialysis facilities. Semi-structured interviews were conducted with 15 participants and interview data were analyzed using the modified grounded theory approach. The study was approved by the Ethical Review Board of Niigata University School of Medicine. The interview data yielded 21 concepts, comprising 2 categories and 7 subcategories. Patients who find themselves in a “Difficult Lifestyle” often try to maintain their health and lifestyle by using required support for hemodialysis patients. Factors for continuing to attend dialysis facilities were the ability to cope with the Difficult Lifestyle and to adjust to Hemodialysis as a Life Priority. It is thought that switching from a model of economic security to one of providing living support will be effective for maintaining elderly dialysis patients’ life with only limited expenses. Additionally, it is necessary to consider the utilization of existing services.

关键词： Elderly Hemodialysis Patient Living Support Qualitative Research

Influence Factors of Mobility-Related Activities of Daily Living in Chronic Dialysis Patients Needing Long-Term Care: Analysis of Long-Term Care Eligibility Assessment Survey Data

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Health 2014年第16期6卷 2174-2183页

作者： utako shimizu Hagiko Aoki Masaru Nakamura Haruo Yamanouchi Kohei Akazawa School of Sciences Faculty of Medicine Niigata University Niigata Japan Division of Legal Medicine Niigata University Graduate School of Medical and Dental Science Niigata Japan Department of Medical Informatics Niigata University Medical and Dental Hospital Niigata Japan

Background: In the near future in Japan, chronic dialysis patients will likely face a situation where the aging and the lengthening of hemodialysis treatment periods will adversely affect the mobility-related activities of daily living (MR-ADL). The aim of this study was to investigate chronological change in MR-ADL among chronic dialysis patients in need of long-term care and the effect of admission to long-term care facilities on their MR-ADL. Methods: Data were analyzed from a long-term care eligibility assessment survey conducted in late March 2009 of 1000 individuals residing in Niigata City, Japan who were approved to receive long-term care. Then data from those individuals who had undergone the assessment survey ≥4 times over a period of ≥4 years were statistically evaluated. To reveal change in MR-ADL, this study performed a three-way analysis of variance with mean survey scores from assessment categories 2 - 5 containing questions related to MR-ADL as the independent variable and the number of eligibility assessment surveys (within-subjects factor), facility admission, and dialysis therapy (between-subjects factors) as dependent variables. Results: We observed the effect of facility admission in individuals aged >70 years for categories 2 - 5, and observed the effect of the number of assessment surveys taken only in women ≥80 years for categories 2 and 5. Regarding the effect of dialysis therapy, female dialysis patients aged ≥80 years and in need of long-term care scored significantly higher on survey items for transferring, grooming, toileting, eating, and instrumental activities of daily living, all of which are indicators of a moderate decline in ADL. Conclusions: Because dialysis is often initiated in women aged around 80 years, ADL in this group of individuals can be improved by the initiation and proper provision of dialysis.

关键词： Chronic Dialysis Patients Activities of Daily Living Long-Term Care Insurance Long-Term Care Insurance Facility

A health economic analysis of combination therapy with infliximab plus elemental diet for moderately to severely active Crohn’s disease

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Health 2014年第1期6卷 107-114页

作者： Shota Saito utako shimizu Zhang Nan Junji Yokoyama Mayumi Watanabe Kenshi Terajima Kohei Akazawa Department of Gastroenterology and Hepatology Niigata University Medical and Dental Hospital Niigata Japan Department of Medical Informatics and Statistics Niigata University Graduate School of Medicine Niigata Japan Department of Medical Informatics Niigata University Medical and Dental Hospital Niigata Japan

Although infliximab (IFX) is effective for inducing and maintaining remission in patients with Crohn’s disease (CD), it is much more expensive than other treatments. The aim of this study is to evaluate the cost-effectiveness of several therapies, including IFX, for moderately to severely active CD. A Markov cohort model was constructed to simulate treatment effectiveness and costs. Transition probabilities, utilities, direct medical costs, and productivity costs were estimated using the results of published research. The primary effectiveness measurement was quality-adjusted life years (QALYs), as estimated by the 15D instrument. Expected effectiveness and total costs were calculated for a 10-year period using a yearly discount rate of 3% for QALYs and costs. Multiple one-way sensitivity analyses were performed by varying parameters that were likely to change QALYs and costs. As compared with nonbiologic therapy, therapy with IFX alone resulted in more QALYs and lower costs for the 10-year period. Combination therapy with IFX and elemental diet yielded an additional 0.252 QALYs at an additional cost of $18,522 as compared with nonbiologic therapy over 10 years. The resulting incremental cost-effectiveness ratio (ICER) of combination therapy vs nonbiologic therapy was $73,500/QALY. Patient body weight was the most important factor for cost-effectiveness. In conclusion it was revealed that combination therapy with IFX plus elemental diet appears not to be a cost-effective treatment for moderately to severely active CD.

关键词： Cost-Effectiveness Crohn’s Disease Elemental Diet Infliximab Markov Model

Effect of the Early Introduction of Mild Mobilization Performed by Nurses on the Recovery of Patients in the Intensive Care Unit

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Open Journal of Nursing 2016年第12期6卷 969-976页

作者： Yuta Mitobe Yu Koyama Hagiko Aoki utako shimizu Yoshiyuki Muramatsu Chikayo Koyama Sayuri Sakai Yuka Iwasa Jun Kikunaga Megumi Taguchi Masakazu Nitta Hiroshi Endoh Masaki Kitajima Shinichiro Morishita Niigata University of Health and Welfare Niigata Japan Department of Nursing Niigata University Graduate School of Health Sciences Niigata Japan Division of Emergency Critical Care Medicine Niigata University Graduate School of Medical Niigata Japan Institute for Human Movement and Medical Sciences Niigata University of Health and Welfare Niigata Japan

Rationale: Recent studies have reported the effectiveness of the early introduction of rehabilitation for preventing muscle weakness in patients in the intensive care unit (ICU). The early introduction of full-scale rehabilitation by a physical therapist is difficult in some cases because of disease severity and/or patient conditions. However, mild mobilization by a nurse (MMN), as a part of standard care performed, may have a positive effect on patient recovery. We examined the effect of the early introduction of MMN on the recovery of patients in the ICU. Methods: We retrospectively examined patients admitted to Niigata University Hospital’s ICU during between April 2014 and March 2015 who were receiving mechanical ventilation for 7 days or more. Patients were divided into two groups according to the date of initiation of MMN: group L comprised patients for whom MMN was started after 72 hours and group E comprised patients for whom MMN was started within 72 hours after ICU admission. The data were analyzed using the Fisher test, Mann-Whitney U test, and Wilcoxon test. Statistical significance was defined as P Results: Sixty-three patients were included: 42 patients in group L and 21 in group E. There was no significant difference between the two groups in patients’ background, including the type of illness, steroid use, presence of sepsis or diabetes, and sequential organ failure assessment (SOFA) score on ICU admission;however, the SOFA score at ICU discharge was significantly decreased in group E compared to that in group L (6.21 versus 4.30;P = 0.034). Conclusion: Our results indicate that MMN may reduce disease severity if started within 72 hours after ICU admission.

关键词： Intensive Care Unit (ICU) Nurse Mobilization Sequential Organ Failure Assessment (SOFA) Score

Challenges and Possibilities of Cell-Based Tissue-Engineered Vascular Grafts

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Cyborg and Bionic Systems 2021年第1期2021卷 16-31页

作者： Junichi Saito Makoto Kaneko Yoshihiro Ishikawa utako Yokoyama Department of Physiology Tokyo Medical UniversityShinjuku-kuTokyoJapan Cardiovascular Research Institute Yokohama City UniversityYokohamaKanagawaJapan Faculty of Science and Technology Meijo UniversityNagoyaAichiJapan

There is urgent demand for biologically compatible vascular grafts for both adult and pediatric *** utility of conventional nonbiodegradable materials is limited because of their thrombogenicity and inability to grow,while autologous vascular grafts involve considerable disadvantages,including the invasive procedures required to obtain these healthy vessels from patients and insufficient availability in patients with systemic *** of these issues could be overcome by tissue-engineered vascular grafts(TEVGs).A large body of evidence has recently emerged in support of TEVG technologies,introducing diverse cell sources(e.g.,somatic cells and stem cells)and novel fabrication methods(e.g.,scaffold-guided and self-assembled approaches).Before TEVG can be applied in a clinical setting,however,several aspects of the technology must be improved,such as the feasibility of obtaining cells,their biocompatibility and mechanical properties,and the time needed for fabrication,while the safety of supplemented materials,the patency and nonthrombogenicity of TEVGs,their growth potential,and the long-term influence of implanted TEVGs in the body must be *** recent advances in TEVG fabrication have yielded promising results,more research is needed to achieve the most feasible methods for generating optimal *** article reviews multiple aspects of TEVG fabrication,including mechanical requirements,extracellular matrix components,cell sources,and tissue engineering *** potential of periodic hydrostatic pressurization in the production of scaffold-free TEVGs with optimal elasticity and stiffness is also *** the future,the integration of multiple technologies is expected to enable improved TEVG performance.

关键词： optimal Engine elasticity

Adenylyl Cyclase Type 2 and 6 Differentially Regulate Vascular Tone and Remodeling in the Ductus Arteriosus

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Adenylyl Cyclase Type 2 and 6 Differentially Regulate Vascul...