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Prioritizing Patient Assessment Data (PAD) Using the Japanese Psychiatric Nursing Assessment Classification System (PsyNACS)©

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Open Journal of Psychiatry 2016年第3期6卷 218-227页

作者： Hirokazu Ito Misao Miyagawa Kazuhiro Ozawa Tetsuya Tanioka Yuko Yasuhara Mutsuko Kataoka Beth King Masahito Tomotake Yumi Kuwamura Rozzano C. Locsin Department of Nursing Institute of Biomedical Sciences Tokushima University Tokushima Japan Department of Nursing Faculty of Health and Welfare Tokushima Bunri University Tokushima Japan Nursing Collaboration Center Gifu College of Nursing Gifu Japan mifune hospital Kagawa Japan Christine E. Lynn College of Nursing Florida Atlantic University Boca Raton FL USA

The study identified priorities of the Patient Assessment Data (PAD) using the Japanese Psychiatric Nursing Assessment Classification System (PsyNACS©) derived from 644 psychiatric nurses’ responses who were practicing in specific units: Acute Care Units (ACU), General Care Units (GCU), Long-term Care Units (LCU), physically Complicated Disease Care Units (CDCU), and Dementia Care Units (DCU). Secondary analysis of the PsyNACS©on-line survey data using four levels of “importance” was used to determine the priorities: 1) unnecessary;2) quite important;3) important and 4) very important. The Mean Factor Points (MFP) and the Welch’s ANOVA were calculated. PsyNACS©score of 3 or higher indicates the PAD as priority. The results showed that in the ACU PAD1, “Psychological symptom”, “Stress coping”, and “Mood disorder and aggression”, and PAD2 “Information of adherence”, and “Information of the psychiatry rehabilitation”, and PAD7 “Situation of the family and social life”, “Relationship to the health care providers”, and “Relationships with others” are high priority (high importance). Other PADs showed results below PsyNACS©score of 3. The GCU had PAD 3 “Balance of water”, the LCU had PAD 4 “Intention/Point of view”, and “Thoughts of the patient” and PAD 7 “Disease and family”. The CDCU showed PAD 2 “Blood test”, PAD 3 “Excretion situation”, and PAD 5 “General health condition”, “Respiratory and chest symptom”, and “Vital signs”, and the DCU had PAD 1 “Cognition function”, and “Delirium and derangement capacity to register failure”, PAD 3 “Function of eating”, PAD 6 “Egestion and cleanliness” and PAD 8 “Activity and sleeping”, and “Mobility capability”. These classifications indicated levels of importance in the CAD comprising the PAD below the score of “2”. Japanese psychiatric hospitals specify assessments according to functional areas. By prioritizing the CAD for each PAD, more effective and efficient assessments can be performed according to practic

关键词： PsyNACS© Nursing Database Priority Nursing Assessment Items Unit Function Psychiatric hospital

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The Development of the Japanese Psychiatric Nursing Assessment Classification System (PsyNACS^©)

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Open Journal of Psychiatry 2016年第1期6卷 20-33页

作者： Hirokazu Ito Misao Miyagawa Kazuhiro Ozawa Tetsuya Tanioka Yuko Yasuhara Mutsuko Kataoka Beth King Masahito Tomotake Rozzano C. Locsin Department of Nursing Institute of Biomedical Sciences Tokushima University Graduate School Tokushima Japan Department of Nursing Faculty of Health and Welfare Tokushima Bunri University Tokushima Japan Nursing Collaboration Center Gifu College of Nursing Gifu Japan mifune hospital Kagawa Japan Christine E. Lynn College of Nursing Florida Atlantic University Boca Raton Florida USA

The purpose of this study was to develop the Japanese Psychiatric Nursing Assessment Classification System (PsyNACS)©. This study used the on-line survey method from February to April 2015. There were 644 respondents comprised of professional nurses with minimum qualification of 3 years’ experience being in a psychiatric unit of a stand-alone 200-bed or more Psychiatric hospital in Japan. Assessment items were derived from 211 specific items selected from nursing textbooks, excluding the North-American-Nursing-Diagnosis-Association (NANDA). The questionnaire contained Cover Letter, Demographic Data Sheet, and the PsyNACS© questionnaire. There were 644 questionnaires accessed but only 435 were completed and valid. Item levels of importance were evaluated: 1) Unnecessary, 2) Not very important, 3) Important and 4) Very important. Data analysis used descriptive and multivariate statistics. Factor analysis (principal factor analysis, varimax rotation), the Kaiser-Meyer-Olkin (KMO) and the Bartlett’s test of Sphericity assessed the adaptive validity of the factor analysis. Factor loadings were set at 0.4 or more for the configuration of items. Internal consistency and reliability were established using Cronbach’s alpha coefficient. Mean factor points were calculated, including standard deviation, range, and confidence interval at 95%. Statistical significance was at 0.05 level. Nine Patient Assessment Data (PAD) with 2 to 5 Cluster Assessment Data (CAD) each were categorized. Thirty one CADs comprised the Patient Assessment Data: (PAD1) Psychological symptom and stress, (PAD2) Information about treatment, (PAD3) Function of eating and balance of water, (PAD4) Life and value, (PAD5) Vital signs and health assessment, (PAD6) Self-care, (PAD7) Social support, (PAD8) Activity, sleeping and mobility capability, and (PAD9) Sexual function and sexual behavior. The PsyNACS© is a classificati

关键词： PsyNACS Psychiatric Nursing Patient Assessment Data Psychiatric hospital

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Tubulointerstitial Nephritis Complicated with Primary Sjogren’s Syndrome under Treatment for Type 2 Diabetes Mellitus

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Open Journal of Nephrology 2012年第4期2卷 105-108页

作者： Shinichi Antoku Hiroyuki Ito Mizuo mifune Hiroko Nawata Masahiro Kato Department of Diabetes Metabolism and Kidney DiseaseEdogawa HospitalTokyoJapan Department of Internal Medicine Edogawa HospitalTokyoJapan Department of Neurology Edogawa HospitalTokyoJapan

Tubulointerstitial nephritis complicated by primary Sj?gren’s syndrome in a patient under treatment for type 2 diabetes mellitus was diagnosed in the early stage of the disease by renal biopsy. The symptoms of primary Sj?gren’s syndrome, such as thirst and polydipsia, were masked by the characteristic symptoms of type 2 diabetes mellitus. An association between sicca symptoms and diabetes mellitus (types 1 and 2) has been previously reported. Hence, it is possible that there are common underlying immunological mechanisms between primary Sj?gren’s syndrome and diabetes mellitus of both types. Intervention with steroids in a timely manner appears to have prevented or slowed the progression of re- nal impairment.

关键词： Tubulointerstitial Nephritis Sjogren’s Syndrome Type 2 Diabetes Mellitus

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The number of antihypertensive agents simply reflects the grade and the risk of atherosclerosis in patients with type 2 diabetes mellitus

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Journal of Diabetes Mellitus 2013年第4期3卷 161-167页

作者： Hiroyuki Ito Mariko Abe Masahiro Shinozaki Takashi Omoto Shinya Nishio Masahide Furusho Shinichi Antoku Mizuo mifune Michiko Togane Tsutomu Sanaka Department of Diabetes Metabolism and Kidney Disease Edogawa Hospital Tokyo Japan Lifestyle-Related Disease and CKD Center Edogawa Hospital Tokyo Japan

Aims: The associations between the number of antihypertensive agents being taken by type 2 diabetic patients and 1) the grade of atherosclerosis according to non-invasive surrogate markers for atherosclerosis and 2) the other risk factor for atherosclerosis, were cross-sectionally investigated. Methods: The association between the blood pressure control and the clinical characteristics was evaluated in 1359 patients with type 2 diabetes mellitus. Results: The number of antihypertensive agents was 1.5 ± 1.4 (2.0 ± 1.2 among the 990 patients with hypertension). The proportion of patients taking no antihypertensive agents was 29%, 22% were taking one, 29% were taking two and 21% of the patients were taking three or more antihypertensive agents. The value of the ankle-brachial pressure index significantly decreased with the increase in the number of antihypertensive agents even if the blood pressure was corrected to the target value. The values of brachial-ankle pulse wave velocity and carotid intima-media thickness were also increased. The prevalence of risk factors for atherosclerosis, such as obesity, hyperlipidemia, chronic kidney disease, hyperuricemia and anemia was significantly elevated with the number of agents. Conclusions: The number of antihypertensive agents simply reflects the grade and risk of atherosclerosis in patients with type 2 diabetes mellitus.

关键词： Hypertension Antihypertensive Agents Intima-Media Thickness Ankle-Brachial Pressure Index Pulse Wave Velocity

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Reduced endogenous insulin secretion in diabetic patients with low-titer positive antibodies against GAD

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Journal of Diabetes Mellitus 2012年第1期2卷 96-100页

作者： Yuichiro Takeuchi Hiroyuki Ito Koshiro Oshikiri Shinichi Antoku Mariko Abe Mizuo mifune Michiko Togane Masahiro Kato Department of Diabetes Metabolism and Kidney Disease Edogawa Hospital Tokyo Japan

Aim: To investigate the clinical characteristics of diabetic patients with a low-titer positive for the anti-glutamic acid decarboxylase 65 antibody (GAD antibody). Methods: The subjects were 420 diabetic inpatients. The endogenous insulin secretion was estimated on the basis of the C-peptide immunoreactivity from a 24 h urine collection (uCPR). Clinical variables were compared between patients negative for the GAD antibody (GAD antibody titer < 1.5 U/mL), a low-titer positive GAD antibody (1.5 U/mL ≤ GAD antibody titer < 10 U/mL) and a high-titer positive GAD antibody (10 U/mL ≤ GAD antibody titer). Results: The low and high-titer positive GAD antibodies were found in 25 and 10 patients, respectively. The uCPR was significantly lower in both the patients with a low (37 ± 33 ug/24h) and high-titer (39 ± 27 ug/24h) positive GAD antibodies than in those negative for GAD antibodies (71 ± 52 ug/24h). The uCPR level was significantly lower in the low-titer positive GAD antibody group (29 ± 22 ug/24h) than in the negative group (67 ± 55 ug/24h) among the patients not taking insulin secretagogues. The difference disappeared in the subjects taking insulin secreagogues. In the stepwise multiple regression analysis, a low-titer positive GAD antibody was independently associated with the uCPR level. Conclusions: Endogenous insulin secretion is reduced in diabetic patients positive for GAD antibodies, even if the titer is low. Earlier initiation of insulin therapy might therefore protect the pancreatic β-cell function in diabetic patients with a low-titer positive GAD antibody.

关键词： GAD Antibody Endogenous Insulin Secretion Urinary C-Peptide SPIDDM LADA

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