Language：Japanese   Publisher：(公社)日本超音波医学会  

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Language：Japanese   Publisher：(公社)日本超音波医学会  

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Language：Japanese   Publisher：(株)インナービジョン  

超高齢社会に突入したわが国では,2025年を目処に地域包括ケアシステムの構築が推進され,高齢者の尊厳の保持と自立生活の支援を目的として,可能なかぎり,住み慣れた地域で自分らしい生活を送れるための準備が進められている。医療が病院から在宅にシフトし,地域の高齢者が「時々入院,ほぼ在宅」と言われるようになっていく中,在宅医療のキーパーソンとなる看護師に求められる役割はますます重要になっている。特に重要なのは,必ずしも現場に医師がいない中で,看護師が患者の身体状態を正しく観察,アセスメントする能力である。近年,看護師が在宅やベッドサイドで,体内を可視化し観察するためのモダリティとして,携帯型超音波診断装置(ポータブルエコー)が注目されている。エコーは,従来から非侵襲,リアルタイムに体内の可視化画像を得られる検査であるが,小型で高性能な装置の登場によって,看護師がポイントオブケア検査として使いやすいものとなり,「第6のフィジカルアセスメント」可視化のツールと呼ばれるようになった。体内を可視化できるだけでなく,画像情報を医療者間で共有でき,さらには療養者,家族とも共有できることで,迅速な治療・ケア方針や意思決定につながる。エコーというモダリティが看護の観察,アセスメントに新しい価値を生み出し,まさにケアイノベーションを起こしたと言える。(著者抄録)

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Language：Japanese   Publisher：(株)医学書院  

＜文献概要＞排泄とは,物質代謝の結果生じた不要になった老廃物を体外に排出することであり,排泄物には尿や便,汗などがある.排泄は人が生きていくために必要不可欠な行為であり,人としての尊厳や自己実現にかかわるため,大変重要である.現在日本は超高齢社会の到来に伴い,運動機能や認知機能が低下した高齢者の自立を支援するケアへの取り組みが進められている.排泄ケアにおいても,高齢者が残された能力で良好かつ最大限自立した排泄ができるような支援が求められており,その1つとして2016年に診療報酬として「排尿自立指導料」が新設された.その後,排尿自立指導料を申請する病院数が増加し,2020年度の改定では,入院中の患者に対する包括的排尿ケアの評価は,基本診療料のなかの「入院基本料等加算」として,「排尿自立支援加算」が新設された.これまでの「排尿自立指導料」は,入院中の患者以外を対象とした包括的排尿ケアの評価に対する「外来排尿自立指導料」に変更となった.また「排尿自立支援加算」となったことで,算定可能な入院料が拡大され,「地域包括ケア病棟入院料」,「回復期リハビリテーション病棟入院料」,「精神科救急入院料」,「精神療養病棟入院料」などで新たに算定可能となった.このように病棟と外来を通して,患者の排尿自立を支援することの重要性の理解が進んでいる.

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Publishing type：Research paper (scientific journal)   Publisher：SAGE Publications  

Background:

Ultrasound guidance increases the success rate of peripheral intravenous catheter placement. However, the longer time required to obtain ultrasound-guided access poses difficulties for ultrasound beginners. Notably, interpretation of ultrasonographic images is considered as one of the main reasons of difficulty in using ultrasound for catheter placement. Therefore, an automatic vessel detection system (AVDS) using artificial intelligence was developed. This study aimed to investigate the effectiveness of AVDS for ultrasound beginners in selecting puncture points and determine suitable users for this system.

Methods:

In this crossover experiment involving the use of ultrasound with and without AVDS, we enrolled 10 clinical nurses, including 5 with some experience in peripheral intravenous catheterization using ultrasound-aided methods (categorized as ultrasound beginners) and 5 with no experience in ultrasound and less experience in peripheral intravenous catheterization using conventional methods (categorized as inexperienced). These participants chose two puncture points (those with the largest and second largest diameter) as ideal in each forearm of a healthy volunteer. The results of this study were the time required for the selection of puncture points and the vein diameter of the selected points.

Results:

Among ultrasound beginners, the time required for puncture point selection in the right forearm second candidate vein with a small diameter (<3 mm) was significantly shorter when using ultrasound with AVDS than when using it without AVDS (mean, 87 vs 247 s). Among inexperienced nurses, no significant difference in the time required for all puncture point selections was found between the use of ultrasound with and without AVDS. In the vein diameter, significant difference was shown only in the absolute difference at left second candidate among inexperienced participants.

Conclusion:

Ultrasonography beginners needed less time to select the puncture points in a small diameter vein using ultrasound with AVDS than without AVDS.

DOI： 10.1177/11297298231156489

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Other Link： http://journals.sagepub.com/doi/full-xml/10.1177/11297298231156489

Language：Japanese   Publisher：(株)ライフ・サイエンス  

■便秘は本来,体外に排出すべき糞便を十分量かつ快適に排出できない状態と定義されており,加齢に伴い有訴者は増加する.評価には自覚症状の聴取が重要となるが,認知症などで意思疎通が困難な高齢者では聴取が困難であり,看護師は便秘のアセスメントや排便ケア方法選択に難渋してきた.■看護師による携帯型超音波画像診断装置(エコー)を利用した可視化は,これまでの診断のための検査として行われている大腸エコーとは異なり,エコーで便貯留をアセスメントしその場の排便ケアを選択するというPoint-of-Care Ultrasound(POCUS)を行うという視点であり,新しい.■エコーの導入は便秘症状の下剤量の減少につながり,看護師が短時間で学ぶことのできる教育プログラム,AI(Artificial Intelligence)によるアシスト機能を備えたデバイスも市販されており,老年看護の新しいアセスメントツールとして今後ますますの活用が期待される.(著者抄録)

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Language：Japanese   Publisher：看護理工学会  

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Language：English   Publisher：看護理工学会  

背景:小児湿疹に対し,紫外線光線療法を長期間行うことは有害である.本研究の目的は紫外線を含まない可視光線療法の小児湿疹への効果を検討することである.方法:シングルケース実験デザイン研究.3週間の非照射期間のあと,30分間の光線療法を週3回,5週間行った.評価項目は,Patient-Oriented Eczema Measure(POEM),経表皮水分蒸散量(TEWL),皮膚表面水分量,pH,TSLP,IL-4,IL-13とした.結果:症例は中等度の湿疹を有する3歳男児で,10ヵ月間の治療を経ても悪化していた.照射・非照射期間を比較しPOEMは臨床的に有意に低下していた.炎症部のTEWLも低下傾向を示した.結論:紫外線を含まない可視光線療法により,かゆみが改善したことで,掻き動作やそれに伴う出血が軽減した.このことから,本療法が小児湿疹の改善に一定の効果をもたらす可能性が示唆された.今後は客観的指標による皮膚バリア機能の改善効果を検証する必要がある.(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J06462&link_issn=&doc_id=20230207280002&doc_link_id=10.24462%2Fjnse.10.0_76&url=https%3A%2F%2Fdoi.org%2F10.24462%2Fjnse.10.0_76&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(一社)日本摂食嚥下リハビリテーション学会  

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Language：Japanese   Publisher：(一社)日本摂食嚥下リハビリテーション学会  

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Language：Japanese   Publisher：(公社)日本看護科学学会  

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Language：Japanese   Publisher：(公社)日本看護科学学会  

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Language：Japanese   Publisher：(公社)日本看護科学学会  

目的:本資料は,日本看護科学学会より公開した「看護ケアのための摂食嚥下時の誤嚥・咽頭残留アセスメントに関する診療ガイドライン」の要約版である.方法:本診療ガイドラインは,「Minds診療ガイドライン作成マニュアル2017」に従い,研究エビデンスと益と害のバランス,患者の価値観などに基づき作成された.結果:身体診査技術を用いた系統的アセスメント,反復唾液嚥下テスト,改訂水飲みテスト,フードテスト,頸部聴診法,超音波診断装置による嚥下観察,内視鏡による嚥下観察に関するクリニカルクエスチョンをもとに,10の推奨が作成された.8つの推奨はGRADE(Grading of Recommendations Assessment, Development and Evaluation)2Cとして評価され,残りの2つはGRADEなしとして評価された.結論:看護ケアのためのアセスメントに焦点を当て,最新の知見を盛り込んだ信頼性の高い診療ガイドラインが作成された.本資料は要約版であり,臨床実践への活用が期待される.(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J01669&link_issn=&doc_id=20230330280032&doc_link_id=%2Feg4jaons%2F2022%2F004200%2F087%2F0790-0810%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Feg4jaons%2F2022%2F004200%2F087%2F0790-0810%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：English   Publishing type：Research paper (scientific journal)  

AIM: This clinical practice guideline aims to provide and recommend methods of assessing aspiration and pharyngeal residue during eating and swallowing and methods of selecting and implementing nursing care for adults to prevent the development of aspiration pneumonia through early and appropriate management of oropharyngeal dysphagia. METHODS: In April 2018, the Japan Academy of Nursing Science established the Supervisory Committee in Nursing Care Development/Standardization Committee to develop clinical practice guidelines for aspiration and pharyngeal residual assessment during eating and swallowing for nursing care. This clinical practice guideline was developed according to the Minds Manual for Guideline Development 2017, with the aim of providing a specific pathway for nurses to determine the policy for selecting management for oropharyngeal dysphagia based on research evidence and multifaceted factors including the balance of benefits and harms and patients' values. RESULTS: Based on the 10 clinical questions related to assessment by physical assessment, the Repetitive Saliva Swallowing Test, Modified Water Swallowing Test, Food Test, cervical auscultation, observation using an ultrasound diagnostic device, and an endoscope, 10 recommendations have been developed. Eight recommendations have been evaluated as the Grading of Recommendations Assessment, Development and Evaluation (GRADE) 2C, and the other two have been evaluated as no GRADE. CONCLUSION: The first reliable clinical practice guideline has been produced from an academic nursing organization that focuses on assessment for nursing care and incorporates the latest findings.

DOI： 10.1111/jjns.12496

PubMed

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Language：Japanese   Publisher：日本老年泌尿器科学会  

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Language：Japanese   Publisher：日本老年泌尿器科学会  

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Language：Japanese   Publisher：日本老年泌尿器科学会  

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Language：Japanese   Publisher：日本老年泌尿器科学会  

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Language：Japanese   Publisher：(公社)日本超音波医学会  

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Language：Japanese   Publisher：(公社)日本超音波医学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Chronic constipation is a common gastrointestinal disorder in older adults, and it is very important to manage chronic constipation. However, evaluating these subjective symptoms is extremely difficult in cases where patients are unable to express their symptoms because of a cognitive or physical impairment. Hence, it is necessary to observe the patient's colonic faecal retention using objective methods. Ultrasonography observation for colonic faecal retention is useful for diagnosing constipation and evaluating the effectiveness of treatment. Since there was no standard protocol for interpreting rectal ultrasonography findings, we developed an observation protocol through an expert consensus. We convened a group of experts in the diagnosis and evaluation of chronic constipation and ultrasonography to discuss and review the current literature on this matter. Together, they composed a succinct, evidence-based observation protocol for rectal faecal retention using ultrasonography. We created an observation protocol to enhance the quality and accuracy of diagnosis of chronic constipation, especially rectal constipation. This consensus statement is intended to serve as a guide for physicians, laboratory technicians and nurses who do not specialise in ultrasound or the diagnosis of chronic constipation.

DOI： 10.3390/diagnostics12020300

PubMed

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Language：English   Publisher：看護理工学会  

背景:高張性脱水は水分や塩分の喪失で生じる血清浸透圧の上昇である.高齢者は脱水に陥りやすいが,地域における有病率の報告は少ない.本研究は在宅療養高齢者における高張性脱水の有病率を明らかにすることを目的とした.方法:在宅療養高齢者33人を対象に横断的観察研究を行い,基本属性のほか,認知機能や血液データなどを調査した.結果:研究対象者は84±6歳で,72.7%が女性だった.血清浸透圧は22人(66.7%)が291mOsm/L以上であり,急性脱水のエピソードはなかった.脱水の有無に対する症状の感度と特異度は,77.3%と18.2%であった.認知機能は血清浸透圧と逆相関し,水分摂取量は要介護度で異なっていた.結論:在宅療養高齢者における高張性脱水の高い有病率が明らかになり,慢性脱水の存在が示唆された.認知機能や身体機能が比較的保たれた高齢者では,脱水のリスクが看過される可能性が考えられた.(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J06462&link_issn=&doc_id=20220303340003&doc_link_id=10.24462%2Fjnse.9.0_123&url=https%3A%2F%2Fdoi.org%2F10.24462%2Fjnse.9.0_123&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(株)精神看護出版  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J01938&link_issn=&doc_id=20211216160001&doc_link_id=2103973&url=https%3A%2F%2Fkango-sakuin.nurse.or.jp%2Fnid%2F2103973&type=%E6%9C%80%E6%96%B0%E7%9C%8B%E8%AD%B7%E7%B4%A2%E5%BC%95Web&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00014_1.gif

Language：Japanese   Publisher：(株)精神看護出版  

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Language：Japanese   Publisher：日本NP学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Publishing type：Research paper (scientific journal)   Publisher：MDPI AG  

The classification of ultrasound (US) findings of pressure injury is important to select the appropriate treatment and care based on the state of the deep tissue, but it depends on the operator’s skill in image interpretation. Therefore, US for pressure injury is a procedure that can only be performed by a limited number of highly trained medical professionals. This study aimed to develop an automatic US image classification system for pressure injury based on deep learning that can be used by non-specialists who do not have a high skill in image interpretation. A total 787 training data were collected at two hospitals in Japan. The US images of pressure injuries were assessed using the deep learning-based classification tool according to the following visual evidence: unclear layer structure, cobblestone-like pattern, cloud-like pattern, and anechoic pattern. Thereafter, accuracy was assessed using two parameters: detection performance, and the value of the intersection over union (IoU) and DICE score. A total of 73 images were analyzed as test data. Of all 73 images with an unclear layer structure, 7 showed a cobblestone-like pattern, 14 showed a cloud-like pattern, and 15 showed an anechoic area. All four US findings showed a detection performance of 71.4–100%, with a mean value of 0.38–0.80 for IoU and 0.51–0.89 for the DICE score. The results show that US findings and deep learning-based classification can be used to detect deep tissue pressure injuries.

DOI： 10.3390/app11177817

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The effectiveness of point-of-care ultrasound (POCUS) for nurses has been demonstrated; however, only a limited number of nurses have been trained to perform POCUS. This article reports on a POCUS train-the-trainer program for nurse educators that targets lower urinary track dysfunction. METHOD: Nurse educators (n = 38) were invited to participate in a POCUS train-the-trainer program, which comprised an e-learning module and a hands-on seminar. Acquisition of knowledge and skills were assessed after the module and seminar, respectively. RESULTS: Questions from the "Basic Knowledge of Ultrasonography" test were answered correctly at a rate of 93.0% (SD, 8.5%). Measured values of bladder urinary volume using ultrasonography were in close agreement with actual values. All of the participants indicated that the program covered the content necessary to use in practice. CONCLUSION: The POCUS train-the-trainer program equips nurse educators with the knowledge and skills needed for training nurses at their institutions. [J Contin Educ Nurs. 2021;52(8):375-381.].

DOI： 10.3928/00220124-20210714-07

PubMed

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Language：Japanese   Publisher：(一社)日本褥瘡学会  

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Language：Japanese   Publisher：(一社)日本褥瘡学会  

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：English   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：English   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：English   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：English   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：English   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：医歯薬出版(株)  

＜Key Point＞・入院基本料の算定要件に組み込まれている褥瘡対策における危険因子の評価項目の一つにスキン-テアがある。・スキン-テアを予防するためにはリスク因子をアセスメントし、リスクの高い患者には早期にケアを実施する必要がある。・2021年に日本人高齢者用のスキン-テアリスクアセスメントツールが開発された。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)  

Advances in patient care for pressure injuries (PIs) have reduced the prevalence of PIs in Japan, although not in recent years. Several single-nucleotide polymorphisms (SNPs) have been identified in genes potentially associated with PIs. However, individual variance among PI risks require targeted investigations that may lead to the identification of PI susceptibilities or preventive care options that directly influence PI development pathways. This cross-sectional study examined the association between PIs and SNPs in genes related to tissue tolerance in patients in a long-term care hospital in Japan. A total of 178 participants (130 control, 20 with superficial PI history, and 28 with deep PI history) were enrolled in this study of eight SNPs in hypoxia inducible factor 1 subunit alpha (HIF1A), vascular endothelial growth factor C (VEGFC), heat shock protein 90 alpha family class A member 1 (HSP90AA1), myostatin (MSTN), and vitamin D receptor (VDR). The primary outcome was a history of superficial and deep PIs in the last 6 months. SNPs were examined by real-time polymerase chain reaction, followed by multivariate logistic regression analyses of the associations between the SNPs and PI history. The results showed a significant association between VEGFC rs1485766 and the history of superficial PIs (odds ratio = 2.95; 95% confidence interval = 1.07-8.11; p = 0.04). Stratified analysis using the Braden Scale (≤14) indicated a significant association between HIF1A rs11549465 and deep PIs (p = 0.04). Our study demonstrated that VEGFC rs1485766 and HIF1A rs11549465 were associated with superficial and deep PI susceptibilities, respectively.

DOI： 10.1111/wrr.12912

PubMed

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Language：Japanese   Publisher：(株)メヂカルフレンド社  

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Language：Japanese   Publisher：(株)メヂカルフレンド社  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J00268&link_issn=&doc_id=20210416070013&doc_link_id=2101709&url=https%3A%2F%2Fkango-sakuin.nurse.or.jp%2Fnid%2F2101709&type=%E6%9C%80%E6%96%B0%E7%9C%8B%E8%AD%B7%E7%B4%A2%E5%BC%95Web&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00014_1.gif

Language：English   Publishing type：Research paper (scientific journal)  

AIM: To estimate diagnostic accuracy of ultrasonography for detecting aspiration and pharyngeal residue in patients with dysphagia. METHODS: A systematic search was conducted in MEDLINE (via PubMed), CINAHL, EMBASE, Ichushi-Web, and Cochrane Library databases to identify articles that showed diagnostic accuracy of ultrasonography for detecting aspiration and residue published in English and Japanese until August 2019. Cross-sectional studies, case-control studies, and cohort studies were included. The diagnostic accuracy results were extracted and the pooled estimated sensitivity and specificity were calculated. The risk of bias of the studies was assessed using the Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies 2. The certainty of the evidence was assessed using the Grades of Recommendation Assessment, Development, and Evaluation methodology. RESULTS: Five studies were included in this review. The pooled estimated sensitivity and specificity for detecting aspiration were 0.82 (95% CI: 0.72-0.89) and 0.87 (95% CI: 0.81-0.92), respectively. One study was included that evaluated ultrasound assessments of pharyngeal residue. The sensitivity and specificity were 0.62 (95% CI: 0.32-0.86) and 0.67 (95% CI: 0.22-0.96), respectively. The certainty of the evidence was low and very low for the diagnostic accuracy of aspiration and pharyngeal residue, respectively. CONCLUSION: Ultrasound is a non-invasive method with good sensitivity and specificity in detecting aspiration as well as reference standards. While risk of bias and small number of studies limited the strength of this systematic review, our results suggested that ultrasound examination was useful as a bedside screening tool for detecting aspiration.

DOI： 10.1111/jjns.12396

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Language：Japanese   Publisher：日本老年泌尿器科学会  

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Language：Japanese   Publisher：(株)メヂカルフレンド社  

褥瘡発生リスクが高い車いすアスリート(30代男性、胸椎損傷、車いすバスケットボール選手)に発生したDTI(深部損傷褥瘡)疑いのアセスメントとケアについて報告した。褥瘡を繰り返してきた患者に対し、DESIGN-R 2020をサーモグラフィ画像とエコー画像を用いて評価することで、皮膚表面からは把握が困難なDTIを確認することができた。また、創部アセスメント、および体圧測定による除圧ケアにより、褥瘡の悪化を防止することができた。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J00268&link_issn=&doc_id=20210416070006&doc_link_id=2101703&url=https%3A%2F%2Fkango-sakuin.nurse.or.jp%2Fnid%2F2101703&type=%E6%9C%80%E6%96%B0%E7%9C%8B%E8%AD%B7%E7%B4%A2%E5%BC%95Web&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00014_1.gif

Language：Japanese   Publisher：日本老年泌尿器科学会  

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Language：Japanese   Publisher：(株)メヂカルフレンド社  

車いすアスリート(30歳代男性、腰椎損傷、車いすバスケットボール選手)の褥瘡管理の際に、エコーを用いることでDTI(深部損傷褥瘡)を発見でき、適切なケアの提供により重症化することなく治癒できた症例について報告した。エコーを用いることで、創部表面のみでは判断できなかったDTIと瘻孔をアセスメントすることができた。また、患者やチームコーチとエコー画像を共有することで、深部組織で生じている現象を理解することができ、体圧管理と感染予防の重要性の認識につなげることができた。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J00268&link_issn=&doc_id=20210416070011&doc_link_id=2101707&url=https%3A%2F%2Fkango-sakuin.nurse.or.jp%2Fnid%2F2101707&type=%E6%9C%80%E6%96%B0%E7%9C%8B%E8%AD%B7%E7%B4%A2%E5%BC%95Web&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00014_1.gif

Language：English   Publishing type：Research paper (scientific journal)  

[Aim] Because painful skin tears frequently occur in older patients, the prevention of skin tears is fundamental to improve their quality of life. However, a risk assessment tool for skin tears has not been established yet in Japan. Therefore, we aimed to propose a risk scoring tool for skin tears in Japanese older adult. [Methods] We conducted a prospective cohort study with 6-month follow-up in two long-term care hospitals in Japan. A total of 257 inpatients were recruited. Patient and skin characteristics were collected at baseline, and the occurrence of forearm skin tears were examined during follow-up. To develop a risk scoring tool, we identified risk factors, and converted their coefficients estimated in the multiple logistic regression analysis into simplified scores. The predictive accuracy of the total score was evaluated. [Results] Of 244 participants, 29 developed forearm skin tears during the follow-up period, a cumulative incidence of 13.5%. Senile purpura, pseudoscar, contracture, and dry skin were identified as risk factors for skin tears. Their weighted scores were 6, 4, 5, and 6, respectively. The area under the receiver operating characteristic curve of the total score was 0.806. At a cut-off score of 12, the sensitivity was 0.86, and the specificity was 0.67. [Conclusion] Our forearm skin tear risk scoring tool showed high accuracy, whereas specificity was low. This tool can contribute to prevent forearm skin tears in Japanese older adults.

DOI： 10.1016/j.jtv.2021.02.010

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Language：Japanese   Publisher：(株)南江堂  

＜文献概要＞▼終末期には,全身状態の悪化により皮膚の還流障害や低酸素化が生じるため,褥瘡を含めた皮膚変化が発生しやすい.▼終末期にある高齢者(非がん患者)の褥瘡の特徴は,腸骨部や大転子部の骨上に一致する「スポット状の赤黒い二重発赤/紫斑」や「線形の明瞭な紫斑」であった.▼終末期の褥瘡ケアでは,患者の安楽とQOL,悪化予防と治癒促進のバランスをとりながら進めることが重要である.

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J00974&link_issn=&doc_id=20210208090010&doc_link_id=issn%3D0022-1961%26volume%3D127%26issue%3D2%26spage%3D199&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0022-1961%26volume%3D127%26issue%3D2%26spage%3D199&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: Chemotherapy causes changes in appearance in patients with cancer. Therefore, to have a normal life, it is necessary for patients to wear a wig. However, wearing a wig may strain an already sensitive scalp during chemotherapy. This study aimed to assess the effects of a hypoallergenic medical wig in breast cancer patients with chemotherapy-induced alopecia (CIA). METHODS: A randomised, single-blind, controlled study was conducted from January 2015 to July 2017 in Tokyo, Japan. Women with non-metastatic breast cancers were enrolled. Participants were provided a hypoallergenic medical wig or a traditional medical wig. The primary endpoint was incidence of scalp dermatitis, including erythema, rash and erosion. The secondary endpoints were incidence of scalp symptoms, alterations in scalp barrier functions and quality of life (QOL). Patients were followed at the start of the first chemotherapy administration and at 13th week. RESULTS: Fifty-nine women were included in the analysis. At 13th week, the incidence of erythema was 44.8% among patients in the intervention group and 86.7% among patients in the control group, in the intention-to-treat analysis (p<0.01). The incidence of erosion tended to decrease in the intervention group at the 13th week (p=0.09). The incidence of scalp symptoms, alterations in scalp barrier functions and QOL were not significantly different between the groups. CONCLUSIONS: The incidence of dermatitis, including erythema, rash and erosion, decreased when wearing the new hypoallergenic medical wig. The gentle hypoallergenic medical wig is useful in improving erythema in cancer patients with CIA.Trial registration number UMIN000021289.

DOI： 10.1136/bmjspcare-2020-002309

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Language：Japanese   Publisher：The Society for Nursing Science and Engineering  

The purpose of this study was to develop a method for more accurate evaluation of fecal retention by an artificial intelligence interpretation support application that determines and displays in red extraction area the presence of fecal retention for rectal ultrasonographic videos taken by home-visiting nurses. In this study, static images were output from rectal ultrasonographic videos taken from medical records of one home-care nursing station. For each static image, the ultrasound expert and the application judged the presence of fecal retention based on half-moon or crescent-shaped hyperechoic findings as extraction area. This study focused on images that were false-positive results for the application when the ultrasound expert&rsquo;s answer was correct. Extracted regions with a depth of less than 50 mm and a longitudinal diameter of less than 14.5 mm were excluded to distinguish them from stool and gas retentions outside the rectum. As a result, the sensitivity was 81.1%, specificity 87.8%, and correct rate 83.7%. A method of adjusting the depth and long diameter of the extraction area was developed as a means for improving the judgement accuracy of the application.

DOI： 10.24462/jnse.9.0_34

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Language：English   Publishing type：Research paper (scientific journal)  

AIMS: While bowel preparation for colonoscopy is the key to successful examination, taking laxatives and showing stools to others causes both physical and mental distress to the patient. Thus, an alternative method to evaluation bowel preparation is necessary. In the current study, we studied the colonic fecal retention by ultrasonography (US) and examined the US finding which reflected completion of BP. MATERIAL AND METHODS: The subjects were outpatients who underwent colonoscopy. This report summarizes the ultrasonographic images of patients who underwent multiple US examinations for all five sites of the colon just before, during, and immediately after bowel preparation. According to the standard protocol, the patients took 2 L of polyethylene glycol-ascorbic acid as a laxative, which was discontinued when the nurse visually judged the stool to be clear. RESULTS: Seven patients in their 50s-80s, none of whom were unable to complete a colonoscopy due to residual feces were included in study. Following bowel preparation, the US images showed anechoic areas with haustration in four or all five areas of the colon. Three of the seven patients received low-dose laxatives (1.1-1.2 L); all three had watery stools in three or more colon areas and none of them were constipated at the time of taking 1 L of laxatives. CONCLUSIONS: Completion of bowel preparation can be assessed by the observation of anechoic areas with haustration in multiple colonic sites by ultrasonography.

DOI： 10.11152/mu-2792

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Language：English   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

目的:スキン-テアの発生は、患者に痛みや不安を生じさせる。スキン-テア予防のためには、日々ケアを行う看護師への教育が重要となる。本研究の目的は、長期療養型病院において看護師を対象にスキン-テア予防教育を実施し、その効果を検討することである。方法:長期療養型病院1施設において前後比較研究を実施した。実施期間は2018年12月から2019年8月であった。看護師はスキン-テア予防教育のセミナーに参加し、スキン-テアの定義、リスク因子、分類システム、治療、予防ケアとケア用品(アームカバー、創傷被覆材、医療用シリコンテープなど)についての教育を受けた。教育効果を評価するため、教育前(1ヵ月)のスキン-テア発生率と教育後(6ヵ月間)の発生率を評価した。結果:42名の看護師が教育セミナーに参加した。また97名の高齢患者の前腕皮膚を確認した。調査施設では、教育セミナー後にスキン-テア予防のための保湿剤、医療用シリコンテープ、被覆材、アームカバーが新たに導入された。教育前1ヵ月のスキン-テア発生率は2.1%であった。教育後6ヵ月間のスキン-テア発生率の詳細は、教育1ヵ月後4.2%、4ヵ月後までは1.1%、6ヵ月後0.0%であった。結論:スキン-テア予防教育の実施は、看護師のスキン-テアへの理解を深め、予防に役立つ可能性が示唆された。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2020&ichushi_jid=J05543&link_issn=&doc_id=20210119370002&doc_link_id=%2Fdv9etwoc%2F2020%2F002404%2F002%2F0379-0387%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdv9etwoc%2F2020%2F002404%2F002%2F0379-0387%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本創傷治癒学会  

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Language：Japanese   Publisher：(一社)日本創傷治癒学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：NATURE PUBLISHING GROUP  

Study design Secondary analysis of a cross-sectional observation study. Objectives To determine the relationship between skin ultrasound images and muscle damage in wheelchair basketball athletes, using skin blotting examinations of the ischial regions. Setting Community, Japan. Methods Fourteen elite wheelchair basketball athletes were recruited. We obtained data regarding participants' characteristics. We undertook ultrasonographic images and quantitative skin blotting of the ischial region before and after training, and after rest. Results We identified Category II and III pressure injuries in 2 of the 12 participants. Structural features were classified into four categories based on ultrasonographic features, namely, normal skin structure, unclear superficial and deep fascia, cloudy fat layer, and fat infiltration and low-echoic lesion/anechoic lesions. The muscle-type creatinine kinase (CK-M) level (median [interquartile range: IQR], 2.98 [2.80-3.47]) in the fat infiltration and low-echoic lesion/anechoic lesion group was significantly higher (1.43 [1.41-1.49]) than in a nonfat infiltration and low-echoic lesion/anechoic lesion group after training (p = 0.03). The interleukin-6 (IL-6) level (median [IQR], 23.5 [16.15-58.97]) in the fat infiltration and low-echoic lesion/anechoic lesion group was significantly higher (1.94 [1.74-4.44]) than in the nonfat infiltration and low-echoic lesion/anechoic lesion group after rest (mean difference = -25.4, 95% CI -61.1 to 10.7, p = 0.03). Conclusions The combination of ultrasonographic images and skin blotting using CK-M and IL-6, could detect early deep tissue damage in wheelchair athletes. These techniques could be potentially useful in the treatment and prevention of pressure injuries. Sponsorship This study was supported in part by YAMAHA Motor Foundation for Sports.

DOI： 10.1038/s41393-020-0442-6

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BACKGROUND: Treatment of breast cancer entails surgery, often followed by chemotherapy. Alopecia is a major, intractable side effect with potentially profound impacts on appearance. We developed a nurse-facilitated program targeting appearance-related symptoms. AIMS: This study explored the effects of the appearance care program on quality of life (QOL). The program was delivered across three sessions, each involving personal reflections on appearance concerns, short lectures on skincare and makeover techniques, and small group discussions. METHOD AND RESULTS: Seventy-two women who attended the appearance care program were invited to participate. We employed a mixed-method design combining quantitative and qualitative methods. QOL instruments were used to measure effects of the program at the first and final sessions and at a one-month follow-up. The qualitative data were collected as open-ended notes regarding participants' perception of the program at the final session and at a one-month follow-up. Fifty-seven women completed all three sessions. Of them, 55 participated in this study. Their mean age was 46.4 years; 39 (70.9%) had partners, and 34 (61.8%) had children. Most participants experienced hair loss at one-month post-program; however, cancer-specific QOL improved after attending the program. Patients' experience of fatigue and weakness may explain observations of decreased physical well-being. Emotional well-being continued to increase 1 month following the program, while social and functional well-being was consistent. Participants felt empowered by the information on skincare and cosmetic techniques and valued the intimate support from the group members facing similar circumstances. CONCLUSIONS: This study showed that the appearance care program increased or maintained the well-being of participants. Findings suggest the appearance care program which promoted group sharing experiences empowered participants and may have enhanced their coping strategies.

DOI： 10.1002/cnr2.1242

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Asteatosis is common in elderly people due to a decrease in the moisture content of the epidermal stratum corneum through a loss of skin barrier function caused by aging. Because itching often accompanies asteatosis, this condition may cause a decrease in quality of life. Care staff in elderly care facilities have many opportunities to provide care for residents. In this study, we examined how educational training on skin care changed the thoughts and actions of care staff in these facilities and how these changes impacted the skin conditions of residents. The subjects for the training were all care staff in facilities because these staff work most closely with facility residents. We performed skin care training for the subjects and investigated changes in the skin conditions of the residents before and after the training. The training promoted the understanding of skin care among the care staff and improved the skin symptoms of residents with asteatosis. However, there were no changes in the severity of itchiness based on a verbal rating scale and in interviews of residents. This study showed that skin care training for the care staff in facilities is effective to improve skin conditions of residents. In addition, it was suggested that a full grasp of the residents' skin symptoms based upon an interview on itching alone was difficult, and thus there is a need to observe skin conditions directly.

DOI： 10.1111/1346-8138.15213

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Language：Japanese   Publisher：日本ストーマ・排泄リハビリテーション学会  

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Publishing type：Research paper (scientific journal)   Publisher：Scientific Research Publishing, Inc.  

DOI： 10.4236/ojn.2020.103021

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Language：Japanese   Publisher：(一社)日本創傷治癒学会  

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Language：Japanese   Publisher：(公社)日本看護科学学会  

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Language：Japanese   Publisher：日本老年泌尿器科学会  

目的:「エコーを用いた排尿管理教育プログラム」修了後の看護師が取得した膀胱内尿量測定用の膀胱像について、その信頼性を検討する。対象と方法:プログラム履修後の看護師1名と超音波検査士1名が、一般病院の入院患者19名(平均年齢79.2歳)を被験者とし、独立して2Dエコーを用いて膀胱内尿量測定用の膀胱像を取得した。取得画像から別の看護師が膀胱内尿量を計測し、超音波検査士による測定を基準として看護師の画像の信頼性を検討した。結果:看護師と超音波検査士が取得した画像を用いて計測した膀胱内尿量の級内相関係数は0.83(p<0.01)であった。各1名の患者で、約100mLの過小誤差と約200mLの過大誤差が生じた。結論:本教育プログラムを受けた看護師は、超音波検査士とほぼ同程度の信頼性で膀胱内尿量計測用の膀胱像の取得が可能であることが示唆された。プログラムの改善と教育効果の検証のためには、今後とも検討が必要である。(著者抄録)

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Language：Japanese   Publisher：(公社)日本看護科学学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：IEEE  

To minimize the occurrence of ulcers in high-risk mobile individuals such as wheelchair users, it is necessary to detect all typical distribution patterns and to indentify the patterns that may be associated with pressure ulcers. However, pattern detection is difficult because the pressure distribution during motion includes a variety of patterns compared to those of static postures. Thus, the establishment of a method to detect typical patterns based on distribution patterns is important. We utilized deep embedded clustering for identification purposes. This clustering technique extracts features using auto-encoder and simultaneously optimizes data points into the clusters, which might realize good clustering performance due to the detected optimal features. We used a pressure distribution dataset that was pre-labeled by nursing experts. The dataset consisted of a total of 26944 distribution images with ten class annotations. The clustering method including traditional approaches (k-means and principal component analysis plus k-means) were compared with deep embedded clustering while the threshold to noise reduction was changing. The deep embedded clustering with 80 mmHg threshold achieved the best performance. This approach also tended to be less dependent on the threshold values.

DOI： 10.1109/EMBC.2019.8856751

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The prevention of progression of Category I pressure ulcers (PUs) to Category II or higher is important, as Category II or higher PUs are open wounds and have a higher infection risk. Prognosis prediction of Category I PUs is necessary to provide successful intensive care for PUs with impaired healing. We focused on skin blotting using plasminogen activator inhibitor 1 (PAI1), interleukin-1α (IL-1α), vascular endothelial growth factor C (VEGF-C), and heat shock protein 90α (HSP90α). This pilot study was conducted at long-term-care and general hospitals to examine the applicability of DESIGN-R and thermography; the feasibility of skin blotting technique; the biomarker candidates, PAI1, IL-1α, VEGF-C, and HSP90α; and sample size for prognosis prediction for Category I PUs. Patients aged >65 years underwent skin blotting, scoring for DESIGN-R, and took thermography images of their Category I PU site. Albumin signals were not detected in one out of three participants. PAI1, IL-1α, VEGF-C, and HSP90α were detected in 19 participants, among whom 11 participants could be followed up after one week. There was no difference in DESIGN-R score and skin surface temperature between normal and impaired healing groups, and the sample size was calculated as 16. In conclusion, the feasibility of skin blotting was confirmed. PAI1, IL-1α, VEGF-C, and HSP90α could be biomarker candidates for prognosis prediction for Category I PU and the combination of VEGF-C and HSP90α could be associated with the prognosis of Category I PU. We need to investigate 842 patients in a future study.

DOI： 10.1016/j.jtv.2019.02.002

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：PUBLIC LIBRARY SCIENCE  

PurposeMany breast cancer patients suffer from chemotherapy-induced hair loss. Accurate information about temporal changes in chemotherapy-induced hair loss is important for supporting patients scheduled to receive chemotherapy, because it helps them to prepare. However, accurate information, on issues such as the frequency of hair loss after chemotherapy, when regrowth starts, the condition of regrown hair, and the frequency of incomplete hair regrowth, is lacking. This study aimed to clarify the long-term temporal changes in chemotherapy-induced hair loss using patient-reported outcomes for chemotherapy-induced hair loss.MethodsWe conducted a multicenter, cross-sectional questionnaire survey. Disease-free patients who had completed adjuvant chemotherapy consisting of anthracycline and/or taxanes for breast cancer within the prior 5 years were enrolled from 47 hospitals and clinics in Japan. Descriptive statistics were obtained in this study. The study is reported according to the STROBE criteria.ResultsThe response rate was 81.5% (1511/1853), yielding 1478 questionnaires. Hair loss occurred in 99.9% of patients. The mean time from chemotherapy until hair loss was 18.0 days. Regrowth of scalp hair occurred in 98% of patients. The mean time from the completion of chemotherapy to the beginning of regrowth was 3.3 months. Two years after chemotherapy completion, the scalp-hair recovery rate was <30% in approximately 4% of patients, and this rate showed no improvement 5 years after chemotherapy. Eighty-four percent of the patients initially used wigs, decreasing to 47% by 1 year after chemotherapy and 15.2% after 2 years. The mean period of wig use was 12.5 months. However, a few patients were still using wigs 5 years after completing chemotherapy.ConclusionsOur survey focused on chemotherapy-induced hair loss in breast cancer patients. We believe these results to be useful for patients scheduled to receive chemotherapy.

DOI： 10.1371/journal.pone.0208118

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Nurses encounter difficulties evaluating constipation in elderly people with physical and cognitive impairment. Transabdominal ultrasonography (US) has been used to evaluate fecal impaction or fecal quality. However, it is unclear whether colorectal US can evaluate constipation symptoms in older people. Using colorectal US, we continuously observed the elderly and clarified the relationship between patterns of fecal distribution changes and constipation symptoms in older people with physical and cognitive impairment at long-term care facilities. This study included patients aged ≥65 years with oral intake. US was performed once a day until the next defecation, and fecal hardness was assessed. US images were extracted and categorized. Then, patterns of fecal distribution changes in the colorectum were classified. Multiple logistic regression analysis was performed to examine related factors associated with a constipation pattern. Among 101 patients, US images of 95 patients were analyzed. In 74.4% of the patients, US showed continuation of reflection with acoustic shadow in the rectum, which was significantly associated with defecation on the bed. Of the patients with a continuous crescent-shaped reflection pattern (R3), 92.9% had hard stool. R3 was found to be significantly associated with a Mini-Mental State Examination score of ≤10. In most of the patients, US detected a continuation of reflection with acoustic shadow in rectal patterns, indicating fecal retention in the rectum. Point-of-care US can be used by nurses to visualize rectal fecal retention as constipation patterns in the older people with physical and cognitive impairment at long-term care facilities.

DOI： 10.3390/healthcare6020055

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Language：Japanese   Publisher：(一社)日本小児神経学会  

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Language：English   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCI LTD  

Purpose: Skin metastasis is one of the most frequent metastases in breast cancer patients. Patients with malignant wounds experience numerous symptoms, including serious wound pain. However, the features of pain related to malignant wounds have not been investigated. Nurses can experience a dilemma when treating these patients due to a lack of knowledge of the pain. The aims of this study were to examine the quality and intensity of malignant wound pain and to determine the association between wound status and pain in the patients with malignant wounds.Methods: Cross-sectional study was conducted. Participants were recruited from a breast centre based in a general hospital. We collected the patients' demographic and wound management data and assessed wound condition. Patients evaluated wound pain intensity and quality over the preceding week using the short-form McGill Pain Questionnaire (SF-MPQ). The association between SF-MPQ results, wound condition, and the time interval for wound care was evaluated using the Spearman's correlation coefficient. The protocol was approved by the Ethical Committee of the each facilities.Results: The median age of the 22 enrolled patients was 61.5 years, and the median time after diagnosis of malignant wound was 15.5 months. Overall, 77.3% of patients complained of pain. Malignant wound pain significantly correlated with the degradation of wound edges, granulation tissue, and the time interval for wound care.Conclusion: We consider that it is necessary to provide pain-control care focused on the wound edge and granulation tissue of malignant wounds through the assessment of malignant wound pain and condition. (C) 2016 Published by Elsevier Ltd.

DOI： 10.1016/j.ejon.2016.05.004

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Language：English   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

【目的】関節拘縮や骨突出などの特徴を有する日本の寝たきり高齢患者は、褥瘡発生の危険性が高いことが知られている。これらの特徴は局所的な体圧上昇を招く。この問題を解決するために、われわれは持続体圧モニタリングを行いながら、局所的に高い体圧を感知し、該当箇所のエアセル内圧を調整することで体圧分散を行う新たな機能を有するエアマットレスを開発した。本研究の目的は、体圧モニタリングのフィードバックよりエアセル内圧を個別に調整し除圧する部分除圧機能を開発し、健常者での除圧効果を確認することである。【方法】13名の健常者を対象に、本プロトタイプエアマットレスの部分除圧機能非作動時と作動時の2条件を設定し、90度側臥位を保持したときの大転子部の体圧、血流、不快感を群間比較した。倫理的配慮は施設の倫理審査委員会の承諾を得て行った。【結果】健常者では、部分除圧を行うことで最大体圧値の軌跡が移動していた。さらに部分除圧が作動することで局所の血流の回復もみられた。また部分除圧作動により痛みによる不快感の減少が認められた。有害事象は認められなかった。【結論】健常者では部分除圧機能による除圧効果が確認でき、褥瘡予防に役立つ可能性が示された。今後は骨突出を有する寝たきり高齢者への適応について検討する必要がある。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J05543&link_issn=&doc_id=20170207500002&doc_link_id=1602817&url=https%3A%2F%2Fkango-sakuin.nurse.or.jp%2Fnid%2F1602817&type=%8D%C5%90V%8A%C5%8C%EC%8D%F5%88%F8Web&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00014_1.gif

Language：English   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

目的:本研究の目的は、赤外線サーモグラフィで捉えた静脈性下腿潰瘍(VLU)の炎症と神経成長因子(NGF)の関係を検証し、滲出液中のNGFの痛みマーカーとしての病態学的な価値を確かめることであった。方法:VLUと診断された成人患者を対象とし、外来での創傷ケア時に創部の赤外線サーモグラフィ画像と滲出液を収集した。画像は「normal temperature」と「high temperature」の2群に分類した。滲出液中のNGFをELISA法で定量したあと、それぞれの創面積で標準化し2群間比較した。本研究は研究実施施設の倫理審査委員会の承認を受けて実施された(#10389-2)。結果:13名の研究参加者より得た計28サンプルが解析対象となり、6サンプルが「normal temperature」に、22サンプルが「high temperature」に分類された。群間比較の結果、「high temperature」群のNGF濃度は「normal temperature」とくらべて有意に低かった(P=0.02)。NGF濃度の中央値の大小関係は、2群間で有意な傾向があった年齢と創面積で層別解析しても矛盾のない結果であった。結論:静脈性下腿潰瘍の滲出液中のNGFが創部の温度上昇を伴う炎症に関連することが明らかとなった。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J05543&link_issn=&doc_id=20170207500003&doc_link_id=1602818&url=https%3A%2F%2Fkango-sakuin.nurse.or.jp%2Fnid%2F1602818&type=%8D%C5%90V%8A%C5%8C%EC%8D%F5%88%F8Web&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00014_1.gif

Language：English   Publishing type：Research paper (scientific journal)  

The identification of appropriate skin tear prevention guidelines for the elderly requires clinicians to focus on local risk factors such as structural alterations of the epidermis and dermis related to skin tears. The aim of this cross-sectional study is to explore the prevalence of skin tears and to explore skin properties related to skin tears in elderly Japanese patients at a long-term medical facility. After doing the prevalence study, 18 participants with skin tears and 18 without were recruited and an evaluation of their skin properties using 20-MHz ultrasonography, skin blotting and also Corneometer CM-825, Skin-pH-meterPH905, VapoMeter, Moisture Meter-D and CutometerMPA580 was undertaken. A total of 410 patients were examined, the median age was 87 years and 73·2% were women. The prevalence of skin tears was 3·9%, and 50% of skin tears occurred on the dorsal forearm. The changes in skin properties associated with skin tears included increased low-echogenic pixels (LEP) by 20-MHz ultrasonography, decreased type IV collagen and matrix metalloproteinase-2, and increased tumour necrosis factor-α by skin blotting. In conclusion, this study suggests that increased dermal LEP, including solar elastosis, may represent a risk factor for skin tears; this indicates that skin tear risk factors might not only represent chronological ageing but also photoageing.

DOI： 10.1111/iwj.12251

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SAGE PUBLICATIONS INC  

Excessive wound exudates are troublesome symptoms of malignant fungating wounds. In particular, such exudates may cause periwound moisture-associated dermatitis (MAD). In this study, we focused on factors that contribute to skin irritation by exudates in breast cancer patients with malignant fungating wounds. Our aim was to identify the relationship between MAD surrounding malignant fungating wounds and levels of various candidate irritating factors in their exudates. We recruited 20 breast cancer patients with exudates from malignant fungating wounds and collected three types of exudate samples: pooled exudate, swab, and fresh exudate samples. We measured the pH, concentrations of polyamines (putrescine [PUT], cadaverine [CAD], spermidine, and spermine), and matrix metalloproteinases (MMP2 and MMP9) in the exudates and cultured them for bacteria. Differences between participants with and without MAD were assessed using Fisher's exact test or the Mann-Whitney U test. Of the 20 participants, 14 had MAD. There were no significant differences in median pH and MMP activity between patients with and without MAD. The level of PUT was significantly higher in the MAD than in the non-MAD group (p = .008), and CAD was detected only in the MAD group (p = .016). Prospective studies are needed to clarify correlations and causal relationships between polyamines and erythema and identify therapeutic targets for preventing the development of MAD.

DOI： 10.1177/1099800415594452

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Language：English   Publishing type：Research paper (scientific journal)  

We investigated the associations between the self-evaluated pain status and two pain biomarker candidates, nerve growth factor and S100A8/A9, in exudate from venous leg ulcer to finally develop an objective pain evaluation method. Patients with venous leg ulcer participated in this cross-sectional observational study conducted between April and October 2014 at two medical facilities. During routine wound care, each participant self-evaluated their pain status at each examination using the 10-point numerical rating scale (present pain intensity) and the short-form McGill Pain Questionnaire 2 (continuous pain, intermittent pain, neuropathic pain, affective descriptors, and total score). Venous leg ulcer exudate sample was collected after wound cleansing. The nerve growth factor and S100A8/A9 concentrations in the venous leg ulcer exudate were measured by enzyme-linked immunosorbent assay and standardized according to the wound area. The association between each pain status and the two standardized protein concentrations was evaluated using Spearman's correlation coefficient. In 30 sample collected from 13 participants, the standardized nerve growth factor concentration was negatively correlated with continuous pain (ρ = -0.47, P = 0.01), intermittent pain (ρ = -0.48, P = 0.01), neuropathic pain (ρ = -0.51, P = 0.01), and total score (ρ = -0.46, P = 0.01). The standardized S100A8/A9 concentration was positively correlated with present pain intensity (ρ = 0.46, P = 0.03) and continuous pain (ρ = 0.48, P = 0.03). Thus, these two proteins may be useful for objective evaluation of wound pain in venous leg ulcer patients.

DOI： 10.1371/journal.pone.0167478

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Language：English   Publisher：AMER SOC CLINICAL ONCOLOGY  

DOI： 10.1200/jco.2015.33.15_suppl.e17673

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Language：English   Publisher：AMER ASSOC CANCER RESEARCH  

DOI： 10.1158/1538-7445.SABCS14-P5-15-17

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Language：English   Publisher：AMER ASSOC CANCER RESEARCH  

DOI： 10.1158/1538-7445.SABCS14-P5-15-09

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Language：English   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：The Society for Nursing Science and Engineering  

&emsp;One aspect of preventive care for diabetic foot ulcers is the production of therapeutic footwear for diabetic patients. Some patients with diabetes do not have therapeutic footwear, even though it is recommended by health providers. Effective intervention is unknown because the production process is unclear. Therefore, the production process for therapeutic footwear for diabetic patients was investigated qualitatively. Twenty-two diabetic patients who visited the university hospital from April 2008 to November 2012 and for whom therapeutic footwear was recommended were recruited. A semistructured interview concerning the process from proposal of therapeutic footwear to its production and subsequent continuous use or, in contrast, its lack of production, was conducted. The core category was"value the design of shoes, and continue to not rely on therapeutic footwear". The subjects who did not have therapeutic footwear valued the design of shoes, interpreted diabetic foot ulcer in their own way, and continued to not rely on therapeutic footwear given that non-ulcerative lesions do not develop into ulcers. Shared knowledge between patients and health providers that functionality of shoes is important and the development of well-designed footwear are needed.

DOI： 10.24462/jnse.2.1_15

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J06462&link_issn=&doc_id=20150130600003&doc_link_id=10.24462%2Fjnse.2.1_15&url=https%3A%2F%2Fdoi.org%2F10.24462%2Fjnse.2.1_15&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：English   Publishing type：Part of collection (book)   Publisher：Nova Science Publishers, Inc.  

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Language：Japanese   Publisher：(公財)大和証券ヘルス財団  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：DOVE MEDICAL PRESS LTD  

Purpose: We aimed to identify distinguishing characteristics in thermographic images of venous leg ulcer (VLU), for objective evaluation of VLU-related nociceptive pain.Patients and methods: Secondary analysis was performed, using existing data obtained from April to November 2010, for patients with VLU. Thermographic images of wounds and their surrounding area were classified according to the periwound temperature pattern as "normal temperature" or "high temperature". These results were compared with the self-reported pain intensity assessed by the short-form McGill Pain Questionnaire. Cohen's kappa coefficients were used to evaluate the interrater reliability for temperature assessment, and Wilcoxon rank sum test was used to compare pain intensities between the two groups.Results: Among 39 thermographic examinations in eight patients, 22 were classified into the high-temperature group and 17 into the normal-temperature group. Kappa coefficients for the temperature classification were 0.90 between the wound, ostomy, and continence nurse and a wound care specialist, and 0.90 between the wound, ostomy, and continence nurse and a graduate student. The pain rating index (Z=-2.981, P=0.003), sensory pain (Z=-3.083, P=0.002), affective pain (Z=-2.764, P=0.006), and present pain intensity (Z=-2.639, P=0.006) ratings were significantly higher in the high-temperature group than in the normal-temperature group, but the visual analog scale (Z=-0.632, P=0.527) was not significantly different between the two groups.Conclusion: Thermographic pattern may reflect VLU-related nociceptive pain due to inflammation and has the possibility of being an easy and rapid tool for objective pain evaluation.

DOI： 10.2147/CWCMR.S67054

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY  

AIM: Primary lymphedema requires continuous conservative treatment during the patient's life, which may affect their health-related quality of life (HRQOL). Physical and psychosocial characteristics related to lymphedema are associated with their HRQOL. This study aimed to assess HRQOL in those patients undergoing conservative treatment and to determine the factors associated with their HRQOL. METHODS: This was a cross-sectional, observational study that included 83 patients with primary lymphedema at an outpatient clinic for lymphedema. HRQOL was assessed with the Medical Outcomes Study 36-Item Short Form Survey (SF-36) and EuroQol 5-Dimension (EQ-5D). Lymphedema status/complications and psychosocial status were evaluated by medical records, physical assessment, and self-administrative questionnaires. RESULTS: The general health perception score in the SF-36 was lower than the age- and sex-stratified national norms (P = 0.001). In the EQ-5D, the proportions of patients with some/moderate or severe problems were 42.2% for pain/discomfort, 21.7% for usual activities, and 20.5% for anxiety/depression. By multiple regression analyses, a lower physical component summary score in the SF-36 was associated with a higher lymphedema stage (P = 0.021), cellulitis within 30 days (P = 0.003), exercise (P = 0.010), and more substance use coping (P = 0.012). A lower mental component summary score was associated with skin lesions over edematous limbs (P = 0.008), less humor coping (P = 0.005), and more self-blame coping (P = 0.014). CONCLUSION: Patients with primary lymphedema have problems in health perception, discomfort, usual activities, and anxiety/depression. Preventing cellulitis and skin lesions and humor coping may be able to improve HRQOL.

DOI： 10.1111/j.1742-7924.2012.00220.x

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Language：English   Publishing type：Research paper (scientific journal)  

Tissue expander and implant (TE/I) breast reconstruction has been increasing recently. In TE/I breast reconstruction, infection leads to reconstruction failure and is the most serious complication. The infection rate was reported to be higher during the tissue expander period than the implant period. However, few studies have investigated the risk factors for infection during tissue expansion following TE/I breast reconstruction. The goal of this study was to identify risk factors for infection during tissue expansion in TE/I breast reconstruction and to develop a simple risk scoring tool for infection that can be used for clinical application. In this retrospective cohort study, 981 patients who received TE/I breast reconstruction were surveyed and analyzed at one of the main clinics performing TE/I breast reconstruction in Japan. Numerous potential risk factors were collected from the clinical charts. Multiple logistic regression analyses were used to identify risk factors for infection. To develop a risk scoring tool, we converted the coefficients of the identified predictors estimated in the multiple logistic regression analyses into simplified risk scores. We assessed the tool discrimination by drawing a receiver operating characteristic curve and calculating the area under the curve. Infection was noted in 47 patients (4.79%) during tissue expansion. In multiple logistic regression analyses, diabetes, repeated expander insertions, larger expander size (≥400 cc), postoperative hormone therapy before silicone implant surgery, preoperative chemotherapy, and nipple-sparing mastectomy were identified as risk factors for infection during expansion. The area under the curve of the risk scoring tool for infection was 0.734 (95% CI: 0.662-0.807). We have revealed risk factors and proposed a risk scoring tool for infection during tissue expansion in TE/I breast reconstruction. This study may contribute to the prevention and prediction of infection. © 2013 Wiley Periodicals, Inc.

DOI： 10.1111/tbj.12175

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCI LTD  

Purpose: Patients with malignant breast wounds (MBWs) have multiple symptoms. In particular, care for exudates or pen-wound moisture-associated dermatitis (MAD) is difficult. However, MAD has not been distinguished from pen-wound dermatitis. Therefore, care for patients with MAD has not been well established. The aim of this study was to describe morphological characteristics of MAD in MBWs and link morphological characteristics of MAD to related factors.Methods: We conducted a qualitative descriptive study and a cross-sectional study. Data were collected by qualitative participant observation and structured interviews. The qualitative descriptive study was conducted using the 'morphoqualitative analysis' method. Data analyses were performed using qualitative research methods. In the cross-sectional study, the participants were classified into 2 groups for comparison: with MAD (MAD group) and without MAD (non-MAD group).Results: Characteristics of 24 MBWs were examined. Morphoqualitative analyses of data generated 17 subcategories and 3 categories. We could morphologically define MAD by findings of 'radial shape matching the dressing' and 'half-fusiform shape over the dressing'. Regarding factors related to MAD, necrotic tissue type was significantly more severe in the MAD group than in the non-MAD group (p = 0.048). Wound exudate leakage was significantly more frequent in the MAD group than in the non-MAD group (p = 0.013).Conclusion: Our study provides several points for nursing MBWs. Morphoqualitative analyses of MAD are quite important for evaluating possible causes of MAD as well as selecting effective interventions. (C) 2013 Published by Elsevier Ltd.

DOI： 10.1016/j.ejon.2013.05.005

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

目的:男性の尿失禁に起因する皮膚障害の予防にはパッドを用いた従来のケアでは不十分である。そこで本研究は新たに開発したパウチを用いた男性用尿失禁ケア用具(パウチ付き紙おむつ)を使用してモデルおよび健常人実験を行い、おむつ内・外への尿漏れ防止効果ならびに皮膚生理機能へ与える影響を評価した。方法:モデル人形と健常男性を対象にパウチ付き紙おむつの使用またはパッドを陰茎に巻くケアを行い、各ケアがおむつ内・外への尿漏れや皮膚生理機能、温湿度、使用者の主観的評価に与える影響を群間で比較した。本研究は東京大学大学院医学系研究科倫理委員会の承認を得て行った。結果:モデル実験ではパウチ付き紙おむつ使用群ですべての実験条件で有意におむつ内・外への尿漏れ割合が減少した。健常人実験(N=15)では、パウチ付き紙おむつ使用群でおむつ内への尿漏れ割合が有意に減少した。また皮膚生理機能は、角質水分量がパッドによるケアで鼠径部、仙骨部、臀部で排尿前より排尿後に有意に上昇し、皮膚pHはパッドによるケアで仙骨部および臀部で排尿前より排尿後に有意に上昇していた。使用者の主観的評価は排尿後の履き心地、かゆみとにおいにおいてパウチ付き紙おむつ使用群のほうが有意に良好であった。結論:パウチ付き紙おむつの使用はパッドによるケアよりもおむつ内への尿漏れの発生や皮膚生理機能の変化を抑えることができた。さらに使用者の主観的な評価も高いことから、新たな尿失禁ケア方法として用いることが期待できる。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J05543&link_issn=&doc_id=20130722410002&doc_link_id=1302710&url=https%3A%2F%2Fkango-sakuin.nurse.or.jp%2Fnid%2F1302710&type=%8D%C5%90V%8A%C5%8C%EC%8D%F5%88%F8Web&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00014_1.gif

Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：(株)総合医学社  

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Language：Japanese   Publisher：(株)南江堂  

＜文献概要＞▼終末期には,全身状態の悪化により皮膚の還流障害や低酸素化が生じるため,褥瘡を含めた皮膚変化が発生しやすい.▼終末期にある高齢者(非がん患者)の褥瘡の特徴は,腸骨部や大転子部の骨上に一致する「スポット状の赤黒い二重発赤/紫斑」や「線形の明瞭な紫斑」であった.▼終末期の褥瘡ケアでは,患者の安楽とQOL,悪化予防と治癒促進のバランスをとりながら進めることが重要である.

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J00974&link_issn=&doc_id=20210208090010&doc_link_id=10.15106%2Fj_naika127_199&url=https%3A%2F%2Fdoi.org%2F10.15106%2Fj_naika127_199&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：English   Publisher：The Society for Nursing Science and Engineering  

Aims and methods: Chemotherapy agents cause damage to the scalp, including hair matrix cells, an inflammatory response activating c-fibers, or basal cells, and induce pain and itching on the scalp. We preliminarily investigated the relationship between epidermal thickness and scalp pain and itching in breast cancer patients undergoing chemotherapy. Epidermal thickness was measured as the depth from the top level of the stratum granulosum using <i>in vivo</i> reflectance confocal microscopy (RCM). Results: Case 1: A 33-year-old Japanese woman complained of scalp itching from baseline to 24 weeks later. Her epidermal thickness decreased during chemotherapy. Case 2: A 37-year-old Japanese woman exhibited scalp pain and itching three weeks later. Her epidermal thickness decreased during chemotherapy. Case 3: A 44-year-old Japanese woman complained of scalp pain and itching during hair loss. Erythema and eczema simultaneously appeared on her scalp. Her epidermal thickness decreased during chemotherapy. Conclusion: This study confirmed the relationship between epidermal thickness and scalp pain and itching during chemotherapy. RCM measurements are non-invasive methods and may be useful in predicting scalp symptoms.

DOI： 10.24462/jnse.8.0_143

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Language：English   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

Objective: Skin tears cause pain and distress for patients, and it is important to educate nurses regarding skin tear prevention. This study aimed to investigate the effectiveness of a nursing education regarding skin tear prevention in a Japanese long-term care hospital. <br> Methods: A pre-post study was conducted at a 736-bed long-term care facility in Tokyo, Japan (December 2018 to August 2019). Nurses attended a skin tear prevention seminar, which provided information regarding the definition of skin tears, risk factors, a skin tear classification system, treatment, preventive care, and various related products (arm protectors, dressings, and skin friendly silicone adhesive tapes). The primary outcome for evaluating the effectiveness of the education program was the incidences of skin tears during the 1-month period before the seminar and during the 6-month period after the seminar. <br> Results: Forty-two nurses were recruited and attended the educational seminar, and 97 older adults consented to evaluations of their forearm skin. The care products introduced in the hospital after the educational seminar were skin moisturizers, silicon medical tapes, silicone foam dressings, and arm protectors. The incidence of skin tears was 2.1% during the 1-month period before the seminar. During the 6-month period after the seminary, the monthly incidences of skin tears were 4.2% during the first month after the seminar, 1.1% during the next 4 months, and 0.0% during the sixth month. <br> Conclusion: Education regarding skin tear prevention may help nurses better identify and prevent skin tears.

DOI： 10.32201/jpnwocm.24.4_379

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J05543&link_issn=&doc_id=20210119370002&doc_link_id=10.32201%2Fjpnwocm.24.4_379&url=https%3A%2F%2Fdoi.org%2F10.32201%2Fjpnwocm.24.4_379&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(一社)日本褥瘡学会  

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Language：Japanese   Publisher：日本コミュニケーション障害学会  

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Language：Japanese   Publisher：日本ストーマ・排泄リハビリテーション学会  

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Language：English   Publisher：看護理工学会  

本研究の目的は高齢者のスキンテア再発を予防するために起因外力に関連するスキンテアの形態的特徴を抽出することである.研究デザインは質的記述的研究で,腕に発生したテア23例の写真と起因外力に関する情報を発見者から半構造化面接で得た.最初にテアの形態的特徴を抽出するために,写真をスケッチして形態的特徴を分類するドラフトを作成した.つぎに,テアの起因外力に関するインタビューから外力サブカテゴリーを抽出した.形態分類ドラフトのカテゴリーとして部位・形・スキンフラップ・紫斑・サイズが含まれた.起因外力に関する情報から起因者(患者・介助者・装着物)と外力のタイプを示すサブカテゴリー(ぶつける・拭く・引っ張る・爪が食い込む・引っ掻く・擦れる)が抽出された.起因外力サブカテゴリーに対応する形態分類ドラフトを分析すると,テアの起因外力を推定する要素として4つの形態的特徴(紫斑・形・円弧の深さ・サイズ)が特定された.(著者抄録)

DOI： 10.24462/jnse.7.0_68

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Language：Japanese   Publisher：日本老年泌尿器科学会  

目的:「エコーを用いた排尿管理教育プログラム」修了後の看護師が取得した膀胱内尿量測定用の膀胱像について、その信頼性を検討する。対象と方法:プログラム履修後の看護師1名と超音波検査士1名が、一般病院の入院患者19名(平均年齢79.2歳)を被験者とし、独立して2Dエコーを用いて膀胱内尿量測定用の膀胱像を取得した。取得画像から別の看護師が膀胱内尿量を計測し、超音波検査士による測定を基準として看護師の画像の信頼性を検討した。結果:看護師と超音波検査士が取得した画像を用いて計測した膀胱内尿量の級内相関係数は0.83(p<0.01)であった。各1名の患者で、約100mLの過小誤差と約200mLの過大誤差が生じた。結論:本教育プログラムを受けた看護師は、超音波検査士とほぼ同程度の信頼性で膀胱内尿量計測用の膀胱像の取得が可能であることが示唆された。プログラムの改善と教育効果の検証のためには、今後とも検討が必要である。(著者抄録)

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Language：Japanese   Publisher：(一社)日本老年医学会  

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Language：Japanese   Publisher：(一社)ライフサポート学会  

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Language：Japanese   Publisher：(株)へるす出版  

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Language：Japanese   Publisher：(株)へるす出版  

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Language：Japanese   Publisher：(一社)日本褥瘡学会  

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Language：Japanese   Publisher：(株)へるす出版  

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Language：Japanese   Publisher：(一社)日本褥瘡学会  

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Language：Japanese   Publisher：(株)へるす出版  

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Language：Japanese   Publisher：(一社)日本小児神経学会  

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：(一社)日本小児神経学会  

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Language：Japanese   Publisher：(株)へるす出版  

CiNii Books

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J-GLOBAL

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J-GLOBAL

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Language：Japanese   Publisher：(公社)日本看護科学学会  

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Language：Japanese   Publisher：(公社)日本看護科学学会  

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Language：Japanese   Publisher：(一社)日本創傷治癒学会  

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Language：Japanese  

CiNii Books

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Language：Japanese   Publisher：(一社)日本褥瘡学会  

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Language：Japanese   Publisher：(一社)日本褥瘡学会  

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Language：Japanese   Publisher：(株)へるす出版  

CiNii Books

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：The Society for Nursing Science and Engineering  

&emsp;This study aimed to describe the relationship between inappropriate conditions due to multiple puncture attempts for catheterization and thrombus formation with subcutaneous edema at catheter failure by qualitative analysis and ultrasonography. Seven categories were extracted, and two stories were identified using qualitative-descriptive analyses. First, when attempting multiple insertions, ＜puncture sites＞ were chosen, such as the ulnar side and dorsum of the hand, while ＜visual judgment of target vein＞ was difficult, and the ＜posture at insertion＞ was contorted. The catheters were not inserted parallel to the sagittal plane, and the echo image confirmed that ＜intravascular position of catheter tip＞ were not parallel to the vessels. Second, with IV cannulation on the radial side, during manipulation of the ＜securement by dressing films＞, the mesh part of the IV dressing covered the connector area and caused it to sink into the patient's skin in the ＜peripheral condition of the hubs/connectors attached to the apparatus＞. These phenomena were observed in many echo images in which the tip of the catheter was placed in the upstream direction of the blood vessels. Our results suggested that the posture of the body during insertion and the securement methods could affect thrombus and edema formation, since mechanical stimuli affected the blood vessels and subcutaneous tissue.

DOI： 10.24462/jnse.5.1_2

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J06462&link_issn=&doc_id=20180206470001&doc_link_id=10.24462%2Fjnse.5.1_2&url=https%3A%2F%2Fdoi.org%2F10.24462%2Fjnse.5.1_2&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：English   Publisher：看護理工学会  

細胞外基質分解酵素(MMPs)は、創傷治癒の進行と阻害にかかわる酵素であり、その活性は創部炎症状態を反映するバイオマーカーとして期待される。しかし、状態の異なる部位が混在する慢性創傷において、MMP活性の分布を可視化する技術は開発されていない。そこで、本研究では創面ブロッティング技術とザイモグラフィ技術を組み合わせて、MMP活性分布解析法の開発を試みた。マウス全層欠損創において、創作成後3、7、10日目に創面ブロッティングを実施し、ゼラチンゲルと反応させた。ゲルのタンパク質染色イメージは画像解析により、従来の電気泳動ザイモグラフィにくらべて感度は低いものの、MMP活性の分布イメージが得られた。MMP活性は創作製後3日目には創縁に分布し、その後創底シグナルに変化するパターンと創縁シグナルが継続するパターンがみられ、シグナル分布パターンが創部炎症状態を反映している可能性が示唆された。(著者抄録)

DOI： 10.24462/jnse.5.1_58

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J06462&link_issn=&doc_id=20180206470007&doc_link_id=10.24462%2Fjnse.5.1_58&url=https%3A%2F%2Fdoi.org%2F10.24462%2Fjnse.5.1_58&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

J-GLOBAL

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Language：Japanese   Publisher：看護理工学会・看護実践学会・国際リンパ浮腫フレームワーク・ジャパン研究協議会  

J-GLOBAL

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Language：Japanese   Publisher：看護理工学会・看護実践学会・国際リンパ浮腫フレームワーク・ジャパン研究協議会  

J-GLOBAL

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Language：Japanese   Publisher：看護理工学会・看護実践学会・国際リンパ浮腫フレームワーク・ジャパン研究協議会  

J-GLOBAL

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Language：English   Publisher：看護理工学会  

皮膚バリア機能の代表的な評価方法に経皮水分蒸散量(TEWL)があげられる。しかし、臨床の場において安定したTEWLの値を得ることはむずかしい。本研究では、皮膚バリア機能の新たな評価方法として、スキンブロッティングによるアルブミン検出法を評価するために、動物と人におけるTEWLとスキンブロッティングによるアルブミン検出強度の相関を分析した。結果として、マウスの背部皮膚ならびに人の前腕皮膚のアルブミン検出強度はTEWLと有意に相関していた(マウス;r=0.56、p=0.02、人;r=0.73、p<0.01)。以上より、スキンブロッティングによるアルブミン検出強度はTEWLの代替としての皮膚バリア機能評価として非侵襲・安定的な方法といえる。(著者抄録)

DOI： 10.24462/jnse.4.2_116

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J06462&link_issn=&doc_id=20170803310004&doc_link_id=10.24462%2Fjnse.4.2_116&url=https%3A%2F%2Fdoi.org%2F10.24462%2Fjnse.4.2_116&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：English   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

目的:精神疾患を有する患者における褥瘡発生の問題解決には、褥瘡の特徴を理解し、発生要因を検討することが重要である。本研究では、精神疾患を有する患者の褥瘡の実態を調査するとともに、質的スケッチ技法により、褥瘡の形態とその発生状況の関係を検討した。方法:まず後ろ向き研究として褥瘡回診のデータから精神疾患を有する患者とその他の患者の比較(研究1)を行い、精神疾患を有する患者の褥瘡の形態的特徴と褥瘡発生状況を質的記述的に分析(研究2)した。結果:対象は精神疾患を有する患者15名、その他の患者262名であった。精神疾患を有する患者は、その他の患者と比較し、年齢が低く、歩行可能であった。さらに褥瘡の保有個数が多く、院外発生が有意に多かった。また座位で発生する褥瘡がみられなかった。精神疾患を有する患者の褥瘡に特有な形態的特徴として、形は<雲状形>と<シャープ形>、色は<まだら>のカテゴリーが抽出された。褥瘡発生状況における褥瘡部位へかかる外力は<小刻みに動く>、<大きく動く>、<まったく動かない>、<自傷行為>、発生要因は、<精神科治療薬の過剰投与>、<過量服薬>、<身体拘束>、<循環不全>があげられた。結論:精神疾患を有する患者は自立度が高く、比較的若年であるにもかかわらず、褥瘡が多発していた。発生状況としては、動きや自傷行為による外力と、精神科治療薬の服用量や身体拘束といったケアによる要因が関係していた。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J05543&link_issn=&doc_id=20171024470002&doc_link_id=1701650&url=https%3A%2F%2Fkango-sakuin.nurse.or.jp%2Fnid%2F1701650&type=%8D%C5%90V%8A%C5%8C%EC%8D%F5%88%F8Web&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00014_1.gif

Language：English   Publisher：看護理工学会  

低栄養状態では、側頭部皮下の筋肉や脂肪の厚みが減少し、側頭部が陥没するが、その客観的評価法は未確立である。そこで、側頭部の皮膚硬度計による測定が皮下の組織厚の代替指標として側頭部の形状を反映し、栄養状態の指標になりうると考えた。健常成人13名において、皮膚硬度計で側頭部の皮膚硬度を、超音波検査法で側頭部の総組織厚、筋厚、脂肪厚を計測し、身体計測による栄養評価を実施した。側頭部の皮膚硬度は、側頭部の総組織厚(r=0.782、p=0.002)、脂肪厚(r=0.717、p=0.006)と有意に相関し、さらに栄養状態の指標であるBody Mass Index(r=0.665、p=0.013)、上腕周囲長(r=0.682、p=0.010)、下腿周囲長(r=0.618、p=0.024)と有意に相関した。側頭部の皮膚硬度は皮下の総組織厚(特に脂肪厚)および栄養状態を反映し、新たな栄養指標になりうると示唆された。(著者抄録)

DOI： 10.24462/jnse.4.1_49

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J06462&link_issn=&doc_id=20170206410006&doc_link_id=10.24462%2Fjnse.4.1_49&url=https%3A%2F%2Fdoi.org%2F10.24462%2Fjnse.4.1_49&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：English   Publisher：国際リンパ浮腫フレームワーク・ジャパン研究協議会  

背景:原発性リンパ浮腫患者とがん関連リンパ浮腫患者では疾患の成り立ちやその背景の違いから健康関連QOL(HRQOL)やコーピングスタイルが異なることが予測される。本研究は,原発性下肢リンパ浮腫患者とがん関連下肢リンパ浮腫患者を比較することにより,原発性リンパ浮腫患者のHRQOLとコーピングスタイルを明らかにすることを目的とする。方法:HRQOLを測定するスケールとしてSF-36日本語版,日本語版HAD尺度(HADS)を用い,コーピングスタイルの測定には日本語版Brief-COPEを用いた。基本属性,リンパ浮腫の状態は診療録,フィジカルアセスメントより情報を得た。結果:原発性下肢リンパ浮腫患者78名,がん関連下肢リンパ浮腫患者63名が対象となった。年齢,性別をマッチングさせた国民標準値と比較すると原発性下肢リンパ浮腫患者におけるHRQOLは全般的健康感(GH)のみ低い結果であった。さらに,共分散分析を用い年齢,性別を調整した両群のHRQOLの比較においては,有意差は認められなかった。HADSでは,不安,抑うつともに点数8(不安,抑うつの疑いのあるスコア)以上の患者の割合は低い結果であった。Brief-COPEの項目では,原発性下肢リンパ浮腫患者における積極的コーピングと自己非難の得点が,がん関連下肢リンパ浮腫患者よりも高い結果であった。結論:原発性下肢リンパ浮腫患者とがん関連下肢リンパ浮腫患者のHRQOLの違いは確認されなかったが,コーピングスタイルの違いが明らかとなった。(著者抄録)

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本褥瘡学会  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：(株)メディカ出版  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J05743&link_issn=&doc_id=20160315290006&doc_link_id=issn%3D2185-7318%26volume%3D6%26issue%3D2%26spage%3D141&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D2185-7318%26volume%3D6%26issue%3D2%26spage%3D141&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：(一社)ライフサポート学会  

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Language：English  

AIM: The purpose of the present study was to assess the difference in foot temperature between tinea unguium-positive older adults with subungual hyperkeratosis and tinea unguium-negative older adults with subungual hyperkeratosis to develop a temperature-based screening method for tinea unguium. METHODS: The present cross-sectional, observational study investigated 51 residents with subungual hyperkeratosis in two facilities covered by long-term care insurance between October 2011 and December 2011. One dermatologist recorded the clinical signs of abnormal toenails. Nail specimens were collected from all abnormal nails, and the presence of tinea unguium was confirmed when fungus was detected by direct microscopy. Foot temperature was measured by infrared thermography. A receiver operating characteristic curve was used to assess the ability to determine whether residents with subungual hyperkeratosis have tinea unguium and to determine the cut-off point. RESULTS: Among the people with subungual hyperkeratosis, the mean toe temperature in the tinea unguium-positive group (30.2 ± 2.6°C) was significantly lower than that in the tinea unguium-negative group (32.8 ± 3.2°C, P = 0.001). The area under the receiver operating characteristic curve was 0.74 (95% confidence interval 0.621-0.876), and the threshold temperature was set at 33.0°C, resulting in a sensitivity of 81.8% and specificity of 65.7%. CONCLUSION: Our study suggests that foot temperature can be used to screen for tinea unguium in people with subungual hyperkeratosis. This non-invasive and simple screening method would help clinicians to set priorities in terms of carrying out direct microscopy to diagnose tinea unguium in elderly residents in care facilities.

DOI： 10.1111/ggi.12380

PubMed

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

私達は先行研究で、皮膚・排泄ケア認定看護師(以下WOC看護師)が、医行為を含めた特定行為としての高度創傷管理技術を行うためのプロトコールを作成し、その有効性を報告した。本研究は、このプロトコールを臨床へ導入し定着させたプロセスを質的に記述することである。対象者は、先行研究実施に伴う教育を受講したWOC看護師10名とし、フォーカスグループインタビューを実施した。得られたデータより逐語録を作成し、高度創傷管理技術を導入し定着させるプロセスを概念化した。結果、特定行為としての高度創傷管理技術を臨床導入し定着させるためにWOC看護師は、【これまでの実践基盤を軸とし安全に医行為を実践できる協働体制を強化】することを実践していた。医行為の安全な実践に対して周囲の認知を得る場を設定、つぎに成果をエビデンスとして提示し、周囲の理解を獲得して技術を定着させる2つのプロセスが明らかになった。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J05543&link_issn=&doc_id=20141027340007&doc_link_id=1402824&url=https%3A%2F%2Fkango-sakuin.nurse.or.jp%2Fnid%2F1402824&type=%8D%C5%90V%8A%C5%8C%EC%8D%F5%88%F8Web&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00014_1.gif

Language：Japanese   Publisher：(一社)ライフサポート学会  

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Language：Japanese   Publisher：(一社)ライフサポート学会  

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Language：Japanese   Publisher：(一社)日本褥瘡学会  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：(一社)日本看護研究学会  

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：一般社団法人 日本看護研究学会  

DOI： 10.15065/jjsnr.20130722157

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Language：English   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

尿失禁は高齢者の健康問題の1つである。尿失禁を有する高齢者は失禁用品を日常的に使用する。特に紙オムツと尿とりパッドの併用は臨床現場で多く、体圧の上昇や蒸れの問題が懸念されている。近年ネットパンツがアウターとして使用されるようになってきた。しかしネットパンツの有用性については十分明らかではないため、幅広い使用にいたっていない。われわれはネットパンツの有用性を明らかにするため、客観的な皮膚温湿度、ならびに主観的な快適性を紙オムツと比較することにより評価した。研究デザインはクロスオーバー試験であり、ネットパンツと紙オムツを交互に着用した。6名の健常人の仰臥位時の臀部皮膚温湿度を経時的に測定するとともに、快適性に関するVASの評価も行った。皮膚温湿度は基準値に対する相対値で比較し、ウィルコクソンの符号付順位和検定を用いて解析した。その結果、60分後の左脇骨部皮膚湿度の相対値は、紙オムツ群よりネットパンツ群で低い傾向にあった(P=0.063)。一方で尿とりパッドに覆われていた仙骨部と恥骨上部は皮膚温湿度ともに両群で差はなかった。VASの評価では、「フィット感のなさ」、「違和感」、「動きにくさ」の項目でネットパンツ群が有意に低値であり、快適に感じていた。本研究より失禁用品は尿とりパッドの選択が重要であり、さらにアウターとしてのネットパンツは主観的にも客観的にも快適であるため、患者のQOL向上に役立つ可能性が示唆された。(著者抄録)

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Language：Japanese   Publisher：(一社)日本創傷治癒学会  

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

難治性のために患者のQOLの低下を招く静脈性下腿潰瘍のケア介入につながるアセスメントツールの将来的な作成上の基礎資料とするために、本研究は肉眼的に観察可能である静脈性下腿潰瘍に特有の治癒のプロセスを明らかにすることを目的とした。6ヵ月間に、静脈疾患が専門の医師が勤務する一般病院に受診した患者の静脈性下腿潰瘍10部位の変化を縦断的に記述し、グラウンデッド・セオリー・アプローチの手法を用いて分析を行った。分析の結果、静脈性下腿潰瘍は、&lt;下肢のうっ滞の改善&gt;に伴い、&lt;創周囲皮膚の正常化&gt;、&lt;滲出液の量と質の改善&gt;、&lt;創面の付着物の減少&gt;が同時期に起こる結果、&lt;肉芽の浮腫の改善&gt;が起こる。その後、&lt;良性肉芽の出現&gt;、&lt;色調変化のある肉芽の出現&gt;がみられ、最終的に創周囲から、または周囲および創内部からの島状の&lt;上皮化の開始&gt;が生じて創閉鎖にいたるというプロセスが抽出された。特に、今回、新たな知見として、(1)肉芽内部の点状の陥凹部分から島状の上皮化が起こること、(2)褐色の肉芽部分からも上皮化が起こることの2点が静脈性下腿潰瘍の治癒過程の特徴として初めて明らかになった。本研究の結果により、静脈性下腿潰瘍は他の慢性創傷とくらべて特徴的な治癒過程をたどること、したがって、静脈性下腿潰瘍特有の創面のアセスメントツールが必要であることが示唆された。(著者抄録)

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

難治性のために患者のQOLの低下を招く静脈性下腿潰瘍のケア介入につながるアセスメントツールの将来的な作成上の基礎資料とするために、本研究は肉眼的に観察可能である静脈性下腿潰瘍に特有の治癒のプロセスを明らかにすることを目的とした。6ヵ月間に、静脈疾患が専門の医師が勤務する一般病院に受診した患者の静脈性下腿潰瘍10部位の変化を縦断的に記述し、グラウンデッド・セオリー・アプローチの手法を用いて分析を行った。分析の結果、静脈性下腿潰瘍は、&lt;下肢のうっ滞の改善&gt;に伴い、&lt;創周囲皮膚の正常化&gt;、&lt;滲出液の量と質の改善&gt;、&lt;創面の付着物の減少&gt;が同時期に起こる結果、&lt;肉芽の浮腫の改善&gt;が起こる。その後、&lt;良性肉芽の出現&gt;、&lt;色調変化のある肉芽の出現&gt;がみられ、最終的に創周囲から、または周囲および創内部からの島状の&lt;上皮化の開始&gt;が生じて創閉鎖にいたるというプロセスが抽出された。特に、今回、新たな知見として、(1)肉芽内部の点状の陥凹部分から島状の上皮化が起こること、(2)褐色の肉芽部分からも上皮化が起こることの2点が静脈性下腿潰瘍の治癒過程の特徴として初めて明らかになった。本研究の結果により、静脈性下腿潰瘍は他の慢性創傷とくらべて特徴的な治癒過程をたどること、したがって、静脈性下腿潰瘍特有の創面のアセスメントツールが必要であることが示唆された。(著者抄録)

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

糖尿病性足潰瘍予防のための靴の種類の検討に資することを目的に、非糖尿病者である20歳以上の女性10名(平均年齢35.6±7.8歳)を対象に、靴を脱いだ後の足部の皮膚温の変化を60分間、サーモグラフィで撮影し、運動靴の場合とパンプスの場合で皮膚温のパターンを比較した。靴の順番は被験者に選択させた。その結果、運動靴の場合は「変化なし」と「趾先から低下」が多かったが、パンプスは「2・3・4趾上昇」が最も多く、ついで「1趾のみ上昇」「1・5趾上昇」が多かった。これらの結果から、パンプスを履いた場合には一部の趾のみに皮膚温の変化を生じており、一時的な血流低下や炎症を起こしている可能性があると考えた。

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Language：Japanese   Publisher：(株)南江堂  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J03022&link_issn=&doc_id=20120221370030&doc_link_id=1202116&url=https%3A%2F%2Fkango-sakuin.nurse.or.jp%2Fnid%2F1202116&type=%8D%C5%90V%8A%C5%8C%EC%8D%F5%88%F8Web&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00014_1.gif

Language：Japanese   Publisher：(一社)日本褥瘡学会  

褥瘡保有の有無は問わず、脊髄損傷(SCI)受傷後にステージIII以上の褥瘡を2回以上発生した経験を持ち、自宅で基本的な日常生活を自立して行っている者を対象に、SCI者が褥瘡を再発する過程に着目し、質的記述式研究方法によって、褥瘡再発に対する認識と再発のプロセスを明らかにするため、半構造化面接によるインタビューを行った。対象者は12名(男性9名、女性3名、平均50.9±7.9歳・33〜61歳)で、平均受傷年齢は20.1±7.7歳、平均受傷歴は30.7±8.8年であった。受傷理由は交通事故や転落で、全員中途障害者であった。SCI者の褥瘡再発プロセスの概念図を作成した。理論的サンプリングの結果、再発のないSCI者は褥瘡への危機感を早期に自覚し、悪化要因の調整を行い、皮膚異常の原因を徹底的に追究しているという点で褥瘡再発者と相違がみられた。再発を繰り返すことで、褥瘡の「予防は困難」であるために「悪化させなければよい」とする「褥瘡のプロセス」に至っていた。「車椅子をこぐことと車の運転は除圧行為」、「創面に痂皮ができれば治癒である」といった誤った認識が明らかになった。SCI者の褥瘡再発を予防するためには、褥瘡発生の危機感を早期に認識できるような教育プログラムを作成し、褥瘡を悪化させないための社会生活の調整方法を具体的に指導していくことが必要と思われた。また、褥瘡の原因を追究できるためには、SCI受傷後より継続したフォローが必要であることが示唆された。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J03465&link_issn=&doc_id=20120313440008&doc_link_id=1202100&url=https%3A%2F%2Fkango-sakuin.nurse.or.jp%2Fnid%2F1202100&type=%8D%C5%90V%8A%C5%8C%EC%8D%F5%88%F8Web&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00014_1.gif

Language：English   Publisher：看護実践学会  

目的:本邦では胃癌において、術後症状の重症度から全摘に焦点を絞った研究が多い。そのため、胃部分切除後長期経過した患者の栄養状態とそれを取り巻く包括的な要因は不明である。本研究では、胃部分切除後長期生存者の栄養状態の実態を明らかにし、必要な看護ケアの示唆を得ることを目的とした。方法:対象は、胃部分切除術を受け10年以上経過した86名であった(回収率90.7%)。身体計測と血液検査、アンケート調査を実施し、栄養状態別に比較をおこない、栄養状態に影響を及ぼす要因を抽出した。結果:40.5%の患者が糖尿病を罹患するとともに、61%の患者が術後10年以上を経過しても10%以上の体重減少が継続していた。これら栄養状態不良群では再建方法・年齢・体脂肪率・皮脂厚・脂肪の摂取量・ヘモグロビン値・主食の量において栄養状態良好群と比較して有意差を認めた。以上の結果より、胃部分切除者の術後の看護介入として、特に脂質の摂取方法の工夫が必要であることが示唆された。(著者抄録)

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J-GLOBAL

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：(一社)日本褥瘡学会  

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Language：Japanese   Publisher：(一社)日本褥瘡学会  

褥瘡を有する入院患者9名(男性4名,女性5名・年齢中央値76歳)を対象に,二層式エアセルマット導入2週間前(対照期)と導入後2週間(実験期)で比較した.1)創面積は実験期で有意に縮小し,DESIGN合計点では実験期で有意に創状態の改善を認めた.2)仙骨部体圧値は実験期で有意に減少したが,ブレーデンスケール,上腕囲,上腕筋部皮下脂肪厚,上腕筋囲では対照期と有意差はなかった.3)褥瘡ケアの直接費用は,エアマットレス代が実験期で有意に高かったが,人的資源・物的資源の全費用では両期で有意差を認めなかった.4)創面積費用対効果は対照期-2298.1円と創拡大に費用を要し,実験期241.3円であった.DESIGN費用対効果は対照期32939.0円,実験期5577.9円と約6倍の効果を認めた

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2006&ichushi_jid=J03465&link_issn=&doc_id=20060705360004&doc_link_id=0601475&url=https%3A%2F%2Fkango-sakuin.nurse.or.jp%2Fnid%2F0601475&type=%8D%C5%90V%8A%C5%8C%EC%8D%F5%88%F8Web&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00014_1.gif

Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本褥瘡学会  

成熟雄マウス創傷モデルの創周囲に黄色ブドウ球菌を塗布して褥瘡状態を作り,創周囲の清潔ケアが創傷治癒過程に及ぼす影響を検討した.清潔ケアは皮膚洗浄剤群,生理食塩水群,ポビドンヨード消毒群,清潔ケアなし群に分け,それぞれの創傷治癒過程を肉眼的および細菌学的に観察した.その結果,創傷治癒は皮膚洗浄剤群,ポビドンヨード群,生理食塩水群,ケアなし群の順に良好で,皮膚洗浄剤群とケアなし群との間に有意差を認めた.創周囲皮膚の角質水分量は皮膚洗浄剤群で最も早い時期に最も高値を示したが,ポビドンヨード群のみ表皮形成完成期に減少して最も低値を示した.組織学的に皮膚洗浄剤群は創傷作製後7日目には再生表皮が創を完全に覆っていたが,ケアなし群では痂皮内に細菌叢が依然観察された.洗浄剤で創周囲皮膚を清潔にすることが,創傷治癒を有効に促進させると考えられた

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Language：Japanese   Publisher：(一社)日本褥瘡学会  

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Language：Japanese   Publisher：日本ストーマ・排泄リハビリテーション学会  

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Language：Japanese   Publisher：(一社)日本老年医学会  

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Language：Japanese   Publisher：(株)アークメディア  

1981〜1992年に胃切除を受けて10年以上経過している患者88名,男性63名,女性25名に問診,身体計測,血液検査を行い,栄養状態について調査を行った.亜全摘群66名,全摘群22名で,平均術後年数は14.6年であった.全摘例では全員が胆嚢,脾臓,膵臓等の合併切除を受けていた.対象の88.6%が現在も通院中であったが,切除範囲には無関係であった.全摘術では体重が10%以上減少した人が多かったが,食欲があると回答した人が多かった.下痢や糖尿病の有無は切除範囲には無関係あった.BMI・上腕囲・上腕筋囲・骨密度は全摘した75歳以上では他の例よりも有意に低値を示した.したがって,胃切除は栄養状態に影響を及ぼすことが多く,胃全摘は亜全的よりも加齢に伴って栄養状態に影響を与えると考えられた

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Language：Japanese   Publisher：(NPO)日本高齢消化器病学会  

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Language：Japanese   Publisher：(株)へるす出版  

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Language：Japanese   Publisher：(一社)日本褥瘡学会  

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Language：Japanese   Publisher：(一社)日本褥瘡学会  

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Language：Japanese   Publisher：(一社)日本看護研究学会  

CiNii Books

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2002&ichushi_jid=J01048&link_issn=&doc_id=20020719410211&doc_link_id=10.15065%2Fjjsnr.20020708214&url=https%3A%2F%2Fdoi.org%2F10.15065%2Fjjsnr.20020708214&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(一社)日本看護研究学会  

CiNii Books

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Language：Japanese   Publisher：一般社団法人 日本看護研究学会  

DOI： 10.15065/jjsnr.20020708214

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Language：Japanese   Publisher：一般社団法人 日本看護研究学会  

DOI： 10.15065/jjsnr.20020708215

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Language：Japanese   Publisher：(一社)日本褥瘡学会  

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