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How nursing students' perceptions of people with psychiatric disabilities change when using the strengths model during practicums: A qualitative research study. NURSE EDUCATION TODAY 2024; 138:106190. [PMID: 38583345 DOI: 10.1016/j.nedt.2024.106190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/19/2024] [Accepted: 03/31/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND The Strengths Model, a framework grounded in the belief that everyone has an inherent capability to cope with challenges, is designed to support the hopes and aspirations of people with psychiatric disabilities, guiding them toward their desired self-image. The model originally gained attention in the field of social welfare and has since become popular in the field of community mental health. There is an increasing demand for nurses to understand and implement this model in the support they provide. OBJECTIVES To clarify how implementation of the Strengths Model in nurse education impacts students' perceptions of their clients with psychiatric disabilities. DESIGN Qualitative descriptive study informed by Grounded Theory. SETTING Public university nursing practicum. PARTICIPANTS Sixteen fourth-year students undertaking a practicum using the Strengths Model. METHODS Semi-structured interviews. RESULTS The core concept identified was that people with psychiatric disabilities uncover their own inherent strengths. Students began their engagement by listening to clients' dreams and goals. Then, three processes were identified that led to the outcome of students seeing clients in terms of their limitations, while one process was identified that led to the alternate desirable outcome of students developing a sense of respect for clients. CONCLUSIONS These findings indicate that the process leading to students developing a sense of respect for clients with psychiatric disabilities involved three interrelated factors: students listening to clients' dreams and goals, both parties working together to discover the clients' dreams, and clients uncovering their own inherent strengths and then leveraging them. Incorporating the Strengths Model, which takes a person-centric approach to support the agency of people with psychiatric disabilities, into nurse education has the potential to foster healthcare professionals who respect people with psychiatric disabilities, see them on an equal footing, and consider themselves partners in facilitating the recovery journey.
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Mothers with depressed mood: help-seeking from husbands and child-rearing behaviors. BMC Womens Health 2022; 22:25. [PMID: 35094704 PMCID: PMC8801119 DOI: 10.1186/s12905-022-01604-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 01/24/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Mothers with depressed mood tend not to seek help or support from others. Yet, there is no research providing a detailed examination of the processes that mothers with depressed mood undergo while seeking child-rearing support from their husbands. This study aimed to clarify the processes that mothers with depressed mood go through in seeking child-rearing support from their husbands and performing child-rearing duties. METHODS The participants were 10 mothers living in Japan who had given birth within the past three years and were suspected of having depression after screening using the Edinburgh Postnatal Depression Scale. Semi-structured interview data were analyzed based on the grounded theory. RESULTS The responses revealed that the mothers felt as though they had insufficient time for themselves, which impelled them to seek support from their husbands, consequently leading them to conclude either that child-rearing and housework are difficult or that child-rearing can be managed some way or another. CONCLUSION When the husbands fully cooperated in child-rearing or demonstrated their willingness to cooperate in child-rearing, despite difficulty, the wives accepted their child-rearing support. On the other hand, if the husbands did not recognize their wives' efforts, the wives did not accept their support, even if they had helped with child-rearing. In this way, the wives re-evaluated their relationship with the husbands based on their husbands' attitudes toward child-rearing.
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410. The Importance of Personal Protective Equipment Education Opportunities and Messages of Encouragement at the Workplace to Reduce Burnout: Cross-sectional Survey After the First Wave of the COVID-19 Pandemic in Japan. Open Forum Infect Dis 2021. [DOI: 10.1093/ofid/ofab466.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The rapid spread of the COVID-19 pandemic has taken a considerable mental strain on frontline healthcare workers (HCWs). Although a number of studies have reported on burnout during the peak of the pandemic, few studies have analyzed it after the pandemic temporally subsided. This study aimed to identify which intervention or support was helpful to reduce the physical and mental burden during the pandemic.
Methods
An online cross-sectional survey of HCWs from June 15 to July 6, 2020, was conducted at a tertiary hospital in Tokyo, Japan. Demographic characteristics, results of the Japanese version of the Maslach Burnout Inventory-General Survey, types of anxiety and stress, changes in life and work after the peak of the pandemic, and types of support aimed at reducing the physical or mental burden, were determined.
Results
Out of 672 HCWs, 149 (22.6%) met the overall burnout criteria. Figure 1 showed the comparison of what helped reduce their physical and mental burden between the burnout group and the non-burnout group. After adjusted by the potential covariates, burnout was more prevalent in women (OR, 3.11; 95% CI, 1.45–6.67; p = .003), and had heightened anxiety due to unfamiliarity with PPE (OR, 1.98; 95% CI, 1.20–3.27; p=.007). Conversely, participants who reported that PPE education opportunities (OR, .484; 95% CI, .236–.993; p = .048) and messages of encouragement at the workplace (OR, .584; 95% CI, .352–.969; p = .037) helped reduce their physical and mental burden had less burnout.
Figure 1. What factors helped reduce the physical or mental burden
Conclusion
The educational interventions for PPE and messages of encouragement at the workplace may be needed to reduce the mental burden for HCWs.
Disclosures
All Authors: No reported disclosures
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Experiences and perceptions of people living with schizophrenia in Japan: A qualitative study. Nurs Health Sci 2021; 23:782-791. [PMID: 34558776 DOI: 10.1111/nhs.12880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 11/28/2022]
Abstract
This descriptive study used a qualitative inductive approach to investigate the subjective experiences and perceptions of people with schizophrenia living in the community during times of difficulty and how they coped. We conducted semi-structured interviews with nine community-dwelling people with schizophrenia and used the KJ method developed by Kawakita Jiro to structure the data obtained. We identified 10 symbols with his method: bewilderment at the onset; helplessness and longing for death; solitude linked to death; precarious daily life; relationships at risk; fear of being stigmatized; pillars of emotional support; will to overcome; hope to never give up; and living with the illness. The results suggest that community mental health nurses should provide support so their patients can continue to have pillars of emotional support and the will to overcome difficulties, as well as continue to use their coping methods, even when experiencing many difficulties. It is important that nurses understand and share in their patients' difficult experiences and hopes when providing support toward their recovery.
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Abstract
Objective We examined the prevalence of burnout among resident doctors and its relationship with specific stressors. Method We conducted a nationwide, online, cross-sectional survey in Japan with 604 resident doctors in 2018-2019. Materials Participants completed the Maslach Burnout Inventory-General Survey to evaluate burnout and provided details of their individual factors and working environmental factors. Chi-square tests and t-tests were conducted for categorical and continuous variables, respectively. The association between burnout and resident-reported causes of stress, ways of coping with stress, number of times patient-safety incidents were likely to occur, and individuals who provide support when in trouble was analyzed using logistic regression analyses after controlling for confounding variables. Results A total of 28% met the burnout criteria, 12.2% were exhausted, 2.8% were depressed, and 56.9% were healthy. After adjusting for sex, postgraduate years, type of residency program, marital status, number of inpatients under residents' care, number of working hours, number of night shifts, number of days off, and resident-reported causes of stress - excessive paperwork [odds ratio (OR): 2.24, 95% confidence interval (CI): 1.32-3.80], excessive working hours (OR: 2.75, 95% CI: 1.24-6.04), low autonomy (OR: 3.92, 95% CI: 2.01-7.65), communication problems at the workplace (OR: 2.24, 95% CI: 1.05-4.76), complaints from patients (OR: 6.62, 95% CI: 1.21-36.1), peer competition (OR: 2.22, 95% CI: 1.25-3.93), and anxiety about the future (OR: 2.13, 95% CI: 1.28-3.56) - were independently associated with burnout. The burnout group had more reported patient-safety incidents that were likely to occur per year (>10) (OR: 2.65, 95% CI: 1.01-6.95) and a lack of individuals who could provide support when in trouble (OR: 1.83, 95% CI: 1.01-3.34) than the non-burnout group. Conclusion This study described the prevalence of burnout among residents who responded to our survey. We detected an association between burnout and resident-reported causes of stress, patient-safety incidents, and a lack of individuals who provide support when in trouble. Further interventional studies targeting ways to reduce these concerns are warranted.
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Health care worker burnout after the first wave of the coronavirus disease 2019 (COVID-19) pandemic in Japan. J Occup Health 2021; 63:e12247. [PMID: 34375497 PMCID: PMC8354617 DOI: 10.1002/1348-9585.12247] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/04/2021] [Accepted: 06/11/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To determine the prevalence of burnout according to job category after the first wave of COVID-19 in Japan and to explore its association with certain factors. METHODS An online cross-sectional survey of health care workers (HCWs) from June 15 to July 6, 2020, was conducted at a tertiary hospital in Tokyo, Japan. Demographic characteristics, results of the Japanese version of the Maslach Burnout Inventory-General Survey, types of anxiety and stress, changes in life and work after the peak of the pandemic, and types of support aimed at reducing the physical or mental burden, were determined. RESULTS Of 672 HCWs, 149 (22.6%) met the overall burnout criteria. Burnout was more prevalent in women (OR, 3.11; 95% CI, 1.45-6.67, P = .003), anxiety due to unfamiliarity with personal protective equipment (PPE) (OR, 1.98; 95% CI, 1.20-3.27, P = .007), and decreased sleep duration (OR, 1.96; 95% CI, 1.20-3.20, P = .008). Conversely, participants who felt that the delivery of COVID-19-related information (OR, .608; 95% CI, .371-.996, P = .048) and PPE education opportunities (OR, .484; 95% CI, .236-.993, P = .048) and messages of encouragement at the workplace (OR, .584; 95% CI, .352-.969; p = .037) was helpful experienced less burnout. CONCLUSIONS There is a need to focus on the above factors to maintain the mental health of HCWs. The delivery of COVID-19-related information and educational interventions for PPE and messages of encouragement at the workplace may be needed to reduce the mental burden.
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Abstract
BACKGROUND Nurses experience moral distress when they cannot do what they believe is right or when they must do what they believe is wrong. Given the limited mechanisms for managing ethical issues for nurses in Japan, an Online Ethics Consultation on mental health (OEC) was established open to anyone seeking anonymous consultation on mental health practice. RESEARCH OBJECTIVE To report the establishment of the Online Ethics Consultation and describe and evaluate its effectiveness. ETHICAL CONSIDERATIONS The research was conducted in accordance with the Declaration of Helsinki. RESEARCH DESIGN This evaluation describes the outcomes of 5 years of operation of the Online Ethics Consultation on mental health in Japan. PARTICIPANTS The Online Ethics Consultation received 12 emails requesting consultation. Consultees included mental health nurses, psychiatrists, and service users. FINDINGS The most common questions directed to the service were about seclusion and physical restraint. Response time from receipt of email to sending a reply was between 1 and 14 days. Despite the disappointing number of consultations, feedback has been positive. DISCUSSION The Online Ethics Consultation was established to assist morally sensitive nurses in resolving their ethical problems through provision of unbiased and encouraging advice. Mental health care in Japan has been less than ideal: long-term social hospitalization, seclusion, and restraint are common practices that often lead to moral distress in nurses and the questions received reflected this. The head of the Online Ethics Consultation sent a supportive, facilitative response summarizing the opinions of several consultants. CONCLUSION This study provides key information for the establishment of an online ethics resource the adoption of which has the potential to improve the experience of nurses, allied health and clients of mental health services. This paper has implications for services concerned with improving patient care, managing nurses' moral distress, building ethics into decision-making.
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Analysis of the emotional experiences of Japanese Alcoholics Anonymous members striving for sobriety. BMC Psychiatry 2019; 19:243. [PMID: 31387570 PMCID: PMC6683575 DOI: 10.1186/s12888-019-2226-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 07/30/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Japan's tolerance of alcohol consumption and intoxication pose extreme difficulties for community-dwelling alcoholics who wish to abstain from alcohol and maintain sobriety. Emotional problems triggered in daily life can easily lead to relapse, especially after abstinence. Alcoholics Anonymous places great emphasis on dealing with attendees' emotional experiences. However, the specific nature of this support is not well understood. Therefore, this study aimed to elucidate the emotional experiences of AA members who strive for sobriety while attending AA and to identify suggestions for new methods of support. METHODS The present study employed an interview method. Data were analyzed using the KJ Method, which was developed by Japanese cultural anthropologist Jiro Kawakita. Study participants were 36 men chosen from AA groups in the Kanto and Kyushu regions of Japan. RESULTS Long-term abstinence was achieved through the following process: 1) gaining objectivity, 2) striving to maintain an attitude of acceptance, and 3) remaining devoted to discipline for one's goals, thereby 4) recovering one's contradictory self. This was an unending process that unfolded as the individual tasks affected each other. To facilitate this process, AA members dealt with risk cues that destabilized post-cessation emotional balance while making daily efforts to regulate their own emotions. CONCLUSIONS To maintain sobriety, AA members strove to regulate their emotions. By doing so, they experienced personal growth and attained a life in which they did not require alcohol (i.e., sobriety). The present study indicated that Japanese nursing and health care workers should be willing to learn from AA members, such as by understanding the 12-step culture. The data also suggest the need to create environments conducive to AA activities, from which many alcoholics derive emotional support.
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Job Stress Factors Affect Workplace Resignation and Burnout among Japanese Rural Physicians. TOHOKU J EXP MED 2018; 245:167-177. [PMID: 29998918 DOI: 10.1620/tjem.245.167] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Shortage of healthcare workers is a global problem. It is important to clarify factors, including job stress, that influence workplace resignation and factors that cause burnout among rural physicians. The study was designed as a cross-sectional questionnaire survey. We sent questionnaires to town or village hospitals and clinics (n = 1,898) in Hokkaido, Tohoku, Shikoku, and Kyushu and Okinawa. The number of participants was 509. Of these 7.7% were female and 21.6% were < 50 years. Internal or general medicine physicians were asked about personal and job factors, job stress based on the demand-control-support model, intention to resign from current position, and burnout evaluated using the Maslach Burnout Inventory-General Survey. Overall, 10.4% of the participants intended to resign, and 21.8% was defined as burnout positive. In the multivariate logistic regression analysis, dissatisfaction with income (OR, 3.63; 95% CI, 1.63-8.10), having one's hometown in another town or village in the same prefecture (OR, 3.53; 95% CI, 1.18-10.62) were significantly related to intention to resign, while high job control (OR, 0.72; 95% CI, 0.58-0.88) had a significantly protective effect. In the multivariate analysis, high job demand (OR, 1.48; 95% CI, 1.28-1.72) was significantly related to burnout, and high job control (OR, 0.66; 95% CI, 0.55-0.78) and high support from co-workers (OR 0.88, 95% CI, 0.78-1.00) had a significantly protective effect. Improving job stress factors, especially job control, and taking into consideration physicians' hometown and income may be important factors to prevent resignation from a current position and burnout among Japanese rural physicians.
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Abstract
Background: Moral distress occurs when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action. Moral distress was found to cause negative feelings, burnout, and/or resignation. Not only external factors such as lack of staff but also internal ones affect moral distress. Moral sensitivity, which is thought of as an advantage of nurses, could effect moral distress, as nurses being unaware of existing ethical problems must feel little distress. Objectives: To examine the impact of moral sensitivity on moral distress among psychiatric nurses, and affirm the hypothesis that nurses with higher moral sensitivity will suffer moral distress more than nurses with less moral sensitivity in two different samples. Ethical consideration: The study obtained ethical approval from the Research Ethics Committee of the Faculty of Medicine at Mie University (# 1111, 20.4.2010), and by the Turku University Ethics Board (29.5.2012). Permissions to undertake the study was obtained from the in two hospital districts and in one city (§ 48/4.10.2012, § 63/4.9.2012, 51/2012 27.8.2012). Informed consent was not formally obtained, because the questionnaire was anonymously reported by the participants who volunteered to answer. The participants responded voluntarily and anonymously. Methods: An anonymous questionnaire containing the Revised Moral Sensitivity Questionnaire and the Moral Distress Scale for Psychiatric nurses was conducted to 997 nurses in 12 hospitals in Japan, and 974 nurses in 10 hospitals in Finland after obtaining of approval by research ethics committees. Data were analyzed using a multi-group structural equation model analysis. Findings: A set of analyses imply that the association of moral sensitivity with moral distress is significant and similar between Japan and Finland, whereas the factor structures of moral sensitivity and moral distress may be partially different. Discussion: The result of this study may indicate that nurses with high moral sensitivity can sense and identify moral problems, but not resolve them. Therefore, supporting nurses to solve ethical problems, not benumbing them, can be important for better nursing care and prevention of nurses’ resignation. Conclusion: Moral sensitivity and moral distress were positively correlated among psychiatric nurses in both Japan and Finland, although the participating nurses from the two countries were different in qualification, age, and cultural background. Nurses with high moral sensitivity suffer from moral distress.
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Burnout Study of Clinical Nurses in Vietnam: Development of Job Burnout Model Based on Leiter and Maslach's Theory. Asian Nurs Res (Korean Soc Nurs Sci) 2018; 12:42-49. [PMID: 29463486 DOI: 10.1016/j.anr.2018.01.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 01/21/2018] [Accepted: 01/22/2018] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This study aimed to create a Vietnamese version of both the Maslach Burnout Inventory-General Survey (MBI-GS) and Areas of Worklife Scale (AWS) to assess the burnout state of Vietnamese clinical nurses and to develop a causal model of burnout of clinical nurses. METHODS We conducted a descriptive design using a cross-sectional survey. The questionnaire was hand divided directly by nursing departments to 500 clinical nurses in three hospitals. Vietnamese MBI-GS and AWS were then examined for reliability and validity. We used the revised exhaustion +1 burnout classification to access burnout state. We performed path analysis to develop a Vietnamese causal model based on the original model by Leiter and Maslach's theory. RESULTS We found that both scales were reliable and valid for assessing burnout. Among nurse participants, the percentage of severe burnout was 0.7% and burnout was 15.8%, and 17.2% of nurses were exhausted. The best predictor of burnout was "on-duty work schedule" that clinical nurses have to work for 24 hours. In the causal model, we also found similarity and difference pathways in comparison with the original model. CONCLUSION Vietnamese MBI-GS and AWS were applicable to research on occupational stress. Nearly one-fifth of Vietnamese clinical nurses were working in burnout state. The causal model suggested a range of factors resulting in burnout, and it is necessary to consider the specific solution to prevent burnout problem.
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Work-family conflict as a mediator between occupational stress and psychological health among mental health nurses in Japan. Neuropsychiatr Dis Treat 2017; 13:779-784. [PMID: 28331330 PMCID: PMC5356920 DOI: 10.2147/ndt.s127053] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Occupational stress among mental health nurses may affect their psychological health, resulting in reduced performance. To provide high-quality, sustainable nursing care, it is necessary to identify and control the factors associated with psychological health among mental health nurses. The purpose of this study was to examine the role of work-family conflict (WFC) in the well-known relationship between occupational stress and psychological health among mental health nurses in Japan. METHODS In this cross-sectional study, data were gathered from 180 mental health nurses who had a coresident child or were married. Data from the Work-Family Conflict Scale, the Generic Job Stress Questionnaire, the Maslach Burnout Inventory-General Survey, and the Center for Epidemiologic Studies for Depression Scale were obtained via self-report questionnaires. The effects of occupational stress and WFC on psychological health were explored by hierarchical linear regression analysis. RESULTS The relationship between emotional exhaustion and occupational factors, including quantitative workload and the variance in workload, disappeared with the addition of WFC (each work interference with family [WIF] or family interference with work [FIW]). The relationship between emotional exhaustion and mental demands disappeared only with the addition of WIF. The relationship between depressive symptoms and variance in workload disappeared with the addition of WFC (each WIF or FIW). CONCLUSION Our findings may encourage hospital administrators to consider the risks of medical staff WFC. Furthermore, longitudinal investigations into the factors associated with WFC are required for administrative and psychological interventions.
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[Relationships between ignoring instructions and response bias when completing questionnaires]. SHINRIGAKU KENKYU : THE JAPANESE JOURNAL OF PSYCHOLOGY 2016; 87:354-363. [PMID: 29620327 DOI: 10.4992/jjpsy.87.15034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Certain participants are insincere, or careless when they respond to questionnaires. To identify such participants, we included three items in a questionnaire that instructed participants to choose a particular response category. Nurses (N = 1,000) responded to this questionnaire in a Web survey. One-hundred-twenty participants failed to follow the instructions for at least one item (non-followers). Analyzing their responses indicated the following: (a) non-followers were more likely to give identical, or midpoint responses; (b) the correlations between their responses to regular and reversed items were low or positive, and their responses to scales containing reversed items tended to show lower internal consistency; and finally, (c) the mean scores of non-followers were closer to the midpoint of the scale, regardless of whether the scale included reversed items. One reason that including reversed items lead to lower internal consistency could be because participants occasionally missed responding to these items. However, the results suggested that non-followers were not diligent in responding to regular items, and merely deleting reversed items from scales will be insufficient to ensure accurate results.
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Development of the salt-reduction and efficacy-maintenance program in Indonesia. Nurs Health Sci 2016; 18:519-532. [DOI: 10.1111/nhs.12305] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 06/08/2016] [Accepted: 07/07/2016] [Indexed: 11/29/2022]
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Self-care practices and health-seeking behavior among older persons in a developing country: Theories-based research. Int J Nurs Sci 2016. [DOI: 10.1016/j.ijnss.2016.02.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Cross-sectional survey of workload and burnout among Japanese physicians working in stroke care: the nationwide survey of acute stroke care capacity for proper designation of comprehensive stroke center in Japan (J-ASPECT) study. Circ Cardiovasc Qual Outcomes 2014; 7:414-22. [PMID: 24823957 DOI: 10.1161/circoutcomes.113.000159] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Burnout is common among physicians and affects the quality of care. We aimed to determine the prevalence of burnout among Japanese physicians working in stroke care and evaluate personal and professional characteristics associated with burnout. METHODS AND RESULTS A cross-sectional design was used to develop and distribute a survey to 11 211 physicians. Physician burnout was assessed using the Maslach Burnout Inventory General Survey. The predictors of burnout and the relationships among them were identified by multivariable logistic regression analysis. A total of 2724 (25.3%) physicians returned the surveys. After excluding those who were not working in stroke care or did not complete the survey appropriately, 2564 surveys were analyzed. Analysis of the participants' scores revealed that 41.1% were burned out. Multivariable analysis indicated that number of hours worked per week is positively associated with burnout. Hours slept per night, day-offs per week, years of experience, as well as income, are inversely associated with burnout. Short Form 36 mental health subscale was also inversely associated with burnout. CONCLUSIONS The primary risk factors for burnout are heavy workload, short sleep duration, relatively little experience, and low mental quality of life. Prospective research is required to confirm these findings and develop programs for preventing burnout.
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YOUNG FEMALE ATHLETES HAVE CHANGED CONSIDERABLY IN THE TWO YEARS AFTER BASELINE EVALUATION IN A PROSPECTIVE STUDY. Br J Sports Med 2014. [DOI: 10.1136/bjsports-2014-093494.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Efficacy of a group-based parenting program on stress and self-efficacy among Japanese mothers: a quasi-experimental study. Nurs Health Sci 2013; 15:454-60. [PMID: 23725544 DOI: 10.1111/nhs.12054] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 02/19/2013] [Accepted: 02/26/2013] [Indexed: 11/29/2022]
Abstract
Early child development and the impact of parenting on later life are of global concern. The rise in child abuse and maltreatment in Japan suggests that measures to increase self-efficacy and reduce stress would benefit Japanese parents. In this study, we explored if Japanese parents attending a 123Magic parenting program reported reduced stress and enhanced self-efficacy. Questionnaire data were collected from 49 mothers attending a parenting program conducted in public nursery schools in one prefecture in Japan. There were significant changes in parenting self-efficacy scores (P < 0.001) and parenting stress scores (P < 0.01). Focus groups with 16 parents also found that there were benefits to parents in terms of increased confidence and less stress. The findings provide support for the role of public health nurses in delivering group-based parenting support in Japan.
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Abstract 33: The Nationwide Survey of Quality of life, Burnout and Depression among Japanese Neurosurgeons and Neurologists, J-ASPECT Study. Circ Cardiovasc Qual Outcomes 2012. [DOI: 10.1161/circoutcomes.5.suppl_1.a33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Burnout is a syndrome of emotional exhaustion and depersonalization that leads to decreased effectiveness at work. A limited amount of information exists about the relationship between specific demographic and practice characteristics with burnout among neurosurgeons and neurologists and no previous survey were conducted for Japanese physicians. The objective of this study is to determine the incidence of burnout among Japanese neurosurgeons and neurologists and evaluate personal and professional characteristics associated with their burnout.
Methods:
Members of the Japanese Neurosurgical Society and Japanese Society of Neurology were sent an anonymous, cross-sectional survey in March 2011. The survey evaluated demographic variables, practice characteristics, career satisfaction, burnout, and quality of life (QOL). Burnout and QOL were measured using validated instruments, Maslash Burnout Inventory and SF-36, respectively.
Results:
Of total 10741 neurosurgeons and neurologists excluding three prefectures in the Tohoku earthquake area, 2724(25.3%) returned surveys. Responders had been in practice 21.9 years, worked 65.9 hours per week, and were on duty 2.95 nights/month and on call 2.02 nights/ week (mean values). Overall, 47.6% of responders were burned out, 58% screened positive for mild symptoms of depression, 27.1% showed sever depressive symptoms. Overall, 27.8 % had a mental QOL score > 1 standard deviation below the population norm and 58% screened positive for mild symptoms of depression, 26.6% showed sever depressive symptoms. Factors associated with burnout included longer working time(OR=1.24/10hour increase,95%CI 1.17-1.31),number of patients(OR =1.08,95%CI 1.03-1.13),number of t-PA treatments(OR=1.17, 95%CI 1.07-1.28), number of on duty nights per month (OR=1.08,95%CI 1.05-1.11),number of on call nights per week (OR=1.08,95%CI 1.05-1.21), more time spending for stroke care (OR=1.09, 95%CI 1.01-1.17). Factors protective for burnout included sleep hours (OR=0.77/1hr increase, 95%CI 0.69-0.85), high income (OR=0.81/60K US $ increase, 0.74-0.88) and year of experience (OR= 0.75, 95%CI 0.68-0.81). After the stepwise selections, sleeping hours, working time, number of on duty nights, high income, number of patients remained in the final prediction model.
Conclusion:
Burnout is common among Japanese neurosurgeons and neurologists. One hour increase of sleeping time reduced the 23% of burnout risk and high income level was also protective for burnout. Additional prospective research is needed to confirm this relationship to prevent the burnout and promote the mental health of Japanese neurosurgeons and neurologists.
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Abstract
AIM This article is a report of the development and psychometric testing of the Stressor Scale for Clinical Research Coordinators. BACKGROUND Job stress is viewed as a situation where working conditions interact with individual worker characteristics and result in disruption of psychological or physiological homeostasis. Clinical research coordinators, also known as research nurses, are professionals who play a central role in clinical trials. They face various problems associated with their responsibilities; however, few studies have reported on their stress. To manage their stress, it is necessary to identify the sources of stress (i.e. stressors). METHOD The 56-item preliminary instrument was developed based on literature review and expert discussions. A total of 589 clinical research coordinators in 186 hospitals in Japan were surveyed in 2011. Statistical analyses on construct and concurrent validity, internal consistency, and test-retest reliability were performed. RESULTS A six-factor solution with 23 items was selected using exploratory factor analysis: 'quantitative workload', 'conflict with investigators', 'ambiguity of work', 'conflict with other clinical research coordinators and with supervisors', 'demands from an affiliate other than the hospital', and 'difficulty in caring for trial participants'. Confirmatory factor analysis affirmed construct validity, with a demonstrated acceptable fit between the factor structure and the observed data. All factors had significant correlations with burnout and psychological distress, which indicated acceptable concurrent validity. Cronbach's alpha coefficients ranged from 0·73-0·82. Intra-class correlation coefficients indicated almost satisfactory test- retest reliability. CONCLUSION Our new instrument has acceptable validity and reliability for evaluating job stressors for clinical research coordinators.
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P2-144 An evaluation of dietary and exercise intervention for hypertensive men. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976i.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
OBJECTIVES We investigated the effects of fatigue on NK cell function and lymphocyte subpopulations in nurses performing shift work using a longitudinal design. METHODS Fifty-seven female nurses engaged in shift work at a hospital in Japan were selected for our study cohort. The hospital used a counterclockwise rotating three-shift system. Night shifts followed day shifts after a seven-hour interval. Immune parameters measured at the beginning of the day shift through to the end of the night shift were compared between two groups stratified by their level of fatigue. Statistical differences were evaluated after adjusting for baseline immune values and other demographic features. RESULTS Subjective feelings of fatigue increased progressively from the beginning of day shifts to the end of night shifts. From the beginning of day shifts to the end of night shifts, NK cell activity and CD16(+)CD56(+) lymphocytes decreased, while CD3(+) and CD4(+) lymphocytes increased. The group with the greater increase in fatigue showed a larger decrease in NK cell activity and a larger increase in CD4(+)lymphocytes when compared with the group reporting less fatigue. These findings did not change after adjusting for demographic factors and sleep hours. CONCLUSION Our data suggest that shift work has deleterious effects on NK cell function and that the effects depend on the degree of fatigue. Proper management of shift work may lessen fatigue in workers and also ameliorate many health problems experienced by shift workers.
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Video analysis of anterior cruciate ligament injuries in sumo wrestling. Br J Sports Med 2011. [DOI: 10.1136/bjsm.2011.084038.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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25
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Psychological profiling of young female handball and basketball players - a pilot study. Br J Sports Med 2011. [DOI: 10.1136/bjsm.2011.084038.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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26
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Effect of low-load eccentric training before high-intensity eccentric exercise on delayed onset muscle soreness, revealed by c-fos expression in the spinal dorsal horn in rats. Br J Sports Med 2011. [DOI: 10.1136/bjsm.2011.084038.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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27
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Consciousness survey of junior-high school handball instructors regarding anterior cruciate ligament injuries in japan. Br J Sports Med 2011. [DOI: 10.1136/bjsm.2011.084038.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Relationship between core strength and balance ability in high school female handball and basketball players. Br J Sports Med 2011. [DOI: 10.1136/bjsm.2011.084038.191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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30
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Abstract
This study aimed to: (1) develop and evaluate the Moral Distress Scale for Psychiatric nurses (MDS-P); (2) use the MDS-P to examine the moral distress experienced by Japanese psychiatric nurses; and (3) explore the correlation between moral distress and burnout. A questionnaire on the intensity and frequency of moral distress items (the MDS-P: 15 items grouped into three factors), a burnout scale (Maslach Burnout Inventory — General Survey) and demographic questions were administered to 391 Japanese psychiatric nurses in 2007—2008. These nurses experienced relatively low levels of moral distress despite the fact that they were commonly confronted by morally distressing situations. All the circumstances in which the participants experienced moral distress were included in the ‘low staffing’ factor, which reflects the characteristics of Japanese psychiatric care. The frequency score of the low staffing factor was a significant predictor of burnout.
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Disturbance of rapid eye movement sleep in senescence-accelerated mouse prone/8 mice is improved by retinoic acid receptor agonist Am80 (tamibarotene). Neuroscience 2010; 167:573-82. [DOI: 10.1016/j.neuroscience.2010.01.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Revised: 01/27/2010] [Accepted: 01/28/2010] [Indexed: 10/19/2022]
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32
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The role of limbic-hypothalamic systems in metabolic responses of phenylalanine to repeated cold exposures in rabbits. EXPERIMENTAL AND CLINICAL ENDOCRINOLOGY 2009; 100:99-105. [PMID: 1305071 DOI: 10.1055/s-0029-1211186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In this study we examine the effects of lesions to limbic or hypothalamic structures on the metabolic responses of phenylalanine in liver slices prepared from rabbits exposed to cold stress (-20 degrees C) for 12 hours at a fixed time once a day. The results were as follows: 1. The 1st cold exposure (cold exposure on the 1st day) had marked and various effects on phenylalanine metabolism, and the metabolic responses of phenylalanine to cold exposure gradually decreased and then completely disappeared with repetitions of exposure in intact rabbits. 2. The metabolic patterns and responses of phenylalanine to the 1st cold exposure were altered by lesioning the periventricular arcuate nucleus (ARC), ventromedial hypothalamus (VMH), stria terminalis (ST) or dorsal fornix (FX). 3. The complete abolishment of the metabolic responses to cold exposure by its repetition was observed in rabbits with lesions in the ARC or VMH as well. 4. In contrast, metabolic responses of phenylalanine to cold exposure in rabbits with lesions in the ST or FX remained even after six exposures. These results suggest that the ARC, VMH, amygdala (AMYG)-ST system and dorsal hippocampus (HPC)-FX system played a role in the metabolic regulation of phenylalanine and in the metabolic responses of phenylalanine to the 1st cold exposure and that the AMYG-ST and HPC-FX systems, but not the ARC or VMH, participated in the process of the metabolic adaptation of phenylalanine to cold exposure.
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Abstract
PURPOSE To compare the prevalence of deep vein thrombosis (DVT), pulmonary thromboembolism (PTE), and bleeding complications in patients receiving heparin or danaproid after hemiarthroplasty or osteosynthesis for hip fractures. METHODS 37 men and 138 women aged 47 to 100 (mean, 80) years underwent either hemiarthroplasty or osteosynthesis for hip fractures; 5 patients with dementia were excluded. All patients received preoperative elastic stocking and postoperative intermittent pneumatic compression. They were divided into 3 groups based on their admission period: controls (n=71), unfractionated heparin (n=44), and danaproid sodium (n=55). Drugs were administered from postoperative day 1 to 7. At day 7, all patients undertook radioisotope venography of the legs and lung perfusion scintigraphy. RESULTS In the control, heparin, and danaproid groups respectively, the DVT rates were 31%, 9.1%, and 5.5%, and the PTE rates were 5.6%, 4.5%, and 1.8%. Only the DVT rate in the control group was significantly higher than that in the heparin and danaproid groups. In the heparin group, one patient had gastrointestinal bleeding, 5 developed wound haematomas, and one had leakage from the drain site for 2 weeks. CONCLUSION Danaproid sodium appeared more effective and safer than heparin, with no bleeding complications occurred.
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Abstract
We describe a new technique of reconstruction of the deficient acetabulum in cementless total hip arthroplasty. The outer iliac table just above the deficient acetabulum is osteotomised and slid downwards. We have termed this an iliac sliding graft. Between October 1997 and November 2001, cementless total hip arthroplasty with an iliac sliding graft was performed on 19 patients (19 hips) with acetabular dysplasia. The mean follow-up was 3.4 years (2 to 6). The mean pre-operative Harris hip score was 45.1 which improved significantly to 85.3 at the time of the final follow-up. No patient had post-operative abductor dysfunction. Incorporation of the graft was seen after two to three months in all patients. Resorption of the graft and radiolucencies were infrequent. This technique is a useful alternative to femoral head autografting when the patient's own femoral head cannot be used.
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Abstract
Idiopathic hypereosinophilic syndrome (HES) is a heterogeneous group of disorders with the common features of prolonged eosinophilia of underdetermined cause and multiple organ system dysfunction. Focal eosinophilic myositis is an uncommon manifestation of HES. We report a case of focal eosinophilic myositis with tender muscle swelling followed by proximal weakness, but without non-systemic symptoms and muscle trophism in the lower limbs. Muscle biopsy specimen showed acute myositis with eosinophil infiltration. Electromyographic features were typical of myositis. The clinical and biochemical response to corticosteroids was excellent, and a relapse that occurred because the steroid dose was not lowered, responded well.
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36
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Histologic analysis of the tibial bone tunnel after anterior cruciate ligament reconstruction using solvent-dried and gamma-irradiated fascia lata allograft. Arthroscopy 2001; 17:32. [PMID: 11600972 DOI: 10.1053/jars.2001.24694] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Anterior cruciate ligament (ACL) reconstruction using free tendon graft requires biologic fixation in the bone tunnel. This report describes the intratunnel histology retrieved from a 47-year-old woman who underwent high tibial osteotomy 17 months after ACL reconstruction using a hybrid graft (a solvent-dried and gamma-irradiated fascia lata allograft as a core wrapped with iliotibial autograft). The patient underwent revision because of pain resulting from osteoarthrotic change, and the graft appeared to be taut and healthy on second-look arthroscopy. The sample was taken from the site of the metaphyseal osteotomy site. Histologic examination of the samples was performed with a light microscope (H&E and Masson trichrome stain). Biologic fixation of the graft to the bone was evident from observation of collagen fiber continuities, resembling Sharpey fibers. Integration of the autograft and allograft seemed to have occurred; the junction between the allograft and the autograft could not be determined. However, there was a difference in ligamentization depending on location. In the peripheral region of the graft (the autograft region), the collagen fibers showed a distinct crimped pattern; the fibroblasts were arranged regularly along the major axis of the collagen fiber bundle. In the central part of the graft (the allograft region), remodeling seemed to be delayed. There were acellular, bubbly or myxoid degeneration areas in which the fiber bundles were less oriented and there was increased vascularity.
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Optically encoded second-harmonic generation in germanosilicate glass by a femtosecond laser. OPTICS LETTERS 1999; 24:911-913. [PMID: 18073893 DOI: 10.1364/ol.24.000911] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Second-harmonic generation in germanosilicate glasses was encoded by coherent superposition of the 810-nm fundamental and the 405-nm second-harmonic light of a femtosecond laser. The difference spectra between the absorption spectra of the glasses before and after preparation were measured. An evident correlation between the induced second-order nonlinearity and the creation of a Ge electron center was observed, suggesting that a band-to-band transition by multiphoton absorption is probably responsible for the photoinduced second-harmonic generation.
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Morphodifferentiation of skeletal muscle fiber ends at the myotendinous junction in the postnatal Chinese hamster: a scanning electron microscopic study. ARCHIVES OF HISTOLOGY AND CYTOLOGY 1998; 61:89-92. [PMID: 9557972 DOI: 10.1679/aohc.61.89] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The postnatal morphodifferentiation of muscle fiber ends at the myotendinous junction was examined by scanning electron microscopy in gastrocnemius muscles of the Chinese hamster. Muscle fiber ends during the first week were simply conical or slightly complex, having a few pit-like invaginations and longitudinal and narrow clefts. By the second week, fiber ends gradually became complicated with an increased number of clefts and finger-like processes. Pits and short clefts linearly arranged towards the fiber tip were visible until the second week. This possibly indicates the linear elongation of the clefts by the fusion of adjacent pits to one another and to preexisting clefts. By the fourth week, the fiber ends had almost fully matured and displayed numerous cytoplasmic processes and lateral grooves.
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Massive autoclaved allografts and autografts for limb salvage surgery. A 1-8 year follow-up of 23 patients. ACTA ORTHOPAEDICA SCANDINAVICA 1997; 68:392-5. [PMID: 9310047 DOI: 10.3109/17453679708996184] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We performed 23 reconstructions with bone grafts autoclaved at 135 degrees C for 10 minutes for extensive bone defects after tumor resection. In 15 cases, the resected specimens were autoclaved and used as autografts. In 7 cases, allografts obtained from amputated extremities or cadavers were autoclaved and immediately stored at -80 degrees C prior to their use. A combination of the two was used in 1 case. The grafts were used in combination with prostheses or other forms of internal fixation. The mean follow-up was 49 (14-98) months. Incorporation of the hostgraft junction was observed radiographically after a mean of 11 (6-17) months in all cases. No recurrence due to the autoclaved bone was observed. However, 10 patients suffered complications, including infection, bone resorption, fracture and loosening of the prosthesis. In terms of Mankin's evaluation of bone grafts, 12 patients were evaluated as good or excellent. We conclude that despite the complications, autoclaved autografts and allografts are viable options for reconstruction in many countries because of the difficulty of obtaining large quantities of fresh frozen allografts.
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[The clinical efficacy of imipenem/cilastatin sodium in orthopedic infections and drug levels in the bone tissue]. THE JAPANESE JOURNAL OF ANTIBIOTICS 1997; 50:622-7. [PMID: 9743907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We evaluated the clinical efficacy of imipenem/cilastatin sodium (IPM/CS--a carbapenem antibiotic) against orthopedic infections, and the drug levels of the bone tissues were determined. The clinical efficacies for 6 patients in the infection group were good in 3 cases, and fair in the other 3; giving an efficacy rate of 50%. Bacteriologically, 8 strains were isolated from patients with the infection and an eradication rate of 87.5% was obtained upon the treatment. In 39 patients that were given the drug prophylactically, no postoperative infections occurred. Mean IPM levels in the bone and the bone marrow at 1 hour after administration in 5 patients of the prophylactic group were 17.3 micrograms/ml and 5.9 micrograms/g, respectively. The ratio of concentrations the bone to those in the bone marrow was 34.6%. The results of this study suggest that IMP/CS reaches to the bone tissue providing sufficient concentrations and that the drug is efficacious for the prophylaxis and the treatment of orthopedic infections.
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Topographic comparison of subneural apparatuses at neuromuscular junctions in normal and dystrophic (mdx) mice: a scanning electron microscope study. JOURNAL OF ELECTRON MICROSCOPY 1997; 46:193-197. [PMID: 9180035 DOI: 10.1093/oxfordjournals.jmicro.a023508] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The differences in the morphodifferentiation of subneural apparatuses (SNAs) at neuromuscular junctions (NMJs) in the extensor digitorum longus muscle of normal and dystrophic (mdx) mice were examined by scanning electron microscopy. In normal mice, primitive shallow cup-like synaptic troughs present at birth had developed to anastomosing grooves containing both pit-like and slit-like junctional folds (JFs) during the 2nd postnatal week. At the 35th day, the SNAs had developed to almost the adult forms, consisting of labyrinthine synaptic grooves with exclusively slit-like JFs. In the mdx mice, the SNAs showed transformation similar to those in the normal mice until the 35th postnatal day. After this period, SNAs with a number of cup-like depressions occurred and increased in number. These morphological changes seemed to be found on regenerating muscle fibers after necrosis, probably indicating the remodelling of their NMJs.
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[A case of rheumatoid arthritis associated with pernicious anemia and bronchiolitis obliterans organizing pneumonia]. RYUMACHI. [RHEUMATISM] 1995; 35:920-6. [PMID: 8720271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A case of rheumateid arthritis (RA) with pernicious anemia (PA) and wandering multiple patchy densities in bilateral lung fields is reported. A 72-year-old woman was hospitalized in February 1994, because of cough. She had already advanced RA (Class IV, Stage IV). She showed macrocytic and hyperchromic anemia as follows ; red-cell count (RBC), 176 x 10(4)/microliters; hemoglobin (Hb),7.2 g/dl; hematocrit (Ht), 21.0% ; MCV, 119.3 fl; and MCH, 40.9 pg. Chest roentgenogram revealed multiple patchy densities in bilateral lung fields and there was no response to the administration of antibiotic agents. From these clinical pictures bronchiolitis obliterans organizing pneumonia (BOOP) was highly suspected. After steroid injection into the joint space, the abnormal lung shadows disappeared. Anemia had been recovering spontaneously, but recurred in July. The results of blood examination were as follows ; RBC, 162 x 10(4)/microliters; Hb, 6.7ng/dl; Ht, 19.1%; MCV, 117.9 fl; and MCH, 41.4 pg. Anti-intrinsic factor antibody was positive. The level of serum vitamin B12 was low, 76 pg/ml. Sternal bone marrow aspiration showed magaloblastic changes with hypersegmentation of granulocytes. PA was diagnosed and improvement was noted after the intramuscular administration of vitamin B12. Subjective symptoms based on RA did not change during the clinical course. It is suggested that the pathogenesis about the combination of RA, BOOP and PA is related to common immunological abnormalities in our patient. A case of RA with PA and BOOP has not been reported previously, thus this case is considered clinically valuable.
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Bioabsorbable osteosynthetic implants of ultra high strength poly-L-lactide. A clinical study. INTERNATIONAL ORTHOPAEDICS 1994; 18:332-40. [PMID: 7698862 DOI: 10.1007/bf00187076] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We have developed reasonably strong but bioabsorbable osteosynthetic screws, pins and nails made of ultra high strength poly-L-lactide (PLLA) and evaluated their use in 143 patients. The PLLA implants have the highest strength among those reported to date. They lose about 10% of their initial strength within 8 weeks, about 40% within 4 weeks and nearly 100% within 20 weeks in vivo. The patients were aged from 9 to 78 years, and the follow up was from 2 to 6 years. The implants were used for fixation of bone grafts in 84 patients, peri- and intra-articular fractures in 49, after osteotomy in 8, and in 2 others. Bony union was not achieved in only one case. In the early stages of the study, breakage of screws occurred in 12 cases (8%), mostly because of an inappropriate size of tap; these problems have not occurred after improvement of the tapping system. There were no cases with abnormal blood tests, infection or foreign body reaction.
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[Multiple cerebral infarction by blood-borne tumor emboli in carcinoma of the mid-pharynx: an autopsy case]. NO SHINKEI GEKA. NEUROLOGICAL SURGERY 1992; 20:997-1001. [PMID: 1407367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In May, 1989, a-54-year old man was admitted complaining of sore throat and tumor of the neck which had persisted for 2 months. Mid-pharyngeal tumor was diagnosed as poorly differentiated squamous cell carcinoma (stage, T3N2M0) and the patient was treated with radiation (Co 65Gy) from May 30 to July 24 and chemotherapy (UFT), which therapies were effective. On Aug. 16, sudden onset of consciousness disturbance and hemiparesis was revealed, and MRI showed small cerebral infarction. He died on Oct. 23, of pneumonia. Pathological diagnosis revealed a case of carcinoma of the mid-pharynx with wide-spread tumor embolism. Multiple cerebral and myocardial infarctions, thrombus in pulmonary arteries and congestion of kidneys with tumor emboli, due to "disseminated intravascular carcinomatosis" were noticed. A direct cause of death was dyspnea due to multiple lung metastases, pneumonia and tumor embolism in the pulmonary and coronary arteries.
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45
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[Intraoperative monitoring of facial electromyographic responses during neurovascular decompressive surgery for hemifacial spasm]. NO SHINKEI GEKA. NEUROLOGICAL SURGERY 1992; 20:757-61. [PMID: 1630566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
UNLABELLED In this paper, we reported our experience of intraoperative facial electromyographic recordings obtained during microvascular decompression for hemifacial spasm. MATERIALS AND METHODS Intraoperative electromyographic recordings from the mentalis muscle during stimulation of the temporal branch of the facial nerve has been attempted in 31 patients. No muscle relaxants were used except for those before intubation. Of 31 patients, 22 were female and 9 were male. The age on admission ranged from 31 to 60 years with a mean of 54 years. RESULTS 1. Abnormal response appeared with a latency of about 10 msec after stimulation. This response disappeared in 30 out of 31 patients at the end of operation. In 4 patients, the abnormal response disappeared prior to decompression of the nerve. 2. 30 patients in whom the abnormal response disappeared were free of spasm immediately after surgery. Hemifacial spasm has been relieved in 28 patients with a follow up period of 6 months to 2 years and 7 months. The remaining two patients had mild spasm. The one patient in whom the abnormal response did not disappear had persistent hemifacial spasm. CONCLUSION The authors think that intraoperative facial electromyographic recording is useful to identify the blood vessel that is causing the spasm and to ensure that decompression of the nerve has been accomplished.
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Follow-up study on metastatic cerebellar tumor surgery--characteristic problems of surgical treatment. Neurol Med Chir (Tokyo) 1990; 30:591-8. [PMID: 1703637 DOI: 10.2176/nmc.30.591] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Recently, the incidence of metastatic cerebellar tumors has increased. The authors operated on 12 cases of metastatic cerebellar tumors, with total or subtotal removal of nodules in brain metastases. Surgical complications observed as a result of postoperative investigation are presented. 1) Some cases developed carcinomatous meningitis within a short period. During removal of a tumor on the superior cerebellar surface attention should be paid to the prevention of dissemination to the cerebral cisterns adjacent to the tumor. 2) Some cases demonstrated peritoneal metastasis probably due to dissemination via the ventriculoperitoneal shunt tube, suggesting that great care should be taken during a shunt operation after removal. 3) Both carcinomatous meningitis occurring after removal and remote metastasis via the shunt tube were related to recurrence after removal of the cerebellar metastatic lesion, raising the issue of whether or not total macroscopic removal should be included in the indications for surgical treatment of cerebellar metastasis. Those cases in which surgery is indicated should also be routinely treated by postoperative irradiation.
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Abstract
Three cases of multiple gliomas with postmortem findings including a rare case of multicentric glioma are presented. A 59-year-old female was hospitalized with decreased mental activity and gait disturbance. Computed tomographic (CT) scans and magnetic resonance (MR) images showed two independent mass lesions in the left frontal and the right temporal lobes, shown by postmortem to have no communication. Histologically, they were a gemistocytic astrocytoma and an anaplastic astrocytoma, respectively. Therefore, multicentric glioma was diagnosed. A 66-year-old male was admitted with slow mentation and gait disturbance. CT scans and MR images demonstrated two mass lesions; one overriding the bilateral frontal lobes through the corpus callosum and the other in the left temporal lobe. Postmortem examination showed that both lesions were glioblastoma and the left temporal tumor was accompanied by subarachnoid dissemination. A 29-year-old male was hospitalized with gustatory hallucination and convulsions of the right upper extremity. CT scans revealed two mass lesions in the right frontal and the left temporal lobes. MR images demonstrated communication between the two lesions through the corpus callosum. The left temporal tumor developed into the occipital lobe and another new lesion appeared in the right temporal lobe despite chemotherapy and irradiation. Postmortem examination revealed communication between the three masses through the corpus callosum. Histologically, all three tumors were glioblastoma. Multicentric gliomas have been reported at various incidences from 2.3 to 9.1%. However, multicentric gliomas with multiple tumors of different histologies are very rare and only 16 cases have been reported. MR imaging is more valuable than CT scanning to detect communication between two or more lesions.
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Scanning electron microscope study of neuromuscular junctions in different muscle fiber types in the zebra finch and rat. ARCHIVES OF HISTOLOGY AND CYTOLOGY 1990; 53:327-32. [PMID: 2390332 DOI: 10.1679/aohc.53.327] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Examination by scanning electron microscopy revealed differences between neuromuscular junctions in the muscle fibers of the zebra finch (bird) and rat. The neuromuscular junctions between the anterior and posterior latissimus dorsi muscles of the zebra finch were compared. The junctions of the former, exclusively slow tonic fibers, were small and numerous along the long axis of a single muscle fiber. The synaptic depressions per junction were few. The junctions of the latter, exclusively fast twitch fibers, were large and consisted of more synaptic depressions than the former. Junctional folds were occasionally found in some depressions. The neuromuscular junctions between the extensor digitorum longus and soleus muscles of the rat were also compared. The former consisted almost entirely of fast twitch muscle fibers, whereas the latter consisted of both slow twitch fibers (75%) and fast twitch fibers (25%). The junctions in the extensor digitorum longus muscle were almost all labyrinthine gutters containing exclusively slit-like junctional folds. In the soleus muscle, two types of junctions were observed. One type was similar to that of the extensor digitorum longus muscle; the other was characterized by labyrinthine gutters containing sparse, narrow slit-like and pit-like junctional folds. We suggest from these structural differences of the subneural apparatuses that the junction of the fast twitch muscle is characterized by the subneural apparatus containing numerous slit-like junctional folds, and that of the slow twitch muscle fiber characterized by the apparatus containing sparse, narrow slit-like and pit-like junctional folds.
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[Evaluation of recurrent metastatic brain tumor of lung cancer origin]. Neurol Med Chir (Tokyo) 1989; 29:895-901. [PMID: 2482938 DOI: 10.2176/nmc.29.895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The authors examined numerous clinical features in 15 patients in whom brain metastases from lung cancer recurred after total or subtotal removal. The incidence of recurrence after initial removal of brain nodules was 46.9% (15 of 32 cases). There was no significant correlation between the incidence of recurrence and the histology of the lung cancer, the site of brain nodules, or age. Recurrent brain nodules were the cause of or contributed to death in 60% of recurrent cases. Recurrence was within 3 months of initial removal of brain nodules in 10 of the 15 patients. Brain metastasis recurred only at the initial site in 11 cases (73.3%). Three patients developed carcinomatous meningitis and one had multiple metastases in addition to recurrence or regrowth at the original site. The primary lung cancer was relatively stable at the time of recurrence of brain nodules in 60% of the patients. Tumor removal and radiotherapy are highly recommended for prevention of early recurrence following initial removal of brain metastases. Removal of metastatic tumor is advised in the event of recurrence after 1 year from initial surgery, since the outcome after second surgery tends to be fair. However, tumor removal and radiotherapy are sometimes capable of inducing recurrence of brain nodules. Therefore, it is hoped that more effective cancer chemotherapy will be developed in the near future.
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[Post-mortem observation of glioma and/or brain tissue compared to C-T scan findings after irradiation]. GAN NO RINSHO. JAPAN JOURNAL OF CANCER CLINICS 1989; 35:1313-23. [PMID: 2810775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
C-T scan findings in glioma and brain tissue after irradiation were histopathologically analyzed with the post-mortem examination of 4 patients. High density of contrast enhancement observed in gliomas mainly corresponded to proliferation of irregular blood vessels and hypodensity reflected less cellular area or necrotic foci in the tumor tissue. A mottled lesion with high density margin in C-T of radionecrosis of the brain tissue observed in a non-glioma patient was formed by coagulation necrosis showing marked proliferation of telangiectatic blood vessels in periphery of lesion and acellular area in the center. It is occasionally impossible to differentiate the findings between delayed radionecrosis of brain and recurrence of glioma using the C-T criteria alone.
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