加瀬 竜太郎

切除不能な肝細胞がん治療に用いられるtyrosine kinase inhibitor(TKI)の副作用の1つにhand-foot skin reaction(HFSR)がある.本研究は手と足におけるHFSR発生率,HFSRの症状,発生時期を明らかにすることを目的とした.本研究はコホート研究で,切除不能な肝細胞がんに対してレンバチニブ,ソラフェニブ,レゴラフェニブによる治療を受ける患者を対象に,2ヵ月間の診察日に問診と手足の写真撮影を行った.写真はフットケアエキスパートナースを含む3名で皮膚症状を確認した.手足それぞれのHFSR発生日をカプラン-マイヤー曲線を用いて描出し,log-rank検定を実施した.本研究は千葉大学大学院看護学研究科倫理審査委員会の承認を得て実施された.研究に参加した58名のHFSR発生率は84%であり,最も多く観察された症状は角質剥離で,参加者の23%は手に,参加者の39%は足にみられた.HFSR発生日の中央値は,手が21日(95%信頼区間17.6～24.3日),足が7日(95%信頼区間11.6～14.3日)と,足のほうが早くHFSRが発生していた(log-rank検定,p<0.01).本研究結果から,HFSRの早期発見には手だけではなく足の観察も重要であると考えられた.看護師はTKI治療開始前から診察日ごとに患者の手足を観察することで軽微な変化も見逃さず,適切な治療につなげる役割が期待される.(著者抄録)

If patients are at risk of self-removal of a catheter, it is necessary to check the condition of the catheter frequently. If this is the only way to prevent self-removal, physical restraint of the patient is required. Furthermore, it is currently necessary to reduce human-to-human contact to prevent COVID-19 infection. Therefore, the development of a sensor system to prevent self-removal of a catheter and reduce human-to-human contact is urgent. The purpose of this study is to examine a sensor system that detects the contact of a patient's hand to a peripheral intravenous catheter in order to prevent self-removal in patients with dementia. This study analyzes the use of a capacitance sensor and an energization sensor to detect the contact of a patient's hand to a catheter. Additionally, the time required from the start of peeling the sensor sheet to the removal of the needle was measured. As the results, the capacitance sensor was difficult to use in a clinical setting because the connection between the seat and cable could be unstable depending on the condition of the connections. The energization sensor was able to recognize the contact of a hand to the catheter by detecting its contact with the sensor. It took at least 28 seconds from detection of the hand contact to the beginning of needle removal. Therefore, it is possible for the caregiver to visit the patient's bedside and stop the self-removal when the sensor sheet detects hand contact. This study is the first step in developing the system that prevents self-removal by detecting hand contact and requires several more steps for clinical use. In the future, we will conduct surveys on more subjects and clinical trials on elderly with dementia to examine accuracy, precision, and repeatability. Using the energization sensor, a self-removal prevention system for dementia patients will be further developed.Clinical Relevance- Developing this self-removal prevention system in the future will allow many dementia patients to no longer be physically restrained, and it will make it possible to remotely detect their actions to prevent self-removal while also minimizing the risk of COVID-19 infection.

Excessive pressure and shear stress while walking cause a risk of callus formation, which eventually causes foot ulcers in patients with diabetes mellitus. Callus under the second metatarsal head (MTH) has been associated with increased shear stress/pressure ratios (SPR). Callus under the fifth MTH has been associated with increased peak shear stress (PSS). The purpose of this study is to examine whether the effect of the suitable size and width of shoes prevents diabetic foot ulcers under the second and fifth MTH. We measured the pressure and shear stress by testing three kinds of sizes and two types of width of shoes. Significant difference was not observed in the SPR under the second MTH among different sizes of shoes. However, the pressure and shear stress were significantly lower when putting on shoes of fit size compared with larger sizes. The PSS under the fifth MTH was significantly smaller when putting on shoes of fit width compared with those of narrow width. Wearing shoes of fit size and width has the potential to prevent callus formation by reducing the pressure and shear stress constituting SPR under the second MTH and PSS under the fifth MTH.

BACKGROUND: Nursing care performed during sleep, including nurse-assisted patient turning, is one of the factors that deteriorates sleep quality but is necessary for pressure ulcer prevention. Thus, it is important to determine when nurseassisted patient turning has the least impact on sleep quality. AIM: The aim of this study was to clarify the impact of nurseassisted patient turning at different sleep stages and to determine the optimal timing of this aspect during sleep. METHODS: The experiment, which consisted of healthy men in their 20s and 30s, was performed over four successive nights per subject. The first night was dedicated to environment adaptation, and the 2nd to the 4th nights were randomly assigned for shallow sleep intervention, deep sleep intervention, and non-intervention. On the intervention day, nurse-assisted patient turning was conducted twice. Overnight sleep conditions were measured by polysomnography (PSG). The PSG waveform transmitted to a tablet was analyzed in real time to determine the stage of sleep. The patient was turned when he entered the planned stage of sleep. RESULTS: The study analyzed fourteen (14) subjects. Shallow sleep time, deep sleep time, and sleep resumption time after nurse-assisted patient turning were compared among the three groups of non-intervention day, shallow sleep intervention day and deep sleep intervention day. There was no significant difference in the shallow and deep sleep time among the three groups. However, sleep resumption time after nurse-assisted patient turning was significantly shorter on the deep sleep intervention day than on the shallow sleep intervention day (p = textbf 0.033). CONCLUSIONS: This study has novelty in examining the impact of nurse-assisted patient turning performed at different sleep stages on subsequent sleep using objective indicators. The study suggested that a deep sleep state is the optimal timing of nurseassisted patient turning due to the short time to sleep resumption.