Development of a blended learning system for nurses to learn the basics of psychoeducation for patients with mental disorders.

BACKGROUND: Psychoeducation should be practiced by various professionals. However, many Japanese psychiatric nurses recognize that psychoeducation should be practiced by other professionals, and show passive attitudes toward learning about evidence-based practices (EBPs), including psychoeducation. We developed a psychoeducation practitioner training program (PPTP) to nurture nurses. However, the PPTP was shown to be ineffective to help nurses achieve psychoeducation skills, although it improved their knowledge of psychoeducation and views on EBP. We developed and evaluated a revised version of the PPTP, integrating blended learning that combines e-learning and group education (BL-PPTP), to nurture nurses' competencies to practice psychoeducation for patients with mental disorders. METHOD: We trained nurses working on acute psychiatric care wards of Japanese hospitals using BL-PPTP, and compared their attitudes for evidence-based practices (EBP attitudes), preparedness for psychoeducational practice, and self-efficacy at 4 points to clarify time-course changes in each participant. RESULTS: Sixty-nine nurses participated, 31 withdrew, and 38 were analyzed. The time needed to complete BL-PPTP ranged from 31 to 259 days, revealing a marked individual difference. There were significant improvements in most participants' EBP attitudes and preparedness for psychoeducational practice at the end of the program compared with the baseline. CONCLUSIONS: BL-PPTP may be useful to nurture nurses' competencies to practice psychoeducation. BL-PPTP developed in the present study may also help disseminate psychoeducation among nurses, and increase the quality of nursing care.

Effects of the Nursing Psychoeducation Program on the Acceptance of Medication and Condition-Specific Knowledge of Patients with Schizophrenia.

The objective of this study was to evaluate the clinical utility of the nursing psychoeducation program (NPE) for improving the acceptance of medication of inpatients with schizophrenia as well as their knowledge regarding their illness and the effects of medication on it. This study was a quasi-experimental study involving a convenience sample and was performed at the acute treatment units of two Japanese psychiatric hospitals. The subjects were recruited from among the inpatients being treated at the acute treatment units and were assigned to either the experimental or control group. The experimental group took part in the NPE, and the control group received the standard treatments for schizophrenia. Data were collected using structured questionnaires; i.e., the Medication Perception Scale for Patients with Schizophrenia (MPS), Drug Attitude Inventory-10 Questionnaire (DAI-10), and Knowledge of Illness and Drugs Inventory. Forty-three patients (13 men and 30 women) agreed in writing to participate in this study. During pre-/postintervention comparisons, the total MPS score, the 'efficacy of medication' subscale score, and the total DAI-10 score exhibited significant group×time interactions.

Differences in the clinical characteristics of Pneumocystis jirovecii pneumonia in immunocompromized patients with and without HIV infection.

BACKGROUND AND OBJECTIVE: The incidence of Pneumocystis jirovecii pneumonia (PCP) in patients with predisposing immunodeficiencies other than AIDS is growing. Knowing the different characteristics and outcomes of PCP according to HIV status would help physicians manage and treat patients with PCP. METHODS: The medical charts of all patients with a proven first episode of PCP, diagnosed between 1997 and 2007 were retrospectively reviewed, and clinical and laboratory data abstracted. RESULTS: Of the 35 patients with PCP, 18 were HIV-positive and 17 were HIV-negative with other immunosuppressive conditions. HIV-negative patients were significantly older than HIV-positive patients. The WCC (10 952 +/- 5669 vs 9750 +/- 3133/microL; P = 0.015), neutrophil counts (9631 +/- 5421 vs 5680 +/- 2628/microL; P = 0.01) and CD4+ lymphocyte counts (329 +/- 502 vs 47 +/- 50/microL; P < 0.001) were significantly higher in HIV-negative patients. Six of the 17 HIV-negative patients had a CD4+ lymphocyte count >300/microL. Serum IgG levels were lower in HIV-negative patients (943 +/- 379 vs 1635 +/- 657 mg/dL; P = 0.017). Mortality was higher in HIV-negative (52.9%) than in HIV-positive patients (0%). On univariate analysis, risk factors for mortality from PCP were the presence of underlying pulmonary disease (odds ratio 4.000, 95% CI: 1.501-10.658) and HIV-negative status (odds ratio 2.125, 95% CI: 1.283-3.518). CONCLUSIONS: The characteristics and outcomes of PCP differ significantly depending on HIV status. The existence of underlying pulmonary diseases may be associated with the prognosis of HIV-negative patients with PCP.

[Clinical statistics of outpatients investigated for asbestos-related lung diseases at a general hospital in Tokyo].

We evaluated 122 outpatients who visited our hospital for examination of asbestos-related diseases between November, 2005 and October, 2006. Patients were divided into three groups; occupational exposure, non-occupational exposure and non-exposure groups. The occupational exposure group showed a significantly higher rate of asbestos-related abnormal findings than the non-occupational exposure plus the non-exposure group (33% vs. 5%, respectively; P = 0.001). Pleural plaque was the most common abnormal finding related to asbestos. Only four of 24 patients with pleural plaques could obtain personal health records for workers enjoyed in dangerous work, whereas the rest of them were not able to mainly because they were self-employed. A health support system is necessary to also cover non-employees.

[A case of bird related hypersensitivity pneumonitis had a progressive course].

A 50-year-old woman was admitted due to productive cough continuing for 3 years. A chest computed tomography showed appearance of nonspecific interstitial pneumonia (NSIP). Thoracoscopic lung biopsy specimens showed mainly a pattern of NSIP with multinucleated cells and cholesterol clefts. She was not a bird fancier, but had indirect exposure to birds in her living environment, and had been using feather-filled duvets for a long time. We established a diagnosis of bird-related hypersensitivity pneumonitis based on antibodies in serum positive to pigeon dropping extracts. She was treated by coadministration of corticosteroids and immunosuppressants, and avoidance of bird-related antigens, but had a progressive course and died of respiratory failure.