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1.
Reprod Biomed Online ; 34(2): 203-210, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27913136

RESUMO

Cytogenetic analysis of the retained products of conception (POC) is the most effective test for identifying miscarriage causes. However, there has been no large-scale study limited to blastocyst transfer. This study retrospectively reports the findings of 1030 cases in which POC analysis was performed after missed abortion following single blastocyst transfer performed at the Shinbashi Yume Clinic. We identified 19.4% as normal karyotypes and 80.6% as aneuploid. These cases broke down into: 62.3% trisomy; 7.8% double trisomy; 0.5% triple or quadruple trisomy; 1.3% monosomy 21; 3.2% monosomy X; 0.1% 47,XXY; 1.0% polyploidy; 1.0% mixed; 1.1% embryonic mosaicism; and 2.4% structural anomalies. In samples with normal karyotypes, 49.5% were female while 50.5% were male. The occurrence of trisomy and double trisomy were both significantly more frequent in the ≥38 years group than in the ≤37 years group (P < 0.01). Trisomy was significantly more frequently associated with fetal heartbeat (P < 0.01); double trisomy, polyploidy and normal karyotype were significantly more frequent with no fetal heartbeat (P < 0.01). There was no significant difference in the frequency of chromosomal abnormalities between the number of miscarriages or blastocyst quality. Thus, POC cytogenetic testing is highly valuable for ascertaining the cause of miscarriage.


Assuntos
Aborto Retido/genética , Análise Citogenética , Transferência Embrionária , Fertilização , Adulto , Aneuploidia , Aberrações Cromossômicas , Feminino , Fertilização in vitro , Humanos , Japão , Cariotipagem , Masculino , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Injeções de Esperma Intracitoplásmicas
2.
Invest Ophthalmol Vis Sci ; 56(9): 5353-61, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26275133

RESUMO

PURPOSE: To correlate a genetic risk score based on age-related macular degeneration (AMD) susceptibility genes with the risk of AMD in the second eye. METHODS: This is a retrospective, open cohort study consisting of 891 unilateral AMD patients, who were followed for at least 12 months and recruited from three institutes. DNAs were genotyped using Illumina OmniExpress, HumanOmni2.5-8, and/or HumanExome. Survival analyses and Cox proportional hazard models were used to examine the association between 11 AMD susceptibility genes and the duration until second-eye involvement in 499 samples from Kyoto University, which were replicated in two other cohorts. Genetic risk score (GRS) was also evaluated. RESULTS: The ARMS2 rs10490924 recessive model (hazard ratio [HR]meta = 2.04; Pmeta = 3.4 × 10⁻³) and CFH rs800292 additive model (HRmeta = 1.77; Pmeta = 0.013) revealed significant associations with second-eye involvement. The dominant model of TNFRSF10A rs13278062, VEGFA rs943080, and CFI rs4698775 showed consistent effects across three datasets (I² = 0%; HRmeta = 1.46, 1.30, 1.51, respectively). The GRS using these five single nucleotide polymorphisms (SNPs) was also significantly associated (HRmeta [per score] = 2.42; P = 2.2 × 10⁻5; I² = 0%). After 10 years from the first visit, the patients within the top 10% by GRS showed a 51% hazard rate, in contrast to 2.3% among patients within the lowest 10% by GRS. CONCLUSIONS: We demonstrated that the GRS using ARMS2, CFH, TNFRSF10A, VEGFA, and CFI was significantly associated with second-eye involvement. Genetic risk has high predictive ability for second-eye involvement of AMD.


Assuntos
Fator H do Complemento/genética , Previsões , Regulação da Expressão Gênica , Degeneração Macular/genética , Proteínas/genética , Receptores do Ligante Indutor de Apoptose Relacionado a TNF/genética , Fator A de Crescimento do Endotélio Vascular/genética , Alelos , Fator H do Complemento/biossíntese , Feminino , Seguimentos , Frequência do Gene , Predisposição Genética para Doença , Genótipo , Técnicas de Genotipagem , Humanos , Incidência , Japão/epidemiologia , Degeneração Macular/epidemiologia , Degeneração Macular/metabolismo , Masculino , Fenótipo , Polimorfismo de Nucleotídeo Único , Proteínas/metabolismo , RNA/genética , Receptores do Ligante Indutor de Apoptose Relacionado a TNF/biossíntese , Estudos Retrospectivos , Fatores de Risco , Fator A de Crescimento do Endotélio Vascular/biossíntese
3.
Mol Endocrinol ; 27(2): 192-202, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23275455

RESUMO

The actions of glucocorticoids at the feto-maternal interface are not well understood. Here, we show that decidualization of human endometrial stromal cells (HESCs) in response to progesterone and cAMP signaling is associated with a strong induction of 11ß-hydroxysteroid dehydrogenase type 1 (11ßHSD1) expression and enzyme activity. Decidualization also triggered a gradual decrease in glucocorticoid receptor (GR) expression and reciprocal increase in mineralocorticoid receptor (MR) levels. Gene expression profiling of differentiating HESCs after small interfering RNA (siRNA)-mediated knockdown of either GR or MR identified 239 and 167 significantly regulated genes, respectively. Interestingly, GR-repressed genes were enriched for Krüppel-associated box domain containing zinc-finger proteins, transcriptional repressors involved in heterochromatin formation. In agreement, GR knockdown was sufficient to enhance trimethylated H3K9 levels in decidualizing cells. Conversely, we identified several MR-dependent genes implicated in lipid droplet biogenesis and retinoid metabolism. For example, the induction in differentiating HESCs of DHRS3, encoding a highly conserved enzyme that catalyzes the oxidation/reduction of retinoids and steroids, was enhanced by aldosterone, attenuated in response to MR knockdown, and abolished upon treatment with the MR antagonist RU26752. Furthermore, we demonstrate that decidualization is associated with dynamic changes in the abundance and distribution of cytoplasmic lipid droplets, the formation of which was blocked by RU26752. In summary, progesterone drives local cortisol biosynthesis by decidual cells through induction of 11ß-hydroxysteroid dehydrogenase type 1 (11ßHSD1), leading to transcriptional regulation of distinct GR and MR gene networks involved in epigenetic programming and lipid and retinoid metabolism, respectively.


Assuntos
11-beta-Hidroxiesteroide Desidrogenase Tipo 1/metabolismo , Decídua/metabolismo , Redes Reguladoras de Genes , Progesterona/metabolismo , Receptores de Glucocorticoides/metabolismo , Receptores de Mineralocorticoides/metabolismo , 11-beta-Hidroxiesteroide Desidrogenase Tipo 1/biossíntese , Diferenciação Celular , Células Cultivadas , AMP Cíclico/metabolismo , Endométrio/metabolismo , Feminino , Perfilação da Expressão Gênica , Regulação da Expressão Gênica , Humanos , Hidrocortisona/metabolismo , Fatores de Transcrição Kruppel-Like , Lipídeos/biossíntese , Antagonistas de Receptores de Mineralocorticoides/farmacologia , Interferência de RNA , RNA Interferente Pequeno , Receptores de Glucocorticoides/biossíntese , Receptores de Glucocorticoides/genética , Receptores de Mineralocorticoides/biossíntese , Receptores de Mineralocorticoides/genética , Retinoides/metabolismo , Roxitromicina/farmacologia , Células Estromais/metabolismo , Dedos de Zinco
4.
J Obstet Gynaecol Res ; 38(9): 1187-93, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22540675

RESUMO

AIM: The rate of oocyte decline follows a biphasic pattern, characterized by acceleration between 32 and 38 years old. Ovarian reserve is also affected by external factors, including ovarian disease and iatrogenic damage. The aim of this study was to histologically evaluate the impact of ovarian endometriomas, laparoscopic cystectomy, and age on follicle reserve in healthy ovarian tissues and in surgically resected cyst walls. MATERIAL AND METHODS: Sixty-one patients were found to have ovarian endometriomas and 42 patients non-endometriotic cysts. A small amount of normal ovarian tissue was obtained during ovarian cystectomy. The follicles in normal ovarian tissue and resected cyst walls were histologically evaluated. RESULTS: The density of follicles in ovarian tissues correlated with the age of the patients in both groups. In women aged <35 years, the relative density of follicles in healthy ovarian tissues was consistently lower in the endometriotic cyst group compared to the non-endometriotic cyst group, with the relative ratio at age 20, 30 and 35 years calculated to be 35.4%, 46.8% and 62.7%, respectively. There was no significant difference between the groups in patients over the age of 35. The resection rate of normal ovarian tissue in cystectomy specimen of the endometriosis group was significantly higher than in the non-endometriotic cyst group (P < 0.001). CONCLUSIONS: Our data suggest that ovarian endometriomas have a detrimental impact on follicle reserve in younger patients. Further, laparoscopic cystectomy for endometriomas may accelerate the rate of oocyte loss associated with aging.


Assuntos
Envelhecimento/patologia , Endometriose/patologia , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Cistos Ovarianos/patologia , Folículo Ovariano/citologia , Adolescente , Adulto , Feminino , Humanos , Laparoscopia/efeitos adversos , Pessoa de Meia-Idade , Cistos Ovarianos/cirurgia , Adulto Jovem
5.
Minim Invasive Ther Allied Technol ; 20(5): 263-6, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21247254

RESUMO

There are two different types of hysterocopes available: Flexible and rigid. Flexible scopes have the ability to observe the whole intrauterine cavity, but it is difficult to perform an operation on endometrial lesions. Rigid hysteroscopes provide superior optical qualities due to higher pixel count. We report the use of a new flexible hysteroscope with narrow band imaging (NBI) system (HYF-V EndoEYE Flexible Video Hysteroscope) and compared the optical qualities of this flexible to those of a rigid hysteroscope using the vascular analysis software "SolemioENDO ProStudy". Twenty-four images of endometrium in eight cases, and 12 images of submucous myoma in six cases were each photographed by two the hysteroscopes. The vascular densities of both endometrium and myoma under conventional light in the flexible scope were significantly higher than with the rigid scope. However the vascular densities under narrow-band light in the two scopes were not significantly different. The vascular densities of the images taken by flexible scope were higher than the images taken by rigid scopes under conventional light. With the rigid scope, microvascular structure may be crumpled by high water pressure. A flexible hysteroscope with NBI system has superior ability to observe the intrauterine cavity and measure vascular density compared to a rigid scope.


Assuntos
Endométrio/irrigação sanguínea , Histeroscópios , Histeroscopia/instrumentação , Leiomioma/irrigação sanguínea , Adulto , Diagnóstico por Computador , Feminino , Humanos , Histeroscopia/métodos , Aumento da Imagem , Pessoa de Meia-Idade
6.
Minim Invasive Ther Allied Technol ; 20(1): 58-61, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21155634

RESUMO

Submucous myomas cause infertility and recurrent pregnancy loss. Several studies have reported successful reproductive outcomes after hysteroscopic myomectomy (HM), but the risk of postoperative intrauterine adhesion is present. We performed laparoscopic myomectomy (LM) for a submucous myoma and second look laparoscopy under observation using a hysteroscope to evaluate the alteration in endometrial vascular density during surgery using vascular analysis software. The patient was a 33-year-old nulliparous infertile woman. She had one submucous myoma of 4 cm in diameter and 50-60% penetration into the myometrium (class T:II; the European Society of Hysteroscopy classification). The surface vascular density of the submucous myoma was 68.6% before the start of surgery, decreased to 51.4% upon vasopressin injection and increased to 67.6% at the end of LM. Intraabdominal and intrauterine adhesions were not seen at second look laparoscopy. The vascular density was 70.8%, and the rate of endometrial blood flow was increased to 112.5% by comparison with the vascular density before the start of surgery. HM is a safe and effective procedure, but carries the risk of scarring the uterine cavity with uterine adhesions. We have to consider LM for women of reproductive age who have a submucous myoma with penetration >50% into the myometrium (class T:II).


Assuntos
Histeroscopia/métodos , Infertilidade Feminina/cirurgia , Laparoscopia/métodos , Leiomioma/cirurgia , Adulto , Diagnóstico por Computador , Endométrio/irrigação sanguínea , Feminino , Humanos , Histeroscopia/efeitos adversos , Complicações Pós-Operatórias , Software , Aderências Teciduais/etiologia , Doenças Uterinas/etiologia
7.
J Minim Invasive Gynecol ; 17(3): 301-5, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20303832

RESUMO

OBJECTIVE: Myoma of the uterine cervix is rare, accounting for about 5% of all myomas. Compared with myomas that occur in the uterine corpus, cervical myomas are closer to other organs such as the bladder, ureter, and rectum, and the approach needs to be modified because the organs that have to be considered differ depending on the location of the myoma. We divided cervical myomas into 2 types according to location, comprising an intracervical type and extracervical types. A clear outline of surgical treatment for cervical myoma has not described in previous papers. We then investigated the surgical strategy for these types. PATIENTS: Subjects comprised 16 patients who were diagnosed with cervical myoma in our hospital between January 2005 and April 2009, and who underwent laparoscopic myomectomy. RESULT: Mean operative time was 105.8 + or - 43.2 (82.8-128.8) min, mean blood loss was 105 + or - 117 (42.6-167.4) ml, and mean specimen weight was 208.3 + or - 195.4 (99.3-306.2) g. Histopathological examination showed atypical myoma in 1 case and leiomyoma in others. CONCLUSIONS: 16 cases of cervical myomectomy were performed safely by developing a uniform strategy that uses a fixed operative procedure, even with laparotomy, if sufficient attention is paid to the following 6 points: 1) attempting to reduce the size of the myoma with the use of preoperative GnRH; 2) determining the positional relationship between the myoma and surrounding organs; 3) temporarily blocking uterine artery blood flow with the use of vessel clips; 4) suppressing bleeding during myomectomy with the use of vasopressin; 5) minimizing the risk of damaging surrounding organs by positioning the incision in the myometrium somewhat lateral to the uterine corpus; and 6) the bottom of the wound after enculation should be pulled up by the forceps for suturing to avoid making dead space.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Laparoscopia/métodos , Neoplasias do Colo do Útero/cirurgia , Adulto , Perda Sanguínea Cirúrgica , Feminino , Humanos , Infertilidade Feminina/cirurgia , Leiomioma/cirurgia , Pessoa de Meia-Idade , Miométrio/cirurgia , Resultado do Tratamento
8.
J Minim Invasive Gynecol ; 17(1): 21-5, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-19892605

RESUMO

The development and onset of endometriosis is associated with angiogenesis and angiogenic factors including cytokines. We analyzed intrapelvic conditions in women with endometriosis via vascular density assessment of grossly normal peritoneum and determination of cytokine levels in peritoneal fluid. Seventy-three patients underwent laparoscopic surgery because of gynecologic disease including endometriosis in our department using a narrow-band imaging system. Each patient was analyzed for peritoneal vascular density using commercially available vascular analysis software (SolemioENDO ProStudy; Olympus Corp, Tokyo, Japan). Each patient was also subjected to analysis of interleukin 6 (IL-6), IL-8, tumor necrosis factor-alpha, and vascular endothelial growth factor concentrations in peritoneal fluid. We defined 4 groups as follows: group 1, endometriosis: gonadotropin-releasing hormone (GnRH) agonist administration group (n=27); group 2, endometriosis: GnRH agonist nonadministration group (n=15); group 3, no endometriosis: GnRH agonist administration group (n=18); and group 4, no endometriosis: GnRH agonist nonadministration group (n=13). No significant differences in peritoneal vascular density between the 4 groups were found under conventional light; however, under narrow-band light, vascular density in the endometriosis groups (groups 1 and 2) was significantly higher. Cytokine analysis of the 4 groups determined that IL-6 and IL-8 concentrations were significantly higher compared with the no endometriosis groups (groups 3 and 4). Tumor necrosis factor-alpha and vascular endothelial growth factor concentrations were not significantly different between groups. In endometriosis, peritoneal vascular density was significantly higher as assessed using the narrow-band imaging system and SolemioENDO ProStudy, whereas GnRH agonist did not obviously decrease vascular density but IL-6 concentration was lower in the GnRH agonist administration group.


Assuntos
Citocinas/análise , Endometriose/patologia , Neovascularização Patológica/patologia , Doenças Peritoneais/patologia , Peritônio/irrigação sanguínea , Adulto , Líquido Ascítico/química , Endometriose/tratamento farmacológico , Endometriose/metabolismo , Feminino , Hormônio Liberador de Gonadotropina/agonistas , Hormônio Liberador de Gonadotropina/antagonistas & inibidores , Humanos , Interpretação de Imagem Assistida por Computador , Interleucina-6/análise , Interleucina-8/análise , Laparoscopia , Neovascularização Patológica/metabolismo , Doenças Peritoneais/metabolismo , Peritônio/metabolismo , Peritônio/patologia , Software , Estatísticas não Paramétricas , Fator de Necrose Tumoral alfa/análise , Fator A de Crescimento do Endotélio Vascular/análise
9.
J Minim Invasive Gynecol ; 16(5): 618-21, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19835806

RESUMO

A pilot study was designed to analyze the vascular density of peritoneal endometriosis in 3 groups of lesions (red, black, and white) in 23 patients with peritoneal endometriosis who underwent laparoscopic surgery using the narrow-band imaging system and vascular analysis software. In the peritoneum, 21 red lesions were present in 10 patients, 12 black lesions were present in 9 patients, 12 white lesions were present in 8 patients, and 2 types of lesion were concomitantly present in 4 patients. Median vascular density of red, black, and white lesions under conventional light was 60.3%, 62.3%, and 60.6%, respectively, and under narrow-band light was 64.4%, 61.5%, and 62.0%, respectively, showing no significant differences among the lesions under either conventional or narrow-band light (p=.71 and p=.84, respectively). The median difference in vascular density under narrow-band and conventional light was not significantly different in black lesions (0.8%) or white lesions (1.0%); however, a difference of 4.5% was noted for red lesions (p <.001). We conclude that red lesions are indicative of early-stage endometriosis with angiogenesis. Use of the narrow-band system and vascular analysis software can enable accurate, objective, and reproducible evaluation of vascular density.


Assuntos
Endometriose/patologia , Doenças Peritoneais/patologia , Peritônio/irrigação sanguínea , Adulto , Endoscopia/métodos , Feminino , Humanos , Neovascularização Patológica/patologia , Projetos Piloto , Software , Adulto Jovem
10.
J Obstet Gynaecol Res ; 35(4): 827-31, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19751354

RESUMO

AIM: To produce a successful pregnancy in a 38-year-old infertile patient with relapsed myoma using a technique we refer to as 'surgery-assisted reproductive technology (ART) hybrid therapy' because it combines ART for cryopreservation of in vitro fertilized eggs with reproductive surgery. METHODS: A 38-year-old nulliparous woman who had undergone abdominal myomectomy and in whom magnetic resonance imaging showed multiple myomas was treated at our University-affiliated hospital and outpatient clinic. Blastocysts were cryopreserved during the preoperative period. Laparoscopic myomectomy was performed after preoperative treatment with a GnRH agonist. Ten months after the operation, the youngest cryopreserved blastocyst was transferred into the uterus and implanted successfully. RESULTS: Treatment resulted in successful implantation and pregnancy. In January 2008, the course of pregnancy had been uneventful and the patient gave birth to a male infant weighing 2998 grams by cesarean section at 37 weeks of gestation. CONCLUSION: We have treated eight patients using hybrid therapy with encouraging results, and we describe these cases herein briefly.


Assuntos
Infertilidade Feminina/terapia , Leiomioma/cirurgia , Complicações Neoplásicas na Gravidez/cirurgia , Técnicas de Reprodução Assistida , Neoplasias Uterinas/cirurgia , Adulto , Criopreservação , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez
11.
J Obstet Gynaecol Res ; 35(3): 520-4, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19527393

RESUMO

UNLABELLED: HEADING AIMS: We evaluated tubal disorders, including peritubal adhesions, as risk factors for repeat ectopic pregnancy (REP) after laparoscopic linear salpingotomy (LS) or salpingectomy for tubal pregnancy. METHODS: This was a retrospective clinical study in a university hospital. RESULTS: Of 43 women monitored for at least 6 months after LS, 28 (65%) subsequently conceived. In 24 (86%) of these women the pregnancy was intrauterine, and four (14%) had REP. Of 40 women with a unilateral tube monitored for at least 6 months after salpingectomy, 24 (60%) conceived. In 17 (71%) of these women the pregnancy was intrauterine, and seven (29%) had REP. There was no significant difference between groups in postoperative pregnancy or REP rates. There was no significant difference in the mean adhesion score by revised American Fertility Society stage points (re-AFS) at operation and the site of subsequent pregnancy in either the LS or the salpingectomy group, although the mean re-AFS score was significantly higher in women who had REP (3.1) than in those whose subsequent pregnancy was intrauterine (0.4). CONCLUSIONS: There was no significant difference in postoperative pregnancy or REP rates following previous LS or salpingectomy. The re-AFS score appeared to be an accurate predictor of the prognosis of subsequent pregnancies.


Assuntos
Doenças das Tubas Uterinas/complicações , Laparoscopia , Gravidez Ectópica/epidemiologia , Gravidez Tubária/cirurgia , Adulto , Tubas Uterinas/cirurgia , Feminino , Humanos , Laparoscopia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Gravidez , Gravidez Tubária/epidemiologia , Recidiva , Fatores de Risco , Aderências Teciduais/complicações , Aderências Teciduais/epidemiologia
12.
Reprod Med Biol ; 8(3): 113-118, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29699316

RESUMO

PURPOSE: To assess outcomes in assisted reproductive technology (ART) in infertile women with endometriosis with respect to their concomitant endometrioma status and surgical history in our department. METHODS: This is a retrospective case control study which analyzes informational data obtained at a university hospital. The study drew from a patient pool of 332 cases (877 cIVF/ICSI cycles) that took place in our department from 2006 to 2008. Sixty-one cases (97 cycles) had major indications for cIVF/ICSI with endometriosis. We classified groups from these 61 cases as follows: an unoperated endometrioma group (A) with 31 cycles, a postoperative endometrioma group (B) with 51 cycles, and a no endometrioma group (C) with 15 cycles. We analyzed and compared these three groups and also included a non-endometriosis tubal infertility group (D) with 27 cycles. RESULTS: In the control group (D), serum FSH levels and the cancellation rates were significantly lower than those of other groups, and the number of developing follicles was higher. E2 levels before oocyte aspiration in the postoperative endometrioma group (B) was lower. Implantation, pregnancy, delivery and miscarriage rates were not significantly different among the four groups. CONCLUSION: The results suggest that endometriosis causes a decrease in endocrinologic ovarian function whether or not an endometrioma is also present. As for E2 level before oocyte aspiration, our results suggest that ovarian reserves might be reduced by endometrioma excision, but this is difficult to evaluate. In the endometriosis groups, cancellation rates were significantly higher, although when embryos were transferred the pregnancy rates were not significantly different when compared with the non-endometriosis group. As for infertile women with endometriomas, our results suggest that preexisting ovarian reserve is reduced by the presence of endometriosis, and ovarian reserve might also be reduced by excision of endometriomas.

13.
14.
Artigo em Inglês | MEDLINE | ID: mdl-17102472

RESUMO

In the past, almost all patients underwent radiotherapy during the hospital stay. So nurses took care of patients after radiotherapy in the hospital where patients could receive nursing care 24 hours a day. However, recently more and more patients have undergone radiotherapy at clinics as outpatients. This benefits them in enabling them to receive the therapy with improving QOL and maintaining their style of living--on the other hand this requires much self-care ability on their part and patient compliance of outpatient visits depends on their own positive decision-making. Nurses are considered to make decisions or take implementation of various kinds of intervention in the limited time of pre and post proceedings of the therapy when they accommodate patients directly. The process of their intervention has not so far been clarified so that the quality of the care depends on the degree of each individual's capacity or devotion. In addition, with the trend in decreasing hospitalized days, it is predicted that more and more patients will undergo outpatient radiotherapy. So it is significant to clarify the process for quality assurance of nursing.


Assuntos
Assistência Ambulatorial , Cuidados de Enfermagem/normas , Radioterapia/enfermagem , Tomada de Decisões , Humanos , Entrevistas como Assunto , Japão
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