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BMC Psychol ; 7(1): 27, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31046844


BACKGROUND: Previous studies have shown a relationship between delirium and depressive symptoms after cardiac surgery with distress personalities linking to negative surgical outcomes. The aim of the present study is to further investigate the association between patients with Type D (distressed) personality with regards to delirium after cardiac surgery. METHODS: We conducted a consecutive-sample observational cohort pilot study with an estimated 142 patients needed. Enrollment criteria included patients aged ≥18 years who were undergoing planned cardiovascular, thoracic and abdominal artery surgery between October 2015 to August 2016 at the University of Tsukuba Hospital, Japan. All patients were screened by Type-D Personality Scale-14 (DS14) as well as the Hospital Anxiety and Depression Scale (HADS) the day before surgery. Following surgery, daily data was collected during recovery and included severity of organ dysfunction, sedative/analgesic exposure and other relevant information. We then evaluated the association between Type D personality and delirium/coma days (DCDs) during the 7-day study period. We applied regression and mediation modeling for this study. RESULTS: A total of 142 patients were enrolled in the present study and the total prevalence of delirium was found to be 34% and 26% of the patients were Type D. Non-Type D personality patients experienced an average of 1.3 DCDs during the week after surgery while Type D patients experienced 2.1 days over the week after surgery. Multivariate analysis showed that Type D personality was significantly associated with increased DCDs (OR:2.8, 95%CI:1.3-6.1) after adjustment for depressive symptoms and clinical variables. Additionally, there was a significant Type D x depression interaction effect (OR:1.7, 95% CI:1.2-2.2), and depressive symptoms were associated with DCDs in Type D patients, but not in non-Type D patients. Mediation modeling showed that depressive symptoms partially mediated the association of Type D personality with DCDs (Aroian test =0.04). CONCLUSIONS: Type D personality is a prognostic predictor for prolonged acute brain dysfunction (delirium/coma) in cardiovascular patients independent from depressive symptoms and Type D personality-associated depressive symptoms increase the magnitude of acute brain dysfunction.

Procedimentos Cirúrgicos Cardíacos/psicologia , Coma/etiologia , Delírio/etiologia , Personalidade Tipo D , Idoso , Encéfalo/fisiopatologia , Estudos de Coortes , Delírio/diagnóstico , Depressão/diagnóstico , Depressão/etiologia , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Personalidade , Projetos Piloto , Prevalência
PLoS One ; 13(3): e0194094, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29534083


BACKGROUND: Pediatric patients, especially in the preverbal stage, cannot self-report intensity of pain therefore several validated observational tools, including the Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Scale, have been used as a benchmark to evaluate pediatric pain. Unfortunately, this scale is currently unavailable in Japanese, precluding its widespread use in Japanese hospitals. OBJECTIVES: To translate and verify the validity and reliability of the Japanese version of the FLACC Behavioral Scale. METHOD: Back-translation was first conducted by eight medical researchers, then an available sample of patients at the University of Tsukuba Pediatric Intensive Care Unit (from May 2017 to August 2017) was enrolled in a clinical study. Two researchers evaluated the validity of the translated FLACC Behavioral Scale by weighted kappa coefficient and intraclass correlation coefficients (ICC). Observational pain was simultaneously measured by the visual analog scale (VAS obs) and reliability was evaluated by correlation analysis. RESULT: The original author approved the translation. For the clinical study, a total of 121 observations were obtained from 24 pediatric patients. Agreement between observers was highly correlated for each of the FLACC categories (Face: κ = 0.85, Leg: κ = 0.74, Activity: κ = 0.89, Cry: κ = 0.93, Consolability: κ = 0.93) as well as the total score (Total: κ = 0.95,). Correlation analysis demonstrated a good criterion validation between the FLACC scale and the VAS obs. (r = 0.96). CONCLUSION: Our Japanese version of the FLACC Behavioral Scale shows high validity and reliability.

Escala de Avaliação Comportamental/normas , Medição da Dor/métodos , Medição da Dor/normas , Criança , Pré-Escolar , Face , Expressão Facial , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Pediátrica , Japão , Masculino , Dor , Psicometria/métodos , Reprodutibilidade dos Testes , Tradução
Acute Med Surg ; 5(1): 98-101, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29445507


Aim: Delirium is a form of acute cerebral dysfunction and is associated with increased length of hospital stay, mortality, and health-care costs for adult patients in intensive care. However, in Japan, there are currently no reliable criteria or tools for diagnosing delirium in critically ill pediatric patients. The purpose of this study was to translate the Cornell Assessment of Pediatric Delirium (CAPD)-a screening tool for pediatric delirium-from English to Japanese for use in the diagnosis of delirium for pediatric patients in pediatric intensive care units. Methods: The back-translation method was used to ensure equivalence in the Japanese version of the CAPD and its accompanying developmental anchor points. The translation process was repeated by a multidisciplinary committee of medical researchers and clinicians. Results: The final back-translated version of the CAPD was submitted to the original author, who gave her approval. Conclusion: The Japanese CAPD was developed and its effectiveness tested using a standardized procedure. Further study is required to test the validity and reliability of the Japanese version of the CAPD.

Acute Med Surg ; 5(1): 102-105, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29445508


Aim: Delirium is associated with various negative clinical outcomes, such as decline in cognitive ability, increased length of hospital stay, and higher mortality. For these reasons, early diagnosis of delirium is critical. Unfortunately, there are no reliable diagnostic criteria or tool of delirium for infants and preschool-aged children in Japan.The aim of the present study was to translate a new delirium assessment tool, the Preschool Confusion Assessment Method for the Intensive Care Unit (psCAM-ICU), for accurately diagnosing clinically ill infants and preschool-aged children, from English to Japanese. Methods: The translation was undertaken with the internationally established back-translation method. The translation was repeated blindly and independently by eight medical researchers and clinicians from multiple disciplines. Any discrepancy evident from the translated works was discussed and resolved. Results: We report the successful development of the Japanese version of psCAM-ICU. However, before its full application, this diagnostic tool requires further testing and study, most notably for its validation and reliability. Conclusion: A Japanese version of the psCAM-ICU was developed.

Life Sci ; 166: 27-33, 2016 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-27742253


Among the dysfunctions and pathologies associated with sepsis, the underlying molecular mechanisms of sepsis-induced acute lung injury (ALI) are poorly understood. Endothelin (ET)-1, a potent vasoconstrictor and pro-inflammatory peptide, is known to be involved in the pathogenesis of ALI in a rat model of sepsis. Here, we investigated whether landiolol hydrochloride, an ultra-short-acting ß-blocker, plays a crucial role in ameliorating and attenuating LPS-induced ALI through modulation of the ET-1 system. Male Wistar rats at 8weeks of age were administered with either saline or lipopolysaccharide (LPS) for three hours (3h) and some of the LPS-administered rats were continuously treated with landiolol for 3h. ALI was induced by LPS, including levels of both circulatory and pulmonary TNF-α and IL-6 but [PaO2] was significantly decreased. LPS also induced a significant increase in levels of pulmonary ET-1 and ET-A receptor, but levels of ET-B receptor, which has vasodilating effects, were remarkably diminished. Further, LPS administration upregulated the pulmonary expression of HIF-1α. Finally, the treatment of LPS-administered rats with landiolol for 3h ameliorated and prevented ALI, normalized the altered levels of pulmonary ET-1 and ET-A receptors. Landiolol also induced significant down-regulation of ET-B receptor in lung tissues in the early hours (phase) of sepsis. However, Landiolol treatment had no effect on the up-regulated inflammatory mediators (TNF-α, IL-6) in both plasma and lung tissues during sepsis, and expression of pulmonary HIF-1α also remained unchanged after landiolol treatment. Collectively, these data led us to conclude that landiolol may ameliorate sepsis-induced ALI via the pulmonary ET system.

Lesão Pulmonar Aguda/tratamento farmacológico , Antagonistas Adrenérgicos beta/uso terapêutico , Regulação para Baixo/efeitos dos fármacos , Endotelina-1/genética , Pulmão/efeitos dos fármacos , Morfolinas/uso terapêutico , Sepse/tratamento farmacológico , Ureia/análogos & derivados , Lesão Pulmonar Aguda/sangue , Lesão Pulmonar Aguda/genética , Lesão Pulmonar Aguda/patologia , Animais , Endotelina-1/análise , Pulmão/metabolismo , Pulmão/patologia , Masculino , RNA Mensageiro/genética , Ratos Wistar , Sepse/sangue , Sepse/genética , Sepse/patologia , Fator de Necrose Tumoral alfa/genética , Ureia/uso terapêutico