[Clinical classification of fall risk using visually obtained information at a memory clinic].

AIM: There are few studies concerning the classification of fall risk by nurses without established fall risk assessment tools. In the present study, clinical classification of fall risk using visually obtained information was compared with the assessment of fall risk in order to evaluate the rationale and validity of the clinical classification of fall risk by nurses. METHODS: New patients who visited the center of comprehensive care and research for memory disorders at the National Center for Geriatrics and Gerontology were enrolled in the present study.Day-shift nurses separately recorded the clinical classification of fall risks through visually obtained information during the 10-minutes waiting time for outpatients.Fall risk assessments such as the Fall Risk Index and Timed Up & Go test, were performed by non-nurse medical staffs. Data were analyzed by an independent researcher who was not involved in obtaining clinical information. RESULTS: Nurse's clinical classification of fall risk using visually obtained information correlated well with Fall Risk Index, Timed Up & Go test, One-leg Standing test and Dorsiflex meter. In addition, subjects classified as having high fall risk were more frequently judged to be frail than classes of moderate or little fall-risk. CONCLUSION: Nurse's clinical classification of fall risk using visually obtained information was judged on their integrated impression including their evaluation of the muscle strength, gait speed and balance.

[Agreement in the responses to self-reported and proxy-reported versions of QOL-HC: a new quality-of-life scale for patients receiving home-based medical care].

AIM: We developed quality-of-life (QOL) scales for patients receiving home medical care. The objective of this study was to examine the agreement between the scores of the scales answered by patients and those answered by their proxy, as cognitive decline may interfere with one's ability to understand complex topics, such as the QOL. METHODS: Participants were pairs of patients receiving home medical care and their proxy. The patients were asked to complete self-reported QOL scales (QOL-HC), and their proxies were asked to complete proxy-reported versions of the QOL scales (QOL-HC for caregivers). We then statistically examined the extent of agreement between the self- and proxy-reported QOL-HC scores using contingency tables and Spearman's rank correlation coefficient. The SPSS software program, version 24, was used for all statistical analyses. RESULTS: The concordance rate between patients and caregivers for questions 1 ( "Do you have peace of mind?" ), 2 ( "Do you feel satisfied with your life when you reflect on it?" ), 3 ( "Do you have someone that you spend time talking with?" ), and 4 ( "Are you satisfied with the home care service system?" ) were 52.3%, 52.3%, 79.5%, and 81.8%, respectively. The total scores for the patients and caregivers were significantly correlated (Spearman's ρ=0.364*). CONCLUSIONS: We created the first QOL scale for patients receiving home-based medical care and for caregivers. The findings of this study suggest that the QOL-HC can be used in clinical practice for the assessment of patients receiving professional home care.

[Follow-up study on elderly patients living at home].

PURPOSE: To elucidate the characteristics of elderly patients registered in the home medical care system. METHOD: A 2-year follow-up study was conducted for 23 elderly patients who were under home medical care for a minimum of 1 year. RESULT: Eleven of the subjects were men, the mean age of the patients was 83.3 +/- 7.6 years, and 65% of subjects were under home medical care for 3 years at a stretch. The median score for the Barthel Index (BI) of activities of daily living was 40, the median score for the 10 cm visual analogue scale (VAS) was 5.7 cm, 91% of the patients needed a caregiver, the mean age of the primary caregiver was 60.3 +/- 12.0 years, and the mean score on the Burden Index of Caregivers (BIC-11) scale was 14.7. CONCLUSION: A follow-up study showed that 65% of patients were under continuous home medical care for 3 years, and the degree of the burden on family and the primary caregiver was moderate.

[A case-control study of factors associated with intermittent home care among elderly inpatients in home care wards].

We present a case-control study that was conducted to examine the factors associated with intermittent home care on elderly inpatients in home care wards. The results showed that the proportion of intermittent home care was approximately 20%, and the risks for intermittent home care were strongly associated with a lack of intention for continued home care for the elderly, lack of experience of home care, refusal of the family caregiver, and protracted length of stay.

[A comparison of the characteristics on cancer and non-cancer in-patients receiving a registration system based home support].

PURPOSE: To clarify the characteristics of cancer and non-cancer in-patients receiving a registration system based home support. METHODS: A total of 254 patients who were hospitalized from April 2009 to March 2010 were included for this observational study. An analysis was made by classifying the subjects into two groups: cancer group and non-cancer group. RESULTS: A comparison of the two groups showed that the cancer patient group consisted of many men (p<0. 01). The average BI score in the cancer patient group tended to be high upon admission and discharge(p<0. 005). The nursing care level was low(p<0. 01), and both the average length of stay(p<0. 01)as well as the average number of admissions were low(p<0. 05). In case of readmission, both the number of days from the previous discharge until the current admission and the number of days from registration until admission were low(p<0. 01). With regard to the number of drugs administered to the cancer patient group(p<0. 01), the use of narcotics(p=0. 000)was high. Sedative measures(p<0. 01)and the percentage of patients receiving nursing instructions(p<0. 01)were also high. On the other hand, the ratio of patients receiving oral care(p<0. 05), nasolgastric-tube(p<0. 01)and PEG(p<0. 01)was low and few patients needed care in relation to respiration(p<0. 01). Dietary care, physical care, bedsores and falls were not statically significant between two groups. The hospital mortality rate was significantly higher (p<0. 01)in the cancer patient group. CONCLUSIONS: A comparison of cancer and non-cancer in-patients regarding the support of a home-based medical care provided through the ward revealed that both home nursing and home medical care were required. Both physical care and preventive support measures were also needed as well. Cooperation between the hospital and community needs should be addressed for an effective home-care support measure during a hospitalization.

Development and validation of a new quality of life scale for patients receiving home-based medical care: The Observational Study of Nagoya Elderly with Home Medical Care.

AIM: To develop and validate a scale that assesses quality of life in patients receiving home-based medical care. METHODS: A new quality of life scale was developed and evaluated in four phases: (i) item generation; (ii) first field study with a 14-item questionnaire; (iii) preliminary validation study, to reduce the number of items to four; and (iv) second field study comprising 40 patients, to evaluate the validity of the final version. Participants were requested to answer both the final version of the scale and the Short Form-8, to enable identification of any relationship between the two. RESULTS: Items were generated after discussions with doctors and care managers, and 14 items were selected for the draft version. In the preliminary validation study, 10 items were deleted, based on the results of statistical analysis of the data from the first field study. A psychometric analysis showed that the final four-item questionnaire had internal consistency (Cronbach's α = 0.7), and a significant association with the Short Form-8. CONCLUSIONS: We created the first quality of life scale for patients receiving home-based medical care. The scale's internal consistency was confirmed, as well as its external validity. This scale can be used independently of factors such as a patient's age, sex, level of independence in the presence of dementia or disability, swallowing function, hearing ability and communication ability, and can be used with ease in routine clinical practice. Geriatr Gerontol Int 2017; 17: 440-448.

[Two cases of infectious mononucleosis-like syndrome associated with human herpes-virus 6].

We experienced two cases of infectious mononucleosis-like syndrome associated with human herpesvirus 6 (HHV-6). One of the patients had been under medication for depression and the other one for schizophrenia. Both of them were taking carbamazepine for more than a week along with the other drugs. The manifestation of the symptoms of those two were almost same, such as high fever, generalized eruption, liver dysfunction, lymph-adenopathy, and existence of atypical lymphocytes. Serological tests for EB virus, cytomegalovirus and herpes simplex virus showed no significant change while the tests for HHV-6 showed increased titers of IgG antibody during the courses. We also examined HHV-6 DNA by real time quantitative PCR tests for HHV-6, and they appeared significantly high in the peripheral blood samples.

A case of diaphragmatic paralysis complicated by herpes-zoster virus infection.

Diaphragmatic paralysis is commonly caused by surgical and traumatic injuries, malignant neoplasm, and neurodegenerative disorders. However, in rare instances, diaphragmatic paralysis due to herpes-zoster virus infection has been reported. Here, we describe an 85-year-old woman who developed left hemidiaphragmatic paralysis within 19 days of the appearance of a typical herpes-zoster rash involving the C4-5 dermatome on the left side. Clinical and radiological findings revealed no local causes of phrenic nerve lesion. The hemidiaphragmatic paralysis was thought to be caused by herpes-zoster virus infection.

Assessments and nursing care for right brain-damaged stroke patients: focusing on neglect and related symptoms.

The purpose of present study was to identify the behavioural characteristics and examine assessments of nursing care among right brain-damaged stroke patients with neglect within 1 year following initial onset. Characteristics related to higher cerebral dysfunction were extracted and patient grouping was attempted through cognition (Mini-Mental State Examination) and physical function (Barthel Index) plots. The characteristics and implications for nursing care for each group were analyzed. Twelve patients were classified into four groups using cognitive-physical function evaluations together with subjective and objective data associated with neglect. 'Neglect' has been regarded as a disorder of spatial perception. However, the characteristics observed in Group 2 suggest that 'neglect' may have another facet, manifesting as disorders in perceiving continuous spatio-temporal changes of an action and comprehending the context of a situation. In these patients, although 'by calling attention' is the conventional care, more appropriate care should be provided based on an assessment of cognitive-physical function and spatio-temporal recognition of an action.