Chieko Fujii

Cross‐cultural traits for personality of patients with Parkinson's disease in Japan

Recent studies suggest that Parkinsons disease (PD) is associated with particular personality traits. Using Cloningerss Tridimensional Personality Questionnaire (TPQ), Menza and colleagues [1993: Neurology 43:505-508] reported a possible association between PD and a reduced score in the novelty seeking (NS) dimension of the TPQ. We sought to determine whether this association, which was found in a study conducted in the United States, could also be found among Japanese PD patients. We performed personality assessments of 67 Japanese PD patients, using the TPQ test. The results suggest that Japanese PD patients have significantly lower scores in the NS dimension of the TPQ, as well as significantly higher harm avoidance (HA) scores, compared with matched control subjects. Furthermore, the PD patients undergoing treatment for depression using antidepressant drugs scored significantly higher in the HA dimension than PD patients who did not receive antidepressant drug treatment. Our results suggest that the high HA score, and the low NS score in the TPQ test observed in patients with PD, is a cross-cultural phenomenon, although the influence of depression, long-term treatment, and premorbid gene/environmental interactions may also affect these personality traits. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 96:1-3, 2000.

Association between polymorphism of the cholecystokinin gene and idiopathic Parkinson's disease.

Parkinsons disease (PD) is characterized by major alterations of neurotransmitter activity due to damage of the substantia nigra. Changes in neuropeptide concentration within the basal ganglia may play an important role in the putative dopaminergic–peptidergic interactions associated with the disease. Cholecystokinin (CCK) modulates the release of dopamine in the mesolimbic pathway and affects dopamine‐related behavior.We analyzed genetic variations in the CCK gene, in both the coding and promoter region, in order to investigate the role of polymorphism in idiopathic PD. Four polymorphic sites of the CCK gene (‐196G/A, ‐45C/T, 1270C/G, 6662C/T) were found in PD patients and controls. Complete linkage disequilibrium was observed between the ‐45 locus and the 1270 locus, and also a possible linkage disequilibrium was found between the ‐45 and ‐196 loci. A significant difference was found in the distributions of three identified genotypes at the ‐45 locus between 116 PD patients and 95 age‐matched control subjects (χ2=7.95, p=0.018, Bonferroni correction; p=0.054). In addition, a significant difference was obtained amongst the three genotypic groups at the ‐45 locus when compared between PD patients who experienced hallucinations (n=23) and those (n=93) who did not (χ2=8.08, p=0.018, Bonferroni correction; p=0.126).Our data suggested that mutations at the ‐45 locus in the promoter region of the CCK gene may influence vulnerability to hallucinations in PD patients treated with l‐dopa.

Vacuum-venipuncture skills: time required and importance of tube order

Background The purpose of this study was to assess specific vacuum-venipuncture skills and the influence of the time involved in skin puncture and blood collection. Methods Thirty subjects undergoing venipuncture in which video analysis was possible were included. These procedures were carried out by four nurses and recorded with a digital camera. Venipuncture skills classified by our observations were delineated on the basis of frame-by-frame video images, and a graph of x and y coordinates was created. Results With the first blood-collection tube, strong blood flow required the practitioner to push the tube back in to compensate for the strong repulsive force in approximately 46% of cases. By the third blood-collection tube, the blood flow had weakened; therefore, the tube was moved up and down. In cases that required a second venipuncture, the tube was already pierced, so the time required to fill it to 5 mL was significantly longer. Conclusion Hand movement of the practitioner is adjusted according to blood flow. Reflex movement in response to strong blood flow may increase the risk of pushing the needle through the vein with excessive force. The time required to fill the tube varies among nurses, tube order, and level of venipuncture skills.

Clarification of the characteristics of needle-tip movement during vacuum venipuncture to improve safety

Background Complications resulting from venipuncture include vein and nerve damage, hematoma, and neuropathic pain. Although the basic procedures are understood, few analyses of actual data exist. It is important to improve the safety standards of this technique during venipuncture. This study aimed to obtain data on actual needle movement during vacuum venipuncture in order to develop appropriate educational procedures. Methods Six experienced nurses were recruited to collect blood samples from 64 subjects. These procedures were recorded using a digital camera. Software was then used to track and analyze motion without the use of a marker in order to maintain the sterility of the needle. Movement along the X- and Y-axes during blood sampling was examined. Results Approximately 2.5 cm of the needle was inserted into the body, of which 6 mm resulted from advancing or moving the needle following puncture. The mean calculated puncture angle was 15.2°. Given the hazards posed by attaching and removing the blood collection tube, as well as by manipulating the needle to fix its position, the needle became unstable whether it was fixed or not fixed. Conclusion This study examined venipuncture procedures and showed that the method was influenced by increased needle movement. Focusing on skills for puncturing the skin, inserting the needle into the vein, and changing hands while being conscious of needle-tip stability may be essential for improving the safety of venipuncture.

Safe venepuncture techniques using a vacuum tube system

The purpose of this study was to determine safe techniques of performing blood collection using an evacuated tube system, particularly with regard to manipulation of the equipment and at the puncture site. Careful observation of the procedure was used to collect data for evaluating the various venepuncture techniques. Nurses were digitally videotaped performing simulated venepuncture. A self-administered questionnaire and unstructured observation of a videotaped recording were evaluated, and valid responses were analyzed from participants who performed venepuncture using various techniques. The participants who changed hands during the procedure were older than those who did not change hands. Needle movements during puncture and insertion, including rotation and insertion in a wave-like trajectory, were observed. Appropriate training, including recommendations for maintaining the stability of the needle tip, is important to ensure safety when performing venepuncture. Movement of the needle should not place too much pressure on the puncture site.

A Comparison of the Effects of Different Equipment used for Venipunctureto Aid in Promoting More Effective Simulation Education

Patient safety during venipuncture is of utmost importance. In Japan, good venipuncture practices are developed in nursing schools and hospitals by the use of educational simulators. This study examined techniques used by experienced nurses to educate nursing students and nurses on venipuncture techniques. Forty-four nurses completed a questionnaire and were videotaped during venipuncture performed on a model of a simulated arm that we had developed. Using software to analyze motion and movement along the X-Y coordinates, we measured puncture angles and distance travelled by the needle using a 20 ml syringe, other syringe sizes, and vacuum tubes. Needle and hand movement were also examined. Venipuncture requires a point of a vein to be identified and insertion of a needle into that puncture site. Simulation training may assist to consciously avoid unnecessary movements caused by hand rotation and also emphasizes the importance of learning the basic movements for needle insertion. It is important that educational methods and evaluation are linked and developed using an appropriate simulator of the venipuncture technique.