Michiyo Oka

Dietary behaviors and sources of support in hemodialysis patients.

Individuals with chronic renal failure generally have strict dietary guidelines. This descriptive study was designed to identify the relationship between sources of social support and dietary management by Japanese hemodialysis patients. A self-administered questionnaire was completed by a convenience sample of 325 adults receiving dialysis. Subjects 65 years and older received more support from family members, doctors, nurses, and technicians than younger subjects. Subjects who had been on dialysis for less than 3 years received more support from nurses and doctors than those who had been on dialysis for longer periods of time. Multiple regression analysis identified that support from family members and nurses were significantly related to dietary behaviors. Nurses working with dialysis patients should remember to use their influence to positively support their patients and to bear in mind that long-term dialysis patients, especially those who are young and unmarried, may benefit from ongoing nursing support and encouragement.

Individual application of the kidney disease quality of life (KDQOL) instrument to monitor the health status of dialysis patients.

Accessible online at: www.karger.com/journals/nef Dear Sir, Recently, the Kidney Disease Quality of Life (KDQOL®) Instrument, consisting of SF-36 and the kidney disease targeted scales, was developed and has been accepted among many countries because of the scientific and statistical accuracy. Originally, these scales were developed for the group comparisons and not for the individual use [1]. Nevertheless, Meyer et al. [2] reported that the SF-36 was useful in monitoring individual dialysis patients’ health status. We speculated that KDQOL questionnaire might be also as useful as the SF-36 for the individual use. Here, we collect individual KDQOL scores and monitor 1 case before and after a medical intervention, as Meyer et al. [2] had tried. 108 seminight hemodialysis patients, mostly socially rehabilitated responded to

Kidney Disease Quality of Life of Japanese Dialysis Patients Who Desire Administration of Sildenafil and the Treatment of Erectile Dysfunction Using Sildenafil

Abstract:  Erectile dysfunction (ED) is common among patients on dialysis therapy. In the present study, we attempted administration of sildenafil to Japanese patients undergoing dialysis. In order to diagnose ED before prescribing sildenafil, we assessed the hemodialysis patients who desired sildenafil by using the five items version of the International Index of Erectile Function (IIEF‐5). In addition, the characteristics of the quality of life in Japanese hemodialysis patients who desired sildenafil were assessed using the kidney disease quality of life (KDQOL). To all 37 male subjects (mean age of 53.8 ± 10.4 years) attending the Outpatient Hemodialysis Unit at Atsugi Clinic (Atsugi City, Japan), it was explained by their primary doctor that the treatment of ED with sildenafil was possible. As a result, 10 patients (27.0%) desired the treatment. For eight patients, ED was diagnosed by IIEF‐5 prior to prescription of sildenafil. The mean IIEF‐5 scores were 6.13 ± 4.67 points. Sildenafil was prescribed to five patients (three diabetic, two non‐diabetic) and sexual function was improved in three cases. The main adverse effect was found to be ventricular arrhythmia in one case. As for KDQOL, the group desiring sildenafil showed significantly high values in Dialysis Staff Encouragement and Patient Satisfaction. Among the other nine dialysis patients (five diabetic, four non‐diabetic; mean age of 58.1 ± 8.9 years) who visited the ED department of Ishida Hospital (Asahikawa City, Japan), sildenafil was effective for all non‐diabetic patients (100%) and for only one diabetic patient (20%). Among all 14 patients at Atsugi Clinic and Ishida Hospital, sildenafil efficacy rates were 83.3% for non‐diabetic patients and 37.5% for diabetic patients. Non‐diabetic patients without the side‐effects were all responders for the sildenafil treatment. The patients who relied on the dialysis staff and were more satisfied with the general treatment in the dialysis institute desired the administration of sildenafil under the present circumstances wherein the dialysis population had few experiences of sildenafil treatment. Diabetic status is thought to be a negative factor for the response of sildenafil treatment in dialysis patients.

Awareness of pre-alcoholic status and changes in such awareness: analysis of narratives by male Japanese patients and their families.

AbstractIn this study, we investigated the extent of awareness on the part of alcoholic people with regard to their alcoholism and changes in such awareness over time. We conducted qualitative, descriptive analysis of data obtained during semistructured interviews of alcoholic people and family members with whom they lived during the pre-alcoholic stage. The awareness of pre-alcoholic people was found to involve seven elements and to undergo changes at three stages of alcohol consumption (when enjoying the effects of alcohol, when escaping from a reality difficult to face directly, and when alcohol began to cause health problems). The results suggest that professional support for pre-alcoholic people should be tailored to the stage of alcohol use of each individual case and should include advice on appropriate alcohol consumption. In addition, identification and follow-up of problematic drinkers and short-term intervention are required.

Nursing care for terminal cancer patients preferring to receive care at home-A study of care support with a focus on primary caregivers-

【目的】本研究は，終末期下顎がんの維持透析患者と家族への支援のあり方を，渡辺式家族アセスメントモデルを参考に検討する．【方法】家族ストレス対処理論，家族システム理論などに理論的基盤をおいている渡辺式家族アセスメントモデルを参考に，「問題の明確化」「援助方針の明確化」「援助目標の明確化」「家族のニーズと援助者の役割の明確化」を明確にした後，支援方針の設定と家族支援を検討し実施した．【結果】モデルを参考にアセスメントし，支援方針と家族支援を検討した結果，死亡前日まで在宅で療養を継続できた．【まとめ】末期がん患者とその家族の看護を行っていく上で，アセスメントモデルを活用することは，患者家族の問題点を明確にし，看護援助の方向性が導き出される．また，終末期患者の看護は患者への援助のみならず，家族内の状況を踏まえた上で家族自身が対処行動を取れ，家族内部の相互作用を高めるための援助が重要である．