Sleep conditions and quality of life among patients with ischemic heart disease after elective percutaneous coronary intervention

In Japan, percutaneous coronary intervention (PCI) is a major therapeutic intervention for ischemic heart disease (IHD). Previous studies suggested that an association of the risk of IHD caused by sleep duration was related to factors closely associated with daily activities. However, in Japan, there is no study about this relationship objectively measured using the actigraphy in patients with IHD. Moreover, there is little reported data about sleep condition and early outcomes of patient’s Health-Related Quality of Life (QOL) after PCI. This study determines the correlations between sleep conditions and QOL (measured by SF36 version 2) of 25 patients with IHD who underwent elective PCI. Data were collected seven days after PCI using night-sleep condition. Using Spearman’s rank test, the results revealed positive correlation between vitality score and longest sleep duration (ρ = 0.43, p = 0.031): social functioning (SF) score and duration of night-time sleep (ρ = 0.42, p = 0.037);total sleep duration (ρ = 0.45, p = 0.026), and longest sleep duration (ρ = 0.44, p = 0.024);mental health score and longest sleep duration (ρ = 0.54, p = 0.006). However, negative correlation was found between physical functioning score and arousal during sleep (ρ = -0.44, p = 0.027). Sleep condition was significantly correlated with QOL. In particular, SF score was positively related to night-time sleep. This seems to indicate that SF score might be related to night-time sleep condition. Moreover, the longest sleep durations were correlated with the mental component summary. The results of the study suggest that not only the length of whole sleep durations leads to better QOL, but also the increase the amount of uninterrupted sleep.

Comparison of Gluteal Muscle Intramuscular Injection Sites of Japanese Healthy Subjects: Considerations for Optimal Insertion of Injection Needle Length

Long Acting Injectable (LAI) medications for patients with schizophrenia is commonly administered to relieve their symptoms. Through shared decision-making and clinical evidence-based, psychiatrists should systematically offer LAIs to all patients requiring long-term antipsychotic treatment as a first-line treatment. Gluteal intramuscular (IM) injection requires accurate insertion of needles into the specific muscle area, often the outer upper quadrant of the buttocks, in order to achieve the required blood concentration. The purposes of this study were to compare the “Distance from the Epidermis to the Under-Fascia (DEUF)” and “Distance from the Epidermis to the Iliac Bone (DEB)” of the buttocks IM injection sites at the dorsogluteal and ventrogluteal sites among healthy Japanese volunteer subjects, and to identify the optimal insertion injection needle length. The DEUF and DEB at the gluteal regions were measured by ultrasonography. Welch’s one-way analysis of variance was used to compare the DEUF and the DEB at the gluteal IM injection regions. There was no statistically significant difference observed between the right and left mean values of DEUF for Hochstetter and Clark’s point at the ventrogluteal sites, and the Four and Three-way split or Double Cross point at the dorsogluteal sites. However in the DEB, the Hochstetter’s point (P < 0.01) at ventrogluteal site on the right side, and Clark’s point (P < 0.05) were significantly shorter than the Double Cross point at dorsogluteal sites (F = 4.38). The left buttocks Hochstetter’s point was significantly shorter than the Double Cross point (F = 4.38, P < 0.01). These results, however, did not establish a statistically significant difference in the DEUF among injection sites. It was considered that the difference in the DEB depended on muscle volume and thickness in the gluteal injection sites.

The relationship between sleep condition and autonomic nervous function in women in their 70s with type 2 diabetes mellitus

The aim of this study was to determine the relationship between sleep condition and autonomic nervous function of women in their 70s with type 2 diabetes mellitus by analyzing the activity counts (AC) on actigraphs and heart rate variability (HRV). Ten healthy women in their 30s to 40s as control and four women patients with type 2 diabetes in their 70s wore the electrocardiograph and an actigraph for 24 hours while keeping a diary of activities, including their sleep and food intake. The Pittsburgh Sleep Quality Index was used to assess subjective sleep conditions. The subjective sleeping results were significantly correlated with those measured by the AC and HRV. However, AC and HRV correlation pattern showed different activity in the patients with type 2 diabetes mellitus. The quality of sleep of those with chronic diabetes was not good even if their HbA1c was well controlled. Furthermore, their automatic nervous function was different from the control group. The sleeping hours of patients with type 2 diabetes were shorter or longer than those of healthy women. Ultimately, this study maintains that it is important to examine automatic nervous functions using objective examination index during the early stage of diabetes mellitus.

Artificial Intelligence and Autonomous Machines: Influences, Consequences, and Dilemmas in Human Care

In the field of robotics and in the health sciences, transitions have been occurring in the control of robots operating with predetermined logic and rules. Robotics in health care are influencing human caring dynamics in many ways such as enhancing dependency and surrender to machine technologies. Situations such as these are charged with possibilities of legal liabilities triggered by influences and consequences of advancing robotic technology dependency. The purpose of this paper is to identify, describe, and explain legal issues and/or dilemmas centered on robotics in healthcare while providing engaging opportunities to limit consequent legalities thus forming beneficial human health care outcomes. Laying bare these liabilities will provide critically informative data that can foster proactive encounters which can or may deter health care liabilities while ensuring quality healthcare outcomes. An attempt is made to re-conceptualize how to view agency, causality, liability responsibility, culpability, and autonomy for the new age of autonomous robots. While it is still not clear how this would turn out, a clear framing of the problem is the first step in the project.

Explanatory Variables as Evidence for Precision in Intramuscular Long-Acting Injections of Patients with Schizophrenia

Intramuscular injections can cause damage to arteries, veins and nerves. Achieving maximum effects of medications through precise intramuscular (IM) injections must be assured and with certainty, particularly with long-acting injection drugs (LAI). The purpose of this study is to determine precision in IM LAIs of patients with schizophrenia. These evidences estimate “Distance from the Epidermis to the Under-Fascia” (DEUF) and “Distance from Epidermis to the Upper-Arm Bone” (DEB) of the deltoid muscle. Explanatory variables include body height, weight, body-mass index (BMI), deltoid-muscle circumference, fat percentage and muscle mass measured by body composition monitor. Sixty nine subjects are included based on the Diagnostic Statistical Manual of Mental Disorders (DSM-IV, 1994), and receive treatments of typical and atypical antipsychotic LAI. There are 46 males and 23 females with average age of 51.41 (Standard Deviation = 13.58) and ranging from 21 to 81 years who are all right-handed. Ultrasonographic data and those from explanatory variables are calculated using Spearman’s rank correlation coefficients. Multiple regression analysis (step-wise method/forced input method) is performed assuming DEUF or DEB as dependent variables. Significant correlations are found with highest adjusted R-square. Paired t-tests show differences in average values of actual ultrasonographic measurements assigned to DEUF or DEB, and the regression equations for accuracy. Ultrasonographic values are assigned multiple-regression equations as true values, and the calculated values are compared with those obtained by regression equations. There are no significant differences observed for either the right or left arm. The multiple regression equations for BMI and fat percentages (upper extremity estimation) of DEUF, and for BMI and injection site circumference of estimated DEB, successfully value the DEUF and DEB. By using these multiple regression equations for IM injection to the deltoid-muscle, DEUF can better ensure accurate LAI into the muscle through body monitor, DEB, and measured values of the deltoid-muscle injection site circumference.

Changes before and after improvement of subjective sleep state of a man diagnosed with pre-diabetes and sleep disorder

The purpose of this case study was to examine the changes before and after improvements of the subjective sleep status of Mr A, a 40-year-old man diagnosed with pre-diabetes and a sleep disorder. Data were collected using a Holter monitor for 24 hours a day for 3 days to assess autonomic nervous activity by recording bed-time and waking time activity (activity counts: ACs). Mr. A kept a diary of activities and completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire. The study revealed that subjective sleeping hours correlated almost precisely with those measured by the actigraph and as described in the diary. Both the parasympathetic and sympathetic nervous system activities were imbalanced. However, no correlation was observed between the ACs and autonomic nervous activity. Subjective sleep state according to the PSQI score improved remarkably by dietary and exercise therapy from 13 to 3 points, after six months, with corresponding high level sleep satisfaction level. Significant correlations were observed between ACs and high-frequency spectral power of R-R intervals, and between ACs and the low-frequency/high frequency ratio of spectral power of R-R intervals. Although Mr. A’s sleep satisfaction level has improved, the autonomic nervous system activity remained different from that of healthy people.

Caring for Older Persons in a Technologically Advanced Nursing Future

As people live longer, a larger percentage will live with multiple chronic conditions and functional impairments such as difficulties with activities of daily living, mobility, and the management of one’s household. The purpose of this paper is to examine the care of older persons in a technologically advanced nursing future by discussing roles and responsibilities of nurses who practice gerontological nursing, and explaining how a technologically advanced future would change the delivery of home health care for older persons in the community. The theory of Technological Competency as Caring in Nursing grounds 3 processes of nursing as knowing persons as caring, wholeness is oneness, and caring as a multi-dimensional process. Harnessing technology for the health of older persons would enable them to live independently, socially engaged, and safely. A technologically advanced nursing future leads to concomitant sustainable disruptive and frugal innovations in healthcare. Nurses in practice must take advantage of these disruptions and consider frugal innovations as the futures of nursing education, practice, and research are here.

Effects of Depth of Needle Insertion with Risperidone Long-Acting Injectable in Persons with Schizophrenia: A Randomized Double-Blind Study

In some cases, if the insertion depth is shallower than expected, intramuscular (IM) injection of risperidone long-acting injectable (RLAI) may not penetrate the muscle fascia. However, if needle insertion depth is deeper than anticipated, needle penetration may cause damage to nerves, arteries and veins. Few clinical studies were done to evaluate the depth of needle length insertion reaching the intended gluteal muscle. The aim of this study was to evaluate the suitable depth of injecting RLAI. Twenty-six patients with schizophrenia were treated with RLAI, and randomly divided into two groups: 50 mm needle inserted group (Group-D, deep insertion, n = 13) and 20 mm needle insertion group (Group-S, shallow insertion, n = 13). For Group-S, the needle length was marked with a spacer at exactly 20 mm. Injections were performed by the psychiatrist or nurse, alternating between the two gluteal sites by double-cross method every two weeks. Clinical psychotic symptoms and injection site reactions were recorded throughout the study period. Experienced psychologists who were blinded from the needle-length experimental variable evaluated patients’ psychotic symptoms using the Positive and Negative Syndrome Scale (PANSS) every two weeks. The plasma 9-hydroxyrisperidone (9-OH-RIS) concentrations were measured every two weeks;comparison data were determined on the 8th week and the 14th week. No significant difference was observed in 9-OH-RIS concentrations, psychotic symptoms, injection site skin reactions of subjects in both groups. However, in Group-D, injection site adverse reactions were confirmed in two subjects (15%). In Group-S, injection site reactions were confirmed in six subjects (46%). Although effective 9-OH-RIS concentrations were obtained with the insertion using both depth, it was concluded that the 50 mm insertion length was more suitable for dorsogluteal IM injections in adult patients with schizophrenia as demonstrated by the incidence of local adverse skin reactions.

The Effect of a Psycho-Educational Program on Psychiatric Symptoms, Drug Attitude and Treatment Satisfaction of Patients with Schizophrenia

The purpose of this study was to determine the effect of a Comprehensive Psycho-Educational Approach and Scheme Set (COMPASS) for patients with schizophrenia who were treated with risperidone long-acting injectable (RLAI), on their psychiatric symptoms, drug attitudes, and treatment satisfaction levels. Participants were sixty-five patients at thirteen hospitals in Japan who met ICD-10 F2 criteria for schizophrenia or schizo-affective disorder and were treated with RLAI. A correlational study design was used to measure the effect of the COMPASS on the psychiatric symptoms, drug attitudes, and treatment satisfaction levels of patients treated with RLAI. Using the following evaluation indicators: The Subjective Satisfaction to Treatment Scale (SSTS), Brief Psychiatric Rating Scale (BPRS), Global Assessment of Functioning (GAF), Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS), and Drug Attitude Inventory-10 (DAI-10), measurements were taken at the beginning of the program (baseline), at the end of the program, and six months after (endpoint). Data analysis included descriptive statistics, Mann-Whitney U test or Wilcoxon signed-rank test, and Spearman’s rank correlation coefficient. Significant differences were observed in BPRS total (p < 0.001), sub-scales of BPRS positive (p < 0.001), BPRS negative (p < 0.01), BPRS affective (p < 0.01), and GAF (p < 0.001). However, there was no significant change in subscale of BPRS manic, DAI-10, DIEPSS, or SSTS but significant positive correlations were found between SSTS and DAI-10 and GAF at baseline;a negative correlation was found between SSTS and BPRS. The findings of the study suggested the benefit of using the COMPASS in conjunction with RLAI to decrease patients’ psychiatric symptomatology and improve treatment satisfaction. In addition, patient satisfaction was found to be an important factor to be considered by the psychiatrist.

Development of the Emerging Theory of Encountering Nursing in a Nurse-Nursed Dyadic Relationship (ThENNDyR)

Encounters are celebrated experiences between persons with connectedness in human situations as expectation. While being in a human dynamic and rhythmic interaction, nursing encounters are dyadic relationships illuminated as patterns of an interconnected relationship moving between the nurse and the nursed, and reflecting person-and-otherness events. The purpose of this paper is to describe the theory of Encountering Nursing in a Nurse-Nursed Dyadic Relationship (ThENNDyR) and to illuminate the four nursing practice processes on which the theory is founded: Knowing as appreciating relational moments;Reflecting as engaging moments;Realizing as patterns of living moments;and Transcending as celebrating moments. Nursing practice occurs in moments in which dyadic relationships transpire as nursing encounters. As fleeting as moments are, the four processes of nursing simultaneously take place as understanding conditions that the who and what of the person warrants persons. “Encountering nursing” is a momentary co-existence of persons in a person-and-otherness situation communicating connectedness-interconnectedness in distinct patterning. Interactions in nursing exist as persons remain wholes and complete in the moment.

Intramuscular Diffusion Status of Risperidone and Aripiprazole Long Acting Injectable (LAI) by Ultrasonography

The aim of this study was to consider the characteristics of intramuscular diffusion status of risperidone and aripiprazole long acting injectable (LAI) by ultrasonography. Subjects were 40 adult subjects diagnosed with schizophrenia and treated with LAI [32 patients were risperidone LAI (RLAI) and 8 patients were aripiprazole LAI (ALAI)]. However, in this paper, only three cases (one RLAI case and 2 ALAI cases) were selected to illustrate the diffusion effects of both LAI. Dorsogluteal intramuscular (IM) injection sites were measured at prone position using the “double cross” method. Before LAI injection, the distance from the epidermis to the under-fascia (DEUF), and distance from the epidermis to the iliac bone (DEI) at the IM injection site were assessed by using ultrasonography: 1) the injection needle was inserted to the gluteus medius, and 2) observed the diffusion status within the muscle injected RLAI and ALAI were confirmed using the B-mode ultrasonography. Both RLAI and ALAI were depicted as high echogenicity with acoustic shadowing. It was considered that the diffusion states of LAIs by ultrasonography were important time course evaluations providing objective evidence.

Prioritizing Patient Assessment Data (PAD) Using the Japanese Psychiatric Nursing Assessment Classification System (PsyNACS)©

The study identified priorities of the Patient Assessment Data (PAD) using the Japanese Psychiatric Nursing Assessment Classification System (PsyNACS&copy;) derived from 644 psychiatric nurses’ responses who were practicing in specific units: Acute Care Units (ACU), General Care Units (GCU), Long-term Care Units (LCU), physically Complicated Disease Care Units (CDCU), and Dementia Care Units (DCU). Secondary analysis of the PsyNACS&copy;on-line survey data using four levels of “importance” was used to determine the priorities: 1) unnecessary;2) quite important;3) important and 4) very important. The Mean Factor Points (MFP) and the Welch’s ANOVA were calculated. PsyNACS&copy;score of 3 or higher indicates the PAD as priority. The results showed that in the ACU PAD1, “Psychological symptom”, “Stress coping”, and “Mood disorder and aggression”, and PAD2 “Information of adherence”, and “Information of the psychiatry rehabilitation”, and PAD7 “Situation of the family and social life”, “Relationship to the health care providers”, and “Relationships with others” are high priority (high importance). Other PADs showed results below PsyNACS&copy;score of 3. The GCU had PAD 3 “Balance of water”, the LCU had PAD 4 “Intention/Point of view”, and “Thoughts of the patient” and PAD 7 “Disease and family”. The CDCU showed PAD 2 “Blood test”, PAD 3 “Excretion situation”, and PAD 5 “General health condition”, “Respiratory and chest symptom”, and “Vital signs”, and the DCU had PAD 1 “Cognition function”, and “Delirium and derangement capacity to register failure”, PAD 3 “Function of eating”, PAD 6 “Egestion and cleanliness” and PAD 8 “Activity and sleeping”, and “Mobility capability”. These classifications indicated levels of importance in the CAD comprising the PAD below the score of “2”. Japanese psychiatric hospitals specify assessments according to functional areas. By prioritizing the CAD for each PAD, more effective and efficient assessments can be performed according to practice unit.

The Development of the Japanese Psychiatric Nursing Assessment Classification System (PsyNACS©)

The purpose of this study was to develop the Japanese Psychiatric Nursing Assessment Classification System (PsyNACS)©. This study used the on-line survey method from February to April 2015. There were 644 respondents comprised of professional nurses with minimum qualification of 3 years’ experience being in a psychiatric unit of a stand-alone 200-bed or more Psychiatric Hospital in Japan. Assessment items were derived from 211 specific items selected from nursing textbooks, excluding the North-American-Nursing-Diagnosis-Association (NANDA). The questionnaire contained Cover Letter, Demographic Data Sheet, and the PsyNACS© questionnaire. There were 644 questionnaires accessed but only 435 were completed and valid. Item levels of importance were evaluated: 1) Unnecessary, 2) Not very important, 3) Important and 4) Very important. Data analysis used descriptive and multivariate statistics. Factor analysis (principal factor analysis, varimax rotation), the Kaiser-Meyer-Olkin (KMO) and the Bartlett’s test of Sphericity assessed the adaptive validity of the factor analysis. Factor loadings were set at 0.4 or more for the configuration of items. Internal consistency and reliability were established using Cronbach’s alpha coefficient. Mean factor points were calculated, including standard deviation, range, and confidence interval at 95%. Statistical significance was at 0.05 level. Nine Patient Assessment Data (PAD) with 2 to 5 Cluster Assessment Data (CAD) each were categorized. Thirty one CADs comprised the Patient Assessment Data: (PAD1) Psychological symptom and stress, (PAD2) Information about treatment, (PAD3) Function of eating and balance of water, (PAD4) Life and value, (PAD5) Vital signs and health assessment, (PAD6) Self-care, (PAD7) Social support, (PAD8) Activity, sleeping and mobility capability, and (PAD9) Sexual function and sexual behavior. The PsyNACS© is a classification of items assessing health care needs within the Japanese psychiatric nursing care environment, and also can be used in various psychiatric patient care situations in all psychiatric units.