記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier Ireland Ltd  

Background: Hemodialysis patients in Japan are aging, but the influence of lifestyle factors on EuroQoL 5-Dimension 5-Level (EQ-5D-5 L) scores in older hemodialysis patients is unclear. This study aimed to measure health-related quality of life using the EQ-5D-5 L for older hemodialysis patients and to identify the lifestyle factors affecting EQ-5D-5 L scores in Japan. Methods: Outpatients aged 65 years or older who had been receiving maintenance hemodialysis for more than 5 years were selected to determine their EQ-5D-5 L scores. Multiple linear regression analysis was applied to identify items affecting the EQ-5D-5 L scores. Results: The response rate was 59.7% (748/1251), after excluding 9 patients who did not fulfill the participation criteria, and we analyzed data from 739 patients (462 men, 277 women) aged 72.9 ± 6.5 years (mean ± standard deviation) with a mean duration of hemodialysis of 15.1 ± 8.8 years. The mean EQ-5D-5 L score was 0.738 ± 0.207. Higher Hospital Anxiety and Depression Scale scores (regression coefficient, −0.467
P &lt
0.001), reduced walking ability (−0.201
P &lt
0.001), duration of hemodialysis (−0.175
P &lt
0.001), age (−0.143
P &lt
0.001), and subjective symptoms (−0.128
P &lt
0.001) showed significant negative correlations with the EQ-5D-5 L score. Conclusions: Reduced walking ability, and Anxiety and Depression, were associated with lower EQ-5D-5 L score and appeared to be important factors in decreasing health for older hemodialysis patients. These results suggest that patients’ families and dialysis facility staff should be trained in early detection of depression and that patients should maintain their walking ability by exercise therapy.

DOI： 10.1016/j.archger.2018.06.006

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：TOHOKU UNIV MEDICAL PRESS  

Hemodialysis patients in Japan are aging and thus more patients need support for attending hemodialysis facilities. This study aimed to clarify how dialysis patients utilize the services covered by Japan's public long-term care insurance (LTCI) system. This cross-sectional study was based on LTCI data of March 31, 2009, the latest available data provided by Niigata City, located on the northwest coast of Honshu. Among 30,349 LTCI users in Niigata City, there were 234 dialysis patients. To clarify the characteristics of the dialysis patients, we compared the utilization of LTCI services between the dialysis patients (234 users) and randomly selected 765 non-dialysis users. We also calculated the annual transportation service costs per patient for dialysis patients who continued home care (home care group) and those who switched to long-term hospital care at LTCI care levels 4 and 5 (hospital admission group). These care levels indicate difficulty in walking or maintaining a sitting posture without assistance. The dialysis group more frequently utilized home care and equipment services, such as renting or purchasing care-support products and support for home equipment repair, and utilized facility services and short-stay services (respite care) less frequently (both p < 0.001). Cost per patient was higher in the home care group than in the hospital admission group, because the transportation services for dialysis patients at care levels 4 and 5 involve higher costs. These findings indicate that LTCI services usable for dialysis patients were limited. Therefore, instead of merely subsidizing transportation expenses, transportation services must be improved. (C) 2015 Tohoku University Medical Press

DOI： 10.1620/tjem.236.9

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE BV  

Background: Combination therapy with infliximab (IFX) and azathioprine (AZA) is significantly more effective for treatment of active Crohn's disease (CD) than IFX monotherapy. However, AZA is associated with an increased risk of lymphoma in patients with inflammatory bowel disease.
Aim: To evaluate the cost-effectiveness of combination therapy with IFX plus AZA for drug-refractory CD.
Methods: A decision analysis model is constructed to compare, over a time horizon of 1 year, the cost-effectiveness of combination therapy with IFX plus AZA and that of IFX monotherapy for CD patients refractory to conventional non-anti-TNF-alpha therapy. The treatment efficacy, adverse effects, quality-of-life scores, and treatment costs are derived from published data. One-way and probabilistic sensitivity analyses are performed to estimate the uncertainty in the results.
Results: The incremental cost-effectiveness ratio (ICER) of combination therapy with IFX plus AZA is 24,917 GBP/QALY when compared with IFX monotherapy. The sensitivity analyses reveal that the utility score of nonresponding active disease has the strongest influence on the cost-effectiveness, with ICERs ranging from 17,147 to 45,564 GBP/QALY. Assuming that policy makers are willing to pay 30,000 GBP/QALY, the probability that combination therapy with IFX plus AZA is cost-effective is 0.750.
Conclusions: Combination therapy with IFX plus AZA appears to be a cost-effective treatment for drug-refractory CD when compared with IFX monotherapy. Furthermore, the additional lymphoma risk of combination therapy has little significance on its cost-effectiveness. (C) 2012 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

DOI： 10.1016/j.crohns.2012.04.007

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective: The cost-effectiveness of renal replacement therapy (RRT) is affected by the composition of treatment. This study aimed to estimate the costs and outcomes associated with changing the composition of RRT modality over time. Methods: By using clinical and cost data from a systematic review, a Markov model was developed to assess the costs and benefits of the four main treatments available for RRT in Japan. The model included direct health service costs and quality-adjusted life years (QALY). Sensitivity analyses were performed to assess the robustness of the results. Results: Over the 15-year period of the model, the current composition of RRT (i.e., the base composition of RRT) was $84,008/QALY. The most cost-effective treatment was when the likelihood of a living donor transplant was increased by 2.4-times ($70,581/QALY). Compared with the base composition of RRT, dominant treatments with respect to cost-effectiveness were when the likelihood of a deceased donor transplant was increased by 22-times and when the likelihood of a pre-emptive living donor transplant was increased by 2.4-times. Little difference was found between these two treatments. One-way sensitivity analysis did not change the cost effectiveness except for costs of chronic hemodialysis and a living donor transplant in subsequent years. Limitations: It is difficult to increase the rate of transplant overall in the shorter term nationally and internationally. Conclusions: Appropriate distribution of all transplant options and hemodialysis is necessary to achieve the most cost-effective solution. © 2012 Informa UK Ltd All rights reserved.

DOI： 10.3111/13696998.2011.653512

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記述言語：日本語   出版者・発行元：新潟大学医学部保健学科  

本研究の目的は、新潟大学医学部保健学科看護学専攻において平成24年度から実施している改訂カリキュラムの教育評価である。4年次生80人を対象に自記式質問紙調査を実施し、回答が得られた59人(73.8%)を分析対象とした。調査内容は、学習目標の達成状況やカリキュラム、保健師および助産師教育課程の科目に関する学生の評価である。学習目標の到達度はほとんどの項目で70%以上が「できた」と回答し、カリキュラム全体の充実度も高い評価であった。また、保健師および助産師の実践内容に関する学習状況も全項目で80%以上が「学習できた」と回答した。一方で、看護実践できる能力の育成や、教養科目と専門科目のバランス、セメスター毎の学習量の配分は他の項目に比べ評価が低かった。よりよいカリキュラムの運用と看護学教育の一層の充実のため、限られた時間数の中で、効果的な教育方法とカリキュラムの進度について検討していく必要がある。(著者抄録)

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記述言語：日本語  

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記述言語：日本語  

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記述言語：日本語   出版者・発行元：(NPO)日本緩和医療学会  

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記述言語：日本語   出版者・発行元：日本慢性看護学会  

本研究の目的は,高齢血液透析患者が通院困難を認識しながら通院を継続する過程を明らかにし,通院継続の要因を検討することである.透析歴10年以上かつ65歳以上の血液透析患者15名を対象に,半構造的インタビューを実施し,修正版グラウンデッド・セオリー・アプローチ法を用いて分析した.高齢透析患者は,[通院するうえでの支えの実感]を得ながら[透析に向き合う決意]を基盤として,【通院継続のための主体的備え】をする.しかし,[思うようにいかないことの出現]を背景に[通院継続に対するゆらぎ]が生じ,[透析に向き合うための調整]と[今の生活を守るための要求]のバランスを保ちながら行う【通院継続のための主体的備え】を難しくする.これらの結果より,患者の通院継続の要因は,【通院継続のための主体的備え】によって[透析継続に対するゆらぎ]をコントロールできることであると考えられる.そのため,看護師は[通院継続に対するゆらぎ]の背景にある[思うようにいかないことの出現]を把握し,患者が【通院継続のための主体的備え】を続けられるように支えることが重要である.(著者抄録)

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