研究者詳細 - 藤井　千枝子

論文 - 藤井　千枝子

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高齢患者の安全のための服薬アドヒアランス　パーキンソン病患者の服薬の自己調整に関連する症状と受療行動のリスク要因

岩佐由美, 藤井千枝子

日本健康医学会雑誌（日本健康医学会） 31 （ 2 ） 150 - 158 2022年07月

ISSN 1343-0025

高齢患者の安全な服薬に示唆を得るため、パーキンソン病患者会会員436人に質問紙調査を行った。248人の分析対象者(有効回答率56.9%)の平均年齢は72.2歳だった。173人(69.8%)が服薬の「自己調整なし」、75人(30.2%)が「自己調整あり」と回答した。両群を比較した結果、「自己調整あり」の平均年齢と平均発症年齢は低く、平均罹患期間は長かった。薬の平均種類数と残薬の平均日数は「自己調整あり」において多く、ともに有意差があった(p<0.05)。二項ロジスティック回帰分析の結果、症状では不眠(OR=3.56:95%CI=1.740-7.271)、オフ症状(OR=2.44:95%CI=1.224-4.864)が服薬の自己調整に対して有意差があるリスク要因で、受療行動では医師に症状を伝えることに困る(OR=2.85:95%CI=1.136-7.131)、医師に薬の考えを話さない(OR=0.34:95%CI+0.131-0.896)、薬を減らしたいと考える(OR=2.33:95%CI=1.045-5.174)が有意差がある服薬の自己調整のリスク要因だった(p<0.05)。医師の専門性、治療満足度は服薬の自己調整に対して有意差があるリスク要因ではなかった。これらから、服薬を自己調整することによる有害事象から高齢患者を守るためには、不眠やオフ症状がある患者に対して症状緩和のために生活環境調整をあわせて行うことや、薬を減らしたいと考える患者や自らの考えを強く持ち治療に積極的に参加する患者に対して本人の考えや思いをより丁寧に把握していく支援が必要だと考えられた。(著者抄録)

Subjective sleep quality and personality traits of patients with Parkinson’s disease post-diagnosis

Fujii C

British Journal of Neuroscience Nursing 17 （ 4 ） 2021年09月

査読有り

Video analysis of safety and reproducibility issues with the timed up-and-go test applied to patients with Parkinson's disease.

Fujii C, Wakizaka N, Araki Y, Tashiro K, Endou M

Disability and rehabilitation. Assistive technology 1 - 6 2021年06月

ISSN 1748-3107

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パーキンソン病患者の転倒予防　オンオフ現象の有無からみた転倒の特徴と転倒予防自己効力感の分析を通して

藤井千枝子, 岩佐由美

高齢者のケアと行動科学（日本老年行動科学会） 25 99 - 112 2020年12月

共著, 査読有り, ISSN 1880-3474

本研究は、パーキンソン病(PD)患者のオンオフ現象の有無からみたPD患者の転倒の特徴から転倒予防の示唆を得ることを目的とした。「一般社団法人・全国PD友の会」の東京都PD友の会の協力を得て、2017年2月に会員822名に対し、無記名自記式質問紙を郵送した。年齢や性別などの基本属性の回答と転倒に関する調査項目に無記入項目がない336名(有効回答率40.9%)を分析対象者とした。オンオフ現象の有無により分類し、オンオフ現象がある回答者が136名(40.5%)、ない回答者が200名(59.5%)であり、オンオフ現象がある群とない群として分析した。平均年齢はある群が71.9±7.9歳、ない群は73.8±7.4歳であった。オフ時間の平均が5.6±4.3時間であった。また、前月に転倒があった140名の受傷部位、転倒時の場所と状況を比較し、ある群は立つ時と服の着脱時に転倒が多く、頭部や臀部を受傷した割合が高かった。転倒予防自己効力感の得点はオンオフ現象の有無に関わらず全体的に低く、重症度が上がるとともに平均得点が下がった。オンオフ現象がある場合は、運動症状を多く有し、薬物の調整が困難となることが考えられ、転倒予防の視点から一つの指標として重要である。PD患者の転倒予防は、(1)転倒予防自己効力感を支えること、(2)オンオフ現象のある場合のオン状態とオフ状態それぞれの転倒予防、(3)自立した活動の時期の転倒予防と介助を伴う時期の転倒予防が必要と思われた。(著者抄録)

パーキンソン病患者の服薬アドヒアランス　薬を自己調整する患者のニーズ分析

岩佐由美, 藤井千枝子

日本公衆衛生学会総会抄録集（日本公衆衛生学会） 79回 355 - 355 2020年10月

共著, ISSN 1347-8060

パーキンソン病患者の生活上の困難と社会参加状況の変化および介護サービス利用の現状　2017年の現状と1995年との比較

藤井千枝子, 岩佐由美

日本難病看護学会誌（(一社)日本難病看護学会） 24 （ 2 ） 213 - 222 2019年12月

共著, 査読有り, ISSN 1343-1692

本研究は、パーキンソン病(以下PD)患者の療養生活支援のために現状を明らかにすることを目的として2017年に東京都PD友の会の会員822名に対し、無記名自記式質問紙を郵送した。本研究に必要な内容に欠損値がない353名(有効回答率40.9%)の回答により、2017年の要介護認定とヤールの分類によるステージと、介護保険のサービス利用状況を分析した。また、1995年に行った同患者会への調査を用いて、社会参加の場と生活上の困難の状況を比較した。平均年齢は、1995年が69.0歳に対し、2017年は73.1歳と高くなり、同居人数は、1995年が2.9±1.6人であり、2017年は2.3±1.1人と減少した。(P<0.001)。1995年と比較し、2017年は社会参加の場と、日常生活で困難ありと答えた回答者が増えた。要介護認定を受けている患者は、66.5%であり、介護保険とヤールの分類のSpearmanの相関係数は0.5であった(P<0.001)。PD患者の高齢化と療養生活の長期化の中での健康寿命の延伸に向けた療養生活支援がさらに重要となる。(著者抄録)

患者安全第一のための基本戦略は何か?　看護の立場から

藤井千枝子

日本医療安全学会学術総会抄録集（(一社)日本医療安全学会） 5回 158 - 158 2019年02月

単著

医療系学生の多職種連携に対する準備状態の変化

門川俊明, 藤井千枝子, 大谷壽一, 横田恵理子

医学教育（(一社)日本医学教育学会） 49 （ Suppl. ） 95 - 95 2018年07月

共著, ISSN 0386-9644

慶應義塾大学医療系三学部合同教育における「チーム形成」についての学び

横田恵理子, 近藤慶太, 大野水季, 太田龍志, 木梨祐輔, 仲道公輔, 藤屋リカ, 宮脇美保子, 小池智子, 井上賀絵, 石川さと子, 鈴木忠, 辻哲也, 藤井千枝子, 門川俊明

日本薬学会年会要旨集（(公社)日本薬学会） 138年会（ 4 ） 229 - 229 2018年03月

共著, ISSN 0918-9823

医療安全管理者との連携による教育への還元

藤井千枝子

日本医療安全学会学術総会抄録集（(一社)日本医療安全学会） 4回 140 - 140 2018年02月

単著

Investigation of the treatment and living assistance needed by patients with young-onset Parkinson’s disease

Iwasa Y., Saito I., Fujii C.

Kobe Journal of Medical Sciences （Kobe Journal of Medical Sciences） 64 （ 5 ） E180 - E188 2018年

共著, 査読有り, ISSN 00232513

© 2018, Kobe University School of Medicine. All rights reserved. This study assessed the symptoms, treatment, social systems use, and perception of living conditions of patients with young-onset Parkinson’s disease (YOPD), and investigated the support needed by them. Method: Among the 252 people who completed our questionnaire, we defined YOPD patients as those diagnosed as young onset or those with onset at ≤40 years. The data were compared with others. Results: There were 24 patients with YOPD (9.5%) (average age: 61.7 years), with an average disease duration 6.4 years longer (p < 0.01) and time until diagnosis 0.7 years longer (p < 0.1) than those of other patients. This group took 1.6 times more types of medicines, and time to their next appointment was 8.6 days shorter than that of other patients (p < 0.05). Patients with YOPD had more pulsive walking and more sweating (p < 0.05), and more motor fluctuation (p < 0.1). More patients with YOPD had a physical disability certificate but felt they were not obtaining the required services (p < 0.05). 45.0% of the YOPD group wanted to work more, more used information and communication equipment (p < 0.05), and more felt their medications were adequate (p < 0.1). Conclusions: Increased awareness of YOPD is needed. YOPD patients have motor fluctuation because of the longer disease duration. Thus, the support of doctors and nurses, and frequent examination visits, are indispensable for controlling symptoms to achieve middle age developmental tasks. Increased support for care-giving, leisure-time activities, and work is also necessary and may help maintain the desire to work in this group.

テキストマイニングで見た難病に対する関心とニーズ

岩佐由美　藤井千枝子

医療情報学 37 （ 3 ） 135 - 145 2017年07月

研究論文（学術雑誌）, 査読有り

看護の機能・役割と安全

藤井千枝子根本ゆき, 楠田清美

医療と安全 6 60-61 2016年12月

Perspectives on effective educational practices regarding venepuncture

藤井千枝子

Journal of Nursing Education and Practice 6 （ 4 ） 76 - 84 2015年09月

研究論文（学術雑誌）, 単著, 査読有り

Comparison of skill in novice nurses before and after venipuncture simulation practice　

藤井千枝子

Journal of Nursing Education and Practice 4 （ 5 ） 16 - 22 2014年

研究論文（学術雑誌）, 単著, 査読有り

Safe venepuncture techniques using a vacuum tube system

Fujii Chieko, Ishii Hiroyuki, Takanishi Atsuo

International Journal of Nursing Practice 19 （ SUPPL.3 ） 11 - 19 2013年09月

研究論文（学術雑誌）, 査読有り, ISSN 1322-7114

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. © 2013 Wiley Publishing Asia Pty Ltd.

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Vacuum venipuncture skills: time required and importance of tube order

Fujii Chieko

Vascular Health and Risk Management 9 （ 1 ） 457 - 464 2013年

査読有り, ISSN 1176-6344

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. © 2013 Fujii.

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

Fujii Chieko

Vascular Health and Risk Management 9 （ 1 ） 381 - 390 2013年

研究論文（学術雑誌）, 単著, 査読有り, ISSN 1176-6344

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. © 2013 Fujii, publisher and licensee Dove Medical Press Ltd.

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人の健康そして地球の健康にとって大切な水と塩の話塩害という環境問題を広げないために

藤井千枝子

Keio SFC journal 11 （ 1 ） 117-125 2011年09月

研究論文（学術雑誌）, 単著, 査読有り, ISSN 1347-2828

Survey on the current status of patients with Parkinson's disease

Fujii Chieko, Masuda Shinya

[Nippon kōshū eisei zasshi] Japanese journal of public health 54 （ 5 ） 338 - 347 2007年05月

研究論文（学術雑誌）, 査読有り, ISSN 0546-1766

OBJECTIVE: The objective was to conduct a survey to examine what support is necessary for patients with Parkinson's Disease (PD) given in-home care in Japan and to determine the current status of care service utilization. In 2004, a questionnaire survey was conducted on the Tokyo chapter members of the Japan PD METHODS: Association and the results were compared with those from the 1995 survey performed on subjects from the same association. In the 1995 survey, half of the association members of the chapter were selected via random systematic sampling. In the 2004 survey, the questionnaire was mailed with a newsletter to all the association members of the chapter. The individuals returned their questionnaires by postal mail. The collection rates were 52.9% in 1995 and 21.3% in 2004. In both surveys, the mean age of RESULTS: the participants was 69.0 years old. The respondents in the 2004 survey had a higher severity of disease and a larger percentage answered that they had predominant symptoms and difficulties with daily life. Regarding participation in various activities, opportunities to work had decreased, but the possibility of meeting people other than at work and to engage in hobbies and relax had increased. Regarding sources of information, decrease was noted for public health nurses and increase for magazines. There was an increase in the number of people who were told that their problem was psychological at their initial diagnosis. 58.2% of the respondents in the 2004 survey received approval for long-term care insurance, and 37.3% of these reported that they their symptoms were more severe than the level for which they were approved. 7.5% of the respondents answered that their condition had worsened after admission to a nursing facility. CONCLUSION: The results of this 2004 survey have limitations and might not be characteristic of all PD patients. However, the respondents answered that their severity of disease was high and their difficulties increased, despite increase in opportunities to enjoy hobbies and to relax. Clearly, some patients feel that their condition is more severe than the level recognized by the primary nursing care authorities, with some considering that their conditions worsened after receipt of services. Understanding the characteristics of PD, provision of services appropriate to patients' symptoms, and ways of incorporating rehabilitation in patients' daily lives appear to be increasingly necessary. Information support is necessary to understand how best to provide psychological support for PD patients.

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