Motoshi Ouchi

Background/Objectives: The super-aged society and shortening of hospital stays in Japan have increased the importance of the role of home-visit nurses. The 2015 Specific Medical Acts Training Program qualified registered nurses with an extended scope of practice (RNs-ESP) to perform specified medical procedures based on physician-prepared protocols. Although the procedural activities of RNs-ESP have been documented, their underlying clinical judgments remain unclear. This study aimed to clarify the clinical judgments of home-visit RNs-ESP in Japan. Methods: This qualitative, descriptive study used participant observation and semi-structured interviews. Five home-visit RNs-ESP with at least 2 years of post-training experience participated. Data were collected from 32 clinical cases during home visits and analyzed using Mayring’s qualitative content analysis, utilizing Tanner’s clinical judgment model as a conceptual framework for operational definition. Results: The clinical judgments of RNs-ESP were classified into five categories and 18 subcategories: “Interpretation of pathological conditions and prediction of changes”, “Directing daily living assistance based on general conditions”, “Construction of the home care system in anticipation of pathological changes”, “Optimization of pharmacotherapy tailored to pathological conditions and daily life”, and “Selection of medical procedures tailored to daily life”. RNs-ESP integrated medical reasoning with patients’ life perspectives to design and implement optimal, highly individualized care plans. Conclusions: The clinical judgments of RNs-ESP are characterized by the integration of pathological assessment and daily life needs, supported by autonomous intervention authority. These judgments are essential nursing practices that balance continuous safe medical treatment with patient dignity and quality of life in home care.

The aim of the present prospective study was to examine whether lipoprotein (a) [Lp(a)] phenotypes and/or low relative lymphocyte concentration (LRLC) are independently associated with coronary heart disease (CHD) in patients with type 2 diabetes mellitus (T2DM). Serum Lp(a) concentration, Lp(a) phenotypes, and RLC were analyzed in 214 subjects. Lp(a) phenotypes were classified into 7 subtypes according to sodium dodecyl sulfate-agarose gel electrophoresis by Western blotting. Subjects were assigned to the low-molecular-weight (LMW (number of KIV repeats: 11–22) ) and high-molecular-weight (HMW( number of KIV repeats: >22 )) Lp(a) groups according to Lp(a) phenotype and to the LRLC (RLC: P < 0.01, 3.621; 95% CI, 1.50-8.75; P < 0.05, and 7.15; 95% CI, 2.17-23.56; P < 0.01, respectively). Our results suggest that both LMW Lp(a) and LRLC are significant and independent risk factors for CHD and that the combination thereof more strongly predicts CHD in patients with T2DM.

The aim of this study was to evaluate the relationship between postprandial glucose level and atherosclerosis in patients without diabetes and cardiovascular disease by determining carotid ultrasonographic variables and serum levels of 1,5-anhydroglucitol (1,5-AG). The subjects were 72 patients without diabetes and cardiovascular disease being treated for hypertension or dyslipidemia. The clinical characteristics of all subjects, including the serum level of 1,5-AG, which appears to be well suited for monitoring postprandial hyperglycemia, were evaluated after an overnight fast. The average intima-media thickness (IMT) and the average pulsatility index (PI) of the right and left common carotid arteries were determined with high-resolution ultrasonography and used as ultrasonographic variables. The subjects were divided into a Lower 1,5-AG group (n = 36) and a Higher 1,5-AG group (n = 36). We evaluated the relationship between clinical characteristics and ultrasonographic variables of the carotid artery in both groups. The average PI in the Lower 1,5-AG group was significantly higher than that in the Higher 1,5-AG group, but the average IMT did not differ between the groups. Linear regression analysis, with the ultrasonographic variables as the dependent variables, with 1,5-AG as the independent variable, and adjusted for other clinical characteristics, showed significant correlation between 1,5-AG and the PI but not between 1,5-AG and IMT. Our results suggest that postprandial hyperglycemia increases carotid artery stiffness, but not morphological change, in patients without diabetes or cardiovascular disease.

Background Urinary N‐acetyl‐β‐D‐glucosaminidase (NAG) excretion is increased in patients with impaired glucose tolerance (IGT). This study investigated when during the oral glucose tolerance test (OGTT) the plasma glucose, urine glucose, and insulin levels correlate most strongly with urinary N‐acetyl‐β‐d‐glucosaminidase (NAG) levels in prediabetic subjects. Methods The OGTT was administered to 80 subjects who had not yet received a diagnosis of diabetes mellitus (DM) and in whom HbA1c levels were ≤6.8% and fasting plasma glucose levels were <7.0 mmol/l. Forty‐two subjects had normal glucose tolerance (NGT), 31 had impaired glucose tolerance (IGT), and 7 had DM according to World Health Organization criteria. Serum levels of cystatin C, the estimated glomerular filtration rate, the urinary albumin‐to‐creatinine (Cr) ratio, urinary and serum β2‐microglobulin, and urinary NAG were measured as markers of renal function. Results NAG levels were significantly higher in subjects with DM and in subjects with IGT than in subjects with NGT. No significant associations were observed between glycemic status and other markers of renal function. Multiple linear regression analysis showed that the NAG level was positively correlated with plasma glucose levels at 120 min of the OGTT and was associated with the glycemic status of prediabetic patients. Conclusion These results suggest that postprandial hyperglycemia is an independent factor that causes renal tubular damage in prediabetes patients.

The aim of this study was to demonstrate the effects of sex and age on serum levels of 1,5-AG in nondiabetic subjects.A total of 1 134 nondiabetic subjects aged 16–96 years with HbA1c less than 6.8% were recruited and divided into 4 HbA1c groups (Q1: HbA1c≤5.3; Q2: 5.4–5.8; Q3: 5.9–6.3; and Q4: 6.4–6.8 [%]). 38 elderly subjects (65 years or older) in the Q3 and Q4 groups (13 men and 25 women) underwent a 75-g oral glucose tolerance test (OGTT).The Q4 group had significantly lower 1,5-AG levels than did the Q1 group among nonelderly males, nonelderly females, and elderly men. In elderly women, 1,5-AG levels did not differ among the 4 HbA1c groups. In both nonelderly and elderly subjects, the 1,5-AG level of the Q1 group was significantly higher in males than in females. Stepwise multivariate regression analysis showed that age was significantly associated with 1,5-AG level in both sexes. HbA1c was significantly associated with the 1,5-AG level in males, while there was no significant association between HbA1c and the 1,5-AG level in females. In the elderly OGTT group, although the glucose levels of both sexes during OGTT were identical, the mean urinary glucose levels and the percentages of subjects with glucosuria were significantly higher in elderly men than in elderly women.Serum 1,5-AG levels were significantly associated with age and sex. The sensitivity of the 1,5-AG level for identifying postprandial hyperglycemia in elderly women with near-normoglycemia is less reliable because they have a higher renal threshold for glucose.