Tado Asami

This study aimed to evaluate the effects of care incorporating passive motion exercise of the ankle plantar dorsiflexion on lower extremity hemodynamics and comfort using physical methods for deep vein thrombosis(DVT)prevention. We recruited 16 healthy women, aged 20-40 years old, using a simple random allocation crossover design. We categorized them into three groups:intermittent pneumatic compression was performed continuously(IPC group);the patients underwent passive exercise of ankle dorsiflexion and plantar flexion(ankle exercise group),and IPC was removed(IPC removal group).We evaluated lower extremity hemodynamics, coagulation and fibrinolysis, autonomic nervous functions, and subjective sensation during each intervention.The ankle exercise group showed a decrease in the maximum blood flow velocity in the femoral vein and deoxygenated hemoglobin. Three coagulation and fibrinolysis complexes, namely, fibrin monomer complex, thrombin-antithrombin complex, and plasmin-alpha2-plasmininhibitor-complex, showed no change among the three groups. One autonomic nervous function, the high-frequency component, remained lower in the IPC group than in the other two groups after 15 minutes. Subjective sensation was highest in the IPC group.The ankle exercise group did not show exacerbation of lower limb venous stasis and coagulability, suggesting that a nursing intervention reduces discomfort that occurs with continuous use of IPC.

We have developed ACTce‑CCM̶ Analysis and Coordination Tools of Clinical Ethics in Critical Care Medicine. The preparation process was carried out in four stages:construct setting and prototype creation, application of prototype version to fictitious cases, clarification of the construct based on focus group interviews, and a fact-finding survey on ethical issues and ethical adjustment. The completed version of ACTce-CCM consists of information organization and assessment frameworks, problem analysis and integration, problem lists, goals, care practices, and ethical adjustment. There are six frameworks for information organization and assessment:pathology and treatment, QOL and QOD, patient intention, family psychosocial situation, medical team situation, and the surrounding situation. The problem lists include those related to the patient, the family, and the medical staff. Goals include those of the medical team and the expected outcomes for the patient/family. Care practices and ethical adjustment consist of three aspects: direct patient care, direct family care, and medical team adjustment.