ABSTRACT
Adipose triglyceride lipase (ATGL) catalyzes the first step of triglyceride hydrolysis. The gene mutations cause neutral lipid storage disease with myopathy (NLSDM) and/or triglyceride deposit cardiomyovasculopathy (TGCV) . Here we give the first report on rehabilitation of a patient with NLSDM and TGCV. The 62-years-old patient was admitted to our hospital for rehabilitation for skeletal myopathy and rehabilitation for cardiac dysfunction (NYHA class Ⅲ , ejection fraction 20%) . He complaint of dyspnea during the activity of daily life and exercise torelance was low. Our rehabilitation program consisted of physical therapy, occupational therapy, nutrition and cardiac education. We had paid a special attention to the intensity of exercise (aerobic training and resistance training) due to the low cardiac function, energy dysfunction and myopathy. After rehabilitation for two months, muscle strength had increased and 6MWT, ATVO<sub>2</sub> had improved. Importantly, the reduction of dyspnea on exertion as well as the increase in exercise capacity are considered to have led to improvement of quality of life.
ABSTRACT
<b>Objectives:</b> Infective endocarditis (IE) has an extremely poor prognosis unless appropriate treatment is received. Hemodialysis patients with IE show higher rates of morbidity and mortality in comparison with non-dialysis patients with IE. We focused on hemodialysis patients, as well as patients in other stages of chronic kidney disease. We sought to assess the relationship between renal function and mortality in patients with IE.<br><b>Methods:</b> We carried out a retrospective cohort study on 45 consecutive patients with IE in an urban teaching hospital between November 2003 and August 2008. We collected demographic and clinical data as well as pre- and post-discharge outcomes. Patients were subdivided into four groups according to their eGFR level at admission: A: eGFR≧60 ml/min/1.73 m<sup>2</sup> (n=23); B: eGFR 30-59 ml/min/1.73 m<sup>2</sup> (n=15); C: eGFR<30 ml/min/1.73 m<sup>2</sup> (n=3); and, D: dialysis patients (n=3). It was not possible to determine the outcome status of one patient. The Trend Test was used to evaluate the association between renal function and mortality.<br><b>Results:</b> There were 29 male and 16 female patients with IE and the mean age was 67.9+-17.6 (SD). There were 10 diabetic patients (22%). Thirty-nine patients (84%) were either discharged or transferred to another hospital. Seven patients (16%) died: two (9%) Group A patients; three (20%) Group B patients; no Group C patients; and, two (67%) Group D patients. Patients with lower eGFR had higher mortality rates (Trend Test, P=0.046).<br><b>Conclusion:</b> We presume a trend towards a higher mortality rate in conjunction with advancing CKD stage.
ABSTRACT
<b>BACKGROUND</b> : Electronic medical records (EMRs) were first introduced in the 1960s, and in Japan they are starting to become popular. Recognizing the need to adapt to a new clinical setting with EMRs, we aimed to explore which interviewing skills were associated with patient satisfaction in this era of EMR use.<br><b>METHODS</b> : A prospective observational study was conducted to evaluate interviewing skills among medical residents and to collate data on patients' satisfaction levels at an outpatient general medicine walk-in clinic at a teaching hospital in Japan. Five trained raters reviewed the video recordings of these interviews and assessed them based on a predetermined set of criteria for medical interview skills developed specifically for an outpatient EMR setting. The relationships between these assessment scores and patient satisfaction levels were analyzed.<br><b>RESULTS</b> : Significant skills that were associated with higher scores of patient satisfaction included : employed appropriate eye contact (P=0.021) ; and, invited patients directly without using a microphone (P=0.008). In addition, the degree of keyboard typing during interviews was not associated with patient satisfaction.<br><b>CONCLUSIONS</b> : In an outpatient setting with EMR, using good non-verbal communication skills to build trustful relationships with patients is more likely to influence patient satisfaction levels. Even when physicians are typing on a keyboard, if they keep appropriate eye contact during medical interviews, patient satisfaction can be improved.