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Objective:To construct an "Internet+nursing service" model for elderly patients at home led by the continuing care service center from the perspective of the Internet, and to provide reference for different types of professional home care services for elderly patients.Methods:From March 2019 to December 2021, relying on the continuing care service center, six links of "discharge preparation, discharge follow-up service, home care service, online diagnosis and treatment, institutional return visit, health guidance" in Wuhan Central Hospital, Tongji Medical College, Huazhong University of Science and Technology were interconnected to construct a closed-loop "Internet+nursing service" model for elderly patients at home. Summarized the workload after the implementation of "Internet+nursing service", and investigated the satisfaction of 149 patients and 112 home sevice nurses.Results:After 2 years and 9 months of implementation, the team provided 11 home care services for elderly patients with diabetes foot dressing change, PICC catheter maintenance, replacement of catheter, wound stoma care and home membrane dialysis etc, and provided 452 home care services for 149 patients. Patient satisfaction was (94.47 ± 3.07) points; the approval of this model by 112 home service nurses was (4.69 ± 0.43) points.Conclusions:The "Internet+nursing service" model for elderly patients at home, which is dominated by the continuous nursing service center, can meet the continuous nursing needs of elderly patients at home. At the same time, expanding nurses′ practice space and enhancing nurses′ professional value will play a positive role in promoting the development of nursing service industry.
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Background: Though coronary artery bypass graft (CABG) is a life-saving surgery and a standardized procedure, the aim of the surgery is survival with quality of life (QOL). The extended role of the nurse was well recommended in community and clinical settings with the support of multidisciplinary team for safe care. The Extended Nursing Care Model (ENCM) provides the framework to facilitate early recovery and thereby improve the QOL and overall productivity after CABG. Aim and Objective: The aim of this article is to compare the difference in QOL of CABG patients with and without ENCM. Materials and Methods: Quasi-experimental Time Series Design with Comparison Group was used to study the effectiveness of ENCM. Among CABG patients enrolled on the day of admission with non-probability purposive sampling technique, 140 patients were randomly and equally distributed in the study and control groups on the day of discharge for recovery management. Generic EQ-5D-5L scale and MacNew Heart Disease-related QOL (MNHDRQOL) questionnaire were used to collect data at frequent intervals. The data obtained successfully from 69 patients in the study group and 63 patients in the control group were analyzed by using SPSS-21 Statistical Software, Mann–Whitney U-test, and Wilcoxon signed-rank test. Results: There was an improvement in the EQ-5D-5L score and MNHDRQOL score from baseline (before surgery) to 6th week and 12th week after surgery. This difference is statistically higher in the study group than in the control group (P <0.05) in all five domains of Euro QOL and all three domains of MNHDRQOL. Conclusion: Nursing care provided by using ENCM is effective in improving the QOL of CABG patients.
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O objetivo deste artigo é apresentar e discutir parâmetros que otimizem o matriciamento em saúde mental como dispositivo de cuidado. Trata-se de estudo qualitativo, orientado pelas teorias psicanalíticas de grupo. Observamos, registramos e analisamos seis reuniões de matriciamento entre serviços especializados e Atenção Primária à Saúde (APS). As principais dificuldades encontradas se referiam a assegurar horários e espaços para as reuniões, bem como disparidades na compreensão sobre a tarefa. Em contrapartida, identificamos também momentos que evidenciam um cuidado mútuo, em sintonia com a literatura sobre as relações entre equipes e usuários. Concluímos destacando a importância do conhecimento sobre os processos psíquicos em jogo no grupo de profissionais, favorecendo, assim, maior clareza sobre sua tarefa e consequente engajamento dos participantes, potencializando o matriciamento como dispositivo de cuidado, tanto dos usuários do Sistema Único de Saúde (SUS) quanto dos profissionais. (AU)
The article presents and discusses parameters that optimize matrixing in mental health as a care device. We conducted a qualitative study guided by group psychoanalytic theories. We observed, recorded and analyzed six matrixing meetings between specialist services and primary health care services. The main difficulties found were finding time and spaces for meetings and differences in understanding about tasks. On the other hand, we observed moments that reveal mutual care in tune with the literature on health team and service user relations. We conclude by highlighting the importance of knowledge about the psychic processes at stake in groups of professionals, facilitating greater clarity regarding tasks and resulting in the consequent engagement of participants (both public health service users and health professionals), thus enhancing matrixing as a care device. (AU)
El objetivo de este artículo es presentar y discutir parámetros que optimicen el apoyo matricial en salud mental como dispositivo de cuidado. Se trata de un estudio cualitativo orientado por las teorías psicoanalíticas de grupo. Observamos, registramos y analizamos seis reuniones de apoyo matricial entre servicios especializados y Atención Primaria de la Salud (APS). Las principales dificultades encontradas se referían a asegurar horarios y espacios para las reuniones, así como disparidades en la comprensión sobre la tarea. En contrapartida, identificamos también momentos que ponen en evidencia un cuidado mutuo, en sintonía con la literatura sobre las relaciones entre equipos y usuarios. Concluimos subrayando la importancia del conocimiento sobre los procesos psíquicos en juego en el grupo de profesionales, favoreciendo de tal forma una mayor claridad sobre su tarea y el consecuente compromiso de los participantes. (AU)
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Humans , Patient Care Team , Primary Health Care , Mental Health , Qualitative ResearchABSTRACT
Objective@#To explore the effect of extended nursing service on malnutrition in patients undergoing maintenance hemodialysis combined with peritoneal dialysis.@*Methods@#According to the formula, 124 patients with malnutrition in maintenance hemodialysis combined with peritoneal dialysis were divided into intervention group and control group by lottery, 62 in intervention group and 62 in control group. The control group received routine specialist nursing and health education during hospital dialysis, while the intervention group received extended nursing services for 6 months, including telephone follow-up, knowledge lectures and Wechat interaction. The nutritional status of two groups of patients was assessed by modified subjective comprehensive nutrition assessment (MQSGA) one day before the implementation of extended nursing service, three months and six months after the implementation of extended nursing service, and the body mass index(BMI), albumin, prealbumin, hemoglobin, serum calcium and serum phosphorus were measured at the same time.@*Results@#There was no significant difference in nutritional status, BMI and blood index between the two groups before intervention (P > 0.05). After 3 months and 6 months of intervention, MQSGA scores of intervention group were (13.28±3.99), (10.17±3.43) respectively, which were significantly lower than those of control group (15.32±3.52), (14.37±3.73). There were significant differences between the two groups (t=2.946, 6.336, P<0.01). After 3 months and 6 months of intervention, BMI was (18.29±2.27), (20.27±2.09) kg/m2, respectively, which were significantly higher than those of control group (16.41±2.32), (16.49±2.26) kg/m2. The difference between the two groups was significant (t=-4.430, -9.372, P <0.01). After 3 months of intervention, albumin, preaalbumin, hemoglobin, serum calcium, and serum inorganic phosphorus in intervention group were (35.63±4.24) g/L, (277.57±29.52) mg/L, (102.03±11.21) g/L,(2.01±0.19) mmol/L, (1.74±0.37) mmol/L; and the control group were (33.19±4.89) g/L, (216.81±24.06) mg/L, (92.58±13.79) g/L, (1.91±0.21) mmol/L, (2.05±0.49) mmol/L, respectively. After 6 months of intervention, the intervention groups were (41.49±6.14) g/L, (344.60±30.56) mg/L, (111.34±10.09) g/L, (2.28±0.18) mmol/L, (1.45±0.33) mmol/L, the control group were (34.16±4.71) g/L, (218.63±24.85) mg/L, (94.36±11.21) g/L, (1.99±0.24) mmol/L, (1.95±0.41) mmol/L. There were significant differences between the two groups (t=-24.484-7.220, P<0.01).@*Conclusions@#Extended nursing service can significantly improve the nutritional status of patients undergoing maintenance hemodialysis combined with peritoneal dialysis.
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Development of medical alliances can provide patients of wound ostomy with cost-effective, safe and effective continuing specialized care at their community, gradually homogenizing hospital-community specialized care. By means of establishing a nurse advice referral and specialist nurses consultation mechanism, Shenzhen Luohu Hospital Group has achieved to share specialist nursing resources between hospitals and social health centers.This practice can reduce re-hospitalization rate of these patients, reduced their economic burden, save medical resources and improve patient satisfaction as well.
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PURPOSE: To compare extended care facility (ECF) and home as discharge destination after total knee arthroplasty (TKA) at a single high-volume tertiary center in South Korea. MATERIALS AND METHODS: We retrospectively analyzed 1,120 primary TKAs (614 patients) performed between January 2012 and December 2013. A telephonic survey was conducted to determine discharge destination. The data reviewed included demographic and surgical data, functional outcome at 2 years and complications within 3 months. RESULTS: ECF and home received 316 patients (51%) and 298 patients (49%), respectively. The ECF group had more bilateral TKA patients than the home group (272 vs. 234; p=0.014) and more patients with additional hospital stay (44 vs. 22; p=0.009). A higher tendency of complications was seen at home (n=8, 2.7%) than the ECF (n=2, 0.6%) (p=0.057). No significant differences were found in any functional outcome measure. Home patients had better patient satisfaction than ECF patients (81.9% vs. 54.3%; p < 0.001). CONCLUSIONS: Patients who returned home after discharge had similar functional outcome at 2 years after surgery and higher patient satisfaction than those in the ECF in spite of the higher tendency of complications. Patients need adequate counseling and education regarding advantages and limitations of the two discharge destinations.
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Humans , Arthroplasty , Arthroplasty, Replacement, Knee , Counseling , Education , Knee , Korea , Length of Stay , Outcome Assessment, Health Care , Patient Satisfaction , Retrospective Studies , Skilled Nursing FacilitiesABSTRACT
Objective Diabetes is a common chronic disease in the elderly and needs long-term treatment. This study aims to determine the effect of extended nursing service in rehabilitation of army retired officers with diabetes. Methods We selected 78 ca-ses of military retired officers with diabetes from September 2010 to September 2012 in Nanjing General Hospital of Nanjing Military Region. According to the different intervention methods, patients were divided into experimental group and control group( n=39 cases) . The control group used conventional nursing service, and the experimental group added extended nursing service on the basis of the control group . After one year follow-up, the fasting blood glucose level, glycosylated hemoglobin ( HbAlc) , self-rating depression scale (SDS) evaluation and self-rating anxiety scale (SAS) and the changes of patients′ satisfaction of the two groups were observed. Results The fasting blood glucose levels and HbAlc of experimental group were significantly better than control group, with statisticalsignificance (P<0.05);The SAS scores (34.9±5.9)and SDS scores (36.9±4.5) of experimental group were significantly lower than the control group(52.3±4.2 and 55.9±3.9), with statistical significance ( t=5.489, t=5.226, P<0.05);The satisfaction degree of the exper-imental group was significantly higher than the control group (99.8%vs 79.9%, χ2=4.898, P<0.05). Conclusion the extension ofnursing service in health rehabilitation in the retired veteran cadres in the army with diabetes can effectively improve the patient′s fast-ing blood glucose levels, reduce depression, as well as improving the nursing service satisfaction.
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Objective To explore the construction and application effects of extended care form for children with epilepsy based on Omaha System.Methods Based on Omaha System,the form was established by referring medical records,literature review and three rounds of focus group discussion.From February to June,2016,48 children with epilepsy were selected as the observation group and received routine care as well as management using the form based on Omaha System;from August to December,2015,48 children with epilepsy were selected as the control group and received routine care and follow-up.The effects of intervention and scores of Family Management Measure were compared between two groups.Results Nursing issues in all domains for the observation group 3 months after intervention were lower than those during hospitalization except financial situation (P＜0.05);there was statistically significant difference in scores of knowledge-behavior-status of main nursing issues before and after intervention except cognition and mental health items (P＜0.05).Duration of hospitalization,expenditure,readmission rate,EEG results and scores of FAMM in the observation group were better than those in the control group (P＜0.05).Conclusion The construction and application of the form based on Omaha System can provide references for longterm management for children.
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Objective To investigate the effect of Omaha system on the self-management ability of patients with glaucoma after discharge, so as to provide evidence for the further development of glaucoma. Methods A total of 86 cases of glaucoma patients were divided into control group and observation group, each group of 43 cases, the control group was given routine discharge guidance and follow-up,the observation group was given continuous nursing care based on the Omaha system.The two groups of patients before and after the discharge of the last 3 days and the end of the 2 months of self-management ability score. Results There was no statistical significance in the life adjustment, functional health care,medical management of diseases level of 3 d before discharge from the hospital(P>0.05).The life adjustment,medical management of diseases level was(8.73±2.51),(20.86±1.55)points at 2 months after discharge in control group,which was higher than that at 3 d before discharge(6.07±1.62), (16.11 ± 3.35) points,there was significant difference(t=2.127, 2.867,P<0.05). The life adjustment, functional health care,medical management of diseases level was(11.25±1.48),(20.78±2.61),(26.74±1.26) points at 2 months after discharge in observation group,which was higher than that at 3 d before discharge (6.12±1.71),(13.62±3.22),(16.04±2.78)points,there was significant difference(t=4.215,3.544,5.328,P<0.05).There was significant difference in the life adjustment,functional health care,medical management of diseases level of 2 months after discharge between two groups (t=2.074, 4.064, 4.878, P<0.05). Conclusions Continuous care based on the Omaha system can improve the life management,functional health care,medical management and general self-management ability of patients with glaucoma.
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Objective To study effect of extended care on quality of life of elderly patients with AIDS and effect on virus load ,so as to provide theory gist for care of AIDS .Methods A total of 80 cases of elderly patients with AIDS diagnosed and treated in our hospital since March 2014 to March 2016 were selected as the subjects of study ,and all patients were treated with highly active an-tiretroviral therapy and other conventional treatment .And 40 cases of patients provided with conventional treatment on the base of highly active antiretroviral therapy were set as control group ,while the other 40 cases of patients provided with extended care were set as observation group .Patients in two groups were evaluated for quality of life via HARRT before and after care ,and two care methods were compared for effect on treatment compliance .Levels of subgroups of T lymphocytes CD4+ before care ,in 3 moths and 6 months after care was examined ,while virus load of HIV was detected via polymerase chain reaction (PCR) .Results The score of HARRT in observation group after care was improved compared with that before care .The treatment compliance of observation group was 95 .00% ,which was significantly higher than 72 .50% in control group(P<0 .05) .The levels of CD4+ in observation group after treating 3 moths and 6 months were dramatically higher than that in the control group(P<0 .05) .After receiving treat-ment ,the proportion of patients with total blood virus load lower than 50 copies/L in observation group was 80 .00% ,which was significantly higher than 62 .50% in control group(P<0 .05) .Conclusion Basic treatment combined with extended care for elderly patients with AIDS could improve quality of life ,treatment compliance and immune functionsignificantly ,so as to assist control for virus load .
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Objective To study effect of extended care on quality of life of elderly patients with AIDS and effect on virus load ,so as to provide theory gist for care of AIDS .Methods A total of 80 cases of elderly patients with AIDS diagnosed and treated in our hospital since March 2014 to March 2016 were selected as the subjects of study ,and all patients were treated with highly active an-tiretroviral therapy and other conventional treatment .And 40 cases of patients provided with conventional treatment on the base of highly active antiretroviral therapy were set as control group ,while the other 40 cases of patients provided with extended care were set as observation group .Patients in two groups were evaluated for quality of life via HARRT before and after care ,and two care methods were compared for effect on treatment compliance .Levels of subgroups of T lymphocytes CD4+ before care ,in 3 moths and 6 months after care was examined ,while virus load of HIV was detected via polymerase chain reaction (PCR) .Results The score of HARRT in observation group after care was improved compared with that before care .The treatment compliance of observation group was 95 .00% ,which was significantly higher than 72 .50% in control group(P<0 .05) .The levels of CD4+ in observation group after treating 3 moths and 6 months were dramatically higher than that in the control group(P<0 .05) .After receiving treat-ment ,the proportion of patients with total blood virus load lower than 50 copies/L in observation group was 80 .00% ,which was significantly higher than 62 .50% in control group(P<0 .05) .Conclusion Basic treatment combined with extended care for elderly patients with AIDS could improve quality of life ,treatment compliance and immune functionsignificantly ,so as to assist control for virus load .
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Objective To investigate the practice effect of WeChat software on extended care for patients with anterior resection syndrome. Methods From August 2014 to August 2015, 50 patients with anterior resection syndrome were chosen as control group. From September 2015 to August 2016, 50 patients with anterior resection syndrome were chosen as experimental group. Patients in experimental group could use WeChat software independently. Control group got extended care by telephone, while experimental group was carried out through WeChat platform. They were followed up for 6 months. WeChat software offered patients professional guidance on evaluation and exercise methods of defecation function by video and text with some figures. The questions from patients were answered through WeChat software during followed up. Results The defecation function after 1 month of surgery for patients with excellent, good, average, poor was 15, 20, 12, 3 cases respectively in the experimental group, and 9, 15, 19, 7 cases respectively in the control group. The defecation function after 3 month of surgery for patients with excellent, good, average, poor was 19, 21, 8, 2 cases respectively in the experimental group, and 12, 18, 17, 3 cases respectively in the control group. The difference of the defecation function after 1,3 months of surgery were statistically significant (χ2=8.395, 8.251, P0.05). The compliance of medication, diet and rehabilitation exercise, regular review after 6 months of surgery for patients was (2.14 ± 0.72), (7.21 ± 1.63), (11.20 ± 0.63), (5.04 ± 0.78) points respectively in the experimental group, and (1.37 ± 0.58), (5.72 ± 1.32),(9.75 ± 1.56),(4.72 ± 0.43)points respectively in the control group, and the differences were statistically significant (t=2.68-5.75, P< 0.01).Conclusion WeChat software can improve defecation function and treatment compliance, thus greatly improve the quality of life of patients with mid-low rectal cancer.
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Objective To investigate the role of the extended-care in improving the compliance with low-salt diet in elderly patients with hypertension.Methods We selected 100 cases of elderly patients with hypertension in hospital.The 100 cases were divided into control group (50 cases) and observation group (50 cases) randomly.Observation group was given comprehensive intervention in low-salt diet education and control group was given traditional low-salt diet education.Tow groups were divided into three stages (on the day of admission,seven days after admission,one month after discharge).We analyzed low-salt cognitive scores,low-salt behavioral scores and salt-intake/d comparably.Results On the day of admission,tow groups had no statistically significant difference (P＞0.05) in low-salt cognitive scores,low-salt behavioral scores and salt-intake/d;seven days after admission,tow groups had statistically significant difforence (P＜0.05) in low-salt cognitive scores,low-salt behavioral scores and salt-intake/d;one month after discharge,tow groups had statistically significant difference (P＜0.05) in low-salt cognitive scores,low-salt behavioral scores and salt-intake/d.Conclusion We use comprehensive intervention method to elderly patients with hypertension in low-salt diet education,through personalized low-salt diet education following evidence-based nursing,we can increase the compliance with low-salt diet in elderly patients with hypertension after discharge and improve blood pressure control effectively and to promote the image of the hospital and achieve the higher satisfaction from patients and families.
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Objective To explore the effect of extended care on the quality of life of patients with permanent colostomy . Methods Clinical data of 268 patients with permanent colostomy were retrospectively analyzed. The patients were randomly divided into the experiment group (n=154) and control group (n=114). Two groups of patients after colostomy were given conventional nursing and telephone follow-up and the experiment group also received extended care such as home visits , seminars and fraternity care. Postoperative follow-up was done for 1 month, 3 months, 6 months, 9 months and 1 year. Core quality of life questionnaire (QLQ C30) was used to investigate the patients after 1 year intervention. Result Compared with the control group, patients′physical function, role function, emotional function, cognitive function, social function and health status rating were significantly improved in the experiment group (P<0.05). Conclusion Extended nursing can provide more comprehensive, systematic, professional nursing, improve the mastery of relevant knowledge and the skills and finally improve patients′quality of life.
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Objective To explore the effect of extended care on behavior mental state of patients with Hirschsprung disease.Methods 40 cases of patients with Hirschsprung disease underwent surgery in our hospital from January 2009 to June 2010 were set as the control group.42 cases of patients with Hirschsprung disease underwent surgery in our hospital from July 2011 to June 2012 were set as the experimental group.The patients in the control group received conventional guidance after Hirschsprung disease surgery before discharge,which included dietary guidance,anus functional exercise,regular anal expansion,follow-up upon discomfort and regular re-visit.The patients in the experimental group not only received conventional guidance after Hirschsprung disease surgery before discharge,but also received systematic extended care plan.The nursing effect was compared between two groups.Results Conduct problems and hyperactivity index of patients in the experimental group were compared with those in the control group,the differences were significant.The scores of learning problems,psychosomatic disorders,impulsivity-hyperactivity and anxiety were lower,and compared with those in the control group,the differences were not significant.Conclusions Implementation of extended care for patients with Hirschsprung disease surgery can improve behavior mental state of them.
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Objective To develop an evidence-based community extended care model for patients with asthma.Methods Mixed research methods were applied to integrate best evidences:80 literatures were included in systemic review; 394 medical records were analyzed; 112 nurses admitted a test and a questionnaire to assess their competence on asthma care; clinical observation to both hospital and community centers were conducted; 6 multidisciplinary experts were consulted; and 100 patients admitted a questionnaire on patient needs and 17 of them were further interviewed.Results The nursing care model with the feature of hospital and community health service center collaborating to provide extended care for patients with asthma was established.Conclusions The development of a nursing care model for practice should be based on the current best evidence generating from the best research evidence,professional judgment on clinical practice requirement and patients' needs.
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Objective To investigate the effects of extended care on the treatment compliance and the quality of life on discharged elderly patients with chronic heart failure. Methods One hundred and eight patients were randomly assigned to the experimental group and the control group with 54 patients in each, the experimental group received extended care for 1 year, including regular telephone and visit follow-up, supporting medical care, diet care, rehabilitation exercises and supervision of self-care. The control group underwent routine health education before discharge. Medical compliance and self-management ability were compared three months, six months and 1 year after discharge, evaluation score of life quality were also compared at discharge and one year after discharge between the two groups. Results There were no significant differences in medication, diet and regular follow-up visits between the two groups. However, the patients in the experimental group showed better compliance than the control group in the self-testing of urine, body weight,and recording of symptoms, body signs and required exercises. Additionally, the patients in the experimental group had higher scores than the control group in the daily life-skills, happiness and the quality of life. Conclusions The extended care significantly improved the treatment compliance and the quality of life in the elderly patients with chronic heart failure.
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We report on two elderly patients in the extended care unit who were successfully treated with Keishi-ka-ryukotsu-borei-to for sexually deviant behavior. Case 1 was a 71-year-old male hospitalized for rehabilitation after surgery for benign prostate hypertrophy. He began to masturbate soon after hospitalization, which made caregivers and other patients very uncomfortable. After the administration of Keishi-ka-ryukotsu-borei-to, his masturbation behavior disappeared. Case 2 was a 90-year-old male hospitalized for rehabilitation after cerebral infarction. He began using obscene expressions and trying to touch female patients about half a year after being hospitalized. His sexually deviant behavior decreased after the administration of Keishi-ka-ryukotsu-borei-to. This strongly suggests that Keishi-ka-ryukotsu-borei-to is useful in the treatment of dementia-related deviant sexual activity in senior citizens.
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We report on two elderly patients in the extended care unit who were successfully treated with “Furidashi” extract (an extraction method of dipping in hot water) of Astragali Radix, for copious sweat. Case 1 was a 65-year-old male hospitalized for rehabilitation after cerebral hemorrhage. He needed a change of clothes three or four times a day because of copious sweat. After administration of Hochu-ekki-to and “Furidashi” extract of Astragali Radix, his sweat decreased. Case 2 was a 66-year-old female hospitalized for rehabilitation after cerebral contusion. She was dripping-wet with perspiration, and had itchy eczema and skin erosions on her trunk. After administration of the “Furidashi” extract of Astragali Radix, her sweat decreased and the erosions were cured. This strongly suggests that the “Furidashi” extract of Astragali Radix provides a convenient and inexpensive treatment against copious sweat accompanied by skin disorder in the elderly.
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We report two elderly cases in the extended care unit who were successfully treated for emitting a strange squealing sound with Sansonin-to. Case 1 was a 97-year-old female who was hospitalized with a strange squeal after repeated aspiration pneumonia. She made this strange sound especially during the night. This sound disappeared with the administration of Sansonin-to (TJ-103: 7.5g/day) except at the times of position change and diaper change, and she also became able to eat after practicing swallowing. Case 2 was an 80-year-old female who was hospitalized after a cerebral hemorrhage. She also made a strange squealing sound during the night. After administration of Sansonin-to, this sound was decreased, and she became able to sleep well at night and live actively with rehabilitation training in the daytime. With an aging society, troublesome behaviors due to dementia will be an increasing problem. These cases suggest that there may be certain conditions of elderly nighttime delirium that are treatable with Sansonin-to.