n.

患者

WordNet

enduring trying circumstances with even temper or characterized by such endurance; "a patient smile"; "was patient with the children"; "an exact and patient scientist"; "please be patient"
a person who requires medical care; "the number of emergency patients has grown rapidly"
a person who seeks the advice of a lawyer

PrepTutorEJDIC

(人が)『忍耐強い』,しんぼう強い,がまん強い / (行動が)根気のよい,忍耐を示す / 〈C〉『患者』,医者にかかっている人
[『弁護』]『依頼人』,訴訟依頼人 / (商売上の)おとくい(customer)

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/07/02 17:03:43」(JST)

wiki en

[Wiki en表示]

A patient is any recipient of health care services. The patient is most often ill or injured and in need of treatment by a physiotherapist, physician, physician assistant, advanced practice registered nurse, psychologist, podiatrist, veterinarian, or other health care provider.

Etymology

The word patient originally meant 'one who suffers'. This English noun comes from the Latin word patiens, the present participle of the deponent verb, patior, meaning 'I am suffering,' and akin to the Greek verb πάσχειν (= paskhein, to suffer) and its cognate noun πάθος (= pathos).

Outpatients and inpatients

An outpatient (or out-patient) is a patient who is not hospitalized for 24 hours or more but who visits a hospital, clinic, or associated facility for diagnosis or treatment. Treatment provided in this fashion is called ambulatory care. Sometimes surgery is performed without the need for a formal hospital admission or an overnight stay. This is called outpatient surgery. Outpatient surgery has many benefits, including reducing the amount of medication prescribed and using the physician's or surgeon's time more efficiently. More procedures are now being performed in a surgeon's office, termed office-based surgery, rather than in a hospital-based operating room. Outpatient surgery is suited best for healthy patients undergoing minor or intermediate procedures (limited urologic, ophthalmologic, or ear, nose, and throat procedures and procedures involving the extremities).

An inpatient (or in-patient), on the other hand, is "admitted" to the hospital and stays overnight or for an indeterminate time, usually several days or weeks, though in some extreme cases, such as with coma or persistent vegetative state patients, stay in hospitals for years, sometimes until death. Treatment provided in this fashion is called inpatient care. The admission to the hospital involves the production of an admission note. The leaving of the hospital is officially termed discharge, and involves a corresponding discharge note.

Misdiagnosis is the leading cause of medical error in outpatient facilities. Ever since the National Institute of Medicine’s groundbreaking 1999 report, “To Err is Human”, found up to 98,000 hospital patients die from preventable medical errors in the U.S. each year, government and private sector efforts have focused on inpatient safety.^[1] While patient safety efforts have focused on inpatient hospital settings for more than a decade, medical errors are even more likely to happen in a doctor’s office or outpatient clinic or center.

Day patient

A day patient or (day-patient) is a patient who is using the full range of services of a hospital or clinic but is not expected to stay the night. The term was originally used by psychiatric hospital services using of this patient type to care for people needing support to make the transition from in-patient to out-patient care. However, the term is now also heavily used for people attending hospitals for day surgery.

Alternative terminology

Because of concerns such as dignity, human rights and political correctness, the term "patient" is not always used to refer to a person receiving health care. Other terms that are sometimes used include health consumer, health care consumer or client. However, such terminology may be offensive to those receiving public health care as it implies a business relationship. (In at least some countries, it is illegal to practice business within any public hospital.)

In veterinary medicine, the client is the owner or guardian of the patient. These may be used by governmental agencies, insurance companies, patient groups, or health care facilities. Individuals who use or have used psychiatric services may alternatively refer to themselves as consumers, users, or survivors.

In nursing homes and assisted living facilities, the term resident is generally used in lieu of patient,^[2] but it is common for staff members at such a facility to use the term patient in reference to residents. Similarly, those receiving home health care are called clients.

Patient-centred healthcare

The doctor-patient relationship has sometimes been characterized as silencing the voice of patients.^[3] It is now widely agreed that putting patients at the centre of healthcare,^[4] by trying to provide a consistent, informative and respectful service to patients, will improve both outcomes and patient satisfaction.^{[citation needed]}

When patients are not at the centre of healthcare, when institutional procedures and targets eclipse local concerns, then patient neglect is possible.^[5] Scandals in the UK, such as the Stafford Hospital scandal and the Winterbourne View hospital abuse scandal, have shown the dangers of silencing the voice of patients. Investigations into these, and similar scandals, have recommended that the health service put patient experience at the heart of what it does, and especially, that the voice of patients is heard loud and clear within the health services.^[6]

There are many reasons for why health services should listen more to patients. Patients spend more time in healthcare services than any regulators or quality controllers. Patients can recognize problems such as service delays, poor hygiene, and poor conduct.^[7] Patients are particularly good at identifying soft problems, such as attitudes, communication, and 'caring neglect',^[5] that are difficult to capture with institutional monitoring.^[8]

One important way in which patients can be put at the centre of healthcare is for health services to be more open about patient complaints.^{[citation needed]} Each year many hundreds of thousands of patients complain about the care they have received, and these complaints contain valuable information for any health services which want to learn and improve patient experience^[9]

Patient satisfaction

Patient satisfaction is a measure of the extent to which a patient is content with the health care which they received from their health care provider.

In evaluations of health care quality, patient satisfaction is a performance indicator measured in a self-report study and a specific type of customer satisfaction metric.

References

^ Janet, Howard. "Malpractice Lawsuits Shed Light on Ailing Outpatient System". My Advocates. Retrieved 28 June 2011.
^ Foundations of Caregiving, published by the American Red Cross
^ Clark, J. A., & Mishler, E. G. (1992). Attending to patients’ stories: Reframing the clinical task. Sociology of Health & Illness, 14(3), 344–372.
^ Stewart, M. (2001). Towards a global definition of patient centred care. BMJ : British Medical Journal, 322(7284), 444–445.
^ ^a ^b Reader, T. W., & Gillespie, A. (2013). Patient neglect in healthcare institutions: a systematic review and conceptual model. BMC Health Services Research, 13(1), 156.
^ Francis R. Report of the mid-Staffordshire NHS Foundation Trust Public Inquiry. London: The Stationary Office, 2013.
^ Weingart SN, Pagovich O, Sands DZ, et al. Patient-reported service quality on a medicine unit. International Journal for Quality in Health Care 2006;18(2):95-101
^ Levtzion-Korach O, Frankel A, Alcalai H, et al. Integrating incident data from five reporting systems to assess patient safety: making sense of the elephant. Joint Commission Journal on Quality and Patient Safety 2010;36(9):402-10.
^ Reader, T. W., Gillespie, A., & Roberts, J. (2014). Patient complaints in healthcare systems: a systematic review and coding taxonomy. BMJ Quality & Safety, bmjqs–2013–002437. doi:10.1136/bmjqs-2013-002437

External links

Jadad AR, Rizo CA, Enkin MW (June 2003). "I am a good patient, believe it or not". BMJ 326 (7402): 1293–5. doi:10.1136/bmj.326.7402.1293. PMC 1126181. PMID 12805157.
a peer-reviewed article published in the British Medical Journal's (BMJ) first issue dedicated to patients in its 160-year history
Sokol DK (21 February 2004). "How (not) to be a good patient". BMJ 328 (7437): 471. doi:10.1136/bmj.328.7437.471.
review article with views on the meaning of the words "good doctor" vs. "good patient"
"Time Magazine's Dr. Scott Haig Proves that Patients Need to Be Googlers!" – Mary Shomons response to the Time Magazine article "When the Patient is a Googler"

UpToDate Contents

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1. 患者中心の医療面接 patient centered interviewing
2. 医師と患者の関係における患者中心の考え方 a patient centered view of the clinician patient relationship
3. 緩和ケア：人生最後の数時間 palliative care the last hours and days of life
4. 小児に対する入院前ケアの留意事項 pediatric considerations in prehospital care
5. 小児における身体的診察：HEENT the pediatric physical examination heent

English Journal

Do Differential Response Rates to Patient Surveys Between Organizations Lead to Unfair Performance Comparisons?: Evidence From the English Cancer Patient Experience Survey.

Saunders CL1, Elliott MN, Lyratzopoulos G, Abel GA.
Medical care.Med Care.2016 Nov 24. [Epub ahead of print]
BACKGROUND: Patient surveys typically have variable response rates between organizations, leading to concerns that such differences may affect the validity of performance comparisons.OBJECTIVE: To explore the size and likely sources of associations between hospital-level survey response rates and pa
PMID 26595223

Promoting Action on Research Implementation in Health Services framework applied to TeamSTEPPS implementation in small rural hospitals.

Ward MM1, Baloh J, Zhu X, Stewart GL.
Health care management review.Health Care Manage Rev.2016 Sep 23. [Epub ahead of print]
BACKGROUND: A particularly useful model for examining implementation of quality improvement interventions in health care settings is the PARIHS (Promoting Action on Research Implementation in Health Services) framework developed by Kitson and colleagues. The PARIHS framework proposes three elements
PMID 26415078

Success for Students and Nurses With Disabilities: A Call to Action for Nurse Educators.

Marks B1, McCulloh K.
Nurse educator.Nurse Educ.2016 Sep 23. [Epub ahead of print]
This article presents a "call to action" for nurse educators to identify and implement best practices supporting the success of students with disabilities given recent federal legislative changes. Best practices for educating students with disabilities in nursing education are discussed. Increasing
PMID 26402910

Evaluating the link between human resource management decisions and patient satisfaction with quality of care.

Oppel EM1, Winter V, Schreyögg J.
Health care management review.Health Care Manage Rev.2016 Aug 27. [Epub ahead of print]
BACKGROUND: Patient satisfaction with quality of care is becoming increasingly important in the competitive hospital market. Simultaneously, the growing shortage of clinical staff poses a considerable challenge to ensuring a high quality of care. In this context, a question emerges regarding whether
PMID 26317303

Japanese Journal

high flow nasal cannulaが奏効した筋緊張性ジストロフィー患者の1症例

麻酔 = The Japanese journal of anesthesiology : 日本麻酔科学会準機関誌 66(3), 303-305, 2017-03
NAID 40021121278

症例報告ラニチジン投与を契機にアカシジアを発症した婦人科がんの1例

日本病院薬剤師会雑誌 = Journal of Japanese Society of Hospital Pharmacists 53(3), 295-298, 2017-03
NAID 40021119812

肝後区域切除 : 体位とエネルギーデバイスの工夫 (特集目で見る腹腔鏡下肝切除 : エキスパートに学ぶ!) -- (エキスパートに学ぶ手技)

臨床外科 = Journal of clinical surgery 72(3), 296-302, 2017-03
NAID 40021119223

症例報告段階的課題設定により円滑な筋電義手導入に至った先天性手指欠損の一例

作業療法ジャーナル 51(3), 257-260, 2017-03
NAID 40021108640

Related Pictures

IN PATIENT Patient In Hospital Bed (1280×853) Patient Testimonials | Center for Digestive Health Severe Sepsis and Mortality: Recent Trends Patient Assistance Patient care | Healthcare technology | Medela Health is Primary: Engaged Patients Are Healthier Patients Patients - Pay Your Bill, FAQs, Get in Touch | CareCentrix

★リンクテーブル★

リンク元	「100Cases 33」「100Cases 59」「患者」「client」「affected individual」
拡張検索	「renal transplant patient」「breast cancer patient」「confused patients」

「100Cases 33」

　　[★]

☆case33　頭痛と混乱

■glossary

accompany

vt.

(人)と同行する、(人)に随行する。(もの)に付随する。～と同時に起こる。～に加える(添える、同封する)(with)

slurred n. 不明瞭

強直間代痙攣 tonic-clonic convulsion

　意識消失とともに全身の随意筋に強直痙攣が生じ(強直痙攣期tonic convulsion)、次いで全身の筋の強直と弛緩とが律動的に繰り返される時期(間代痙攣期clonic convulsion)を経て、発作後もうろう状態を呈する一連の発作。

■症例

28歳、女性　黒人　南アフリカ　手術室看護師　ロンドン住在

主訴：頭痛と混乱

現病歴：過去3週間で頭痛が続いており、ひどくなってきた。現在も頭痛が持続しており、頭全体が痛い。友人曰く「過去六ヶ月で体重が10kg減っていて、最近、混乱してきたようだ」。発話は不明瞭。救急室にいる間に強直間代痙攣を起こした。

・診察 examination

やせている。55kg。38.5℃。口腔カンジダ症(oral candidiasis)。リンパ節腫脹無し。心血管、呼吸器系、消化器系正常。痙攣前における神経検査では時間、場所、人の見当識無し。神経局所症状無し(no focal neurological sign)。眼底両側に乳頭浮腫有り。

・検査 investigation

血算：白血球増多

血液生化学：ナトリウム低下

CT：供覧

■キーワード＆着目するポイント

・口腔カンジダ症(oral candidiasis)

・頭痛、精神症状、強直間代痙攣

・眼底両側に乳頭浮腫

・CT 所見

・低ナトリウム血症は二次的なもの

■アプローチ

・口腔カンジダ症(oral candidiasis)　→　細胞免疫低下状態(DM、免疫抑制、AIDSなど) or 常在細菌叢の攪乱(長期の抗菌薬の使用)

　・The occurrence of thrush in a young, otherwise healthy-appearing person should prompt an investigation for underlying HIV infection.(HIM.1254)

　・More commonly, thrush is seen as a nonspecific manifestation of severe debilitating illness.(HIM.1254)

・精神症状、強直間代痙攣　→　一次的、あるいは二次的な脳の疾患がありそう

・頭痛　→　漠然としていて絞れないが、他の症状からして機能性頭痛ではなく症候性頭痛っぽい。

・眼底両側に乳頭浮腫　→　脳圧亢進の徴候　→　原因は・・・脳腫瘍、ことにテント下腫瘍と側頭葉の腫瘍、クモ膜下出血、脳水腫など、そのほか、眼窩内病変、低眼圧などの局所的要因、悪性高血圧、血液疾患、大量出血、肺気腫などの全身的要因 (vindicate本のp342も参考になる)

　・頭痛と脳圧亢進　→　頭蓋内圧占拠性病変、脳炎(IMD.274)

・CT 所見　→　ringformの病変、脳浮腫、脳圧亢進

・低ナトリウム血症　→　脳ヘルニアに続発して起こることがあるらしい。実際には下垂体にトキソプラズマによる病変が形成されることにより起こりうる。

・そのほか出身地、体重減少もHIVを疑わせる点

パターン認識でHIV + 精神症状 + てんかん発作(強直間代痙攣) + 脳圧亢進 + CT 所見 = 一番ありそうなのはToxoplasma gondiiによるトキソプラズマ脳症 cerebral toxoplasosis (トキソプラズマ脳炎 toxoplasmic encephalitis)

■Toxoplasma gondii

　原虫　胞子原虫類

(感染予防学 080521のプリント、CASES p,92、HIM p.1305-)

・疫学：西洋では30-80%の成人がトキソプラズマの感染の既往がある・・・うぇ(CASES)。日本では10%前後(Wikipedia)。

・生活環

　・終宿主：ネコ：ネコの小腸上皮細胞で有性・無性生殖　糞便にオーシストの排泄

　・中間宿主：ヒト.ブタを含むほ乳類と鳥類：無性生殖で増殖、シストの形成

　　　急性期の増殖盛んな急増虫体 tachyzoiteとシスト内の緩増虫体 bradyzoite

・病原、病因 phathogenesis

　・緩増虫体(bradyzoite)、接合子嚢(oocyst)

・感染経路

　1. オーシストの経口摂取

　2. 中間宿主の生肉中のシストの経口摂取

　3. 初感染妊婦からの経胎盤感染。既感染なら胎盤感染しないらしい(HIM.1306)

　(4)移植臓器、輸血。確率は低い(at low rate)(HIM.1306)

・病態

　1. 先天性トキソプラズマ症　congenital toxoplasmosis

　　　①網脈絡膜炎、 ②水頭症、 ③脳内石灰化、 ④精神・運動障害

　2. 後天性トキソプラズマ症　acquired toxoplasmosis

　　(1) 健常者

　　　・多くは不顕性感染。発熱、リンパ節腫脹、皮疹(rash)

　　　・(少数例)筋肉痛、暈疼痛、腹痛、斑状丘疹状皮疹(maculopapular rash)、脳脊髄炎、混乱(HIM.1308)

　　　・(まれ)肺炎、心筋炎、脳症、心膜炎、多発筋炎

　　　・網膜、脈絡叢に瘢痕や、脳に小さい炎症性の病変を残すことあり(CASES)。

　　　・急性感染の症状は数週間で消失　筋肉や中枢神経系に緩増虫体が残存

　　(2)HIV 感染者、臓器移植例、がん化学療法例

　　　シスト内緩増虫体→急増虫体→播種性の多臓器感染

　　　AIDSでは、トキソプラズマ性脳炎が指標疾患 AIDS-defineing illness(CASES)

・治療

　(日本)アセチルスピラマイシン、ファンシダール(感染予防学 080521)

■トキソプラズマ脳炎 toxoplasmic encephalitis、トキソプラズマ脳症 cerebral toxoplasosis

・症状

　発熱、頭痛、混乱ｍ、痙攣、認知の障害、局所神経徴候(不全片麻痺、歯垢、脳神経損傷、視野欠損、感覚喪失)(CASES)

・画像検査

　(CT,MRI)多発性、両側性、ring-enhancing lesion、特に灰白質-白質境界、大脳基底核、脳幹、小脳が冒されやすい(CASES)

・鑑別診断(臨床症状・画像診断の所見で)

　リンパ腫、結核、転移性脳腫瘍(CASES)

・病歴と画像所見からの鑑別診断

　リンパ腫、結核、転移性腫瘍

？

このCTがcerebral toxoplasmosisに特徴的かは不明

□最後に残る疑問

　AIDSでWBC(leukocyte)の数はどうなるんだろう？？？AIDSの初診患者ではWBCが低い人が多いらしいし()、HIVはCD4+ T cellとmacrophageに感染して殺すから、これによってB cellは減るだろうし、CD8+ T cellも若干減少するだろうからWBCは減るんじゃないか？！好中球はAIDSとは関係ない？好中球は他の感染症に反応性に増加している？ちなみに、好酸球は寄生虫(原虫)の感染のために増える傾向にあるらしい(HIMのどこか)。

葉酸拮抗剤である。

サルファ剤と併用され、抗トキソプラズマ薬、抗ニューモシチス・カリニ薬として相乗的に働く。

ST 合剤

SMX-TMP

スルファメトキサゾール・トリメトプリム合剤 sulfamethoxazole and trimethoprim mixture

□AIDSの定義(http://en.wikipedia.org/wiki/CDC_Classification_System_for_HIV_Infection_in_Adults_and_Adolescents)