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1 Parkinsonapomorphine ****, *** ****, ***** apomorphine Parkinson Parkinson apomorphine 7 apomorphine Key Words : apomorphine sulfate, Parkinsons disease, selfinjection apomorphine20 1 Parkinson LDOPA Parkin son apo morphine apomorphine 1. Parkinsonapomorphine SD Yahr On donepezil LDOPA mg/ 45745mg/ apomorphineldopa mg/ 3 apomorphine Apomorphine 5 2 Vol. 32No

apomorphine 1mg/ 1 apomorphine 2. apomorphine1 16 11.4 6.1 Apomorphine Fig. 1 apomor phinefig. 2 apomorphinefig. 3 5 3 30 1. a. 5 71 3 42 3 42Fig. 4A 1 b. 4 57 2 29Fig. 4A 2. a. Parkinson Visual analog scale 01010 6.

2 apomorphine 1mg/ 1 apomorphine 2. apomorphine Apomorphine Fig. 1 apomor phinefig. 2 apomorphinefig a Fig. 4A 1 b Fig. 4A 2. a. Parkinson Visual analog scale Fig. 1 An injector for apomorphine It has a digital window to guide the injection. The injection proce dure has 5 steps, with 47 processes per step. Patients have to fol low a total of 28 processes for the first injection of a new cartridge and 17 procedures thereafter until the cartridge has an insuffi cient amount for the next injection Fig. 4B b. Parkinson Fig. 4B c. Apomorphine 2 6mg/ mg/ 2 5/3.11.0/ Fig. 4B d Fig. 4C Fig. 4C Vol. 32No

Fig. 2 An apomorphine selfassessment diary Patients were asked to describe their mobility, the development of dyskinesia, and sleep, indicating the time in the upper panel of this time tablelike

3 Fig. 2 An apomorphine selfassessment diary Patients were asked to describe their mobility, the development of dyskinesia, and sleep, indicating the time in the upper panel of this time tablelike diary. They were also required to describe the time of levodopa intake, the effectiveness of apomorphine, and side effects such as sleepiness, faintness/dizziness/unsteadiness, and nausea. e. Apomorphine Parkinson apomorphine Parkinson Vol. 32No

4 Fig. 3 A coaching questionnaire for selfinjection of apomorphine The questionnaire consists of two parts, a selfassessment questionnaire and a checklist of the injection. The former asked patients or their guardians about 1. The disease, 2. Support, 3. Injection, 4. Side effects, and 5. Administration. The latter is used for a nurse to check 1. The preparation and 2. The procedures of the apomorphine injection. Vol. 32No

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6 Fig. 4 Results of questionnaire and observations in the nurseled clinic for selfinjection of apomorphine A. The preparation and injection of apomorphine. The graph shows the numbers of patients who did not wipe the top of the cartridge or the cap WC, who did not collect air in the cartridge to eject it CA, who did not follow procedures after CA just before the injection BI, who made any errors during the preparation TP, who did not recap the used needle with advice from a nurse RC, or who did not recap the needle with or without advice TI. B. Results of questionnaire. The graph shows the numbers of patients who had freezing of gait FG, gait difficulty GD, difficulty in ris ing DR, and falls. Dr indicates that doctors or nurses were fully consulted, and Fa indicates that family members, friends, or care coordi nators were fully consulted. Injection was done by only the patient Pt, by only the caregivers in the family Ca, or by both PtCa. C. Side effects. Patients often had skin induration Ind, eruptioneru, itchiness Itc, or either ones TS. Other side effects included sleepiness Sle, dizziness Diz, and unsteadiness US. 2 Parkinson Parkinson apomorphine 29 5 Apomorphine 32 Vol. 32No

7 Apomorphine LDOPA Donepezil COI 1 Corzias GC, Papavasiliou PS, Fehling C et al : Similarities be tween neurologic effects of Ldopa and of apomorphine. N Engl J Med 282 : 3133, Prog Med 34 : , Tomlinson CL, Stowe R, Patel S et al : Systematic review of levodopa dose equivalency reporting in Parkinsons Disease. Mov Disord 25 : , : 6769, : 2938, 2009 Clinical Relevance of a Nurseled Clinic for Selfinjection of Apomorphine in Outpatients with Parkinsons Disease Kuniko TACHIBANA*, Ryoko YAMAMOTO*, Shuichi UENO**, *** Hikaru SAKAMOTO**Makito HIRANO**, ***, Yusaku NAKAMURA** *Department of Nursing, Sakai Hospital Kinki University Faculty of Medicine **Department of Neurology, Sakai Hospital Kinki University Faculty of Medicine ***Department of Neurology, Kinki University Faculty of Medicine Selfinjection of the dopamine agonist apomorphine is used to treat patients who have Parkinsons disease with wearingoff phenomenon. However, the use of this treat ment is occasionally problematic; for example, patients dur ing offperiods often cannot independently perform selfin jection. To solve such problems, we opened a nurseled clinic in which a new coaching questionnaire was adminis tered by outpatient clinic nurses to check patients under standing of disease, to observe side effects of treatment, and to assess injection techniques. Seven patients who were ad mitted to our hospital and successfully instructed to use apomorphine were studied. Five patients had skin side ef fects, although all seven patients reported that the injection sites were appropriately changed every day. To solve this problem, the nurses reeducated the patients and their guardians about the correct procedures for injection and ro tation of injection sites and provided instructions on meth ods to reduce the extent and frequency of skin side effects, which led to the alleviation of side effects. Our nurseled clinic thus facilitated the early detection of various causes of side effects and reeducated patients about the correct use of apomorphine. Vol. 32No

The Journal of the Japan Academy of Nursing Administration and Policies Vol 7, No 2, pp 19 _ 30, 2004 Survey on Counseling Services Performed by Nursi

The Journal of the Japan Academy of Nursing Administration and Policies Vol 7, No 2, pp 19 _ 30, 2004 Survey on Counseling Services Performed by Nursing Professionals for Diabetic Outpatients Not Using