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Department of Cellular Physiology ＆ Signal Transduction Sapporo Medical University School of Medicine
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What is Ethical Organizational Culture? - Why is an organizational culture required in a healthcare environment? Can we create an ethical organizational culture?
Get PDFWhat does it mean to create an ethical organizational culture? Why is an ethical organizational culture so important?
Kitai (2014) defines organizational culture as "the values, beliefs, philosophies, ideas, and norms created and shared by organizational members. In the 1980s, "corporate culture theory" focused on the hard aspects of organizational structure. In the field of nursing, it is emphasized in Magnet Hospitals, and in the field of healthcare, it is noted as "safety culture. In the field of nursing administration, it was included in the "Management Ladder for Hospital Nurse Managers" (2019) and described as "creating an organizational culture where ethical issues can be discussed on a daily basis." In this paper, we first look at how the concept of organizational culture can be captured and how it has been examined in previous studies, and then examine what aspects of "organizational culture" are understood through three clinical cases. We will then consider how "ethical organizational culture" in medical and nursing organizations should be viewed and whether it can be created.journal articl
Marked Response to Nivolumab by a Patient With SMARCA4-Deficient Undifferentiated Urothelial Carcinoma Showing High PD-L1 Expression: A Case Report
Get PDFBackground: SMARCA4 is a component gene of the SWI/SNF (SWItch/Sucrose NonFermentable) chromatin remodeling complex;
undifferentiated tumors associated with its functional deletion have been described in several organs. However, no established
treatment for these tumors currently exists.
Case: In this study, we report a case of a SMARCA4-deficient
undifferentiated urothelial carcinoma with high PD-L1
expression
that was effectively treated with nivolumab after early relapse following treatment for non-invasive
bladder cancer. The histological
morphology of the rhabdoid-like
undifferentiated tumor of unknown primary led us to suspect a SWI/SNF-deficient
tumor,
and subsequent immunostaining led to the diagnosis of a SMARCA4-deficient
undifferentiated tumor. This effort also led to the
identification of the developmental origin of this SMARCA4-deficient
undifferentiated tumor as a non-invasive
bladder cancer.
We also carried out a detailed immune phenotypic assay on peripheral T cells. In brief, a phenotypic change of CD8+T cells from
naive to terminally differentiated effector memory cells was observed.
Conclusion: Regardless of the organ of cancer origin or cancer type, SWI/SNF-deficient
tumors should be suspected in undifferentiated
and dedifferentiated tumors, and immune checkpoint inhibitors may be considered as a promising treatment
option for this type of tumor. The pathogenesis of SMARCA4-deficient
anaplastic tumors awaits further elucidation for therapeutic
development.journal articl
Self-assessment scale for the community-based and emergency practice
Get PDF札幌医科大学博士（医学）doctoral thesi
1.Measurement of the median nerve strain within the carpal tunnel using a capacitance-type strain sensor: A cadaver study 2.Thumb pronation efficacy of Camitz tendon transfer with insertion on the ulnar capsule of the metacarpophalangeal joint: a cadaver study
Get PDF札幌医科大学博士（医学）thesi
当院においてOncotype DX® を実施した2症例のShared decision making
Get PDF医療現場において化学療法省略可否等の治療方針決定を行う場合、かつてはInformed consentが主流であったが、現在は患者と医療者が協力し意思決定を行うShared decision making（以下SDM）が拡がりつつある。2023年9月、多遺伝子アッセイの一つであるOncotype DX®が保険収載され、乳癌術後化学療法の省略を判断する上で補助となる情報が増えることとなった。
今回我々は保険収載後に当院でOncotype DX®を実施した2症例について検討し、本検査がSDMに与える影響について考察した。
Oncotype DX®を実施することにより、患者、医療者双方の意思決定において有益な情報となり得る可能性が示唆された。一方で、患者、医療者双方の意見と検査結果の乖離等、慎重な判断が求められる症例が出現する可能性も懸念された。あくまでも検査はSDMを行う際のツールの一つとして捉え、患者と医療者が対話を重ね、治療方針を決定することが重要と思われた。journal articl