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Usefulness of Health Assessment Training in a University Hospital
Get PDF本研究の自的は、卒後2・3年目看護師を対象とした「ヘルスアセスメント研修」受講者のアンケート記載内容から、研修の効果および看護師教育への示唆を得ることである。研究方法は、質的帰納的分析とし、過去5年間のアンケート記載内容を分析した。結果、記載内容は研修で最も学べたことと、研修で得られたことに大別された。学べたこととして、患者の＜全体像を把握することの大切さ＞と＜患者の立場で考える大切さ＞が全年度で抽出できた。＜退院後の生活を見据えた情報収集の必要性＞は、2017年度より抽出された。研修で得られたことについては、自己の振り返りから、＜自己の知識不足＞＜自己の課題の気づき＞等が抽出された。今後の研修において、看護の基本となる変わらないものと変化していくものを考慮して企画していく必要がある。さらに、集合研修による意見交換は、受講者のリフレクションとなり看護実践能力を高めていくことにつながるが、メンバー構成を考慮する必要性や教育・サポート体制の充実も示唆された。Using the questionnaire survey conducted on participants of the Health Assessment Training Program for nursing graduates with one-two years' experience，this study aimed to obtain information on the effectiveness of the training program and its implications on nurse education. The study used qualitative inductive analysis as a research method，and the results were organized into two categories: what the nurses learned most and what they gained from the training. The most important concepts learned throughout all five years of training were “the importance of understanding the patient's complete picture” and “the importance of thinking from the patient's perspective”. The “need to collect information with an eye on life after discharge" was extracted from FY2017.“Insufficient knowledge” and “Awareness of one's challenges" were extracted from self-reflection as an answer to the question,“What was gained from the training?" In future training，it is imperative to plan for what will remain unchanged as the basis of nursing and what will change. Furthermore，exchanging opinions in group training sessions will cause participants to reflect on and enhance their practical nursing skills. Therefore，there is a need to consider the composition of members in a group and the enhancement of the education and support system
Terminological Issues of American Nursing in Japanese Nursing : Qualitative Interview Study to Nurses
Get PDFアメリカ看護由来の用語の使用実態の解明を目指して、臨床看護師にインタビューを実施した。テキストマイニングによる分析で、[インパク卜はあるが説明につまる用語]を中心として、[現実と乖離する用語と概念][スタッフの言語化不足で患者が苦しむ][原因を掘り下げる思考がなく行き詰る]など8カテゴリーが生成された。言葉と中身、理論と実践の乖離が解決されない背景には質問できないという文化的背景の影響が示唆された。用語の理解、確認、言語化の不足が、看護師を取り巻く様々な問題の背景になっていると考えられる
エンドシアリン/CD248は骨肉腫の浸潤と転移を抑制する潜在的な治療標的となる可能性がある
Get PDFEndosialin/CD248/tumor endothelial marker 1 is classified as a C-type lectin-like transmembrane receptor, found on the plasma membrane of activated mesenchymal cells, which binds to fibronectin. Although endosialin is expressed at high levels in stem-like cells of sarcomas, its role has not been fully uncovered. The present study aimed to determine whether endosialin expression is associated with tumor progression and metastasis, and whether endosialin has the potential to act as a novel therapeutic target in osteosarcoma (OS) using MORAb-004/ontuxizumab, a humanized monoclonal antibody, which targets the type C lectin domain of endosialin. The results demonstrated that endosialin was highly expressed in OSs with metastatic disease. Furthermore, MORAb-004 had no cytostatic effect on OS cells in vitro and did not change the expression of stem cells and differentiation markers; however, it inhibited migration of OS cells. Taken together, these results suggest that endosialin may play a role in migration, and may be involved in the metastatic process of OSs. Furthermore, MORAb-004 reduces the motility of OS cells, and suppresses invasion and the development of metastatic lesions.博士（医学）・甲第829号・令和4年3月15日Copyright: © Kondo et al. This is an open access article distributed under the terms of Creative Commons Attribution License(https://creativecommons.org/licenses/by-nc-nd/4.0/)
日本における保険診療全透析患者追跡と死亡数の現状
Get PDFBackground: The survival rate of chronic dialysis patients in Japan remains the highest worldwide, so there is value in presenting Japan's situation internationally. We examined whether aggregate figures on dialysis patients in the National Database of Health Insurance Claims and Special Health Checkups of Japan (NDB), which contains data on insured procedures of approximately 100 million Japanese residents, complement corresponding figures in the Japanese Society for Dialysis Therapy Renal Data Registry (JRDR). Methods: Subjects were patients with medical fee points for dialysis recorded in the NDB during 2014-2018. We analyzed annual numbers of dialysis cases, newly initiated dialysis cases- and deaths. Results: Compared with the JRDR, the NDB had about 6-7% fewer dialysis cases but a similar number of newly initiated dialysis cases. In the NDB, the number of deaths was about 6-10% lower, and the number of hemodialysis cases was lower, while that of peritoneal dialysis cases was higher. The cumulative survival rate at dialysis initiation was approximately 6 percentage points lower in the NDB than in the JRDR, indicating that some patients die at dialysis initiation. Cumulative survival rate by age group was roughly the same between the NDB and JRDR in both sexes. Conclusion: The use of the NDB enabled us to aggregate data of dialysis patients. With the definition of dialysis patients used in this study, analyses of concomitant medications, comorbidities, surgeries, and therapies will become possible, which will be useful in many future studies.博士（医学）・甲第818号・令和4年3月15日© 2021. The Author(s). Open Access This article is licensed under a Creative Commons Attri bution 4.0 International License, which permits use, sharing, adapta tion, distribution and reproduction in any medium or format, as long
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Efficacy Of A Combination Of Transarterial Chemoembolization And Radiation Therapty For Patients With Hepatochellular Carcinoma Ineligible For Resection Or Radiofrequency Ablation.
Get PDFPurpose: The local control rate of trans-arterial chemoembolization (TACE) for the patients with hepatocellular carcinoma (HCC) was unsatisfactory compared to resection or radiofrequency ablation (RFA). To increase the local control rate for tumors, we performed radiation therapy followed by TACE in our institution. The purpose of this study was to evaluate the efficacy and toxicity of the TACE and radiotherapy combination in HCC patients ineligible for resection or RFA.
Material and Methods: Between January 2017 and April 2020, 33 patients with HCC ineligible for resection or RFA were treated with a combination of TACE and radiation therapy. Eight patients were initial cases, and 25 were recurrent or residual cases. A total dose of 40-60 Gy in 5-20 fractions was delivered to the 50-90% isodose line.
Results: The median follow-up period was 16 months (range, 6-47 months); the objective response rate was 66.7%; and the 1- and 2-year overall survival rates, 72.7% and 62.5%, respectively. The objective response rate for HCCs <5 em was 79.2%; the 1- and 2-year overall survival rates, 91.7% and 62.5%, respectively; median progression-free survival, 13.5 months (range, 3-47 months), and the 1- and 2-year local progression-free survival rates, 95.8% and 85.7%, respectively. There was one case each of grade 2 radiation esophagitis and ascites after three months of irradiation.
Conclusion: The combination of TACE and radiation therapy shows good local control and acceptable toxicity, particularly in HCCs <5 cm and may be a good treatment option
Biological Dose Evaluation Of Radiotherapy By Equivalent Dose In 2Gy Fractions (EQD2) In Recurrent Glioblastoma.
Get PDFThe standard treatment for glioblastoma is surgery followed by radiation therapy (RT) and temozolomide (TMZ) chemotherapy. A total dose of 60 Gy given in 2 Gy fractions (fr) with concurrent and adjuvant TMZ has been recommended; however, local recurrences are frequent and the prognosis remains very poor. In this study, the equivalent dose in 2Gy fr (EQD2) at the recurrent site of glioblastoma was assessed to evaluate the biological effect of RT on glioblastoma considering that α/β ratios might vary from 1 to 10 Gy.
Recurrences were found in gross tumor volume (GTV) areas in all 11 patients, and 8 of them also showed recurrence in clinical target volume (CTV). Differences in EQD2 according to α/β ratios were relatively small in high-dose areas around 60 Gy; however, low-dose areas often showed significant differences of EQD2 according to the α/β ratios. In patients that received 60 Gy in 2 Gy fr, EQD2 was less than the original physical dose and became smaller as the α/β ratio became smaller. The comparison of the dose distribution of EQD2 and dose volume histogram (DVH) of EQD2 between α/β ratios 1 and 10 suggested that little difference was found in relatively high-dose areas but a significant difference was found in low-dose areas. In contrast, if the fraction size was larger than 2 Gy, EQD2 was greater than the original physical dose and it became larger as the α/β ratio became smaller. In conclusion, this study showed that the standard RT 60 Gy in 2 Gy fr is insufficient for glioblastoma, and it suggested that biological effects might differ significantly according to each fraction size of radiation and α/β ratio of the linear quadratic (LQ) model