Kagawa Prefectural University of Health Sciences Research Result Repository
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Temporal Changes in Estradiol and Follicular Stimulating Hormone due to Oral Tamoxifen in Premenopausal Patients with Breast Cancer: Examination of 20 Cases over Approximately 2 Years
Get PDFapplication/pdfTAMによる卵巣過剰刺激作用はかねてより問題となっているが，性腺系への作用，経時的変化の実態は明らかになっていない．初発の乳がん患者において術前から術後TAM内服22か月までのホルモン値を測定し，高エストロゲン血症の発症頻度を含む経時的変化を明らかにした．乳腺外科クリニックにて，同意の得られた閉経前ホルモン感受性陽性乳がん患者に対し，術前から術後（4,10,16,22か月）の定期フォロー時エストラジオール（E2），性腺刺激ホルモン（LH，FSH）を測定した．20例の平均年齢は44.9±2.81(40-50)歳であった．術前の月経は19例で順調であり，LH高値のPCOを疑わせる月経不順の1例のみ術前高E2（>400pg/ml）を示した．術後の総測定回数は78回で，そのうち18回（12例）で高E2がみられた．３か月間無月経でも異常高値をみるものが２例あった．今回の検討症例は40代の症例がほとんどであったにもかかわらず，高エストロゲン血症の発生頻度が今まで報告されてきたより多く，患者の年齢により高エストロゲン血症の発症頻度がかわることはなかった．年齢は少なくとも独立した因子ではなく，卵巣の予備能や環境因子の影響が大きいと考える．予想以上に多くの症例でE2は高値を示すことがわかったが，持続して高値を示すことは多くないこともわかった．内膜への影響の報告もあり，TAM治療の際には乳腺外科と婦人科の連携が必須である．
Adjuvant hormone therapy for hormone-sensitive breast cancer has established the efficacy of tamoxifen (TAM). TAM is widely used in premenopausal patients. In the present study, hormone levels were measured beginning preoperatively to 22 months after oral administration of TAM in patients with first-episode breast cancer. Changes over time, including the frequency of hyperestrogenism, were evaluated. With patient consent, estradiol (E2) and gonadotropin (luteinizing hormone [LH], follicle-stimulating hormone [FSH]) levels were measured at regular follow-up at 4, 10, 16, and 22 months in premenopausal, hormone-sensitive, positive breast cancer patients treated at a Breast Surgery Clinic. The mean age of 20 patients was 44.9 ± 2.81 (40-50) years. Preoperative menstruation was regular in 19 patients. Only one patient with high LH and suspected polycystic ovary syndrome had high preoperative E2 (>400 pg/mL). The total number of postoperative measurements was 72. Of these, 18 (12 cases) showed high E2. There were two cases in which abnormally high values were observed even after amenorrhea for 3 months. Most of the patients in this study were in their 40s. However, the frequency of hyperestrogenism was higher than previously reported, and the frequency of hyperestrogenism did not change with patient age. Age was at least not an independent factor. However, ovarian reserve and environmental factors are believed to have significant impacts. E2 was high in more cases than expected, but was not often persistently high. Effects on the endometrium have been reported, and breast surgery and gynecological cooperation are essential for TAM treatment
Analysis of Medical Accidents by Midwives
Get PDFapplication/pdf公益財団法人日本医療機能評価機構の医療事故情報収集等事業では医療機関から医療事故情報を収集し，毎年公表している．本研究は，この医療事故情報を用いて助産師における医療事故情報のデータを分析し，事故の影響，助産師経験年数による医療事故内容を比較検討することを目的とした．分析対象は，医療事故情報の報告年2010 ～ 2021 年，第1 当事者の職種は助産師とした．事故の発生状況等を収集し，事故の要因の根本原因分析を行った．第1 当事者が助産師による11 年間の医療事故は98 件，事故の概要は療養上の世話，発生場所は病室，発生時間は16 時以降18 時までの発生が多かった．事故後の医療は7 割に実施され，そのうち8 割は軽微から濃厚な治療を受けていた．医療事故の当事者は経験年数が平均10 年，3 ～ 15 年未満が5 割を占めた．医療事故の発生要因は，当事者に関わる要因が9 割を占め，そのなかで「確認を怠った」，「観察を怠った」要因が多かった．医療事故の影響と発生要因の比較では「連携ができていなかった」は事故の影響が有意に認められ，助産師の経験年数と発生要因の比較では3 ～ 15 年未満の助産師は「連携ができていなかった」が有意に多かった．助産師は経験年数に関わらず，医療を提供する時には，2 人以上で確認や観察を丁寧に行い，緊急時における早急な対応ができるような多職種との連携を強化することが医療安全につながる．The Japan Council for Quality Health Care collects information on medical accidents from medical institutions to publish annually. This study aimed to analyze the data on medical accidents among midwives using information provided by the Council for Quality Health Care and to compare the impact of accidents and their content according to the years of midwifery experience. Medical accidents that occurred between 2010 to 2021, where the first party was a midwife, were included in the analysis for this study. Circumstances of the accidents were collected and a root cause analysis of the factors contributing to the accidents was conducted. There were 98 medical accidents in which the first party was a midwife. Most accidents were under nursing care, and occurred in hospital rooms between 16:00 and 18:00. Post-accident medical care was provided to 70% of the patients. Of these, 80% received minor to intensive treatment. Midwives had an average of 10 years of experience, and 50% had less than 3–15 years of experience. Factors related to the parties involved accounted for 90% of the medical accidents. Among these, “failure to check” and “failure to observe” were the most common factors. A comparison of the degree of the accident and the factors that caused it showed that “there was no coordination,” which had a significant impact on the accident.
In a comparison of midwives' years of experience and the factors that caused, midwives with less than 3–15 years of experience were significantly more likely to say that “there was no coordination.” Regardless of their years of experience, midwives should carefully check and observe of mother and baby with two or more people and strengthen cooperation with multiple professions when providing medical care to respond promptly in an emergency and ensure medical safety
"Evaluation of the effectiveness of metacognitive training in community-dwelling people with schizophrenia – Toward application to psychoeducation –"
Get PDFapplication/pdf"本研究の目的は，地域で生活している統合失調症患者を対象として，メタ認知トレーニング（以下MCT）の効果を検討し，心理教育のツールとしての活用を考察することである．
デイケアに通所中の19 名（男性：13 名，女性6 名）を対象者として，MCT を8 回実施（1 ／ w）した．MCT 実施の前後で，4 種類の質問紙の回答を統計的に比較した．また，対象者のMCT に対する満足度を調査する質問紙への回答を依頼した．
統合失調症に特徴的な認知の偏りを測定する質問紙のデータを比較すると，MCT 介入後に数値が低下し，有意差と中程度の効果量が認められた（p ＝ 0.03，ｄ＝ 0.55）．その他の3 種類の尺度では有意差は認められなかった．
これらの結果から，MCT を用いた介入は，統合失調症に特徴的な認知の偏りを改善するために有効であることが示唆された．さらに，満足度調査の結果から，MCT の実施に対して対象者は概ね満足していることが明らかとなった．
これらのことから，MCT は統合失調症者が楽しみながらグループで心理教育を実施することが可能なツールであると推察された.""This study aimed to evaluate the effectiveness of metacognitive training (MCT) in communitydwelling people with schizophrenia and discuss the results in the context of MCT as a psychoeducational tool.A total of 19 community-dwelling daycare users with schizophrenia (13 men and 6 women) attended 8 MCT sessions (1/w). Participants' responses to 4 different questionnaires before and after MCT were statistically compared. The participants were also asked to complete a questionnaire survey about their satisfaction with MCT.
The comparison of questionnaire scores measuring cognitive biases characteristic of schizophrenia before and after MCT showed a significant score decrease and a medium effect size after MCT (p = 0.03, d = 0.55). For the ozther three questionnaires, no significant differences in scores before and after MCT were observed.
These results suggest that the MCT intervention is effective in improving cognitive biases associated with schizophrenia. Furthermore, the results of the satisfaction survey revealed that the participants were generally satisfied with MCT.
These findings suggest that MCT could be used as an enjoyable group psychoeducational tool for people with schizophreni
