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Small Incision Kidney Transplantation with Living Related Donors
Get PDFINTRODUCTION: Due to improvements in technique and the use of mechanical devices, small incision kidney transplantation (SI-KT) with living related donors was developed in our institution to reduce post-operative pain and improve cosmesis. In this study, we describe this approach specifically in regard to Japanese patients, and compare it with ordinary incision kidney transplantation (OI-KT).
PATIENTS AND METHODS: We performed SI-KT on 13 patients between August 2012 and March 2020. A 6 to 9 cm Gibson’s incision was made to approach the iliac fossa where the graft was placed. An historical OI-KT group was selected to match the SI-KT group in regard to age, gender, BMI, donor and recipient characteristics. Factors affecting the operation and management of the patient were compared between the SI-KT and OI-KT groups.
RESULTS: The average skin incision was 7.6cm and 13.2cm in the SI-KT and OI-KT groups, respectively. The operating time, estimated blood loss, graft weight, and recipient body mass index (BMI) were comparable in both groups. The average length of both veins and arteries in the SI-KT group were significantly longer. There were no statistical differences in the use of analgesics. No functional differences or complications were observed in the two groups.
CONCLUSIONS: Although the length of the skin incision depends in part on recipient BMI and the size of the graft kidney, SI-KT from living donor can be performed successfully. In this study, there were no differences comparing OI-KT and SI-KT, but the amount of analgesics used tended to be less, and the satisfaction of the recipients tended to be higher in the SI-KT group.departmental bulletin pape
慢性冠動脈疾患患者における経皮的冠動脈インターベンション実施時の使用薬剤数と有害事象の関係：CLIDASデータベースによる虚血性心疾患ガイドライン推奨薬とそれ以外に分けた際のイベント発生比較
Get PDF自治医科大学博士（医学）令和7年度doctoral thesi
Sudden Death During Bathing: Autopsy Reveals Cerebral Arteriovenous Malformation
Get PDFArteriovenous malformations (AVMs) in the brain can induce seizures, potentially leading to fatal accidents. Here, we present an autopsy case of sudden death related to bathing, wherein a cerebral AVM may have been the precipitating factor. A man in his seventies, with no significant medical history, was discovered deceased in a bathtub. Notably, he had a history of methamphetamine use and admitted to consuming the drug 2 days before his demise. Initially, authorities suspected methamphetamine involvement in his death, prompting a forensic autopsy. Post-mortem examination revealed indications of drowning along with an AVM located on the basal surface of the left frontal lobe. Histopathological analysis revealed gliosis in the surrounding brain parenchyma, indicative of tissue ischemia resulting from vascular stealing. Additionally, hemorrhaging was observed around the right dorsal metacarpal vein, identified as the drug injection site. However, toxicological analysis and histopathological findings suggested methamphetamine was unlikely to have contributed to his death. The cause of death was determined to be drowning, with the cerebral AVM potentially precipitating seizures preceding the event. Despite frequent occurrences of bath-related deaths in Japan, autopsies in such cases are uncommon. This case underscores the significance of conducting autopsies in bath-related fatalities to uncover underlying pathologies.departmental bulletin pape
Teaching Activities to Develop Students' Abilities to Use Information with Tablet Devices in the Practical Training of Nurses
Get PDF〔目的〕臨地実習時間内におけるタブレット端末を用いた情報活用力を育む教授活動を明らかにする。
〔方法〕2021年度成人看護学臨地実習において，実習病棟で使用したタブレット端末の検索履歴，実習教育企画に関する学習支援者の評価，学習支援者が任意で記載した情報活用力を育む学習環境の記録を研究対象とし，それぞれ記述統計，質的記述的に分析した。
〔結果〕臨地実習時間内においてタブレット端末を用いた情報探索は，主に実習開始1日目から4日目に行われ，学習支援者は『自ら学生に接近して対話をしながら学生の関心事を探る』，『既習事項を発問しながら知識の想起と活用媒体の使い分けを示す』，『受け持ち患者の理解を促しアセスメントに活かす筋道を示す』，『得た知識を受け持ち患者への実践にどう応用できるか共に考える』，『どう行動するかベッドサイドに行く前に学生のイメージ化をはかる』という教授活動を展開していた。
〔考察〕学習支援者は，形式知を臨地実習の場で活用していくやり方を実際に学生に示す機会としてタブレット端末を活用していたことが示唆された。departmental bulletin pape
Career-specific support needs for municipal public health nurses in child abuse prevention
Get PDF目的：市区町村保健師のキャリア別の活動支援ニーズを明らかにし，子ども虐待予防における市区町村保健師への活動支援を検討することである。
方法：首都圏の市区町村保健師229名の回答を得た。子ども虐待予防における活動支援ニーズの記載があった193名の回答を，活動支援ニーズについて内容分析を行い，サブカテゴリ，カテゴリを生成した。それを保健師経験等のキャリア別にロジスティック回帰分析を実施した。
結果：保健師の活動支援ニーズは，【サポート的な職場環境】等の５つのカテゴリが生成された。新任期は【スキルアップの機会の確保】中堅期やベテラン期保健師は【職場を越えた支援体制】が高く，特にベテランは専門家との相談体制が高かった。
考察：保健師の子ども虐待予防における活動を支えるためには，キャリアに応じた，実践的，教育的，体系的な事例検討等の人材育成や，個人負担を軽減させる職場内外のサポート体制の構築が重要である。departmental bulletin pape
Difficulties and Ideas of Neonatal Intensive Care Unit Nurses for the Practice of Family-centered Care Under Restricted Visiting During COVID-19 Countermeasures
Get PDF目的：新型コロナウイルス感染症対策による面会制限下で新生児集中治療室（以下NICU）看護師がファミリー・センタード・ケア（以下FCC）を実践する上での困難と工夫を明らかにする。
方法：研究デザインは質的記述的研究である。フォーカス・グループ・インタビューで，データ収集を行い，安梅のグループインタビュー法を参考に分析を行った。研究対象者は,NICU4年以上かつNICUと新生児回復室両方の勤務経験があり，新生児集中ケア認定看護師によるFCCの勉強会に参加した看護師であった。グループ数は６グループ，1グループの人数3名から5名（総人数25名）であった。
結果：面会制限がFCCの実践を困難にしたこととして，重要カテゴリー5つが抽出された。面会制限下で工夫して行ったFCCとして【限られた時間の中で家族を尊重した関わり】などの6つの重要カテゴリーが抽出された。
考察：NICU看護師は，面会制限によりFCCの実践に多くの困難を感じていたが，機会を逃さず高いコミュニケーション能力やチーム力を発揮し，限られた時間の中で工夫してFCCを実践していた。departmental bulletin pape
Effects of antithrombotic therapy on the diagnosis and longterm postoperative outcomes of patients with colorectal cancer
Get PDFPurpose: This study aimed to examine the effects of antithrombotic therapy (ATT) on the early detection and long-term postoperative outcomes of colorectal cancer (CRC).
Methods: This retrospective cohort study included 311 patients who underwent surgery for CRC between January 2004 and December 2017 at our institution. Cancer staging, overall survival (OS), and disease-specific survival (DSS) at the final postoperative diagnosis of patients with and without preoperative ATT (ATT group [n = 66] and control group [n = 245], respectively) were analyzed. Patients were followed up 3 years after their last registration.
Result: The ATT group had a higher mean age than the control group (77.8 ± 8.3 vs. 72.8 ± 11.5 years). Disease stage distribution showed no difference. The ATT group had a significantly higher frequency of CRC diagnosed by bleeding-related events (P = 0.034) and tended to have a right-sided colon primary, pTis/pT1, and smaller tumor size. Additionally, postoperative OS did not differ between the groups (P = 0.81), but the ATT group tended to have better DSS (P = 0.12).
Conclusion: Although gastrointestinal tract bleeding in patients undergoing ATT may contribute to the drug’s adverse events, it facilitated the early detection of CRC. ATT may lead to early CRC detection and improved long-term postoperative outcomes.departmental bulletin pape