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“Haberi” in “Ochikubo Monogatari ” (3) ― Examples of Not Showing Respect to the Listener ―
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Simulation Learning for Lower-year Students to Develop Clinical Judgment Competency
Get PDF2022 年度入学生から適用となった同志社女子大学看護学部の新カリキュラムは，看護実践能力を育成するこれまでのカリキュラムを発展させ，臨床判断能力の育成を主軸とするものとなっている。新カリキュラムでは，タナーの臨床判断の概念を用いて，学生の卒業までの各学年を段階的に評価していく。本稿は，2 年次生の最初の時期に実施された6 回のシミュレーション・ベースの授業を報告する。シミュレーション学習の課題は，入院治療によって臥床状態となっている高齢女性の事例において，生活空間の安全についての判断が含まれる看護実践である。授業は，INACSL のベストプラクティススタンダードの基準からみて，一定の質が保たれていることが確認された。学生の自己評価からは，模擬的な看護の学習体験を通して臨床判断の理解が得られたことが確認され，低年次生において臨床の思考を体験する意義が考察された。departmental bulletin pape
ゲンジモノガタリ マキバシラノマキ キタノカタ ノ ジンブツゾウ ト リベツ ノ ロンリ ネタゲニ ココロヤマシ ト ヒョウシタ シュタイ オ タンショ トシテ
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Pharmacokinetics of itraconazole oral solutions in patients undergoing hematopoietic stem cell transplantation or cancer chemotherapy for hematological diseases
No full textPurpose: The pharmacokinetics of itraconazole (ITCZ) administered as an oral solution (ITCZOS) to adult patients with hematologic diseases were compared according to treatment type.
Methods: Twenty-four patients who had undergone autologous (Auto) or allogeneic (Allo) hematopoietic stem cell transplantation or cancer chemotherapy (Chemo) participated in this study. These 24 patients received 20 mL of ITCZ-OS once daily for consecutive days. Blood concentrations of ITCZ and its active metabolite hydroxyitraconazole (OH-ITCZ) were determined at 2, 5, and 20 h after the first dose and immediately before dosing (trough, Cmin) on Day 8. Cmin was compared between the Auto, Allo, and Chemo groups.
Results: The mean ± standard deviation of ITCZ blood concentrations at 2 and 5 hours after the first dose were 216 ± 276 ng/mL and 237 ± 276 ng/mL, respectively. Cmin on Day 8 was 346 ± 292 ng/mL. Cmin was not significantly different among the three treatment groups; however, the values in the Auto and Allo groups were lower than those in the Chemo group. The coefficient of variation ranged from 38 to 107%, with a maximum in the Allo group.
Conclusions: ITCZ blood concentrations 2 and 5 h after the first dose tended to be lower than the maximum blood concentration (Cmax) in healthy adult volunteers after a single dose, and the Cmin on Day 8 was also lower than that in previously reported healthy adult volunteers. The time to Cmax of ITCZ reported in healthy adult volunteers is 2.2 hours, however, the ITCZ concentration at 5 h was higher than that at 2 h in the subjects of this study. These results suggest that patients with hematologic diseases have a lower absorption rate and delayed absorption compared with healthy adults. In contrast, although there were no significant differences in the blood concentrations according to the type of treatment, there were large fluctuations, particularly in patients undergoing Allo. These results suggest the need for therapeutic drug monitoring to ensure the efficacy of ITCZ-OS, particularly in patients undergoing Allo.【目的】成人血液疾患患者におけるイトラコナゾール（ITCZ）の内用液剤（ITCZ-OS）の体内動態を治療の種類別に比較検討した。
【方法】ITCZ-OS が１日１回20 mL で投与された成人患者24例を対象とした。ITCZ および活性代謝物の水酸化イトラコナゾール（OH-ITCZ）の血中濃度測定が初回服用２時間後、５時間後、20時間後および服用８日目の投与直前（Cmin）で行われた。自家造血幹細胞移植（Auto）群、同種造血幹細胞移植（Allo）群および化学療法（Chemo）群でCmin を比較した。
【結果】全24例の初回服用２時間後と５時間後のITCZ 血中濃度の平均値±標準偏差は、それぞれ216±276 ng/mL および237±276 ng/mL、服用８日目のCmin は346±292 ng/mL であった。Cmin は各治療群間で有意差はなかったが、Chemo 群に比べAuto およびAllo 群では低い傾向を示した。変動係数は38～107％で、Allo 群で最大であった。
【考察】初回服用２時間後と５時間後のITCZ 血中濃度は、健康成人に単回投与時の最高血中濃度に比べ低値を示し、服用開始８日目のCmin も健康成人より低値であった。健康成人における最高血中濃度到達時間は2.2時間であると報告されているが、本研究において服用５時間後のITCZ 血中濃度は２時間後のそれより高値であった。これらのことから、血液疾患患者では健康成人に比べ吸収率の低下と吸収の遅延が生じていると考えられた。一方、治療の種類別の血中濃度に有意な差は認められなかったが変動が大きく、特にAllo 施行例では変動幅が大きかった。これらより、ITCZ-OS の有効性を確保するため、特にAllo 施行例で血中濃度モニタリングに基づく投与設計を行う必要性が示唆された。departmental bulletin pape
A review of perspectives required by experts in consultation through discussion
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A Reconsideration of “Up in Michigan”:A Story beyond a Heroine’s Love
No full textPrevious studies of Ernest Hemingway’s “Up in Michigan” have focused mainly on the issues of love and sex between the characters, Liz and Jim. In the story in which the heroine, Liz is infatuated with Jim, the two are given typical feminine and masculine images. Critics have naturally interpreted the story within the contrasting framework of man and woman. However, they have been apt to overlook another aspect of the story involving an individual’s recognition of reality which transcends the idea of a woman’s love for a man. In this paper, I would like to discuss the reciprocal relationship between two layers of the story development: the one concerning Liz’s longing for Jim, and the other concerning the problem in recognizing reality described through Liz’s way of perception. Due to the organic interweaving of these two layers, Jim as the object of Liz’s romantic feelings comes to represent the reality which she is forced to face. The frame of the sexes is maintained throughout the story, but when there is a noticeable simplification of this framework, it becomes clear that it has been used as an elaborate device to link the heroine’s infatuation with the issue of reality perception. By examining one of the earliest short stories of Hemingway from a creative point of view, we can prove that it is an ambitious piece contrived in a much more meticulous way than has been considered.departmental bulletin pape