カンジャ キョウイク シドウ ギジュツ オ ガクシュウ スル タメ ニ ドウニュウ シタ ガクセイカン ノ role-playホウ ニ ヨル コウカ ノ イチコウサツ : 2ガタ トウニョウビョウ ノ セイジン ジレイ ノ インスリン チュウシャ ショクジ シドウ オ トオシテ

本研究は、糖尿病患者の事例を用いて、role-play法による教育指導演習後の学びを調査し、学習効果を考察することを目的とした。対象はT短期大学看護学科3年生72名とした。その結果、演習後の学生の学びは、「対象者が理解できる説明」、「行動変容に向けた教育指導の展開」、「看護師自身の準備と態度」、「対象理解の重要性」の4つのカテゴリーに分類され、「支援」、「具体性」、「準備」、「態度」の要因から構成されていた。学生間のrole-play法を用いた患者教育演習での学習効果は、対象者の理解状況を把握しようとする態度で行動変容に向けて支援する具体策を用いて指導していくこと、患者教育指導内容を準備して指導することであった。This study utilizes the case study of diabetic patients to examine learning from the demonstration of educational instruction through the role-play method and to evaluate its pedagogical effects. The subjects of this study are 72 sophomore nursing students at T junior college. As a result of research, post-demonstration learning among the students was broken into four categories of "explanation comprehensible to the learning subject", "development of teaching instruction directed toward behavioral change", "preparedness and attitude of nurses themselves", and "importance of understanding the learning subject", and it was structured from factors of support, concreteness, preparedness, and attitude. The learning effects for students who used the role-play method during demonstration of patients\u27 education was to guide the learning subjects with an attitude that assess their patients\u27 understanding level and to do this with concrete strategies that supported behavioral change while preparing and guiding the content of patients\u27 education

健常高齢者におけるプレフレイルに陥る要因の検討

【はじめに】　日本の高齢化率は、世界に例をみない速度で進行しており、2019年には28.4％に達し、2060年には38.4％に達すると見込まれている。人生100年時代における新たな健康観の創生が求められ、健康づくりの在り方も大きな変容を遂げつつあり、保健医療施策においては、健康寿命の延伸の重要性が高まっている。フレイルとは高齢期において生理的予備機能が低下することでストレスに対する脆弱性が亢進して不健康を引き起こしやすい状態と定義される。可逆性を有することから、フレイルの兆候を早期に見出し、適切な介入を図ることが、要介護高齢者の増加の抑制につながるとされている。危険因子として、身体活動、身体・心理的要因、栄養、環境要因などの様々な要因が指摘されるが、多角的に検討した研究は少なく、一定のコンセンサスは得られていない。そこで本研究においてフレイルの前段階とされるプレフレイルに着目し、プレフレイルに陥る要因について多角的に検討した。【方法】　対象は、健常高齢者の長期縦断疫学研究 （Nagoya Longitudinal Study for Healthy Elderly; NLSHE）に参加した地域在住高齢者である。2014年の調査に参加した対象者712名のうち、調査項目に欠損があるものを除き、フレイルの基準によってロバストであり、4 年後にも同様の調査に参加した148名を対象とした。ロバストを維持したものをロバスト群、プレフレイルに移行したものをプレフレイル群の2 群に分け、縦断的に解析した。フレイルの評価には、Japanese version of theCardiovascular Health Study を用い、体重減少、筋力低下、疲労感、歩行速度低下、身体活動量低下の5 項目のうちひとつも該当しないものをロバスト群、1 ～ 2 つ該当するものをプレフレイル群とし、3 つ以上に該当したものは除外した。【結果】　本研究において4 年後にプレフレイル状態に移行した者は32名（21.9％）であり、男女別にみると、男性13名（20.0％）、女性19名（23.5％）であった。プレフレイル群で男女とも、通常歩行速度がプレフレイル群で有意に低値を示し、運動習慣が有意に少なかった。また男性では、Geriatric depressionscale-15の得点が有意に高く、家族および友人等からの孤立状態であるものが有意に多かった。さらに、男性はMini Nutritional Assessment が有意に低値であり、たんぱく質の摂取量が有意に低値であった。【結語】　フレイル評価の5 項目に加え、身体活動量、精神状態、社会的孤立にも多角的に着目することでフレイルへの予防や改善につながると考えられる。[Background & Aims]Japan’s aging rate is expected to be 28.4% in 2019 and 38.4% in 2060. The creation of a new view of health in the era of 100 years of life is required, and the way of health promotion is undergoing major changes, and the importance of extending healthy life expectancy is increasing in health care measures. Frailty syndrome is a decrease in physiological reserve function in old age, which increases vulnerability to stress and tends to cause unhealth. Since it is reversible, it is said that finding signs of frailty at an older stage and taking appropriate intervention will lead to the suppression of the increase in the number of orderly people requiring nursing care. Various factors such as physical activity, somatic / psychological factors, nutrition, and environmental factors have been pointed out as risk factors, but there are few studies that have examined them from various angles, and a certain consensus has not been obtained. Therefore, in this study, we focus on pre frailty, which is the pre-stage of flail, and examine the factors that cause prefrailty from various angles.[Methods]The subjects were community-dwelling elderly who participated in the Nagoya Longitudinal Study for Healthy Elderly (NLS-HE). 712 subjects who participated in the 2014 survey, excluding those with missing items, were robust by the frailty criteria and participated in the same survey 4 years later. Of the 712 subjects who participated in the 2014 survey, 148 were robust by the frailty criteria, except for those with missing items, and participated in the same survey four years later. The subjects were divided into two groups: the robust group (those who remained robust) and the prefrailty group (those who transitioned to prefrailty), and analyzed longitudinally. The Japanese version of the Cardiovascular Health Study was used to assess frailty, and the robust group was defined as those who did not have any of the following five symptoms: weight loss, muscle weakness, fatigue, decreased walking speed, and decreased physical activity; the prefrailty group was defined as those who had one or two of the following symptoms. Those with three or more items were excluded.[Result]In the present study, 32 patients (21.9%) transitioned to the prefrailty state after 4 years, 13 (20.0%) were males and 19 (23.5%) were females, according to gender. In both men and women, normal walking speed was significantly lower in the prefrailty group, and exercise duration was also significantly lower in the prefrail group. In addition, scores on the Geriatric Depression Scale 15 were significantly higher in men, and significantly more of them were isolated from family and friends. In addition, men had significantly lower mini-nutrition ratings and significantly lower protein intake.[Conclusions]In addition to the five items of frailty evaluation, it is thought that focusing on physical activity, mental state, and social isolation from multiple angles will lead to prefrailty and improvement of frailty

An Immunobiochemical Significance to Do Quantitative and Qualitative Analysis of Serum Amyloid A Protein (SAA), C-reactive Protein (CRP) Included in Various Body Fluid Obtained from Mother and Perinate on Perinatal Period

Serum amyloid A protein (SAA) and C-reactive protein (CRP) are one of the human plasma proteins that have been recognized as an important host defense molecule. It is reported that SAA is produced with the mammary gland which is an extrahepatic producing tissue in various mammals except human and being secreted into colostrum. We have previously made clear that CRP is included in human colostrum and also what an automated commercially available latex-enhanced assay is effective to explore SAA in human colostrum and to measure its concentration. Consequently, the immunobiological significance of SAA and CRP contained in human colostrum has been of major concern. In this study, we examined to measure of these concentration by the high sensitive assay and to investigate the molecular attributes by western blotting. SAA was contained in the all of breast milk obtained from seventeen cases available. The mean concentration of SAA included in the breast milk increased from 0.135±0.33 μg/ml of the childbirth day to 1.494±1.17μg/ml in the observed puerperal period. There was a peak of the level of SAA on the third puerperium day. It was in contrast with the level of the milk CRP having reached a peak on the second puerperium day, and both levels of the blood SAA and CRP having become a peak on the first puerperium day. The molecular weight of SAA included in breast milk was 12 kDa the same as maternal blood, but CRP had a difference among the two materials in contrast with SAA. As for the molecular weight of CRP included in colostrum, different two molecules were observed. One was 23 kDa with a known molecule same as being included in the maternal blood, the other was larger in about 50 kDa. Though CRP had not been included in feces of infant after ablactation, the CRP molecules included in neonatal feces after lactation was molecular weight of 23 kDa the same as breast milk. Furthermore CRP was also contained in meconium, but the molecular weight was not identified. This is the initial report that showed that SAA included in human breast milk is arrived in maximum on the third puerperium day, and showed that CRP have different molecular weight between maternal blood and colostrum whereas SAA don\u27t have a difference. That SAA in mammary gland epithelial cells is induced by prolactin or lipopolysaccharide, that SAA increases intestinal mucin to provide a protective barrier and inhibits adhesion to the gut wall of enteropathogenic Escherichia coli has been recently reported by other researchers. When we consider them and evaluate this study, it is speculated that SAA and CRP which would be transferred from mother to a newborn infant through colostrum carry an important role to confer phylaxis ability on the newborn infant

CYTOPATHOLOGICAL FEATURES OF ASCITES IN A CASE OF PERITONEAL SARCOMATOID MESOTHELIOMA

Generally, malignant sarcomatoid mesothelioma (MSM) has few desquamated tumor cells in the ascitic effusion when compared to those of epithelioid type, and is said to present difficulty in cytopathological diagnosis. There are few reports of the cytopathological features of MSM. We report herein cytopathological features of tumor cells found in ascites of a 58-year-old male patient with MSM. In ascitic fluid, sarcomatoid large atypical polygonal and short spindle cells with irregular nuclei, irregular membranous invagination, and distinct nucleoli were seen. Although there is no definite evidence of mesothelial differentiation in sarcomatoid atypical cells in the ascitic fluid by immunostaining, a diagnosis of peritoneal malignant mesothelioma was made according to the histopathological features of a surgical peritoneal sample and the clinical course of this patient. When various sarcomatoid atypical cells are seen in the ascitic fluid, it seems to be necessary to include MSM in the differential diagnosis