感染防止対策の重要性の再認識

【はじめに】基礎看護教育に活用するための看護実践能力を向上することを目的とし，病棟へ出向した．カルバペネム耐性腸内細菌検出と対策徹底についての緊急通告を受けて今回は，感染防止対策の重要性に焦点をあてて報告する．【方法】平成26年10月から12 月，出向先の病棟にて，チームの一員として看護を行った．病床数32床，看護師数20人で，チームナーシングとプライマリー制をとっていた．【報告】出向先の病院では，施設内感染防止体制の確保及び推進のため，院内感染防止対策委員会が設置され，その中心的な実践活動を担う教職員の集団として，ICTが活動を行っている．病棟からは，主任と看護師1人が構成員になっており，週に一回，医療に係る感染防止のためラウンドを行い，結果を病棟にフィードバックして改善に努めている．出向先の病棟は，術後の状態の変化に常に配慮しなければならない患者がいる一方，状態は落ち着いているものの，患者のペースに合わせて安全を担保しながら，時間をかけてケアを行う必要性がある患者も多くいた．その多様な業務の中でも看護師は，標準予防策を徹底しようと相互協力し日々看護を行っていたが，カルバペネム耐性腸内細菌患者の発生があった．その原因として，医療者が感染の媒体になってしまった可能性が否定できないと考える．感染の原因は医療者にあり，自分が媒体者であるという自覚をもち，目的・根拠を十分に理解したうえで行動することが必要であると考える．学生に対しても，教員間で原理原則や根拠に関する共通の認識をもち，教育にあたることが大切であると再確認した．【まとめ】感染防止に関する知識や技術は，基礎看護学の演習の中でも早期に教育を行う．根拠を踏まえて，正しい知識と技術で実施できるような教育計画の再考が必要と考える

DEVELOPMENT OF LABEL-FREE BIOSENSOR FOR DETECTING STEROID HORMONE CONCENTRATION IN FISH

A novel label-free immunosensor for detecting steroid hormone was developed. The principle of the sensor system is based on differences in the electrochemical activity induced by an immunoreaction that depends on the levels of steroid hormone in the sample. A gold electrode functionalized with 3-mercaptopropionic acid (MPA) self- assembled monolayer was used to fabricate electrochemical immunosensor. In addition, single-wall carbon nanotube (SWCNT) was selected to expandthe dynamic range of the sensor. The sensor was immersed into a sample solution and measurements were determined by cyclic voltammetry. Each electrochemical measurement including sample immerse only took about 15min. In this study, we introduced an application of our sensor in detecting 17, 20β- dihydroxy-4-pregnen- 3-one (DHP). The immunosensor showed a specific response to DHP, and the oxidation peak current linearly decreased in the range of 7.8-500.0pg ml-1 (without SWCNT) and 15.6-50000.0pg ml-1 (with SWCNT). The sensor system was then applied to monitor DHP of goldfish (Carassiusauratus) and was compared with the levels of the same samples determined using ELISA as the convention method. Blood plasma of fish was collected every 3h after administering a DHP inducer. A good relationship (coefficient: 0.934) was observed between DHP levels determined by both methods. Keyword: Biosensor, Steroid hormone, Immunoassay, Fish, Single-walled carbon nanotube

看護師の共感経験と情動知能との関係

＜目的＞看護師の共感経験と情動知能との関係を明らかにする．＜方法＞ A 県内の6 病院に勤務する看護師930人を対象に自記式質問紙調査を行った．共感経験は，角田による共感経験尺度，情動知能は，豊田らによる情動スキルとコンピテンス尺度を用いた．分析は統計解析ソフトIBM SPSS Ver.19 for Win. を用いて記述統計量，共感経験4 群間の差の検定には一元配置分散分析，その後の検定にはTukey法を行った．＜結果＞回答697人（回収率74.9%）有効回答692人（有効回収率99.3%）で，このうち今回は女性638人（92.2%）を分析した．A 両向型183人（28.7%），B 共有型140人（21.9%），C 不全型213人（33.4%），D両貧型102人（16.0%）であった．平均年齢は, 全体で36.8±10.2歳で，4群別でみるとA 35.8±9.8（SD）歳，B 35.6 ± 9.8 歳，C 37.7 ±10.3 歳，D 38.5 ± 10.8 歳でDが最も高かった．看護師経験年数は，全体で13.6 ± 9.6年，A 12.5 ± 9.2 年，B 13.4 ±9.5 年，C 14.2 ± 9.7 年，D 14.8 ± 10.0 年でDが最も長かった．勤務形態は，全体では2交代制342人（53.6%）が最も多く，そのうち4群別はC 114 人（53.5%）が最も多かった．情動スキルとコンピテンス尺度の下位尺度別に平均値と標準偏差でみると，「認識と理解」では，全体33.4 ± 7.4点で，4群別は最も高かったのはB 36.8 ± 6.9 点で，A,C,D に比べ有意（P ＜ 0.05）に得点が高かった．「表現と命名」では，全体24.0 ± 5.1 点で，4群別では最も高かったのはB 25.2 ± 5.4点でC,D に比べ有意（P ＜ 0.05）に得点が高かった．「制御と調節」では全体24.9 ± 4.4 点で，4群別は最も高かったのはB 26.2 ± 4.3 点で，C,D に比べ有意（P ＜ 0.05）に得点が高かった．共感経験の4群別は，B共有型は情動知能の3下位尺度「認識と理解」「表現と命名」「制御と調節」が，A,C,D に比べ有意に高く，同情的に相手を理解している看護師が情動知能を用いていることが明らかとなった．＜結論＞看護師の情動知能は共感経験類型により異なることをふまえた，共感性の高い看護実践を支援する方法の検討が必要であることが示唆された．Objective: This study aimed to clarify the relationship between nurses ’ experience of empathy and emotional intelligence.Methods: A cohort of 930 nurses was given self-administered questionnaires, and a total of 692 valid responses were used for analysis. The survey included the Kakuta experience of empathy scale and the Toyoda emotional skill and competence scale, as well as the backgrounds of subjects.　In the statistical analysis, descriptive statistics were calculated using IBM SPSS ver.19 for Microsoft Windows （TM）. In the test of diff erences between four experience of empathy groups, one-way analysis of variance was performed followed by Tukey’s test.Result: The four groups were A 183 persons（ 28.7%）, B 140 persons（ 21.9%）, C with 213 persons（33.4%）, and D with 102 persons （16.0%）. The mean age of all subjects was 36.8 ± 10.2 （SD）years. Of the 4 groups, mean age was 35.8±9.8（ SD） years in A, 35.6±9.8 years in B, 37.7±10.3 years in C, and 38.5 ± 10.8 years in D, the highest. Years of nursing experience were 13.6 ± 9.6 years for all subjects, 12.5 ± 9.2 years for B, 14.2 ± 9.7 years for C, and 14.8 ± 10.0 years for D, the longest. Of the four experience of empathy groups, B had significantly higher scores than groups A, C, and D on three subscales of emotional intelligence:“ recognition and understanding,”“ expression and naming,” and “control and regulation.”This shows that nurses who understand other people compassionately use emotional intelligence.Conclusions: Based on the finding that a nurse\u27s emotional intelligence changes with empathy experience type, it is suggested that examination of how to support nursing practices with a high level of empathy is needed

Host range and receptor utilization of canine distemper virus analyzed by recombinant viruses: Involvement of heparin-like molecule in CDV infection

AbstractWe constructed recombinant viruses expressing enhanced green fluorescent protein (EGFP) or firefly luciferase from cDNA clones of the canine distemper virus (CDV) (a Japanese field isolate, Yanaka strain). Using these viruses, we examined susceptibilities of different cell lines to CDV infection. The results revealed that the recombinant CDVs can infect a broad range of cell lines. Infectivity inhibition assay using a monoclonal antibody specific to the human SLAM molecule indicated that the infection of B95a cells with these recombinant CDVs is mainly mediated by SLAM but the infection of 293 cell lines with CDV is not, implying the presence of one or more alternative receptors for CDV in non-lymphoid tissue. Infection of 293 cells with the recombinant CDV was inhibited by soluble heparin, and the recombinant virus bound to immobilized heparin. Both F and H proteins of CDV could bind to immobilized heparin. These results suggest that heparin-like molecules are involved in CDV infection

Atypical gaze patterns in children and adults with autism spectrum disorders dissociated from developmental changes in gaze behaviour

Eye tracking has been used to investigate gaze behaviours in individuals with autism spectrum disorder (ASD). However, traditional analysis has yet to find behavioural characteristics shared by both children and adults with ASD. To distinguish core ASD gaze behaviours from those that change with development, we examined temporo-spatial gaze patterns in children and adults with and without ASD while they viewed video clips. We summarized the gaze patterns of 104 participants using multidimensional scaling so that participants with similar gaze patterns would cluster together in a two-dimensional plane. Control participants clustered in the centre, reflecting a standard gaze behaviour, whereas participants with ASD were distributed around the periphery. Moreover, children and adults were separated on the plane, thereby showing a clear effect of development on gaze behaviours. Post hoc frame-by-frame analyses revealed the following findings: (i) both ASD groups shifted their gaze away from a speaker earlier than the control groups; (ii) both ASD groups showed a particular preference for letters; and (iii) typical infants preferred to watch the mouth rather than the eyes during speech, a preference that reversed with development. These results highlight the importance of taking the effect of development into account when addressing gaze behaviours characteristic of ASD

看護学生の内発的動機づけと授業形態別にみた学びたい気持ちの変化との関連

【目的】本研究は，授業を受けたことによる看護学生の学びたい気持ちの変化が，内発的動機づけに影響を及ぼすかを，授業形態別に明らかにすることで，自律的な学習を支援するための教育の示唆を得ることを目的とした．【方法】関東地方の看護系大学3校の1 ～ 4 年生1,089人を対象に，平成25年7月から10月にかけて，自記式質問紙調査を行った．調査内容は，①対象者の背景（性別，年齢，学年，入学動機，将来の目標，良好な人間関係を築けると思う），②看護学生の学習動機づけ尺度，③授業形態別（講義形式，グループワーク，ゼミナール形式，看護技術演習，施設見学実習，基礎看護学実習［受け持ち患者あり］，各論実習）受講の有無，④授業形態別の「学びたい気持ちの変化」5件法であった．分析方法は，SPSS ver.21 を用いて基礎統計量，尺度と質問項目はKruskal-Wallis 検定とMann-Whitney U 検定（Bonferroni 調整），Spearman の相関係数をみた．本研究は，A 大学倫理審査委員会の承認を得て，郵送法で行った．【結果】回収数542人（回収率49.8％）で，そのうち511人（有効回答率94.3％）を分析対象とした．性別は男性56人（11.0％），女性455人（89.0％），平均年齢は20.4±1.8（SD）歳であった．〈看護への内発的動機づけ〉は，全ての授業形態で「学びたい気持ちが強くなった」学生の得点は有意（p＜.001）に高く，看護技術演習と正の相関（p＜.01，r＝.434）があった．【結論】看護を学習するための全ての授業形態において，受講することにより学びたい気持ちが強まる学生は内発的動機づけが高く，中でも看護技術演習では，「学びたい気持ちの変化」との間に正の相関がみられたことから，看護技術演習で看護学生の自尊心や有能性を高められるような授業を行うことで学生の学びたい気持ちは強くなり，〈看護への内発的動機づけ〉を高めることが示唆された

Induction of lymphangiogenesis through vascular endothelial growth factor-C/vascular endothelial growth factor receptor 3 axis and its correlation with lymph node metastasis in nasopharyngeal carcinoma

The contribution of the lymphatic system to tumor metastasis is being increasingly appreciated through studies of human cancers. As the biological behavior of nasopharyngeal carcinoma (NPC) depends on its nodal status, patients with advanced nodal status show a higher tendency toward a poor outcome. Here, we examined the role of lymphangiogenesis on lymphatic spread of NPC. We also evaluated the involvement of vascular endothelial growth factor (VEGF)-C/VEGF receptor 3 (VEGFR3) signaling pathway on lymphangiogenesis in NPC. Furthermore, we tested whether Epstein-Barr virus (EBV)-latent membrane protein (LMP) 1 induces VEGF-C. Forty-one patients with NPC were evaluated for expressions of VEGF-C and its receptor, VEGFR3, and LMP1 proteins and lymphatic vessel counts (LVC) highlighted by anti-podoplanin employing immunohistochemistry. The VEGF-C induction by LMP1 was then tested with Western blotting and enzyme-linked immunosorbent assay in vitro. The LVC and VEGF-C expression were significantly higher in cases with advanced regional lymph node metastasis (N2,3) than those with no or limited lymph node involvement (N0,1) (p = 0.0380 and p = 0.0109, respectively). In VEGF-C/VEGFR3-positive cases, the LVC were significantly increased compared with VEGF-C/VEGFR3-negative cases (p = 0.0007). However, LMP1 expression did not show significant associations with LVC and VEGF-C-expression scores (p = 0.1210 and p = 0.1324, respectively). Induction of VEGF-C protein by LMP1 was not detected in vitro. These results suggest the involvement of the VEGF-C/VEGFR3 axis in the induction of lymphangiogenesis which results in lymphatic spread of NPC. However, EBV-LMP1 was not associated with the mechanism. © 2011 Elsevier Ltd. All rights reserved

基礎看護学実習Ⅱが看護学生の思いやり行動と看護職アイデンティティに及ぼす影響

　本研究は，基礎看護学実習Ⅱが看護学生の思いやり行動と職業的アイデンティティに及ぼす影響について明らかにすることを目的とした．　A大学看護学部2年生96人を対象に，基礎看護学実習Ⅱ前後に自記式質問紙調査を行った．実習前62人（回収率64.6%），実習後71人（74.7%）のうち，62人（有効回答率実習前100%，実習後87.3%）を分析対象とした．調査には，尾原による思いやり行動評価尺度と藤井らによる職業的アイデンティティ尺度を用いた．分析には統計解析ソフトSPSS Ver.19.for Win. を用い，Wilcoxon の符号付順位和検定とSpearman の順位相関係数をみた．　結果は，男性1人（1.6%），女性61人（98.4%）で，平均年齢19.9 ± 0.3（SD）歳であった．看護師になることへの迷いでは，ある者が実習前33人（53.3%），実習後33人（53.2%）で変化はみられなかった．将来の希望職種では，看護師が実習前53人（65.5%），実習後51人（56.8%）で最も多かった．思いやり行動評価については，最も得点が高かったのは＜相手の態度表情を読み取る＞実習前平均3.8± 0.7 点，実習後平均3.8 ± 0.7 点であり，最も得点が低かったのは＜相手の気持ちを察する＞実習前平均3.5 ± 0.5 点，実習後平均3.4 ± 0.7 点であった．実習前後では，思いやり行動の得点に違いがなく有意差もみられなかった．職業的アイデンティティについては，実習前後ともに最も得点が高かったのは＜社会への貢献の志向＞で，実習前平均5.2 ± 0.9 点，実習後平均4.8 ± 1.4 点であり，有意（p<.05）に実習後が下がっていた．最も得点が低かったのは，実習前＜看護職として必要とされることへの自負＞平均4.3 ± 1.1 点で，実習後＜看護職の選択と成長への自信＞と＜看護職として必要とされることへの自負＞平均4.3±1.3点であった．思いやり行動評価総得点と職業的アイデンティティ総得点では，両者に正の相関（実習前r=.62, 実習後r=.53，p<.01）がみられた．　以上のことから，看護学生の思いやり行動は，2週間の基礎看護学実習期間では変化がみられなかったが，思いやり行動は職業的アイデンティティに影響を及ぼしており，相手の立場に立ち考え理解しようとする姿勢が，職業的アイデンティティを高めることが推察された．The purpose of this research was to clarify the effect of basic nursing practice Ⅱ on thesympathetic attitudes and professional identity of nursing students. A self-report questionnaire survey was conducted on 96 students at A Medical University School of Nursing before and after basic nursing training Ⅱ. I assumed 62 people (eff ective answer before training 100% , after training87.3% ) among 62 people before training (response rate 64.6% ) and 71 people after training (74.7% ). The sympathetic attitude scale of Ohara and professional identity scale of Fujii were used. The statistical analysis software SPSS Ver.19.for Win. was employel for analysis along with the rank sum test of Wilcoxon and correlation coefficient of Pearson. As a result, there were 1 male (1.6% ) and 61 women (98.4% ) subjects, and the average age was 19.9 ± 0.3 (SD). 26 (41.9% ) people hesitated about becoming a nurse before training and 25 people (40.3 % ) after it. The type of employment most hoped for was nursing before training among 51 people (56.8 % ) and after training among 53 people (65.5 % ). “Being considerate of others,”which scored highest, was 3.8 ± 0.7 before training and 3.8 ± 0.7 points after training. This meant “being Sensitive to the other\u27s feelings .” The lowest score training was 3.4 ± 0.7 points and after training 3.5±0.5　points, with regard to“ respect for the other\u27s feelings.” No significant difference was noted before and after training in considerate behavior. The highest scores were for professional identity before (5.2 ± 0.9) and after training (4.8 ± 1.4),in terms of “contributing to society.”It was “self-confidence about what was needed as a nurse” which scored lowest before training (4.3 ± 1.1),“the choice of the nurse and confidence in growth” was 4.3 ± 1.3 points, and “self-confidence in what was needed as a nurse” after training. The “intention to contribute to society” (p<.05) was significantly low after training. An equilateral correlation was found between sympathetic attitudes and professional identity(before training r=0.62, after training r=0.53,p<.01). From the foregoing, sympathetic attitudes of nursing students showed no change during the two-week basic nursing training Ⅱ . However, their sympathetic attitudes influenced their professional identity, and their understanding of other persons could be taken to mean a heightened sense of professional identity

Lymphangiogenesis in regional lymph nodes predicts nodal recurrence in pathological N0 squamous cell carcinoma of the tongue

Aims: Cancer cells induce de-novo lymphatic vessel growth within draining lymph nodes before they metastasize. The aim of this study was to retrospectively evaluate lymph node lymphangiogenesis before the establishment of nodal recurrence in squamous cell carcinoma (SCC) of the tongue. Methods and results: Surgical specimens from 28 patients with pT2-T3N0M0 SCC of the tongue after local excision with supraomohyoid neck dissection were studied by immunohistochemistry. Intranodal lymphatic endothelium was highlighted by podoplanin staining to evaluate lymphatic vessel counts (LVCs). Primary tumour sections were examined for the expression of lymphangiogenic factors: vascular endothelial growth factor (VEGF)-C and VEGF-D. LVCs in regional lymph nodes were significantly increased in the cases with nodal recurrence (P=0.0013). Simultaneous increases in VEGF-C and VEGF-D expression were significantly associated with both an increase in LVC in regional lymph nodes (P=0.0001) and a decrease in the rate of survival without nodal recurrence (P=0.016). Conclusions: Knowing the status of lymphangiogenesis in the regional pN0 lymph nodes in tongue cancer would help in predicting which patients will develop nodal recurrence. The use of a therapeutic approach which blocks lymphangiogenic factors, such as VEGF-C and VEGF-D, may be beneficial in suppressing the lymphatic spread of tongue cancer with intense intranodal lymphangiogenesis. © 2012 Blackwell Publishing Ltd.発行後1年より全文公開