Euthanasia: Understanding Ethical Issues through Role-Play

Having transformed traditional ethics, people have empowered themselves and put ethics under their control. An individual\u27s value has become the center of all decision making. where has ethics gone? Why has ethics been fossilized? when an individual desperately needs a litmus test to check his stance, why cannot he re-visit ethics and apply its insights to solving his problems? I wish to believe that there might be a legacy of conventional ethics in the form of universal rules, regardless of time, culture, and context, to be passed on to the next generation. Has God given us life, death, and choice of life? Has God also given us the ability to understand another person\u27s pain? If so, we need to be conscientious about what is an appropriate way to resolve problems along with multi-disciplinary approaches in the postmodern world. How much has ethics tried to adapt current science/technology? Has ethics offered us any appropriate way of dealing with what\u27s right and/or wrong or with alternatives, whenever we are in the midst of complicated problems? when did we begin to omit ethics in our decision making process? Ethics seems not to be the sole value, but it has to compete with other contemporary values. The presently burning issue called euthanasia is everyone\u27s business, one we all have to face. I wonder if death is part of God\u27s purpose for lives or a divine appointment. The conundrum intertwined with euthanasia relates to how to reach a satisfactory end of life backed up by ethics. Critical and Creative Thinking could help us go through the crux of the issue and mold an individual\u27s ethical decision, while maintaining a balance with social justice. My goal in this synthesis paper is two fold: to provide a theoretical description of euthanasia and to prepare English teaching materials for Japanese college students on reading comprehension, by garnering the latest news/research from leading newspapers, periodicals, and the internet, and role play to help exchange views, to share empathy and I hope to create a climate of mutual trust among participants by the time role-play reaches its debriefing session

Promoting truth-telling (the concept and its practice) with effective communication in medical settings: with particular focus on end of life care in Japan

This thesis deals with the concept and practice of truth-telling in medical settings. In particular, it analyses the way in which truth-telling is enacted in the context of end of life care in Japan. The thesis addresses not only the content of what is communicated in encounters between physicians and medical personnel with patients and their family carers (next of kin), it also discusses the way in which information concerning diagnosis, treatment, and prognosis is communicated. That is to say, in the quality and integrity of the encounter. The thesis offers a literature survey of research studies that address truth-telling in medical settings in the USA, the UK, and in Japan, offering a comprehensive survey of studies written in English and Japanese. It investigates the history of the concept and practice of truth-telling in medicine from the turn of the twentieth-century to the present day, and it connects this history to the developing field of medical ethics. Over the course of this history one can identify a shift – especially in the West – away from medical paternalism towards patient-centered medical care, in which patient autonomy and self-determination are highly valued. This has influenced the understanding and practice of truth-telling in medicine. Japan, however, has preserved certain cultural values, traditions, and conventions that affect medical practice. The thesis analyses the effect of these behavioural norms on truth-telling practices in end of life care in Japan. It is argued that the hierarchical society, strong family structure, paternalistic culture, and conversational etiquette of Japan tend to stymie effective communication and limit truth-telling concerning diagnosis, treatment, and prognosis in medical settings. In light of the findings of the literature survey, the thesis proposes some concrete ways to promote truth-telling and effective communication in medical settings, including through the building of trust between interlocutors and through the reflective praxis of critical and creative contemplation

ロウネン カンゴ ガク ジッシュウ ニ オケル カンゴ ガクセ ノ ニンチショウ コウレイシャ ニ タイスル カンケイ ケイセ ノ カテイ : ガクセイ イッジレイ ノ ブンセキ

背景 老年看護学実習において, 看護学生 (以後学生) が認知症高齢者を理解し, 良い関わりを持つことが困難であると報告されている. しかし, それらは学生の記録に基づいたものであり, 学生の観察の視点や無意識の行動は含まれていない. そこで, 学生がどのように認知症高齢者を理解し関わっていくかという関係形成の過程を明らかしたいと考え本研究に着手した. 目的 介護老人福祉施設における老年看護学実習で, 学生の認知症高齢者に対する関係形成の過程を明らかにする. 方法 対象は, 介護老人福祉施設で認知症高齢者を受け持った学生1名である. データ収集は, 認知症高齢者 (以後A氏) に関わる学生の観察者としての参加観察と半構成質問紙による学生への面接および学生の実習記録とした. 分析方法は, 参加観察, 面接, 記録のデータから, 学生のA氏への関わりに関連する場面を再構成し, 学生のA氏に対する関係が形成された場面を抽出した. 結果 学生が認知症高齢者に対する関係形成に関連した場面は, 次の6つの場面であった. (1)関わる方法がわからず, A氏の表情を観察しその意思を読み取ろうとした. (2)教員のアドバイスによりA氏に関わる手段を発見した. (3)A氏との関わりから得た情報と施設からの情報により, 抱いていた印象が変化し, A氏の理解を深めた. (4)無意識にA氏の行動を観察し, A氏の状態に応じた生活機能を高める看護ケアを行った. (5)A氏の施設における生活目標を理解し, 自立支援をした. (6)レクレーションでのA氏の自発的な行動から, その情報を活用して筋力訓練を指導した. 結論 学生は, 実習初日の認知症高齢者に対する戸惑いをきっかけに思考し, 教員や施設の情報を意識的に取り入れてより良い関わりを模索しながら, 認知症高齢者の生活機能を高める看護を積極的に提供していることがわかった. そのため, 教員は学生の認知症高齢者への関係形成の過程をよく観察し, 学生の思考過程に注目しながらを指導することが必要であると考える.Background We do not use these symbols in English During geriatric nursing practicums, nursing students are reported to experience difficulties understanding and relating to how to provide care for the elderly, especially the elderly with dementia. However, previous reports have not examined the thoughts and unconsciousness behavior of students. As nursing educators, we studied here how a nursing student understood and started to provide care for a elderly with dementia.Purpose To clarify the process of how, in a geriatric nursing practicum, a student established a connection with the elderly with dementia at elderly welfare facilities.Methods This qualitative study that collected data through participant observation and semi-structured interview, focusing on one nursing student. The student\u27s practicum records were referenced as needed. The participating student on a geriatric nursing practicum provided consent to be the subject of this study. The involvement of the student with an elderly individual with dementia for whom she was responsible was the target of study. The method of analysis was to reconstruct from the data obtained from participant observation, interview, and practicum records the situations where the student starting providing care to the elderly person with dementia.Results The results showed that the student established a connection in the following six situations; 1) when not understanding what was needed, trying to understand the intention of the elderly person from facial expressions; 2) finding a way to become involved with the elderly person based on nurse educators\u27 advice; 3) deepening understanding of the elderly person by requesting that staff allow access to official records; 4) supporting the elderly person to enhance her functioning in daily life by confirming the validit

Transcriptional factors associated with epithelial-mesenchymal transition in choroidal neovascularization

Purpose: To investigate the transcriptional factors associated with epithelial-mesenchymal transition (EMT) in choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). Methods: Paraffin sections of CNV obtained from patients with AMD (n=12) were stained for transcriptional factors related to EMT, i.e., Snail, Slug, SIP1, and Twist. As a control, postmortem sections of ocular normal tissue were used. Furthermore, using a human retinal pigment epithelial (RPE) cell line (ARPE-19), reverse transcription–polymerase chain reaction (RT–PCR) and immunofluorescence microscopy were performed to explore the cellular localization and expression levels of EMT-associated transcriptional factors upon cytokine stimulation. Results: Of 12 specimens, 11 CNV tissues (91.6%) showed staining for Snail localized in cellular nuclei, particularly in those of RPE cells. Snail was strongly co-localized with α-smooth muscle antigen (SMA) in RPE cells. In contrast, postmortem human retina showed no Snail staining in RPE cells. Other transcriptional factors, Slug, Twist and SIP1 were not detected in CNV or normal human retina. In ARPE-19 cells, RT–PCR and immunofluorescence microscopy showed that Snail mRNA was upregulated by transforming growth factor (TGF)-β and VEGF stimulation. Furthermore, TGF-β induced relocalization of Snail to the nucleus in RPE cells. Conclusions: The current data indicate that Snail is a major transcriptional factor for EMT changes of RPE cells in human CNV

Detection and Typing of Genital High-Risk HPV DNAs in Cervical Scrapes Using the E6E7-Specific Consensus PCR

Specific types of human papillomaviruses (HPVs) are closely associated with the development of genital carcinomas. We previousy reported a PCR method which amplifies the E6E7 sequence from 6 different high-risk genital HPVs (HPV16, 18, 31, 33, 52 and 58) (J Gen Virol 1991, 72 : 1039-1044.). To amplify broader types of genital high-risk HPVs, we have modified our consensus primers by extending 9 nucleotides at the 3 end of the sense primer and changing 5 nucleotides at the 5 end of the anitisense primer. Genotype diag-nosis was carried out by AvaII plus Rsal digestion. This modified PCR method enabled the detection of trace levels of at least 11 types of genital high-risk HPVs (HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56 and 58), at subpicogram to sub-nanogram amounts of cloned DNA, amplified after the consensus PCR. We applied this method to analyze 155 cervical scrapes from patients who had been diagnosed with premalignant or malignant cervical lesions. HPVs were detected in 63.0% of mild dysplasia (17/27), 100% of moderate dysplasia (all 12 cases), 91.7% of severe dysplasia (11/12), 95.8% of carcinoma in situ (23/24), and 80.0% of invasive cervical cancer (52/65). HPV16 was present predominant-ly (60.9%), followed by HPV58 (153%), HPV52 (13.9%), HPV31 (13.0%), HPV18 (6.1%), HPV35 (2.6%), HPV51 (2.6%), HPV56 (2.6%), HPV33 (1.7%) and HPV39 (1.7%). Five cases contained unclassified types (4.3%). The results indicate that this modified E6E7 consensus PCR method provides a quick and easy way to detect and diagnose genotypes of the high-risk genital HPVs from scraped cells

Barreiras ao acesso das pessoas com deficiência aos serviços de saúde: uma revisão de escopo

OBJETIVO Analisar as evidências científicas relativas às barreiras para o acesso de pessoas com deficiência aos serviços de saúde. MÉTODOS Realizou-se uma revisão de escopo estabelecendo-se a perguntanorteadora: “Quais são as principais barreiras que as pessoas com deficiência enfrentam no acesso a serviços de saúde?” O levantamento dos artigos foi realizado em julho de 2019, em seis bases de dados de literatura científica. Dos 1.155 documentos identificados nas buscas, após seleção por título e resumo, foram lidas na íntegra 170 publicações e, após leitura, 96 artigos foram incluídos e categorizados conforme referencial teórico. RESULTADOS As principais barreiras indicadas pelos usuários do serviço foram: comunicação falha entre profissionais e paciente/cuidador; limitações financeiras; questões atitudinais/comportamentais; oferta de serviços escassa; barreiras organizacionais e de transporte. As principais barreiras apresentadas pelos prestadores de serviços foram: falta de treinamento/capacitação aos profissionais; falha do sistema de saúde; barreiras físicas; falta de recursos/tecnologia e barreiras de idioma. CONCLUSÕES Ficou evidente que as pessoas com deficiência enfrentam diversas barreiras ao tentarem acesso aos serviços de saúde de que necessitam e que usuários e profissionais de saúde têm visões distintas e complementares sobre as dificuldades.OBJECTIVE To analyze the scientific evidence regarding barriers to the access of people with disabilities to health services. METHODS A scoping review was carried out from the main question: “What are the main barriers that people with disabilities face in accessing health services?” The articles were surveyed in July 2019 in six scientific literature databases. Of the 1,155 documents identified in the searches, after selection by title and abstract, 170 publications were read in full and, thus, 96 articles were included and categorized according to the theoretical framework. RESULTS The main barriers indicated by the users of the service were: communication failure between professionals and patient/caregiver; financial limitations; attitudinal/behavioral issues; scarce service provision; organizational and transport barriers. The main barriers presented by service providers were: lack of training to professionals; failure of the health system; physical barriers; lack of resources/technology; and language barriers. CONCLUSIONS It was evident that people with disabilities face several barriers when trying to access the health services they need and that users and health professionals have distinct and complementary views on difficulties

The Double Polymerase Chain Reaction with Consensus Primers Permits Rapid and Sensitive Detection of Genital Human Papillomavirus Oncogenes

We have developed a sensitive procedure for the detection of relatively low copy numbers of multiple genital human papillomaviruses (HPVs) using the polymerase chain reaction (PCR). HPV DNAs were detected by agarose gel electrophoresis and ethidium bromide staining after 2 rounds of PCR amplification (double PCR) with outer and inner consensus primer pairs for HPV-6, 11, 16, 18, 31, 33, 52, and 58. The detection limit of this method (i. e., 10?? copy of HPV DNA per cell in 1 μg cell DNA) was sufficient for analysis of cervical intraepithelial neoplasia (CIN) specimens. Overall prevalence rate of HPV was 100% in 20 cases of CIN specimens. HPV typing by restriction enzyme analysis revealed that HPV-16 sequence was present in 11 cases, HPV-18 in 1 case, HPV-31 in 4 cases, HPV-33 in 1 case, HPV-52 in 2 cases, HPV-58 in 3 cases, and an unidentified type(s) in 3 cases. There were 4 cases of mixed infections. This procedure obviates the use of hybridization- based for-mat for identification of at least 8 types of HPV sequences present in a small fraction of cells within a heterogeneous population

カイゴ ロウジン フクシ シセツ ニ ニュウキョスル ヨウカイゴ コウレイシャ ニ タイスル カンゴ ガクセイ ノ エンジョ カテイ ニ オケル チャクガンテン

背景 看護基礎教育カリキュラムの改正が行われ,老年看護学では,学生が高齢者及びその生活機能を理解し,高齢者への看護実践能力を高める指導が求められている.そこで,学生が高齢者と関わる時間や生活援助の機会が多いと思われる生活の場としての「介護老人福祉施設」で,学生が高齢者と関わる過程を分析することで,実習指導の示唆を得たいと考えた.目的 介護老人福祉施設における老年看護学実習で,学生の要介護高齢者への援助過程における着眼点を明らかにする.方法 研究デザインは,質的帰納的研究である.対象は,研究に同意の得られた介護老人福祉施設で老年看護学実習を行った学生6(男子1)名である.データ収集は,高齢者に関わる学生を参加観察(観察者として)し,実習終了後に半構成質問紙による面接を行った.分析は,参加観察と面接および学生の実習記録を統合して行った.結果 得られたデータは,学生6名が高齢者8名に関わった38場面であった.実習経過では,初日の学生は,高齢者との関わりに戸惑い,その関わりを模索していた.3日目は,記録や教職員の助言等を参考に,高齢者の看護ニードを把握し援助した.最終日は,学生が主体的に高齢者の自立を支援した.これらの援助過程には,学生が高齢者への援助の関わりに着眼した視点があり,その類型を分類したところ,1)高齢者の残存機能に働きかける,2)高齢者との人間関係を重視する,3)高齢者の生活行動を重視する,4)高齢者の健康的な反応を引き出す,5)高齢者の感情を重視する,の5類型が抽出された.結論 学生が高齢者を援助する着眼点は,5類型が認められた.指導者は,抽出された学生の高齢者への援助の類型を活用して,教育的支援を行うことが重要と考える.Background Following revisions of the curricula for basic nursing education,students in geriatric nursing receive instruction on understanding elderly individuals and their daily functioning,and enhancing their nursing skills when working with them.And we sought to determine which suggestions are necessary for practicum instruction by analyzing the processes of students when interacting with elderly care recipients at a nursing home in geriatric nursing practicum. Purpose To explore the opinions of nursing of students interacting with elderly care recipients at a nursing home in a geriatric nursing practicum. Methods This study employed a qualitative and inductive study design.Participants were six students (one male) who consented to participate and who were completing their geriatric nursing practicum at a nursing home for the elderly. Data were collected through participatory observations of the students interacting with the elderly care recipients and semi-structured interviews after practicum completion.For analysis,we created transcripts by integrating materials from the observations,interviews,and practicum records. Results/Discussion We obtained data from 38 scenes where the six students interacted with eight care recipients.In terms of processes,on the first day they tended to be confused and struggled in their interactions with the individuals. On Day 3,they were likely to look at records and seek advice from their instructors,and attempted to understand the nursing needs of the care recipients and assist them.On the final day of their practicum,the students were actively supporting the independence of the care recipients.In the processes of assistance,we extracted five categories of particular perspectives the students had while assisting the care recipients :( 1) working on the care recipients\u27 remaining functions,(2) emphasizing interpersonal relationships with them,(3) emphasizing their daily living behaviors,(4) eliciting healthy reactions from them,and (5) valuing their feelings. Conclusion There were five categories of the student opinions of nursing for elderly.We suggest that instructors utilize these categories in their provision of educational support

看護職者のメンタルヘルス向上を目指した足浴の効果に関する予備的検討

Objective: There are few studies that have subjectively and objectively verified the efficacy of footbaths as a means of relieving stress. The purpose of the present study was to validate the stress-reducing efficacy of footbaths both subjectively and objectively by means of a stress indicator, chromogranin A (CgA). Methods: The subjects were 21 female nurses working at a general hospital. After evaluating their current mental and physical condition, and measuring their salivary CgA levels, the subjects took a 10-min footbath. After the bath their mental and physical condition was evaluated again, and their salivary CgA levels were measured again. The changes in their mental and physical state before and after the footbath were assessed by the Wilcoxon signed-rank test. CgA levels taken before and after the footbath were assessed by the paired t-test. Results: The results showed that both their subjective mental and physical condition improved and their CgA levels were lower after the footbath than before. Conclusions: These results suggested that footbaths can exert a restorative effect on the stress associated with the performance of nursing duties and are effective in relieving nurses' stress