ニンンチショウ コウレイシャ ノ ザイタク カイゴシャ ガ イダク カイゴ ノ コウテイテキ ナ ニンシキ ト トクセイ ニ カンスル ケンキュウ

認知症高齢者を在宅で介護している介護者の抱く介護の肯定的な認識と地域および特性の差異を明らかにすることを目的とした。調査は、認知症高齢者の介護者705人を対象者に郵送法を実施し、350人を分析対象者とした。分析方法は、介護充実感の因子分析、続柄、地域別による介護充実感の分散分析を行った。結果、介護充実感は、「達成感」「一体感」の2つの下位尺度で構成されていることが明らかになった。続柄の比較では、配偶者と嫁(p=0.019)で有意差が認められた。地域の比較では、有意差は認められなかった。本研究の結果から、認知症高齢者の介護者の抱く介護の肯定的な認識として、達成感、一体感の2要因の概念が明らかになった。臨床の場での、認知症高齢者の介護者の肯定的な認識の評価に、本研究で用いた介護充実感が活用できると考えられる。介護の肯定的な認識は、続柄による違いが認められ、続柄別による支援方法を検討する必要があるといえる。(著者抄録)The purpose of the present work was to identifyp ositivea ppraisal,r egional difference,a nd characteristics for caregiverso f elderly with dementia at home. The investigationw as mailed to 705 subjects who care for elderly with dementia, and 350 subjects were analyzed. Statistical methods used factor analysisa nd anova for caregivingg ratificationo f relationship,R egionI . Result, caregivingg ratification, "attainmentf eeling" ,"closeness feeling"of two factors revealed that the scale was composed. Comparison of the relationship,a nd spouse( p= 0.019)w ere shown to have significantD ifference.C omparison of region showedn o significantd ifference.T he results of this study showed that positivea ppraisalf or caregiverso f elderlyw ith dementia constitutedt wo factors o f"attainmentf e eling"," c losenessf eeling". Caregivingg ratificationc ould be used in the clinicalf ield, as the purpose to evaluate positivea ppraisal for caregiverso f elderlyw ith dementia. Positivea ppraisalr ecognizedt he differenceo f relationship,a ndwhether or not healthcare professional assisting to caregivers of elderly with dementia need to recognize differenceo f relationship.原著論文 = Original articl

ニンチショウ コウレイシャ オ カイゴ スル カゾク ノ カイゴ ケイゾク イコウ ノ ヨウイン ニ カンスル ケンキュウ

本研究では、介護満足感やその他関連すると思われる要因と在宅で介護する家族の介護継続意向の関連を調査し、その結果を考慮した支援内容を検討することを目的とした。対象は、A県内で認知症高齢者を介護する家族介護者で、通所介護、通所リハビリテーションおよび重度認知症デイケアを利用し協力の得られた320人である。介護継続意向と関連のあると思われる要因を検討した。その結果、家族介護者の介護継続意向に有意な関連があった要因は、介護満足感、認知症高齢者との関係性、行動・心理症状の有無、家族外支援者の有無であった。在宅での家族介護者の介護継続を支援するためには、介護負担度を軽減する働きかけだけでなく、介護満足感を高める支援方法を実施することで介護継続意向を高める可能性が考えられる。また、在宅での介護支援を進めるためには、家族介護者のおかれている在宅介護時期を考慮する必要性も示唆された。(著者抄録)This study aims to discuss support services, based on the result of examining the relationships between care-giving satisfaction and related factors, and care continuity intention of family caregivers. The study was performed with 320 family caregivers of the elderly with dementia who utilized daycare or rehabilitation services for the elderly with severe dementia in A Prefecture, Japan. As a result, the factors significantly related to care continuity intention of family caregivers are care-giving satisfaction, relationships with the elderly, and presence of behavioral disorder and supporters outside the family. The result suggested that the care continuity of the family could be enhanced not only by the reduction of the caregivers\u27 burden but also by the promotion of caregivers\u27 satisfaction. In addition there is a need to take account of home care periods for family caregivers, in order to promote at-home care support.原著論文 = Original articl

Recurring radiation-induced angiosarcoma of the breast that was treated with paclitaxel chemotherapy: a case report

Background Angiosarcoma of the breast is very rare and can be divided into primary and secondary angiosarcoma. Radiation-induced angiosarcoma (RIAS) is classified as secondary angiosarcoma. Diagnosis of RIAS is difficult due to its rarity, and the interpretation of pathological imaging is complicated. In the National Comprehensive Care Network (NCCN) guidelines, the first choice of treatment is surgery with negative margins. Adjuvant radiotherapy (RT) for close soft tissue margins should be considered. Preoperative or adjuvant chemotherapy of nonmetastatic disease is not recommended for angiosarcoma. We report a case of RIAS, which was impossible to diagnose with core needle biopsy (CNB) but was diagnosed by excisional biopsy. The patient was then administered adjuvant chemotherapy using conjugated paclitaxel (PTX). Case presentation A 62-year-old woman noticed a tumor in her right breast. She had a history of right breast cancer and had undergone breast-conserving surgery, RT, and tamoxifen therapy 8 years previously. CNB, which was performed twice, was inconclusive. The tumor was surgically excised and pathological analysis yielded a diagnosis of angiosarcoma. She then underwent a right mastectomy. One month after she underwent right mastectomy, a nodule reappeared on the skin of her right breast, and excisional biopsy revealed recurrence of angiosarcoma. A few weeks later another nodule reappeared near the post-operative scar and excisional biopsy revealed recurrence of angiosarcoma. We assumed that surgical therapy was insufficient because the patient experienced relapse of angiosarcoma after complete mastectomy. After the second recurrence, we treated her with systemic chemotherapy using PTX. There was no evidence of recurrence 8 months after chemotherapy. Conclusion Although angiosarcoma is difficult to diagnose, many patients have a poor prognosis. Therefore, prompt treatment intervention is desired. Moreover, there is little evidence regarding adjuvant therapy of angiosarcoma since it is a rare disease. We consider that adjuvant therapy helped to effectively prevent recurrence in the patient after complete excision

ニンチショウ カイゴ ノ コウテイテキ ニンシキ ニ チャクモク シタ カゾク エ ノ ジョウホウ テイキョウ ニ ヨル カイニュウ ト コウカ

認知症高齢者の在宅介護者が抱く介護の肯定的認識に関するリーフレットを用いた簡便な情報提供による介入が、肯定的認識の向上と介護負担感の軽減に与える効果を明らかにした。研究対象者は、研究協力施設の2施設を利用している認知症高齢者の主介護者20人とした。対象者は、介入群、対照群に無作為に割り当てた。介入として、肯定的認識に関するリーフレットを用いた情報提供を介護支援専門員が行った。介入群では、介入前、介入直後、介入1ヵ月後に自記式質問紙調査を行った。介護者の概要は、介入群では女性8人、対照群では女性9人であった。介入群の対象者では、介護の肯定的認識のみ得点の向上が認められ、介護負担感、認知症の行動・心理症状(BPSD)では、介入前後では変化がなかった。本研究の結果から、認知症高齢者の介護者の肯定的認識の向上には、肯定的認識への直接的な働きかけの効果と、リーフレットの内容をさらに充実させることで効果を高める必要性が示唆された。(著者抄録)The present study aimed to verify the efficacy of a simple, yet basic, method of support, specifically, the handing out of information leaflets on positive appraisal of caregiving and to evaluate whether this method increased positive appraisal of their tasks and led to a relief of burden for caregivers providing at-home care for patients with dementia. A total of 20 primary caregivers of patients with dementia using two facilitiesconsented to participate in this study and were randomly allocated to either an intervention or control group. Care managers were asked to provide the intervention group with leaflets promoting a positive appraisal of caregiving. Self-completed questionnaire surveys were conducted before intervention, immediately after intervention and one month after intervention to evaluate their positive appraisal of caregiving, caregiver burden and behavioral and psychological symptoms of dementia (BPSD) . Caregivers were predominately women in the intervention (n = 8) and control (n = 9) groups. Positive appraisal of caregiving increased in the intervention group at one month after intervention. No changes were observed for either caregiver burden or BPSD. The present findings suggest that the effects of providing caregivers with information leaflets are limited and that first-hand information should be the primary focus in order to encourage caregivers to have a higher positive appraisal of their tasks.研究報

ニンチショウ コウレイシャ ノ カゾク カイゴシャ ノ カイゴ フタンカン ニ チャクモク シタ カンベン ナ シエン ト ソノ コウカ

認知症高齢者の家族介護者が抱く介護負担感に関する簡便な支援の効果を明らかにした.研究対象者は,研究協力施設の2施設を利用している認知症高齢者の主介護者34人とした.介入として,短縮版Zarit介護負担尺度日本語版(J-ZBI_8)に基づいた簡便な支援を介護支援専門員が行った.対象者には,支援1か月前,支援直後,支援1か月後に聞き取り調査か自記式質問紙調査を行った.介護者の概要は,女性が28人と多くを占めていた.支援前後では,介護負担感(ρ=0.992),肯定的認識(ρ=0.735),介護継続意思(ρ=0.152)で有意差は認められなかった.しかし,介護負担感がハイリスク群の対象者では,介護継続意思の変化量が非ハイリスク群と比べて有意に向上していた(ρ=0.045).本研究の結果から,認知症高齢者の介護者の介護負担感の軽減には,主観的な介護負担感を把握し,それに基づく支援をさらに充実させることで効果を高める必要性が示唆された.The present study aimed to verify the efficacy of using an onsite prompt support for caregiver burden for caregivers of persons with dementia in caregiving appraisal. Thirty-four primary caregivers of persons with dementia staying at two care facilities consented to participate in this study. Long-term care support specialists provided support based on care burden standards. The measures were administered as selfreport questionnaires or as interviews before the support was conducted, during the support, immediately after, and one month after to evaluate changes in caregiver appraisal. Participants were predominately women (n = 28) . There was no significant difference in caregiver burden (p = 0.992), positive appraisal (p = 0.735), or caregiving continuation (p = 0.152) before and after the support. However, among participants who had a high risk of caregiver burden, continuation of caregiving improved significantly over the period of support; this was not found for participants without a high risk. According to the study results, caregiver burden among caregivers of persons with dementia could be reduced by improving their understandingof the subjective feelings of caregiver burden.研究報

Clinical background factors as predictors of the efficacy of 5-aminosalicylic acid suppositories in patients with ulcerative colitis

Introduction: Although the efficacy of 5-aminosalicylic acid (ASA) suppositories for ulcerative colitis (UC) has been reported in many studies, many studies have also described poor adherence to 5-ASA suppository regimens. We aimed to identify the clinical background factors that influence adherence to 5-ASA suppositories to improve adherence and efficacy of the treatment. Methods: We conducted a retrospective cohort study of 61 patients with active UC who were using 5-ASA suppositories. All patients underwent endoscopy and rectal biopsy for histological diagnosis prior to 5-ASA suppository treatment. The efficacy of 5-ASA suppository treatment was compared in relation to clinical background factors (sex, age, disease duration, disease type, clinical activity, Ulceratve colitis Endoscopic Index of Severity, histological activity, serum C-reactive protein level, concomitant use of immunomodulators, history of steroid use, and dose of oral 5-ASA). Results: The efficacy of 5-ASA suppositories was significantly related to low Lichtiger Colitis Activity Index (LCAI) scores and proctitis type prior to its use. In terms of sex, females tended to show higher efficacy. Multivariate logistic regression analysis using these three factors showed high predictive value for the efficacy of 5-ASA suppositories (AUC, 0.788; sensitivity, 87.2%; and specificity, 63.7%). Discussion/Conclusion: This study is the first to extract clinical background factors for predicting the efficacy of 5-ASA suppositories. The use of 5-ASA suppositories in patients who are expected to show efficacy will be effective in improving patient co-operation