がん患者・家族と看護師間のコミュニケーションに関する文献検討

がん患者・家族と看護師間のコミュニケーションに関する研究動向や内容を分析し、研究の動向と今後の研究課題を考察した。対象文献は16件あり、「がん患者・家族と関わる看護師のコミュニケーションの特徴」「がん患者・家族とのコミュニケーションに対する看護師の認識」「がん患者・家族とのコミュニケーションを助けるツールの開発・評価」「がん患者・家族が求めるコミュニケーション」の4つに分類された。様々な臨床経過のがん患者・家族とのコミュニケーションについて研究が進んでおり、患者を大切に思う姿勢を育む支援や、看護師が患者とのコミュニケーションを振り返り、意味付けする機会など新たな試みを検討する必要性が考えられた

Increase of nitrosative stress in patients with eosinophilic pneumonia

<p>Abstract</p> <p>Background</p> <p>Exhaled nitric oxide (NO) production is increased in asthma and reflects the degree of airway inflammation. The alveolar NO concentration (Calv) in interstitial pneumonia is reported to be increased. However, it remains unknown whether NO production is increased and nitrosative stress occurs in eosinophilic pneumonia (EP). We hypothesized that nitrosative stress markers including Calv, inducible type of NO synthase (iNOS), and 3-nitrotyrosine (3-NT), are upregulated in EP.</p> <p>Methods</p> <p>Exhaled NO including fractional exhaled NO (FE_NO) and Calv was measured in ten healthy subjects, 13 patients with idiopathic pulmonary fibrosis (IPF), and 13 patients with EP. iNOS expression and 3-NT formation were assessed by immunocytochemistory in BALf cells. The exhaled NO, lung function, and systemic inflammatory markers of the EP patients were investigated after corticosteroid treatment for 4 weeks.</p> <p>Results</p> <p>The Calv levels in the EP group (14.4 ± 2.0 ppb) were significantly higher than those in the healthy subjects (5.1 ± 0.6 ppb, p < 0.01) and the IPF groups (6.3 ± 0.6 ppb, p < 0.01) as well as the FE_NOand the corrected Calv levels (all p < 0.01). More iNOS and 3-NT positive cells were observed in the EP group compared to the healthy subject and IPF patient. The Calv levels had significant positive correlations with both iNOS (r = 0.858, p < 0.05) and 3-NT positive cells (r = 0.924, p < 0.01). Corticosteroid treatment significantly reduced both the FE_NO(p < 0.05) and the Calv levels (p < 0.01). The magnitude of reduction in the Calv levels had a significant positive correlation with the peripheral blood eosinophil counts (r = 0.802, p < 0.05).</p> <p>Conclusions</p> <p>These results suggested that excessive nitrosative stress occurred in EP and that Calv could be a marker of the disease activity.</p

Application of thermoresponsive HPLC to forensic toxicology: determination of barbiturates in human urine

A high-performance liquid chromatography (HPLC) method has been developed for the assays of five barbiturates in human urine using a new thermoresponsive polymer separation column, which is composed of N-isopropylacrylamide polymer. According to elevating the column temperature from 10 ℃ to 50 ℃, five barbiturates, such as metharbital, primidone, phenobarbital, mephobarbital and pentobarbital, became well separated by this method. Five barbiturates showed good linearity in the range of 0.2-10 mg/ml. Good accuracy, precision and recoveries for these drugs were obtained at 1 and 5 μg/ml urine. The method with the new-type column seems to have high potential to be extensively used in forensic toxicology for analysis of many drugs and poisons by HPLC and HPLC-mass spectrometry (MS) (-MS)

がん告知後の患者対応場面演習を行った看護学生のコミュニケーション技術の変化 : 実習前，実習初期，実習後期における自己評価の比較より

慢性期・終末期患者を受け持つ成人看護実習において、実習初期と後期にがん告知後患者対応場面演習を取り入れた。実習前と2回の演習後に記入する自己評価から、看護学生のコミュニケーション技術の変化を明らかにし、教育効果を検討した。実習前から実習初期演習後は、10項目で有意差があり、9項目で上昇、1項目で低下した。特に患者の思いや考えを引き出す技術や情報提示に関する項目の得点が上昇した。また話題の導入の項目で得点が有意に低下した。実習初期から後期の演習にかけて、全ての項目で得点は有意に上昇した。その中でも特に看護者の感情や考えなどを患者に表現する技術で得点が上昇した

外来におけるⅠ型糖尿病患者の理解 : セルフケア不足理論を用いて

外来において、青年期の1型糖尿病患者にオレムのセルフケア不足理論を用いたアセスメントを実施し、患者理解を試みた。その結果、①発達課題への対処や人生設計において、不安や葛藤、ストレスや孤独感により自己概念の修正が困難となる危険性、②低血糖症状の出現と合併症の危険性、③再び不規則な生活となる可能性、という3点が看護問題として明らかになった。セルフケア不足理論は、患者のセルフケア能力も評価したうえでセルフケア不足を明確にでき、患者の社会的側面や発達上の課題に伴う自己概念の修正についての深いアセスメントが可能であった。外来看護では、その時その時の細やかな情報収集と患者理解が重要である

がんサロン訪問における「患者・家族の声を聴く」看護学生の倫理的学び

看護教育において看護の対象者についての理解を深める教育方法として、がん患者とその家族が集い、情報交換や交流を行なうがんサロンへの訪問を行っている。「患者・家族の声を聴く」ことによる看護学生の倫理的学びを課題レポートから質的に分析し、明らかにした。学生は＜人間の生命、人間としての尊厳＞＜知る権利、自己決定のための支援＞＜信頼関係の形成とそれに基づく看護＞＜プライバシーの保護・尊重＞＜専門職をめざした自己研鑽＞＜謙虚に学ぶ姿勢＞の6カテゴリー、23サブカテゴリーについて学んでいた。当事者の「声を聴く」ことにより、看護者としての倫理的ケアへの感受性や問題意識を養う機会となることが示唆された

がん告知後の患者対応場面演習における看護学生の学び : 実習初期にロールプレイング演習を取り入れて

慢性期・終末期患者を受け持つ成人看護実習において、看護学生の患者とのコミュニケーションを支援するために患者対応場面のロールプレイング演習を導入した。演習後の看護学生の感想・学びの記録から看護学生の学びを明らかにし、教育効果を検討した。その結果、患者の理解の領域では2カテゴリー、よりよい関係を築くための対応の理解の領域では4カテゴリー、自分自身に関することの領域では3カテゴリーの学びを得ていた。学生は演習により患者理解と学生に必要とされるよりよい対応についての理解が促され、さらに自分自身を振り返ることで実習におけるコミュニケーションへの目標・動機づけとなっており、演習の教育効果が明らかとなった

Identification of novel proteins differentially expressed in pluripotent embryonic stem cells and differentiated cells

Mammalian pluripotent stem cells possess properties of self-renewal and pluripotency. These abilities are maintained by the strict regulation of pluripotent stem cell-specific transcription factor network and unique properties of chromatin in the stem cells. Although these major signaling pathways robustly control the characteristics of stem cells, other regulatory factors, such as metabolic pathways, are also known to modulate stem cell proliferation and differentiation. In this study, we fractionated protein samples from mouse embryonic stem (ES) cells cultured with or without the leukemia inhibitory factor (LIF). Protein expression was quantified by 2-dimensional differential gel electrophoresis (2D-DIGE). In total, 44 proteins were identified as being differentially expressed in the pluripotent stem cells and the differentiated cells. Surprisingly, half of the identified proteins were the proteins localized in mitochondria, which supply cellular energy and regulate cell cycle, development, and cell death. Some of these identified proteins are involved in the metabolic function and the regulation of pluripotency. Further analysis of the identified proteins could provide new information for the manipulation of pluripotency in ES cells

Anti-integrin αvβ6 autoantibodies in patients with primary sclerosing cholangitis

[Background] Patients with primary sclerosing cholangitis (PSC) possess autoantibodies against biliary epithelial cells. However, the target molecules remain unknown. [Methods] The sera of patients with PSC and controls were subjected to enzyme-linked immunosorbent assays to detect autoantibodies using recombinant integrin proteins. Integrin αvβ6 expression in the bile duct tissues was examined using immunofluorescence. The blocking activity of the autoantibodies was examined using solid-phase binding assays. [Results] Anti-integrin αvβ6 antibodies were detected in 49/55 (89.1%) patients with PSC and 5/150 (3.3%) controls (P < 0.001), with a sensitivity and specificity of 89.1% and 96.7%, respectively, for PSC diagnosis. When focusing on the presence or absence of IBD, the proportion of the positive antibodies in PSC with IBD was 97.2% (35/36) and that in PSC alone was 73.7% (14/19) (P = 0.008). Integrin αvβ6 was expressed in bile duct epithelial cells. Immunoglobulin (Ig)G from 15/33 patients with PSC blocked integrin αvβ6-fibronectin binding through an RGD (Arg–Gly–Asp) tripeptide motif. [Conclusions] Autoantibodies against integrin αvβ6 were detected in most patients with PSC; anti-integrin αvβ6 antibody may serve as a potential diagnostic biomarker for PSC

Identification of an Anti–Integrin αvβ6 Autoantibody in Patients With Ulcerative Colitis

指定難病「潰瘍性大腸炎」の自己抗体発見 --新たな診断や治療開発へ--. 京都大学プレスリリース. 2021-03-09.Background and Aims: Ulcerative colitis is the most frequent type of inflammatory bowel disease and is characterized by colonic epithelial cell damage. Although involvement of autoimmunity has been suggested in ulcerative colitis, specific autoantigens/antibodies have yet to be elucidated. Methods: Using 23 recombinant integrin proteins, we performed enzyme-linked immunosorbent assays on sera from patients with ulcerative colitis and controls. Integrin expression and IgG binding in the colon tissues of patients with ulcerative colitis and controls were examined using immunofluorescence and coimmunoprecipitation, respectively. The blocking activity of autoantibodies was examined using solid-phase binding and cell adhesion assays. Results: Screening revealed that patients with ulcerative colitis had IgG antibodies against integrin αvβ6. In the training and validation groups, 103 of 112 (92.0%) patients with ulcerative colitis and only 8 of 155 (5.2%) controls had anti–integrin αvβ6 antibodies (P < .001), resulting in a sensitivity of 92.0% and a specificity of 94.8% for diagnosing ulcerative colitis. Anti–integrin αvβ6 antibody titers coincided with ulcerative colitis disease activity, and IgG1 was the major subclass. Patient IgG bound to the integrin αvβ6 expressed on colonic epithelial cells. Moreover, IgG of patients with ulcerative colitis blocked integrin αvβ6–fibronectin binding through an RGD (Arg-Gly-Asp) tripeptide motif and inhibited cell adhesion. Conclusions: A significant majority of patients with ulcerative colitis had autoantibodies against integrin αvβ6, which may serve as a potential diagnostic biomarker with high sensitivity and specificity