ザイタク リョウヨウシャ ト カイゴシャ ノ ソウゴ コウイ ブンセキ : アル セキツイ ソンショウシャ ノ キガエ バメン ニ チュウモク シテ

Our purpose of this study is to describe a field of home care in detail and to explore the lay knowledge (or body knowledge) and the particularity of the home care. We research the field by interaction analysis. A patient ‘F’ who has paralysis in the lower half of the body and the left upper limbs, permitted us video recording of her everyday life. We especially focus on the scene of (1) “putting on the jacket” and (2) “putting on the gloves (and so on)” with the help of two caregivers (housekeepers) in this paper. As a result of our analysis (1), we find that the caregivers move as if they were F’s hands and that the movements of them are overlapped in about 2 seconds. We also find that there is about 5 seconds interval between taking gloves and putting them on (2). ‘F’ holds out her hands, monitoring the caregivers’ movements one after the other. The F’s body consists in the intercorporeality with the caregivers. As A. Nishizaka suggests ‘the body distributed’, the body counters the distribution though F's body seems to be distributed in home care

制度的場面について : 緊急電話のエスノメソドロジー

In the first part (part1) ，we are going to illustrate what procedures sustain “proper emergency calls" inside and outside of the telephone emergency calls (119-talks). For that purpose，we analyzed the medical and fire emergency calls and their settings. The data were audio and videotaped at two dispatch centers in Japan from 1994 to 1995. First of all，following the studies by Don H. Zimmerman，we paid our attention to the inside of the talks. We found three features: (1) At the opening of the talk，the dispatcher asked the caller about the category of the emergency， (2) Both participants (caller and receiver) wanted to confirm the appropriateness (relevancy) of the emergency call， and (3) At the closing，almost every dispatcher said that a emergency vehicle was now leaving or had left already. Secondly，we investigated the video-data by referring to the studies by Jack Whalen. We found four important issues，which were useful for cooperative work within dispatch centers: (1) Dispatchers used item-line-up formats，(2) Dispatchers used some rather primitive communication tools，for example paper memo and white board. (3) Dispatchers were surrounded by well-integrated space-sound environments，and (4) Dispatchers take some particular body arrangements，including postures，to realize more collaborative works in the centers. By taking such procedures mentioned above， they accomplish and manage the emergency calls，and we may understand it is these procedures that construct the institutional settings of emergency dispatch centers. In part II，w e will examine institutional settings regarding the relationship between the (talk-in-) interaction and the institutions. Analyses of interaction are sometimes criticized that it is insufficient for treating institutions. However，we will note that the critics presuppose the interaction such a narrow way that it is limited at the micro-level. We would like to suggest so to speak the radicality of the interaction. First，we review the discussions in EM and CA regarding talk and institutional settings or the organization of work in order to examine this issue. Secondly，we consider another side of the problem that the concrete interactions which are observed in institutional settings do not accord easily with the nature of institutions which investigators suppose. After these examination，we investigate how the rules are followed or used by member as a part of skills informing their institutional feature

チュウト シンダン トイウ カテゴリー ヘンカ ノ ナカ デ イキル : ハッタツ ショウガイシャ ノ チュウト シンダン ケイケン ト ジコ タンキュウ ノ シャカイガク

There are similar characters between regional science research and developmental disorder research. The subjects of each field can be categorized into various types. When conducting research from the subject’s perspective, it is necessary, when connecting factors involved in categories, to treat matters related from the point of view of subject who are handling matters from their own strategic resources. Here is where the characteristics are similar between the two research fields. The present study considers the interdisciplinary overlap shared between regional science and developmental disorder research concerning the situation of undergoing a midlife diagnosis. Diagnoses undergone during midlife is defined as a diagnosis after the person has grown up, is able to self-select and mobilize resources and with the various resources conduct complex selections to accept or ease the impact of the diagnosed self. Thus, in the present study, interviews were conducted to investigate persons diagnosed in midlife with a developmental disorder. Based on the interview data, we clarify what strategies the persons developed upon diagnosis and how those particular strategies were related to characteristic of the diagnosed disorder. Following Fujimura, Masayuki’s perspective, we assume that contemporary society is a risk society In addition, we discuss, based on the hypothesis of the influence of a risk society, how to live or how to live after being diagnosed with a developmental disorder. As a result, we found that for those diagnosed with a developmental disorder, rather than the influence and effect of the diagnosis itself, critical is the influence and effect of the decisions of various organized systems of self-determination that are invoked upon the diagnostic. Furthermore, we found that there is a considerable differences in orientations of individual diagnosis and the reorganization strategies of living. However, this diversity represents similar characters of strategies of living in society with developmental disorders

Intensive endoscopic resection for downstaging of polyp burden in patients with familial adenomatous polyposis (J-FAPP Study III) : a multicenter prospective interventional study

Background Total colectomy is the standard treatment for familial adenomatous polyposis (FAP). Recently, an increasing number of young patients with FAP have requested the postponement of surgery or have refused to undergo surgery. We aimed to evaluate the effectiveness of intensive endoscopic removal for downstaging of polyp burden (IDP) in FAP. Method A single-arm intervention study was conducted at 22 facilities. Participants were patients with FAP, aged ≥ 16 years, who had not undergone colectomy or who had undergone colectomy but had ≥ 10 cm of large intestine remaining. For IDP, colorectal polyps of ≥ 10 mm were removed, followed by polyps of ≥ 5 mm. The primary end point was the presence/absence of colectomy during a 5-year intervention period. Results 222 patients were eligible, of whom 166 had not undergone colectomy, 46 had undergone subtotal colectomy with ileorectal anastomosis, and 10 had undergone partial resection of the large intestine. During the intervention period, five patients (2.3 %, 95 % confidence interval [CI] 0.74 %–5.18 %) underwent colectomy, and three patients died. Completion of the 5-year intervention period without colectomy was confirmed in 150 /166 patients who had not undergone colectomy (90.4 %, 95 %CI 84.8 %–94.4 %) and in 47 /56 patients who had previously undergone colectomy (83.9 %, 95 %CI 71.7 %–92.4 %). Conclusion IDP in patients with mild-to-moderate FAP could have the potential to be a useful means of preventing colorectal cancer without implementing colectomy. However, if the IDP protocol was proposed during a much longer term, it may not preclude the possibility that a large proportion of colectomies may still need to be performed

コウトウ キョウイク カイカク ノ ソウゴ コウイ ブンセキ : ビデオ エスノグラフィー ケンキュウ ノ ネライ ト コウガクブ トシ コウガク エンシュウ ノ ジッサイ

ビデオエスノグラフィーは、当事者的知識を十分に摂取しながら行うビデオ分析であり、我々は この方法で、高等教育改革の現場を研究した。生涯学習社会の到来を受けて、日本の高等教育は現在第 2 次世界大戦直後以来の改革期にある。すなわち、「知識」より「生涯学習能力」の獲得を志向した、 自発性を尊重するような様々な取り組みがなされ始めている。この高等教育の現場に対し、ワークプレ ース研究を行った。Ｂ大学工学部都市工学演習α班を分析対象とした調査の結果、①演習の課題解釈に は「従来の指標の相対化の要求の程度」を巡って２つの解釈があり得たこと、②班内にはその２種類の 解釈に対応した葛藤・対立的相互行為が存在したこと、③にもかかわらず、班内葛藤を生きる当事者が ともに専門性（「都市工学」）を志向していたこと、④したがって、課題理解のいかんにかかわらず、 班活動の全体が「都市工学演習」と呼び得るものになっていたこと、⑤その一方で、最終審査会場（ジ ュリー）ではこの２重性が十分レリバントなものとして浮かび上がって来ていなかったこと、これらの ことがわかった。諸結果を総合すると、学生の自主的活動を尊重するタイプの、新しい学習方法の吟味・ 評価のためには、学生によるその方法の実践状況の分析が有意義であるだろうこと、また、それは、場 合によっては教員の評価のパラダイムを変える力を持つだろうことなどが予測された。なお、本報告は、 文科省科学研究費補助金「高等教育改革のコミュニケーション分析－現場における文化変容の質的検討 －」（基盤研究（Ｂ）、 課題番号 １８３３０１０５、研究代表者：樫田美雄）ほかによる研究成果 の一部である

医学教育の相互行為分析 : 「OSCE」における実践の論理

The purpose of this paper is to explicate characteristics and logic of OSCE in medical education using ethnomethodology and video-ethnography. We will first introduce the methods we use, namely ethnomethodology and video-ethnography. then present our findings from activities and logic of practices that we captured in our research. We will then move to our findings that OSCE is neither a simple medical examination nor a simple assessment of medical knowledge. OSCE is collaboratively achieved as a very distinct activity which can not be called other than OSCE in and through the interaction among all three participants, namely, Medical Student, SP (Simulated Patient), and Examiners.本研究は,エスノメソドロジー研究,特にヴィデオ・エスノグラフィーという手法によって,医学教育におけるOSCEを分析したものである。あらかじめインタビューなどのフィールドワークを実施した上で,実際の試験場面をヴィデオ録画し,繰り返し検討する形で経験的な研究を行った。論文の前半でエスノメソドロジー研究,ヴィデオ・エスノグラフィ,フィールドワークといった調査の手続きについて詳しく述べた後,後半では,ヴィデオ録画に基づき,OSCEに特徴的な論理について詳らかにした。OSCEは,特有の実践の論理を持つ。たとえば,「身体検査を行うという側面」と「医学知識の評価という側面」を不即不離に合わせ持っている。探求の結果,OSCEが,医学生,模擬患者,そして評価者がそれぞれの関心に基づいて,「身体検査をするという課題」と「試験として成り立たせるという課題」を重なり合わせながら,自分達に望まれているさまざまな役割を協調的に遂行していく形を取っていること,すなわち共同的な諸行為の特有の実践の論理を持った集積として理解できることがわかった