患者アドボカシー相談活動における相談者のエンパワメント形成過程

本研究の目的は,患者アドボカシー相談活動における相談者と相談対応者の関わりのなかで,対応者の援助内容と相談者のエンパワメントの形成過程について明らかにすることである。過去48事例の相談記録の中から,対応者が認識したエンパワーされたと考える相談者のポジティブな変化のみられた22事例を対象に内容分析によるカテゴリー抽出を行った。その結果,対応者の"理解・受け止め""問いかけ・振り返り""提案・指示""情報提供""支持""助言・指導"など6つの援助を通して,"相談者自身が気持ちを表出する""気持ちが落ち着く""問題の整理と意識化""問題解決方法を考える""問題解決行動への意思決定"の5つの局面でエンパワメント形成が認められた。The purpose of this study is to clarify the clients' empowerment features and the support they receive in advocacy consultations between the clients and consultants. A content analysis and categorization were performed, targeting 22 consultation cases (out of 48) which, nurses recognized, were empowered displaying positive changes. Results showed the clients were provided by the consultants with six types of intervention: 1) understanding and acceptance of the situation, 2) questioning and looking back, 3) suggestion and instruction, 4) supplying information, 5) ongoing support, and 6) advice and guidance. In receiving such support, the clients were found to go through the five stages of empowerment formation: 1) expression of personal feelings, 2) calm self-assessment, 3) recognition and awareness of the specific problems, 4) problem solving, and 5) decision making for taking specific problem-solving action

Analysis of Dietary Intake during Consecutive-Day Chemotherapy for Bone and Soft-Tissue Sarcomas

BackgroundBone and soft tissue sarcomas are commonly treated with consecutive-day chemotherapy regimens consisting of multiple anticancer agents. Chemotherapy-induced nausea and vomiting (CINV) is a serious adverse effect of these regimens and may result in decreased energy intake during chemotherapy. Decreased energy intake may lead to undernutrition and may cause adverse effects on patient quality of life and survival.MethodsPatients with bone and soft tissue sarcomas who received consecutive-day chemotherapy were retrospectively evaluated. CINV and dietary energy intake were assessed, as well as the occurrences of hiccups and constipation during chemotherapy.ResultsA total of 13 patients, 10 males and 3 females, with a total 16 chemotherapy courses were included in the study. All patients received antiemetic prophylaxis. The CINV control rate, defined as no emesis and no rescue therapy, gradually decreased from chemotherapy day 1 (94%) to day 5 (75%). Four patients experienced emesis, two of whom had been treated with a cisplatin-containing regimen. Decreased dietary energy intake was possibly associated with CINV during chemotherapy. Anorexia was grade 2 except for one case of grade 3. The incidences of hiccups and constipation were high on days 3–5.ConclusionAntiemetic prophylaxis treatment did not prevent emesis due to consecutive-day chemotherapy, especially with cisplatin-containing regimens, in patients with bone and soft-tissue tumors. Dietary energy intake decreased during chemotherapy, and this appeared to be associated with CINV. In addition, the incidence of hiccups and constipation increased during the course of consecutive-day chemotherapy regimens. Although these results are based on a small number of patients, it may be important to observe nutritional status during chemotherapy, as this may reflect a patient’s general condition. Nutritional counseling might be useful in supporting nutritional status in patients undergoing chemotherapy

Biological Monitoring of human exposure to neonicotinoids using urine samples, and neonicotinoid excretion kinetics

[Background] Neonicotinoids, which are novel pesticides, have entered into usage around the world because they are selectively toxic to arthropods and relatively non-Toxic to vertebrates. It has been suggested that several neonicotinoids cause neurodevelopmental toxicity in mammals. The aim was to establish the relationship between oral intake and urinary excretion of neonicotinoids by humans to facilitate biological monitoring, and to estimate dietary neonicotinoid intakes by Japanese adults. [Methodology/Principal Findings] Deuterium-labeled neonicotinoid (acetamiprid, clothianidin, dinotefuran, and imidacloprid) microdoses were orally ingested by nine healthy adults, and 24 h pooled urine samples were collected for 4 consecutive days after dosing. The excretion kinetics were modeled using one- and two-compartment models, then validated in a non-deuterium-labeled neonicotinoid microdose study involving 12 healthy adults. Increased urinary concentrations of labeled neonicotinoids were observed after dosing. Clothianidin was recovered unchanged within 3 days, and most dinotefuran was recovered unchanged within 1 day. Around 10% of the imidacloprid dose was excreted unchanged. Most of the acetamiprid was metabolized to desmethyl-Acetamiprid. Spot urine samples from 373 Japanese adults were analyzed for neonicotinoids, and daily intakes were estimated. The estimated average daily intake of these neonicotinoids was 0.53-3.66 μg/day. The highest intake of any of the neonicotinoids in the study population was 64.5 μg/day for dinotefuran, and this was <1% of the acceptable daily intake

医学中央雑誌からみた看護情報学の動向とその捉え方

The purpose of this study is to analyze transitions in the literature of Nursing Informatics in Japan, and to establish basic materials to elicit what Nursing Informatics should be. We searched out 73 reports with the keyword "Nursing Informatics" in Igaku-Chuo Zasshi produced by Japan Medical Abstract Society (Web version) as of June, 2003. These reports have been classified into five categories and 21 subcategories. As for contents, the five categories have been 1) Practical use of nursing information, 2) Information education, 3) Construction of information systems, 4) Informational acquisition, and 5) Standardization of nursing information. Chronologically, these categories have been characterized in three periods. In the first period (1988～1994), reports were written about practical use of nursing information and information education, in the second period (1995～1999), about information systems, and in the third period (2000～2003), about informational acquisition and standardization of nursing information. The development of Nursing Informatics must be systematized to select, correlate, and exploit nursing information, with full utilization of the capabilities of using computer science