緩和ケアにおける人材育成研修の成果と課題 : 修了生の看護実践・自己の姿勢への活用

A県における緩和ケアの研修を修了した修了生173名に、研修後の看護実践と自己の行動の変化について質問紙調査を行った。その結果、身体症状の緩和や傾聴、日常生活への支援に関する看護実践、自己の姿勢・態度の変容に活かしやすく、精神症状の緩和、遺族ケア、意思決定、地域連携に関する看護実践には活かしにくかった。一方、スキルアップの動機づけにもなっていた。今後は、難しいと感じる分野の研修内容・方法の検討、モチベーションの維持・向上のための環境調整やフォローアップの機会が必要であることが明らかになった

Accumulation of secretory vesicles in the lacrimal gland epithelia is related to non-Sjögren's type dry eye in visual display terminal users.

Previous observations in a rat model of a non-Sjögren's syndrome (non-SS) type of dry eye seen in users of visual display terminals (VDT) indicated that secretory vesicle (SV) accumulation in the lacrimal gland epithelia contributes to the condition. Here, to examine this possibility in humans, we compared the lacrimal gland histology and percent SV area in the cytoplasm of acinar epithelial cells using light microscopy and transmission electron microscopy, in patients with VDT work-related non-SS dry-eye (VDT group), SS-induced dry-eye, and autopsied normal controls. In addition, the VAMP8 (vesicle-associated membrane protein 8, an exocrine-pathway molecule) and Rab3D (mature vesicle marker) were histochemically examined in lacrimal gland tissue sections. The lacrimal gland acini were larger in the VDT group than in the SS group, and the percent SV area was significantly higher in the VDT group than in the normal controls (P = 0.021) or SS group (P = 0.004). Immunostaining revealed abnormal distributions of VAMP8 in the VDT and SS groups. Rab3D was more strongly expressed in the cytoplasm of acinar epithelial cells in the VDT group than in that of normal controls. The duration of VDT use was significantly longer in the VDT group than in the other groups. These findings suggest that excessive SV accumulation in the acinar epithelia may contribute to the reduced tear secretion in VDT users