QOL and self-efficacy of patients with chronic hepatitis C for three months after interferon therapy began

本研究は,Interferon 治療過程におけるC型慢性肝炎患者のQOL 及びSelf-efficacy の変化と相互の関連性を,治療開始後3ヶ月までの期間において探求することを目的に行った.C型慢性肝炎患者45人を対象に,自記式質問紙調査法により,入院時と治療開始後1ヶ月,3ヶ月の3回にわたる縦断的調査を実施した.その結果,以下のことが明らかになった.1.QOL は,治療開始後1ヶ月以内に低下し,3ヶ月まで低値のまま推移し,副作用の影響を受けていた.2.Self-efficacy は,治療中の変化は見られず,副作用の影響を受けていなかった.3.QOL 下位尺度である心の健康,活力,社会生活機能と,Self-efficacy の間に,正の相関を認めた.今後は支援検討に向けて,疾患特異的なSelf-efficacy やQOL 尺度を開発し,それらを用いてQOL とSelf-efficacyの関連性を確認する必要があろう.The purpose of this study was to investigate changes in the quality of life (QOL) and the self-efficacyof patients with chronic hepatitis C during the interferon treatment process, and mutual relevance,forthree months after the medical treatment began. The subjects were 45 patients with chronic hepatitis C,who answered a total of 3 surveys conducted at the time of hospitalization, one month after medicaltreatment began, and three months after using a questionnaire. As a result, the following conclusions weremade:1. QOL declined for one month after medical treatment began, and maintained a low value for threemonths. QOL was influenced by side effects.2. Self-efficacy did not change during the medical treatment. Self-efficacy was not influenced by sideeffects.3. In the relation of QOL and self-efficacy, a positive correlation between scales of QOL (such as mentalhealth, vitality, and social functioning) and self-efficacy was observed.For the support examination in the future,it is necessary to develop a self-efficacy and QOL standardrelation to hepatitis C disease,and the relationship between QOL and self-efficacy that uses a properoutcome measure is likely to be confirmed

Cognition, Training, and Education of Nurses in Oral Feeding Assistance for Hospitalized Patients: A Comparative Study among Nurses in China and Japan

This study compared cognition, training, and education regarding oral feeding assistance provided to hospitalized patients among nurses in China and Japan. The participants included 401 nurses from two general hospitals (China, 141; Japan, 260). The survey items included demographic characteristics, cognition about who should assist with oral feeding, the need for professional knowledge and skills, supporting patients with particular needs, essential steps in oral feeding assistance, and evaluation of training and relevant education. In total, 107 Chinese (75.9%) and 184 Japanese (70.8%) nurses returned completed questionnaires. Compared to Japanese nurses, a larger proportion of Chinese nurses (5.6% vs. 42.1%, p < 0.001) responded that a “family member” should assist with oral feeding. Most (92.5% of Chinese and 98.9% of Japanese, p < 0.01) nurses recognized the need for professional knowledge and skills. In both groups, cognition was high for eating environment and aspects of patients’ physical condition, such as dysfunction and position, but inadequate for aspects of patients’ psychological conditions, such as emotional state and appetite. Limited learning experiences, such as attending lectures, undergoing training, and exposure to literature, were observed among Chinese nurses compared to Japanese nurses. Compared to Japanese nurses, Chinese nurses showed inadequate cognition concerning the role of nurses in oral feeding assistance. The degree of cognition regarding this assistance may be associated with relevant learning experiences. To improve the quality of oral feeding assistance and execution of related nursing duties, greater emphasis on oral feeding assistance is necessary in the Chinese nursing curriculum

開腹手術患者における下肢筋組織厚の術前・術後の変化

In order to establish an objective and convenient technique to assess postoperative recovery following laparotomy, in particular activities of daily living, we measured the thickness of muscle tissues by ultrasound sonography. In the present study, the following four muscular compartments were selected: rectus femoris, biceps femoris, extensor digitorum longus, and soleus. These account for a large portion of the systemic skeletal musculature and are important for locomotion. Subjects were 28 patients who underwent moderately invasive surgery for stomach or colon cancer. The results showed that muscle thickness decreased significantly in all four compartments. Rectus femoris exhibited the greatest reduction in thickness and was most affected by short-term or long-term recumbency. Furthermore, for soleus, the tendency was that the longer the recumbency, the greater the wasting. These findings suggest that, of the four areas of the lower limb, rectus femoris is most affected by short-term recumbency and is most suited for objectively assessing postoperative recovery. The results of the present study suggest that it would be effective to design a recovery program focused on maintaining the femoral extensor muscles, which are most affected by short-term recumbency following laparotomy.広島保健学学会 特別講

The self-esteem and the activities of daily living in inpatients after an ischemic stroke

急性期の脳梗塞患者の自尊感情と日常生活動作の関連を明らかにするために,入院中の脳梗塞患者150人に調査協力を依頼した.調査協力の同意が得られなかった患者25人と調査前に退院された患者17人を除き,108人(72.0%)(男性74人,女性34人,平均年齢64.5(SD 12.5)才)にアンケート調査を実施した.自尊感情(Rosenberg のSelf-Esteem,以下RSE と記載)は平均29.9(SD 6.1)点,日常生活動作(Barthel index,以下BI と記載)は平均89.4(SD 16.0)点であり,RSE とBI の間にはBI が低いとRSE が低いという正の相関がみられた(Spearman のρ= 0.461,p < 0.001).また,BI が低いことと「女性である」「高齢である」「入院時の機能障害が重い」の関連が示唆された.急性期には,脳梗塞患者の日常生活動作の自立に向けた援助と,自尊感情を高める介入が必要であると考えられた.The purpose of this study was to investigate the relationship between self-esteem and the activities of daily living in inpatients after an ischemic stroke. The level of Rosenberg's Self-esteem and the Barthel index were examined. There were 108 respondents (74 males and 34 females). Based on these results, selfesteem was significantly correlated to the Barthel Index (Spearman's ρ=0.461, p<0.001). Findings indicated that low self-esteem related to dependence, and the level of dependence showed a negative association with women, the elderly and severe disability. These results suggested the necessity of rehabilitation for re-acquiring the skills of daily living and enhancement of self-esteem in patients who are dependent.広島保健学学会 特別講

Development of early neutropenic fever, with or without bacterial infection, is still a significant complication after reduced-intensity stem cell transplantation

AbstractLittle information is available on the clinical characteristics of infectious complications that occur in the early period after reduced-intensity stem cell transplantation (RIST). We retrospectively investigated the clinical features of neutropenic fever and infectious episodes within 30 days after RIST in 76 patients who had received fluoroquinolones as part of their antibacterial prophylaxis. Preparative regimens included cladribine 0.66 mg/kg or fludarabine 180 mg/m2 plus busulfan 8 mg/kg. All but 1 patient survived 30 days after transplantation, and 75 patients (99%) became neutropenic within a median duration of 9 days. Neutropenic fever was observed in 29 patients (38%), and bacterial infection was confirmed in 15 (20%) of these, including bacteremia (n = 13), bacteremia plus pneumonia (n = 1), and urinary tract infection (n = 1). The causative organisms were gram-positive (n = 9) and gram-negative organisms (n = 7), with a mortality rate of 6%. Neither viral nor fungal infection was documented. Multivariate analysis showed that the presence of neutropenia at the initiation of preparative regimens was an independent risk factor for subsequent documented bacterial infections (P = .026; 95% confidence interval, 1.25–35.1). We conclude that neutropenic fever and bacteremia remain common complications in RIST

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

The presents and the prospects of the education of the radiology nursing for the undergraduate nursing students in Japan <Issues>

放射線診療領域の進展は目覚ましく, 日常の一般診療においては検査や治療など多様な形態の多数の機器が活用されている. しかし, 日常診療の補助を司る一般看護職の知識や技術は, 卒後研修を受講しない限り, 看護基礎教育レベルに留まってしまう. 同様に, 大規模災害時の医療提供の最前線には, 一般看護職が活躍することを併せ考えると, 看護基礎教育レベルの放射線看護領域の教育状況についての検討が必要と考える. 本稿では, 看護基礎教育課程を概観し, 教科書的成書と看護師国家試験問題における取り上げ方などを検討し, 今後の在り方について展望した

The degree of burden experienced by caregivers caring for the frail elderly at home : with a focus on incontinence care

本研究の目的は,65歳以上の高齢者(以下,被介護者)の介護を在宅で主に担う家族介護者(以下,主介護者)の介護負担感に,被介護者の排尿状況や主介護者・被介護者各々の各属性がどのように関連しているかを明らかにすることである。介護負担感の把握にZarit介護負担尺度日本語版(以下,J-ZBI),尿失禁の分別判定に排尿チェック表を各々用いて作成した質問紙を,協力施設の対象者162名に配付した。その結果,101名(62.3%)から有効回答を得,内94名(93.1%)の被介護者に尿失禁を認めた。J-ZBI得点は,被介護者に尿失禁「有」群(38.6±19.2点)が「無」群(29.3±22.6点)よりも高かった。主介護者の介護負担感を示すJ-ZBI得点は,被介護者の排尿時に「介助不要」より「半・少し介助」を要す方が高い傾向を示した(p < 0.1)。また,尿とりパッド「着用」群を介護する主介護者の方が「非着用」群を介護する者よりJ-ZBI得点が高い傾向を示した(p < 0.1)。一方,介護支援者「有」群は「無」群よりJ-ZBI得点が低かった(p < 0.05)。これらの結果から,排尿介護による介護負担感を低減するためには,尿とりパッド「着用」や排尿時に「半・少し介助」が必要な被介護者に,トイレ移動や排尿時の下着の上げ下げ・尿とりパッド交換のためのリハビリテーションを実施し,被介護者の排尿行動能力の向上に努めることが必要であると考えられた。The purpose of this study was to investigate the impact on their caregiver of urinary incontinence in frail elderly persons cared for at home. The study also aimed to explore the relationships between the characteristics of the elderly and their caregivers, and the degree of burden experienced by the caregivers. Questionnaires were distributed to 162 caregivers. The questionnaire consisted of demographic questions, the Japanese version of the Zarit Burden Inventory (J-ZBI), and a voiding check sheet used to identify the types of urinary incontinence. Of 162 caregivers, 101 returned completed questionnaires (a 62.3% response rate). The results showed that 94 out of 101 elderly persons (93.1 %) had urinary incontinence. The degree of care burden experienced by caregivers was higher when they had to care for elderly with urinary incontinence than those without it. Moreover, the J-ZBI scores of the caregivers were moderately higher when the elderly required a moderate degree of voiding assistance than when they required no assistance (p < 0.1). Similarly, the J-ZBI scores were moderately higher when the caregivers had to care for elderly who used incontinence pads, compared with those who did not use them (p < 0.1). On the other hand, the J-ZBI scores of caregivers who received support from others were significantly lower compared with those without support (p < 0.05). It is important to improve the toileting ability of elderly persons who need incontinence pads and/ or a moderate level of voiding assistance by providing adequate rehabilitation training. Such training includes exercise in transferring to a toilet, exercise in pulling underwear up and down and exercise in wearing incontinence pads

The needs of the radiology course in the undergraduate nursing education in Japan: A literature review of foreign countries nursing college

【目的】諸外国の看護基礎教育カリキュラムにおける放射線関連科目の設置状況を調べ， 日本の看護基礎教育時の放射線教育の必要性を考察した． 【方法】英語版ホームページ公開をする看護系大学を対象に，インターネット検索サイトでカリキュラム内の放射線関連科目設置の有無を調べた．その他，看護碁礎教育の放射線学に関する文献，指針も調べた． 【結果】放射線関連科目を置く大学は，アメリカのLewis大学とオーストリアのGraz大学のみで， Lewisは科目「RadiationTherapy」を，Grazは科目「First Aid, Disaster Management and Radiation Protection」を設置していた．指針ではWorld Health Organizationの患者安全カリキュラムガイド，欧州のRadiation Protection No175に医療者養成時から必要な放射線学の内容が示されていた 【考察】諸外国の看護系大学においても放射線教育は殆どされていなかったが，指針として放射線医療を安全に提供するために，医療者養成時に教授すべき内容が示されていた．日本においても患者安全に立脚した放射線教育が必要だと考える．[Objective] We investigated the set up of radiology course in the undergraduate nursing education in foreign countries. And we discussed needs of radiology course in the undergraduate nursing education in Japan. [Methods] The English homepages of the nursing colleges were targeted and investigated. We investigated whether there was a course on radiology in the undergraduate curriculum of nursing college in foreign countries or not, by using several Internet search sites. In addition, literatures and guidelines related in the undergraduate nursing education were searched using several databases and Internet search sites. [Results] Lewis University (Lewis) in the USA and Medical University of Graz (Graz) in Austria already had a course of radiology. The radiology course were "Radiation Therapy" in Lewis and "First Aid, Disaster Management and Radiation Protection" in Graz. The training content necessary for medical staff were shown in Patient Safety Curriculum Guide by World Health Organization and in Radiation Protection No 175 by European Commission. [Discussion] It was clear that there were not many colleges had the course on radiology in the undergraduate curriculum of nursing in foreign countries. There were the guidelines shown in the training content necessary for medical staff. It was intended to provide radiation medical care safely. We considered it necessary for nursing students to be taught about radiology for patient safety at the time of undergraduate nursing education

The effects of horticultural activities on the cognitive and psychological functions of elderly with dementia <Original Articles>

施設入所中の10名の認知症高齢者に園芸活動を実施し,園芸活動が対象の認知機能と心理社会的機能に及ぼした影響について検討した.園芸活動の前後にはFive cognitive tests (5cog) を行い,各セッションの前後には唾液中クロモグラニンA (CgA) を測定した.また,各セッション終了後には, 『園芸活動運営記録用紙』にセッション中の対象者の状況を記録し,その内容を5cogやCgAの結果と併せて分析した. その結果, 5cogの『単語記憶』に統計学的に有意な差を認めたり,写真を用いた活動の振り返りでは対象者同士の会話の発展を認めたりするなど,認知機能への効果が確認された.一方,作業方法が理解できず,作業の遂行が困難だったセッションではCgA値が上昇していたり,難聴を有する者は全てのセッションでCgA値が上昇していたりと精神的ストレスを増加させる可能性のある状況について確認することができた