Investigation of the Influence of Mentors in the Workplace Environment of Nurses, including Associated Occupational Stress and Willingness to Continue Working

13301甲第4701号博士（保健学）金沢大学博士論文要旨Abstract 以下に掲載：Journal of Wellness and Health Care 41(2) pp.23-39 2018. Wellness and Health Care Society. 共著者：Hiromi Morioka, Kazuyo Kitaok

Malacoplakia of probable retroperitoneal origin.

A case of extravesical malacoplakia, the first case in Japan, is described in detail. The patient was a 61-year-old woman with a right flank mass. Radiologically, the mass was thought to be of the renal origin. Surgically, however, the tumor was found attached not only to the cortical surface but extended to the retroperitoneum and psoas muscle. Pathological examination confirmed the lesion to be malacoplakia characterized by the presence of von Hansemann cells and Michaelis-Gutmann bodies.</p

メンターが看護師の職場環境、職場ストレス、および就業継続意思におよぼす影響に関する研究

This study was performed to examine the conditions surrounding the existence of mentors on Japanese nurses, and to examine how the existence of mentors affects the workplace environment and associated occupational stress as well as the influence on willingness of nurses to continue working. Data were collected in a cross-sectional manner using a questionnaire distributed to a total of 1,517 nurses working in seven hospitals in Japan. The number of valid survey responses was 1,275 （average valid response rate = 95.0%）. The Japanese Mentoring Functions Questionnaire with nine items, the Japanese Areas of Worklife Survey （AWS）, and the Japanese Maslach Burnout Inventory-General Survey （MBI-GS） were used in this study to examine mentoring, the workplace environment, and occupational stress, respectively. We created an original scale to measure willingness to continue working. Approximately 60% of the nurses had mentors. Notably, more nurses in their 20s and 30s had mentors than those in their 40s or older. Nurses that had mentors showed significantly greater willingness to continue working. On the AWS, five scales of control, reward, community, fairness, and values, except workload, revealed a significantly higher accommodation state in the workplace. On the MBI-GS, those nurses that had mentors reported significantly lower levels of exhaustion and cynicism, while professional efficacy was significantly higher. In analysis by Structural Equation Modeling （SEM）, “mentors affect community in the workplace environment” and “mentors affect feeling of professional efficacy” were selected as the final models. The final model showed a significant relationship between the existence of mentors and the desire to continue working in the current place.本研究の目的は、日本の看護師を対象として、メンターの存在に関する実態を調べ、メンターの存在が職場環境や職業性ストレスにどのような影響をおよぼすか、さらに看護師の就業継続意思への影響を検討することであった。　質問紙法により横断的にデータ収集を行い、対象者は、7 つの病院に勤務する全看護者とし、合計 1,517 名であった。有効回答数は、調査票 1,275 票（平均有効回答率＝ 95.0％）であった。メンターは日本版 Mentoring Functions Questionnaire-9 items、職場環境は日本版 Arear of Worklife Survey（AWS）、職業性ストレスは日本版バーンアウト測定尺度 Maslach Burnout Inventory-General Survey（MBI-GS）を用いて測定した。看護師の就業継続意思は、独自に作成した尺度を使用し測定した。　約６割の看護師がメンターを持っていた。特に、20 歳代や 30 歳代の看護師の中でメンターを持つ者の割合が、40 歳代以上の看護師と比べて高かった。メンターを持つ看護師のほうが、就業継続意思が有意に高かった。AWS で測定した職場環境に関しては、仕事の負担を除く裁量権、報酬、共同体、公平性、価値観の 5 つの側面による職場適合状態が有意に高くなっていた。また、MBI-GS に関して見ると、メンターのいる者の疲弊感とシニシズムが有意に低く、逆に職務効力感が有意に高くなっていた。最終的に共分散構造モデル解析をした結果、メンターは、看護師の職場環境の中でも共同体に影響を、また職務効力感に影響をおよぼしているという最終モデルが選ばれた。就業継続意思との関係については、メンターは今勤務している部署で働き続けたいとの間に有意な関係が認められた

Advantage of Insulin Glulisine Over Regular Insulin in Patients With Type 2 Diabetes and Severe Renal Insufficiency

ObjectivesTo compare the efficacy and safety of insulin glulisine over regular insulin in patients with type 2 diabetes and severe renal insufficiency.SubjectsOur study included 18 patients with type 2 diabetes and a mean (range) estimated glomerular filtration rate of 13.2 mL/minute/1.73 m2 (5.8-27.6), which corresponds to stage 4-5 chronic kidney disease.DesignAfter titration of doses, regular insulin was administered thrice daily on Day 1, along with continuous glucose monitoring for 24 h starting at 7 am. Exactly equal doses of insulin glulisine were administered on Day 2. Area under the curve (AUC) for blood glucose level variation after breakfast (AUC-B 0-4), lunch (AUC-L 0-6), and dinner (AUC-D 0-6) were evaluated.ResultsAUC-B 0-4 and AUC-D 0-6 were significantly lower with insulin glulisine than with regular insulin (AUC-B 0-4: 3.3 ± 4.7 vs. 6.2 ± 5.4 × 102 mmol/L·minute, respectively, P = .028; AUC-D 0-6: 1.8 ± 7.3 vs. 6.5 ± 6.2 × 102 mmol/L·minute, respectively, P = .023). In contrast, AUC-L 0-6 was higher with insulin glulisine than with regular insulin (AUC-L 0-6: 7.6 ± 6.4 vs. 4.2 ± 8.7 × 102 mmol/L·minute, respectively, P = .099), suggesting a prolonged hypoglycemic action of regular insulin after lunch.ConclusionsInsulin glulisine effectively suppressed postprandial hyperglycemia, whereas regular insulin caused a prolonged hypoglycemic action. These findings support the effectiveness and safety of insulin glulisine in patients with type 2 diabetes and severe renal insufficiency

Luteal blood flow in patients undergoing GnRH agonist long protocol

<p>Abstract</p> <p>Background</p> <p>Blood flow in the corpus luteum (CL) is closely related to luteal function. It is unclear how luteal blood flow is regulated. Standardized ovarian-stimulation protocol with a gonadotropin-releasing hormone agonist (GnRHa long protocol) causes luteal phase defect because it drastically suppresses serum LH levels. Examining luteal blood flow in the patient undergoing GnRHa long protocol may be useful to know whether luteal blood flow is regulated by LH.</p> <p>Methods</p> <p>Twenty-four infertile women undergoing GnRHa long protocol were divided into 3 groups dependent on luteal supports; 9 women were given ethinylestradiol plus norgestrel (Planovar) orally throughout the luteal phase (control group); 8 women were given HCG 2,000 IU on days 2 and 4 day after ovulation induction in addition to Planovar (HCG group); 7 women were given vitamin E (600 mg/day) orally throughout the luteal phase in addition to Planovar (vitamin E group). Blood flow impedance was measured in each CL during the mid-luteal phase by transvaginal color-pulsed-Doppler-ultrasonography and was expressed as a CL-resistance index (CL-RI).</p> <p>Results</p> <p>Serum LH levels were remarkably suppressed in all the groups. CL-RI in the control group was more than the cutoff value (0.51), and only 2 out of 9 women had CL-RI values < 0.51. Treatments with HCG or vitamin E significantly improved the CL-RI to less than 0.51. Seven of the 8 women in the HCG group and all of the women in the vitamin E group had CL-RI < 0.51.</p> <p>Conclusion</p> <p>Patients undergoing GnRHa long protocol had high luteal blood flow impedance with very low serum LH levels. HCG administration improved luteal blood flow impedance. This suggests that luteal blood flow is regulated by LH.</p

Neuropathic Pain in Rats with a Partial Sciatic Nerve Ligation Is Alleviated by Intravenous Injection of Monoclonal Antibody to High Mobility Group Box-1

High mobility group box-1 (HMGB1) is associated with the pathogenesis of inflammatory diseases. A previous study reported that intravenous injection of anti-HMGB1 monoclonal antibody significantly attenuated brain edema in a rat model of stroke, possibly by attenuating glial activation. Peripheral nerve injury leads to increased activity of glia in the spinal cord dorsal horn. Thus, it is possible that the anti-HMGB1 antibody could also be efficacious in attenuating peripheral nerve injury-induced pain. Following partial sciatic nerve ligation (PSNL), rats were treated with either anti-HMGB1 or control IgG. Intravenous treatment with anti-HMGB1 monoclonal antibody (2 mg/kg) significantly ameliorated PSNL-induced hind paw tactile hypersensitivity at 7, 14 and 21 days, but not 3 days, after ligation, whereas control IgG had no effect on tactile hypersensitivity. The expression of HMGB1 protein in the spinal dorsal horn was significantly increased 7, 14 and 21 days after PSNL; the efficacy of the anti-HMGB1 antibody is likely related to the presence of HMGB1 protein. Also, the injury-induced translocation of HMGB1 from the nucleus to the cytosol occurred mainly in dorsal horn neurons and not in astrocytes and microglia, indicating a neuronal source of HMGB1. Markers of astrocyte (glial fibrillary acidic protein (GFAP)), microglia (ionized calcium binding adaptor molecule 1 (Iba1)) and spinal neuron (cFos) activity were greatly increased in the ipsilateral dorsal horn side compared to the sham-operated side 21 days after PSNL. Anti-HMGB1 monoclonal antibody treatment significantly decreased the injury-induced expression of cFos and Iba1, but not GFAP. The results demonstrate that nerve injury evokes the synthesis and release of HMGB1 from spinal neurons, facilitating the activity of both microglia and neurons, which in turn leads to symptoms of neuropathic pain. Thus, the targeting of HMGB1 could be a useful therapeutic strategy in the treatment of chronic pain

成人看護学実習における看護技術経験の実態

本研究の目的は、看護技術チェックリストを用いて成人看護学実習における看護技術の経験状況を明らかにし、成人看護学における臨地実習での教育・指導内容について検討することである。成人看護学実習Ⅰ（急性期実習）・Ⅱ（慢性期実習）を履修した学生に対し、看護技術チェックリスト90項目を用いて実習中の看護技術経験を調査した結果、急性期実習、慢性期実習ともに80％以上経験できた看護技術は、「快適な病床環境を作る」、「食事摂取状況のアセスメント」、「栄養状態のアセスメント」、「バイタルサイン測定」、「一般状態の変化」、「系統的な症状の観察」、「測定値・症状等からのアセスメント」、「スタンダード・プリコーションに基づく手洗い」、「防護用具の装着」、「療養病床を安全に整える」、「転倒・転落・外傷予防」の11項目であった。未経験が50％以上の項目は急性期実習で51項目、慢性期実習で64項目であった。臨地実習において学生が看護技術の経験を増やすことに限界はあるが、少ない経験からでも最大限の学びが得られるよう関わることや、看護技術の経験の機会を逃さない関わりが教員には必要であると示唆された

成人看護学実習において自己効力感を高める実習指導の検討 : 実習状況別の臨地実習自己効力感の違いおよびECTBを用いた実習指導評価との関連

成人看護学実習における実習状況別の臨地実習自己効力感の違いおよび、学生による実習指導評価との関連を明らかにすることを目的とし、効果的な実習指導方法への示唆を得る。成人看護学実習を履修した看護学生３年生91名を対象とし、臨地実習自己効力感および日本語版ECTBを用いた実習指導評価の自記式質問紙調査を実施した。その結果、成人看護学実習経験回数別における臨地実習自己効力感は、「対象の理解・援助効力感」の［患者の症状や状態を観察し、症状の変化に気づくこと］のみ、成人看護学実習２回目のほうが有意に高く、その他、成人看護学実習内容や受け持ち患者数などによる有意差はみられなかった。臨地実習自己効力感と実習指導評価の相関では、臨地実習自己効力感の「対象理解・援助効力感」と「指導者との関係性維持・学習姿勢効力感」が、ECTBのすべての構成要素に正の有意な相関を示した。また、臨地実習自己効力感の「友人との関係性維持効力感はECTBの「実践的な指導」「学習意欲への刺激」に正の有意な相関を示した。本研究により、実習指導者による実践的・理論的な指導、かつ学習意欲への刺激や学生への理解がなされるような指導は、学生の対象理解や看護援助への自信となり、指導者との関係性の構築や学習へ向かう姿勢を高め、自己効力感が向上することが示唆された

Discovery of widespread transcription initiation at microsatellites predictable by sequence-based deep neural network

Using the Cap Analysis of Gene Expression (CAGE) technology, the FANTOM5 consortium provided one of the most comprehensive maps of transcription start sites (TSSs) in several species. Strikingly, ~72% of them could not be assigned to a specific gene and initiate at unconventional regions, outside promoters or enhancers. Here, we probe these unassigned TSSs and show that, in all species studied, a significant fraction of CAGE peaks initiate at microsatellites, also called short tandem repeats (STRs). To confirm this transcription, we develop Cap Trap RNA-seq, a technology which combines cap trapping and long read MinION sequencing. We train sequence-based deep learning models able to predict CAGE signal at STRs with high accuracy. These models unveil the importance of STR surrounding sequences not only to distinguish STR classes, but also to predict the level of transcription initiation. Importantly, genetic variants linked to human diseases are preferentially found at STRs with high transcription initiation level, supporting the biological and clinical relevance of transcription initiation at STRs. Together, our results extend the repertoire of non-coding transcription associated with DNA tandem repeats and complexify STR polymorphism