地域社会で生きるがんサバイバーを支援するスタッフ養成経験型学習プログラムの試み

ファミリー・ホスピス株式会社京都府立医科大学大学院保健看護学研究科独立行政法人 国立病院機構 京都医療センター京都大学大学院医学研究科大阪大学CO デザインセンタ―Family Hospice, Ltd.Graduate School of Nursing for Health Care Science, Kyoto Prefectural University of MedicineNational Hospital Organization, Kyoto Medical CenterGraduate School of Medicine, Kyoto UniversityCenter for the Study of CO Design, Osaka University本研究は、地域社会で生きるがんサバイバーを支援するスタッフを養成するための学習プログラムを展開し、学習効果を検討することを目的とした。13名を対象にプログラムを実施した。本プログラムの特徴は、支援者が患者－医療者といった役割や立場にとらわれず、Safe Community of Inquiry（以下、ScoI）に基づく対話を体験し、対話的態度を身に付けることを試みた点である。プログラムの評価指標は、量的な評価として対話評価項目、批判的思考態度尺度、講義内容の理解度、対話体験の自己評価などを設定した。さらに、質的評価として、対話体験の自己評価の選定理由から得られた質的データ、支援に対する認識を設定した。分析対象者は12名であった。対話評価項目、批判的思考態度尺度の前後比較において有意な差は認めなかったが、講義内容の理解度、対話体験、支援に対する認識の自己評価は高かった。対話体験の自己評価の選定理由から得られたデータの質的分析では、対話体験の特徴として【自分らしくいられる場への信頼】【問いの本質への探究】【ケア的思考への気づき】【自己内省することにより得られた発見】の4カテゴリが抽出され、本プログラムの対話体験が、SCoIに基づく対話として成立していたことが示唆された。量的評価による有意差は認めなかったが、講義の理解度、対象者の対話体験の質的分析結果等から本プログラムの実施可能性が示唆されたと考える。今後はプログラムを修正した上で、評価指標も含め再構築していくことが課題である

Trends in the effect of COVID-19 on consultations for persons with clinical and subclinical eating disorders

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has increased the risk of individuals developing eating disorders and has exacerbated existing eating disorders. This observational study investigated the impact of the COVID-19 pandemic on patients with clinical and subclinical eating disorders. Methods This study was conducted over a period of four years: two years before and after the onset of the COVID-19 pandemic in Japan. We recorded the number and types of consultations provided by the Eating Disorder Treatment and Support Center coordinator. For subgroup analysis, data were classified by age, body mass index, and source of consultation, including patients, families, and personnel. The Seasonal Decomposition of Time Series by Loess was used for time series analysis. Results The total number of consultations increased after the start of the pandemic and peaked around the beginning of 2022, before subsequently falling despite the increase in the number of COVID-19 infections. A similar trend was observed in patients aged 10–29 years. The study period coincided with social isolation and school/college/university closures. Conclusions The number of eating disorder consultations increased after the start of the pandemic. Although COVID-19 infections persisted, the pandemic’s impact was transient

Effects of Repeated I-131-Meta-Iodobenzylguanidine Radiotherapy on Tumor Size and Tumor Metabolic Activity in Patients with Metastatic Neuroendocrine Tumors

I-131-meta-iodobenzylguanidine (I-131-MIBG) radiotherapy has shown some survival benefits in metastatic neuroendocrine tumors (NETs). European Association of Nuclear Medicine clinical guidelines for I-131-MIBG radiotherapy suggest a repeated treatment protocol, although none currently exists. The existing single-high-dose I-131-MIBG radiotherapy (444 MBq/kg) has been shown to have some benefits for patients with metastatic NETs. However, this protocol increases adverse effects and requires alternative therapeutic approaches. Therefore, the aim of this study was to evaluate the effects of repeated I-131-MIBG therapy on tumor size and tumor metabolic response in patients with metastatic NETs. Methods: Eleven patients with metastatic NETs (aged 49.2 +/- 16.3 y) prospectively received repeated 5,550-MBq doses of I-131-MIBG therapy at 6-mo intervals. In total, 31 treatments were performed. The mean number of treatments was 2.8 0.4, and the cumulative I-131-MIBG dose was 15,640.9 + 2,245.1 MBq (286.01 MBq/kg). Tumor response was observed by CT and 18F-FDG PET or by F-18-FDG PET/CT before and 3-6 mo after the final I-131-MIBG treatment. Results: On the basis of the CT findings with RECIST, 3 pa tients showed a partial response and 6 patients showed stable disease. The remaining 2 patients showed progressive disease. Al though there were 2 progressive-disease patients, analysis of all patients showed no increase in summed length diameter (median, 228.7 mm [interquartile range (10R), 37.0-336.0 mm] to 171.0 mm [IQR, 38.0-270.0 mm]; P = 0.563). In tumor region-based analysis with par tial-response and stable-disease patients (n = 9), I-131-MIBG therapy significantly reduced tumor diameter (79 lesions; median, 16 mm [IQR, 12-22 mm] to 11 mm [10R, 6-16 mm]; P < 0.001). Among 5 patients with hypertension, there was a strong trend toward systolic blood pressure reduction (P = 0.058), and diastolic blood pressure was significantly reduced (P = 0.006). Conclusion: Eighty-two percent of metastatic NET patients effectively achieved inhibition of disease progression, with reduced tumor size and reduced metabolic activity, through repeated I-131-MIBG therapy. Therefore, this relatively short-term repeated I-131-MIBG treatment may have potential as one option in the therapeutic protocol for metastatic NETs. Larger prospective studies with control groups are warranted

Effects of Repeated 131I-meta-iodobenzylguanidine Radiotherapy on Tumor Size and Tumor Metabolic Activities in Patients with Metastatic Neuroendocrine Tumors

131I-meta-iodobenzylguanidine (131I-MIBG) radiotherapy has shown some survival benefits in metastatic neuroendocrine tumors (NETs). European Association of Nuclear Medicine (EANM) clinical guidelines for 131I-MIBG radiotherapy suggest a repeated treatment protocol, although none currently exists. The existing single-high-dose 131I-MIBG radiotherapy (444 MBq/kg) has been shown to have some benefits for patients with metastatic NETs. However, this protocol increases adverse effects and it requires alternative therapeutic approaches. Therefore, the aim of this study was to evaluate the effects of repeated 131I-MIBG therapy on tumor size and tumor metabolic response in patients with metastatic NETs