Comparison in the views of life and death between nurses and docters of a University Hospital

医師と看護師の死生観とその影響要因の相違をふまえ，質の高い緩和ケアチームについて検討することを目的とした．A 大学病院に勤務する医師と看護師に死生観について質問紙調査を行った．平井らが開発した死生観尺度（▯＝０．８８，７因子２７項目）を用いた．有効回答は医師１２０名（医師群）と看護師３４７名（看護師群）であった。統計処理については危険率５％未満を有意差とした．分析にはSPSS１１．０J for Windows（SPSS社製）を用いた．倫理的配慮は倫理審査会の承認を得た後，対象者へは参加の自由とプライバシーの保護を保証した．①「死への恐怖・不安」と「人生の目的意識」の因子には群間で有意差は認められなかった．②「死後の世界観」，「解放としての死」，「死からの回避」，「死への関心」や「寿命観」の５因子において両群間で有意に看護師群の方が高かった．③年齢などの各要因と死生観尺度との関係は両群者ともに年齢と「寿命観」で有意差が認められた．④死を迎える時に，希望する場所と死生観尺度得点に有意差が認められた．医師と看護師の死生観は「死後の世界観」などの因子得点で有意差が認められ，緩和ケアチームを効果的に展開していくためには双方の死生観の理解と，ケアへの活用の必要性が示唆された．A high quality palliative care team has been examined considering the differences between doctors and nurses in their views of life and death and its influential factors. A survey has been conducted on doctors and nurses employed at A University Hospital in their views of life and death. “Rinroshiki Syakudo”, a scale developed by Hirai et al（▯＝０．８８，７ factors，２７ items）, has been used as a scale of their views. The results of １２０ doctors and ３４７ nurses were analyzed by t-test, and significant difference was defined as a risk below ５％. SPSS １１．０J for Windows（by SPSS）was used for the analysis. After an approval of an audit for an ethical consideration, participants were ensured their freedom to participate and privacy protection. １） No significant differences have been found in factors “death anxiety” and “life purpose” in scales of views of life and death ２） However ５ factors， “after life belief”， “death relief”，“death avoidance”， “death concern” and “supernatural belief” were significantly high in nurses. ３） There was also a significant difference between the age and their “supernatural belief” in both doctors and nurses. ４） There were also significant differences in “where they want to die” and the total score of the scale, when facing own death. There being differences in factors such as “afterlife belief” between doctors’ views and those of nurses, the result suggested the need to understand both of the views and reflect them to palliative care

ニンプ ノ ジドウシャ ウンテン ニ カンスル ケンキュウ ダイ3ポウ ウンテンチュウ ノ Cardiotocogram モニタリング

原

Differences among epitopes recognized by neutralizing antibodies induced by SARS-CoV-2 infection or COVID-19 vaccination

SARS-CoV-2 has gradually acquired amino acid substitutions in its S protein that reduce the potency of neutralizing antibodies, leading to decreased vaccine efficacy. Here, we attempted to obtain mutant viruses by passaging SARS-CoV-2 in the presence of plasma samples from convalescent patients or vaccinees to determine which amino acid substitutions affect the antigenicity of SARS-CoV-2. Several amino acid substitutions in the S2 region, as well as the N-terminal domain (NTD) and receptor-binding domain (RBD), affected the neutralization potency of plasma samples collected from vaccinees, indicating that amino acid substitutions in the S2 region as well as those in the NTD and RBD affect neutralization by vaccine-induced antibodies. Furthermore, the neutralizing potency of vaccinee plasma samples against mutant viruses we obtained or circulating viruses differed among individuals. These findings suggest that genetic backgrounds of vaccinees influence the recognition of neutralizing epitopes

Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ): a patient-based evaluation tool for hip-joint disease. The Subcommittee on Hip Disease Evaluation of the Clinical Outcome Committee of the Japanese Orthopaedic Association

AbstractBackgroundThe Japanese Orthopaedic Association Hip Score is widely used in Japan, but this tool is designed to reflect the viewpoint of health-care providers rather than that of patients. In gauging the effect of medical therapies in addition to clinical results, it is necessary to assess quality of life (QOL) from the viewpoint of patients. However, there is no tool evaluating QOL for Japanese patients with hip-joint disease.MethodsWith the aim of more accurately classifying QOL for Japanese patients with hip-joint disease, we prepared a questionnaire with 58 items for the survey derived from 464 opinions obtained from approximately 100 Japanese patients with hip-joint disease and previously devised evaluation criteria. In the survey, we collected information on 501 cases, and 402 were subjected to factor analysis. From this, we formulated three categories—movement, mental, and pain—each comprising 7 items, for a total of 21 items to be used as evaluation criteria for hip-joint function.ResultsThe Cronbach’s α coefficients for the three categories were 0.93, 0.93, and 0.95, respectively, indicating the high reliability of the evaluation criteria. The 21 items included some related to the Asian lifestyle, such as use of a Japanese-style toilet and rising from the floor, which are not included in other evaluation tools.ConclusionsThis self-administered questionnaire may become a useful tool in the evaluation of not only Japanese patients, but also of members of other ethnic groups who engage in deep flexion of the hip joint during daily activities

Antibody titers against SARS-CoV-2 decline, but do not disappear for several months

Background: To develop an effective vaccine against a novel viral pathogen, it is important to understand the longitudinal antibody responses against its first infection. Here we performed a longitudinal study of antibody responses against SARS-CoV-2 in symptomatic patients. Methods: Sequential blood samples were collected from 39 individuals at various timepoints between 0 and 154 days after onset. IgG or IgM titers to the receptor binding domain (RBD) of the S protein, the ectodomain of the S protein, and the N protein were determined by using an ELISA. Neutralizing antibody titers were measured by using a plaque reduction assay. Findings: The IgG titers to the RBD of the S protein, the ectodomain of the S protein, and the N protein peaked at about 20 days after onset, gradually decreased thereafter, and were maintained for several months after onset. Extrapolation modeling analysis suggested that the IgG antibodies were maintained for this amount of time because the rate of reduction slowed after 30 days post-onset. IgM titers to the RBD decreased rapidly and disappeared in some individuals after 90 days post-onset. All patients, except one, possessed neutralizing antibodies against authentic SARS-CoV-2, which they retained at 90 days after onset. The highest antibody titers in patients with severe infections were higher than those in patients with mild or moderate infections, but the decrease in antibody titer in the severe infection cohort was more remarkable than that in the mild or moderate infection cohort. Interpretation: Although the number of patients is limited, our results show that the antibody response against the first SARS-CoV-2 infection in symptomatic patients is typical of that observed in an acute viral infection