An actual condition survey on “career development regarding cancer nursing”

本研究の目的は，看護職者のキャリアディベロップメント支援のための継続教育プログラムの構築の基礎資料を得るために，A県下の看護職者のがん看護に関する学習状況やキャリア志向の実態を明らかにすることである．A県下病床数１００床以上の外・内科を併設する病院１７施設の看護職者１０１７名中６８６名（回収率６７．５％）を分析対象とした．結果，がん看護に関する学習項目全てにおいて学習ニードが高かった．また，がん看護の学習機会を持つ者や学習の阻害要因はないと回答した者が多かった．職業的満足感では“看護の仕事にやりがいを感じている”“仕事上での目標がある”と回答した者が多く，“今の看護の仕事に満足している”とした者は約半数であった．がんに関する資格取得希望者は少なかった．がん看護に関する学習ニードと対象者の背景および学習機会，阻害要因，キャリア志向との関係については，学習機会があると回答した方が学習ニードの合計得点の平均値が高かった（P＜０．０５）．また，阻害要因があると回答した方が学習ニードの合計得点の平均値が高かった（P＜０．０５）．職業的満足感では“看護の仕事にやりがいを感じている”で〈そう思う群〉の方が学習ニードの合計得点の平均値が高かった（P＜０．０５）．“仕事上での目標がある”では〈そう思う群〉の方が学習ニードの合計得点の平均値が高かった（P＜０．０５）．“今の看護の仕事に満足している”では〈思わない群〉の方が学習ニードの合計得点の平均値が高かった（P＜０．０５）．資格取得希望者の方が学習ニードの合計得点の平均値が高かった（P＜０．０５）．以上より，がん看護に関する学習ニードの高さが示された．がん看護に関するキャリアディベロップにおいて，施設側と教育側の連携と学習ニードを充実させていくことが鍵となることが示唆された．The objective of this study was to elucidate the actual conditions of learning needs for cancer nursing and career-intended mind among nursing staff in Prefecture A in order to obtain basic information for establishing a continuing educational programs as support for developing a career of nursing staff. A survey was conducted on １０１７ nurses working at one of １７ hospitals with ≥１００ beds in Prefecture A that have both a department of surgery and a department of internal medicine. Answers from ６８６ nurses （response rate, ６７．５％）were analyzed. The results indicated that there was a high level of learning needs in all learning items regarding cancer nursing. In addition, many nurses answered that they had opportunities to learn cancer nursing or that they had no obstacles to learn. Regarding job satisfaction, many nurses answered that they “feel worthwhile in nursing work” and “have objectives in their jobs” and approximately half of them answered that they “are satisfied with current nursing work”. Few nurses had a desire to acquire qualifications for being engaged in a high level of cancer care. In comparison of average scores of learning needs, nurses who answered there was a learning opportunities have higher scores than total average scores（P＜０．０５）. In addition, learning need was high the one where had a hindrances to learning（P＜０．０５）. As for the learning needs regarding cancer nursing and the relations of the career intention, learning need was higher Agree group in “find nursing work rewarding” （P＜０．０５） and “have career objectives” （P＜０．０５）. Furthermore, learning need was higher Disagree group in “are satisfied with current nursing work” （P＜ ０．０５）. Learning need was higher a qualification applicant （P＜０．０５）. These findings indicate a high level of learning needs regarding cancer nursing. It is necessary for “career development regarding cancer nursing” to be filled up in cooperation and learning need

Dietary treatment for the aged (A study on dietary treatments for the aged conducted at the time of leaving hospital and on the results of interviews with discharged patients)

高齢者を対象とした退院指導の評価を行う目的で、70歳以上の外来通院患者を対象として、患者が受けた退院指導の内容、理解度、実践状況の3つの要素について分析を行った。その中から、特に食事指導に焦点をあて在宅療養の視点から退院指導の問題点を考察した。食事指導を受けて退院した患者の約半数は更に指導を希望していた。指示された指導が実践できない患者の理由は、(1)指導不足、(2)意欲の喚起不足、(3)協力者の知識不足が上げられた。患者が希望している指導の内容は、食事療法の指導だけでなく、治療食や老人に適した食事についてであった。特に、栄養価の高い食事への関心が高く、具体的な指導を希望していた。また、看護婦による、社会資源を活用すべきかどうか、訪問看護を適応すべきかどうかの判断が、退院に向けてのアセスメントの内容として問題となった。With the purpose of estimating the quality of care given to elderly patients who are about be discharged, we made an analysis of three main factors. The first is the details of discharge-care, secondly the degree to which the patient underdtands the type of care, and thirdly the care practice situation ; focusing on outpatients who are more than 70 years of age. Bringing meal treatment into focus, we examined the problems of discharge-care from the viewpoint of home treatment. About half of the discharged patients who were given meal treatment in the hospital hope to have further personal medical direction about their meals after being discharged. The reasons why the directed treatments couldn't be practiced by the patients were given as follows ; (a) deficiency of medical guidance, (b) insufficient encouragement of practice, (c) cooperator's having lack of knowledge about care of the aged. The details of medical treatments which the elderly patients want to be given are not only what is called meal treatment but also knowledge about food for patients and about appropriate meals for the aged. The patients seem to be highly interested in nutritious food and hope to have concrete advice for following a nutritious diet. Additionally, what is important in deciding the question of discharging is how to make good use of social resources by nurses and how to apply visiting nursing to be aged

Research of the problems on the elderly patients at discharge from the hospital concerning their health and daily life at home

高齢者の退院指導及び在宅看護の在り方を検討した研究は少ない。そこで、高齢者の自宅院時に持つ健康上及び生活上の問題を明らかにすることを目的に、面接調査を行った。対象は、中・四国の3国立大学付属病院と1総合病院で退院許可のあった70歳以上の患者78名とした。調査内容は、退院時の患者の身体状態・日常生活動作・退院時の患者の状況・家族の状況・健康に対する意識や取り組みについてとした。その結果、(1)高齢の自宅退院患者の23.1％は、身体状態上継続看護が必要であった。(2)退院患者の20.5％が、退院後生活を自立する為に介助が必要であるとしていた。(3)退院患者の57.7％は心配事を持ち、50％は相談・指導を希望していた。(4)患者の世話人の42.3％は職業を持ち、27.3％は健康を害していた。(5)退院患者の73.1％は何らかの健康管理がなされ、84.7％は生きがいを持っていた。Now there are few researehes into the guidance which be done for the elderly patients at the time of leaving the hospital and into the ways of their home nursing care. Therefore, we did interview the elderly patients in order to make it clear what problems they have about their health and their life. In the three national university hospitals in Chugoku District and Shikoku District and one general hospial, we focussed on the 78 patients more than seventy years old who were allowed to leave the hospital. The purpose of our research is to know body condition and the situation of the patients leaving the hospital, activities of their daily life, the situation of their family and their consciousness and care about their health. After having done this research we conclude as follows, (1) 23.1 percent of all the patients need continuing nursing care from the viewpoint of their body condition after leaving the hospital. (2) 20.5 percent of all the patients need help from their family or others to support themselves at home. (3) 57.7 percent of all the patients have worries and 50 percent of them have a wish to consult with the doctors or the nurses and to be guided by them. (4) 42.3 percent of people who take care of patients have their own job and suffer from poor health. (5) 73.1 percent of all the patients who leaves the hospital were given some health care before entering the hospital and 84.7 percent of them seem to lead a life worth living

Evaluation of the Total Design Method in a survey of Japanese dentists

BACKGROUND: This study assessed the application of the Total Design Method (TDM) in a mail survey of Japanese dentists. The TDM was chosen because survey response rates in Japan are unacceptably low and the TDM had previously been used in a general population survey. METHODS: Four hundred and seventy eight dentist members of the Okayama Medical and Dental Practitioner's Association were surveyed. The nine-page, 27-item questionnaire covered dentist job satisfaction, physical practice, and dentist and patient characteristics. Respondents to the first mailing or the one-week follow-up postcard were defined as early responders; others who responded were late responders. Responder bias was assessed by examining age, gender and training. RESULTS: The overall response rate was 46.7% (223/478). The response rates by follow-up mailing were, 18% after the first mailing, 35.4% after the follow-up postcard, 42.3% after the second mailing, and 46.7% after the third mailing. Respondents did not differ from non-respondents in age or gender, nor were there differences between early and late responders. CONCLUSION: The application of TDM in this survey of Japanese dentists produced lower rates of response than expected from previous Japanese and US studies

A review of literature concerning safety in midwife-managed delivery units systems in Japan

院内助産システムの安全性を探ることを目的とし、医学中央雑誌を用いて、「院内助産システム」また、「院内助産」、「助産師外来」「バースセンター」のキーワードで国内文献を検索した。ヒットした 8３1 件のうち、２01２ 年から 5 年間に絞り ２61 件、さらに原著論文に限定して85 件が抽出された。そのうち、運用基準、医師への移行(医療介入 )率の記載、分娩アウトカム指標の記述がある文献 11 件を分析対象とした。　助産師外来の記載があった文献は 5 件、院内助産は 10 件、助産師外来と院内助産の記載があった文献は 4 件であった。　助産師外来から非助産師外来への移行率は 4.0 〜 8.8% であり、非助産師外来のローリスクからハイリスク移行率 9.0% に比較して低率であった。また、院内助産における医師の医療介入率は9.6〜44.4％で、非院内助産における医療介入率41〜46.6%より低率であった。分娩アウトカムは児の体重と臍帯血 pH、会陰裂傷においては非院内助産と有意差がなかった。　院内助産システムの運用基準は、産婦人科診療ガイドラインを基本に、各施設で独自に選定対象基準を記載しており、助産師外来は、妊娠初期から中期まで医師が担当する協働の実態があった。助産師外来と院内助産の安全性が示唆される一方で、分娩の施設間で運用基準が異なるため、系統的なメタ分析を妨げているという課題が見えた。以上から院内助産システムの運用に関するガイドラインの検討と院内システムの標準化を進展することが早急の課題と考える。This study was performed to verify the safety of midwife-managed delivery units in Japan based on a review of the domestic literature.　We conducted a literature review using the Ichushi-Web (Japan Medical Abstracts Society) and searched the domestic literature with the keywords “midwife-managed delivery units system,” “midwife-managed delivery units,” “midwife-led examinations,” and “birth center.” A total of 8３1 articles were identified, of which ２61 papers were published between ２01２ and ２016, from which 85 were extracted as original articles. Eleven transcripts were analyzed by extracting the transfer rate from midwife-led examinations to obstetrician-led examinations, obstetric intervention of midwife-managed delivery units, neonatal and physiological outcomes, and safety.　There were five studies with descriptions of midwife-led examinations, ten studies with descriptions of midwife-managed delivery units, and four describing both systems. The rate of transfer to obstetrician-led examinations was 4.0% – 8.8%, which was low compared to the high-risk transition rate of 9.0% for obstetric outpatients. The obstetric intervention rate in midwife-managed delivery units was 9.6% – 44.4%, which was lower than the obstetric intervention rate of 41% – 46.6% in deliveries managed by physicians. The neonatal and physiological outcomes were not significantly different according to the weight of the child, umbilical cord arterial blood pH, or perineal lacerations in the physician control group.　The operation criteria of midwife-led examinations and midwife-managed delivery units are based on the Obstetrics and Gynecology Clinical Practice Guidelines, and many facilities have established their own criteria. 　In outpatient midwifery clinics, the doctor was in charge from early pregnancy to mid-term.　This study suggested that midwife-led examinations and midwife-managed delivery units have good levels of safety. On the other hand, there were differences in operation standards among the facilities, which prevented more reliable meta-analysis of midwife-managed delivery units.　To further disseminate midwife-managed delivery units, it is necessary to evaluate not only the outcome items but also operational criteria, and establish standards according to the environment, facilities, and personnel of each facility

Mast Cell Infiltration is Associated with Myelofibrosis and Angiogenesis in Myelodysplastic Syndromes

Myelodysplastic syndromes are a heterogeneous group of clonal hematopoietic stem cell disorders characterized by persistent peripheral cytopenia with morphological and functional abnormalities of hematopoietic cells. Mast cells infiltrate into or around tumor tissues and play a role in remodeling of the stromal microenvironment, contributing to tumor progression. Increased mast cell numbers are associated with fibrosis, angiogenesis and a poor prognosis in human carcinomas. The aim of this study was to determine whether mast cell infiltration contributes to myelofibrosis or angiogenesis in myelodysplastic syndromes. We evaluated the correlation between mast cell density and the extent of myelofibrosis and angiogenesis in myelodysplastic syndromes. Fifty bone marrow biopsies taken from patients with a diagnosis of myelodysplastic syndromes were examined. Grading of myelofibrosis was evaluated by silver impregnation staining. Mast cell density and microvessel density were evaluated by immunohistochemistry. Human mast cells have been divided into two phenotypes. We designated a tryptase-positive mast cell as MCT and a chymase-positive mast cell as MCTC. Microvessels were identified by CD34-positive endothelial cells. Microvessel density and the extent of myelofibrosis were significantly greater in patients with high MCT and MCTC density compared to those with low MC density. Based on this, we suggest that the presence of high mast cell numbers is associated with myelofibrosis and angiogenesis in myelodysplastic syndromes