2017 National survey of adherence to neonatal pain management care guideline in Japanese NICUs

平成29年度日本新生児看護学会受託研究　報告

Management of Neonatal Ovarian Cyst

Objective: There is no guideline for the treatment of neonatal ovarian cysts. The present study analyzed our clinical management of such cysts, as well as the results of treatment. Methods: The present study involved 16 patients with neonatal ovarian cysts who had been diagnosed and treated between January 2002 and December 2016. We classified the cysts into two groups based on ultrasonographic images: (1) simple cysts (SCs)—thin-walled, round, or anechoic; (2) complex cysts (CCs), containing fluid-debris level, solid masses, or intracystic septa. We analyzed the clinical characteristics and results in the two groups. Results: Ten of the patients had SCs and six had CCs. Fourteen were diagnosed during the prenatal stages. Of the 10 patients with SCs, eight were managed using observation only, and the cysts spontaneously resolved in all such cases. Six patients had CCs, including one with an SC that had developed into a CC. Eight of the patients underwent surgical treatment, and the surgical methods did not differ in terms of operation time or complication rate. None of the oophorectomy specimens contained any normal ovarian tissue. Conclusion: We operated on all CCs and on SCs more than 40 mm in diameter, while patients with SCs less than 40 mm in diameter were managed using observation only, as were those in whom differential diagnosis was not possible. We must emphasize that percutaneous aspirations are safe, and we recommend transumbilical incisions, because they preserve both esthetics and ovarian function

Examination of Selective Low-pressure Fine Needle Aspiration Cytology Under Ultrasound Guidance

Cytology by fine-needle cytology is indispensable for diagnosing head and neck tumor, especially for thyroid nodule. There are two methods of fine needle cytology; one of fine-needle aspiration cytology (FNAC and another of fine-needle non-aspiration cytology (FNNAC). These previous procedures has each disadvantage such as the mixing of blood or low yield of cells. We proposed a new technique: selective low-pressure fine needle aspiration cytology (SLOP-FNAC) to overcome the backwards of previous procedures. We used the scoring system by Mair et al. to evaluate smear quality of specimens obtained with FNNAC and SLOP-FNAC. SLOP-FNAC smears exhibited higher scores in amount of cellular material, degree of cellular degeneration and cell yield, and retention of appropriate architecture compared to FNNAC smears. The SLOP-FNAC smears scored significantly higher for amount of cellular material and retention of appropriate architecture evaluated (P = 0.0261 and P = 0.0024, Student’s t-test). SLOP-FNAC may be a useful cell sampling technique that reduces blood contamination while securing a high cell yield with maintaining tissue structure

Experiences of mothers with infants admitted to neonatal intensive care unit preceding the decision to discharge : Focusing on mothers with infants suffering from diseases that might require long hospitalization <Article>

本研究の目的は,入院が長期化しやすい疾患をもつ子どもの母親が,NICUに入院している子どもの退院を決心するまでの経験を明らかにし,NICU退院支援における看護上の示唆を得ることとした. 研究参加者は,子どもがNICUに入院中の母親8名とし,データは半構造化面接法によって収集した.面接内容は,子どもと一緒に暮らすことへの考えや思いとした.データ分析は,Colaizziの現象学的方法を参考に行った. その結果,母親がNICUに入院した子どもの退院を決心するまでの経験は,込み上げる愛おしさ,経過への安堵,親子分離の受け入れ,出生したことの受け入れ,退院後の生活を想定した不安,退院に対する家族からの精神的支え,育児への自信獲得,家族が一緒に暮らすことへの一貫した考え,家族のあるべき姿の再認識の9テーマで表された。これらはさらに,子どもへの肯定感情,親としての納得,退院への本格的な準備,退院への確固たる意思の4テーマクラスターに集約できた. 親としての納得,退院への確固たる意思のテーマクラスターから,NICU退院支援における新たな看護上の示唆が得られた.The purpose of the study was to observe the experiences of mothers with infants suffering from diseases that might require long hospitalization at NICU, preceding the decision to discharge and to obtain clinical implications regarding discharge support in NICU. Semi-structured interviews were conducted with eight mothers with infants admitted to the NICU. Data on their thoughts and feelings about living with their infants was collected and analyzed with reference to Colaizzi's phenomenological method. The analysis resulted in the identification of four theme clusters with nine themes. The theme cluster 'Positive feelings towards infant' comprised two themes: Growing sense of affection and Feeling relieved at the progress. The theme cluster 'Acceptance as parents' comprised two themes: Acceptance of parent-infant separation and Acceptance of birth. The theme cluster 'Preparing for discharge' comprised three themes: Anxiety about life after discharge, Psychological support from family on discharge, and Becoming confident in infant-care. The theme cluster 'Determination on discharge' comprised two themes: Consistent thinking regarding living together as a family and Renewed recognition of how a family should be. New clinical implication was obtained from the theme clusters 'Acceptance as parents' and 'Determination on discharge'

Laparoscopically assisted cervical canalization and neovaginoplasty in a woman with cervical atresia and vaginal aplasia

Cervical atresia is a Müllerian duct system anomaly, and it is often associated with vaginal aplasia. We report the case of a 17-year-old girl who presented with primary amenorrhea and cyclical abdominal pain, and was diagnosed with cervical atresia and vaginal aplasia that were treated laparoscopically. Laparoscopically assisted cervical canalization and neovaginoplasty were performed to relieve dysmenorrhea and allow for sexual intercourse and fertility. We did not use a bowel segment, skin, or peritoneum as a graft for the neovaginoplasty. To prevent adhesions and promote epithelialization, we used an estrogen-containing cream. Moreover, we did not use a vaginal mold. The patient is free of cervical stenosis and able to have intercourse. Long-term follow-up is necessary to ensure a future pregnancy and childbirth

The state of current use of Home Visiting Nurse Station for home medical care for child and support for child care education

本研究では,小児のための訪問看護ステーションの活用及び,訪問看護ステーションと他施設間の連携・協働に関する現状と課題を明らかにすることを目的とした.調査対象は訪問看護ステーションを利用している子どもの親7名であった.調査方法は半構成型の面接調査とし,結果は記述的に分析した.子どもの主病名は低出生体重児,先天性表皮水泡症,低酵素性虚血脳症,喉頭軟化症,全前脳泡症であり,年齢は3ヶ月以上8歳8ヶ月以下,訪問看護ステーション利用期間は1ヶ月以上2年8ヶ月以下であった.調査結果から次の課題が明らかとなった : 1)退院直後から適切な訪問看護を提供するため,退院前の病院での子どもの状態観察や家族との話し合い,家族への訪問,病棟スタッフとの情報交換を行う必要がある.; 2)訪問看護師は医療面だけではなく,育児支援･指導や両親･家族の援助など幅広い看護ケアを提供していくことが重要である.; 3)各施設間での連携･協働が十分に確立していない状況下で,家族は各職種に対する役割を判断･選択していた.今後各施設間における連携･協働体制を確立していくことが不可欠である.Purposes of this qualitative study were to clarify the state of current use of Home Visiting Nurse Station (HVNSt) for children and cooperation and collaboration between HVNSt and related institutions.Subject population was 7 who used HVNSt for children. Diagnosis of children were very low birth weight, congenital epidermolysis bullosa, hypoxic ischemic encephalopathy or laryngomalacia. Age of them was from 3 months to 8 years 8 months. Period of use HVNSt were from 1 month to 2 years 8 months.Result were as follows: 1) Visiting Nurse should communicate with family and medical staff in hospital to get much information and provide good home medical care after discharge; 2)It is important for parent, brother and sister; 3)When communication and collaboration were not established with related institutions, family decided the role of each profession; thus connection with Visiting Nurse Station and related institutions must be established