Effects of Postprandial Body Position on Gastrointestinal Motility, the Autonomic Nervous System and Subjective Comfort

We examined postprandial body positions’ effects on gastrointestinal motility, the autonomic nervous system and subjective comfort, i.e., whether lowering the head after a meal is beneficial for gastrointestinal motility and the prevention of pressure ulcer. We examined 10 healthy subjects and compared 3 body positions: (1) Seated upright. (2) Lying on a bed with the head at 60° and knees up by 20° (60° position). (3) Identical to (2) until post-meal; the head was then lowered to 30° (60°-30° position). Gastrointestinal motility was assessed as gastrointestinal sounds measured by sound-editing software. Digital plethysmography assessed autonomic nerve function as heart rate variability. The pressure ulcer risk was estimated as subjective comfort/discomfort using a visual analog scale. Gastrointestinal sounds increased post-meal. The 60°-30° position showed the highest number of sounds and longest cumulative sound duration. Post-meal, sympathetic activation was suggested in the 60° position, whereas vagal activity was relatively preserved in the 60°-30° position. The 60°-30° position was the most comfortable, and the 60° position was least comfortable. Lowering the head after a meal is beneficial to augment gastrointestinal motility and decrease the pressure ulcer risk. The 60° head-up position increases the pressure ulcer risk

カンゴ ジッセン ノウリョク コウジョウ ノタメノ ガクシ カテイ ニオケル カンゴ キソ キョウイク ト ソノ ヒョウカ ホウホウ ノ コウチク ニ ムケテ ダイ 1 ホウ ヘイセイ 21 ～ 23 ネンド ソツギョウ ジ カンゴ ギジュツ トウタツ ド ノ ブンセキ

本看護学科では、看護学生の卒業時看護技術到達度の評価を平成21年度より継続してきた。平成23年度には大項目22項目・小項目119項目からなる調査票を見直し「学生の到達度の自己評価」と「臨地実習での経験」を把握できる評価尺度に改訂した。本研究は、平成21〜23年度までの3年間の大項目22項目における全体的評価を行うとともに、平成23年度調査における学生の到達度の自己評価と臨地実習での経験との関連について分析した。対象者は編入生を除く看護学科4年次生とし、全臨地実習終了後に調査を行った。結果、看護技術到達度の平均値は【活動・休息援助技術】(88.1%)が最も高く、【呼吸・循環を整える技術】(31.4%)が最も低かった。また、臨地実習の経験が少ない項目の到達度が低い傾向にあった。本結果より【呼吸・循環を整える技術】等に関する本学科の教育の現状把握による課題の明確化と、実習環境の調整、シミュレータ等の活用方法の検討の必要性が示唆された

カンゴ ジッセン ノウリョク コウジョウ ノタメノ ガクシ カテイ ニオケル カンゴ キソ キョウイク ト ソノ ヒョウカ ホウホウ ノ コウチク ニ ムケテ ダイ 2 ホウ コキュウ ヲ トトノエル ギジュツ ニオケル カンゴ キョウイク ノ ゲンジョウ ト コンゴ ノ カダイ

多様化する国民のニーズや高度先端医療などに対応でき、安全・安心な医療を提供できる看護師の要請が求められている。我々は、本学学士課程における看護実践能力向上のための看護基礎教育とその評価方法の構築に向けて、現在の教授-学修方法の明確化が必要であると考え、本学科学生の教育課題である「呼吸を整える技術」に焦点を当て、呼吸に関わる授業状況の調査を専任教員へ実施した。本調査結果より、教員は呼吸に関する教育内容ごとに学習成果を明確に提示した上で教授の強化を図っていることが明らかとなった。今後の優先課題として、実際に患者を看る機会が少ない現状やその学習環境の制約を補うシミュレーション教育の新規導入を加味し、卒業時および領域別の看護技術到達目標とその到達度の再設定が必要であることが示唆された

The development of a scale to measure stress recognition during the treatment of diabetes patients

　The purpose of this study was to establish a measurement scale for "stress recognition in receiving treatment" in patients with diabetes. A self-completed questionnaire was distributed to 149 type-2 diabetes outpatients in March-May 2015 after authorization from Okayama Prefectural University and the ethics committee of the hospital. 　The "stress recognition in receiving treatment" scale was designed as a second-order factor model consisting of 14 items and the following four factors : the respondent's sense of (1) the burden of being sick, (2) the burden on interpersonal relationships, (3) the burden of treatment, and (4) the burden of medical expenses. 　Stress recognition in treatment means recognition of being stressed in the burdens related to the illness, interpersonal relationships, treatment and medical expenses. 　The suitability of the questionnaire data was then evaluated with a structural equation model. The suitability of the factor model to the data satisfied the statistically acceptable standards as Comparative Fit Index (CFI) ＝0.931, Root Mean Square Error of Approximation (RMSEA) ＝0.096, Tucker-Lewis Index (TLI) ＝0.946. 　As the construct validity was not examined by the scale created in this study or by existing scale, it was verified by using the degrees of mental healthiness and HbA1c that were proved to be associated with the sense of burden. 　In addition, the construct validity of the questionnaire was supported by a significant correlation between the Japanese version of the WHO-Five Well-being Index (S-WHO-5-J) and the patients' HbA1c levels. The use of this measure is expected to contribute to the early detection of a decline in a diabetic patient's activities of daily living and to the early confirmation of patients' support status

Effectiveness of water pressure method in colorectal endoscopic submucosal dissection by novice endoscopists

Background and Aims: Colorectal endoscopic submucosal dissection (ESD) remains challenging for novice endoscopists. Not only underwater conditions but using active water pressure, water pressure method (WPM) can help widen the submucosal layer. This study aimed to clarify the usefulness of WPM in colorectal ESD, especially for novice endoscopists. Methods: This study was ex vivo study, which enrolled three novices. Each endoscopist performed conventional ESD (C-ESD) and ESD with WPM (WPM-ESD) 10 times on the excised bovine rectum. The treatment outcomes were compared between the two groups. Results: Median procedure time was significantly shorter in the WPM-ESD group than in the C-ESD group (54 [interquartile range {IQR}, 42–67] vs. 45 [IQR, 34–55] min, p = 0.035). Although no significant difference in the activation time of electrical surgical unit (ESU) during the procedure was noted, the interval time during the procedure at which the ESU was not activated was significantly shorter in the WPM-ESD group (52 [IQR, 40–65] vs. 42 [IQR, 32–52] min, p = 0.030) than in the C-ESD group. Moreover, the time required for the endoscope to enter the submucosa was significantly shorter in the WPM-ESD group than in the C-ESD group (8.0 [IQR, 6.0–10] vs. 5.0 [IQR, 3.0–6.0] min, p < 0.001). Conclusion: The present study reveals that the WPM method significantly shortens the procedure times for novice in colorectal ESD, especially the interval time which refers to the time spent creating the field of view, and the time required for the endoscope to enter the submucosa

Colorectal endoscopic submucosal dissection using the water pressure method for diverticulum-associated lesions: A case series study (with video)

Background and study aims Colorectal endoscopic submucosal dissection (ESD) of diverticulum-associated lesions is challenging because these lesions require precise excision in narrow spaces. The water pressure method (WPM) uses active water pressure by the waterjet function under saline solution-filled conditions. This study aimed to determine the feasibility of WPM for resection of diverticulum-associated lesions. Patients and methods This was a retrospective, observational case series study. We reviewed diverticulum-associated lesions treated by ESD with WPM at our institution between June 2017 and July 2021. Diverticulum-associated lesions were classified as follows: type 1, lesions in contact with or within 3 mm of the edge of a diverticulum; type 2, lesions that partially infiltrated the interior of a diverticulum; and type 3, lesions that infiltrated the interior of and completely covered the diverticulum. We collected data on the clinical characteristics and outcomes of the lesions. Results Seven diverticulum-associated lesions were treated with ESD using WPM. The median lesion size was 37 mm (interquartile range: 25–54 mm). There were three cases of type 1, three cases of type 2, and one case of type 3. Three lesions were resected circumventing the diverticulum, and four lesions involved resection of the diverticulum. The en bloc resection and R0 resection rates were 86 %. One patient had severe fibrosis, which caused perforation, and in another patient, the diverticulum was too deep and narrow to be completely isolated. Conclusions WPM allowed for precise procedures in the diverticulum. The feasibility of WPM has been suggested for diverticulum-associated lesions, although cases have been complex

First clinical experience with esophageal ESD using a novel adjustable traction device

Background and study aims In esophageal endoscopic submucosal dissection (ESD), the effectiveness of traction including clip-thread method has been reported, but it is difficult to adjust the direction of traction. Therefore, we developed a dedicated over-tube type traction device (ENDOTORNADO) that has a working channel and allows traction from any directions by rotating itself. We investigated the clinical feasibility and potential usefulness of this new device in esophageal ESD. Patients and methods This was a single-center, retrospective study. Six cases of esophageal ESD with ENDOTORNADO from January to March 2022 (tESD group) were compared with 23 cases of conventional esophageal ESD performed by the same operator from January 2019 to December 2021 (cESD group) in terms of clinical treatment outcomes. Results In all cases, en bloc resection was achieved without intraoperative perforation. The total procedure speed was significantly increased in tESD group (23 vs. 30 mm2/min, P = 0.046). In particular, the submucosal dissection time was significantly reduced to about one-quarter in tESD group (11 vs. 42 min, P = 0.004). Conclusions ENDOTORNADO creates the adjustable traction from any directions and may have the clinical feasibility. It would be an option for human esophageal ESD

ジッケン ヲ ドウニュウ シタ キソ カンゴ ギジュツ エンシュウ ノ ガクシュウ ノ コウゾウカ

実験を導入した基礎看護学技術演習の学習を構造化し、その効果を検討した。その結果、実験を行う中での【実験方法と知識の深まり・新たな発見】は、[実験の楽しさの実感】、【科学的根拠に基づいた安全・安楽なケアの必要性】、【効果的な表現方法と学習の進化】に波及効果があった。また、実験の過程で【目標達成に向けたチーム作り】を行い、そのために必要な個人の役割や姿勢は【人間形成の高まり】に繋がっていた。そして、それは看護の実践と役割を追求するためのさらなる探究心を生み出していた。以上より、実験演習は研究的態度やケアの創造性、問題解決能力を育成する機会となり、実験を通して知的生産への興味や楽しさを知ること、チーム聞の連携を通して自己の人間形成を高めるために有効であることが示唆された。We structuralized a study of experiment-introduced practice for basic nursing skill, and considered effects of the practice. As a result, "experimental method and deepening of knowledge, and new understandings" in the experiment had a spin-off effect on"realization of pleasure in experiment" , "necessity for safe and comfortable care based on scientific evidence" , and "effective expressiontechnique and advancement in learning" . Also, "team building for target achievement" in the process of experiment was conducted, and individual role and attitude for achievement resulted in "betterment of character formation" , which produced further sense of inquiry to pursue nursing practice and role. As remarked adove, it was suggested that an experimental practice becomes anopportunity to develop attitude toward reserch,creativity in nursing care and problem-solving skills, and that it is effective to find interests and pleasure in intelligent production through experiment, and to cultivate self-character formation through team cooperation