看護師の臨床判断を基盤とした脳卒中患者の移乗時における「見守り解除」のアセスメント指標の開発

The objective of this study was to develop indicators to decide when to complete observation of the bed -wheelchair transfer of convalescent stroke patients based on clinical judgments made by nurses to promote the independence of patients. 　The study involved the following 3 steps : In Step 1, aiming at collecting assessment items to decide on when to stop observation-only transfer, a focus group interview was performed involving 17 nurses working on convalescent rehabilitation wards. In Step 2, the validity of assessment items collected in Step 1 was investigated involving 12 nurses undergoing training in the certified nurse curriculum specializing in stroke rehabilitation. In Step 3, the assessment items prepared in Step 2 and judgment of the completion or continuation of observation by nurses were investigated involving 84 stroke patients under observation during transfer in 13 convalescent rehabilitation wards. Logistic regression analysis was performed regarding the gender and age of patients and assessment items in which significant differences were observed on univariate analysis as independent variables, and the clinical judgments concerning the completion of observation-only transfer made by nurses as dependent variables. 　Nineteen assessment items were extracted through Steps 1 and 2. These comprised 6 domains : cognitive ability and transfer mobility, patient s feeling regarding transfer, risk of trauma by falling, and states of taking oral central nervous system-acting drugs and independence in activity related/similar to transfer activity. The following 2 assessment items were significantly associated with the clinical judgment concerning the completion of observation made by nurses on logistic regression analysis in Step 3 : ‘the patient can move after confirming that the target of transfer is present at a transferable position every time’ and ‘the patient can move after putting on footwear every time’. 　The above findings suggested that nurses assessed the cognitive and motion balance abilities of patients based on the above 2 items and made a decision on the completion of observation during transfer. For the assessment items concerning the completion of observation-only transfer in stroke patients, 2 items : ‘the patient can move after confirming that the target of transfer is present at a transferable position every time’ and ‘the patient can move after putting on footwear every time’, may be useful. 本研究の目的は、回復期にある脳卒中患者のベッド・車椅子間移乗において、見守りを 解除し自立へと移行する際の看護師の臨床判断に基づいた指標を開発することである。 　本研究は以下の３段階で実施した。第１段階では、移乗時の見守りを解除する際のアセ スメント指標の収集を目的として、回復期リハビリテーション病棟看護師１７名を対象に フォーカス・グループ・インタビューを行った。第２段階では、脳卒中リハビリテーショ ン看護認定看護師教育課程に研修中の看護師１２名を対象に、第１段階で得られたアセスメ ント指標の内容妥当性の検討を行った。第３段階では、回復期リハビリテーション病棟１３ 病棟で移乗時の見守りを受けている脳卒中患者８４名と看護師を対象に、第２段階で作成し たアセスメント指標と移乗時の見守り解除してよいかどうかの看護師の判断を調査した。 さらに、患者の性別と年齢および多変量解析にて有意差の認められたアセスメント指標を 独立変数、移乗時の見守り解除に関する看護師の判断を従属変数としたロジスティック回 帰分析を行った。 　その結果、第１段階および第２段階を通して１９項目のアセスメント指標が抽出された。 第３段階において、看護師の移乗時の見守り解除における臨床判断と有意な関連が認めら れたアセスメント指標は、「毎回移乗目的物が移乗可能な位置にあることを確認してから 移乗できる」と「毎回履き物を履いてから移乗できる」の２項目であった。 　以上から、脳卒中患者の移乗時の見守り解除に関するアセスメント指標として上記２項 目が有用である可能性が示唆された。[原著

看護師の臨床判断を基盤とした脳卒中患者における移乗時の「見守り解除」に関するアセスメント指標の開発

取得学位 : 博士（保健学）, 学位授与番号 : 医博甲第2186号 , 学位授与年月日 : 平成23年3月22日, 学位授与大学 : 金沢大学, 審査結果の報告日 : 平成23年2月15

The effect of service dogs on the improvement of health-related quality of life

To assess the effects of service dogs on health-related quality of life (HRQOL), we conducted a survey of 10 service dog owners using SF-36v2 (Medical Outcomes Study 36 Item Short-Form Health Survey Version 2.0) and compared it with a matched control group of people with physical disabilities who did not have service dogs but were eligible for one. The scores for mental health and role emotional of service dog owners were relatively high, and their mental component summary was higher than the general population norm. These results indicate that service dogs affect the mentality of their owners. The comparison with the control group indicated that service dogs alleviate the mental burden of daily activities, and subjectively improved the physical functioning of their owners. This study showed that service dogs have positive functional and mental effects on their disabled owners.</p

Effects of 16-Week Consumption of Caffeinated and Decaffeinated Instant Coffee on Glucose Metabolism in a Randomized Controlled Trial

Objective. Observational studies have shown a protective association between coffee consumption and type 2 diabetes mellitus whereas caffeine or caffeinated coffee acutely deteriorates glucose tolerance. We investigated the effects of chronic drinking of instant coffee on glucose and insulin concentrations during a 75 g oral glucose tolerance test. Methods. Overweight men with a mild-to-moderate elevation of fasting plasma glucose were randomly allocated to a 16-week intervention of consuming 5 cups of caffeinated (n=17) or decaffeinated (n=15) instant coffee per day or no coffee (n=13). Results. The caffeinated coffee group showed statistically significant decreases in the 2-hour concentrations and the area under the curve of glucose while neither decaffeinated coffee nor coffee group showed such a change. Waist circumstance decreased in the caffeinated coffee group, increased in the decaffeinated coffee group, and did not change in the noncoffee group (P=0.002). With adjustment for the change in waist circumference, caffeinated and decaffeinated coffee consumption were associated with a modest decrease in the postload glucose levels. Conclusion. Both caffeinated and decaffeinated coffee may be protective against deterioration of glucose tolerance

Atrazine-Induced Aromatase Expression Is SF-1 Dependent: Implications for Endocrine Disruption in Wildlife and Reproductive Cancers in Humans

BACKGROUND: Atrazine is a potent endocrine disruptor that increases aromatase expression in some human cancer cell lines. The mechanism involves the inhibition of phosphodiesterase and subsequent elevation of cAMP. METHODS: We compared steroidogenic factor 1 (SF-1) expression in atrazine responsive and non-responsive cell lines and transfected SF-1 into nonresponsive cell lines to assess SF-1’s role in atrazine-induced aromatase. We used a luciferase reporter driven by the SF-1–dependent aromatase promoter (ArPII) to examine activation of this promoter by atrazine and the related simazine. We mutated the SF-1 binding site to confirm the role of SF-1. We also examined effects of 55 other chemicals. Finally, we examined the ability of atrazine and simazine to bind to SF-1 and enhance SF-1 binding to ArPII. RESULTS: Atrazine-responsive adrenal carcinoma cells (H295R) expressed 54 times more SF-1 than nonresponsive ovarian granulosa KGN cells. Exogenous SF-1 conveyed atrazine-responsiveness to otherwise nonresponsive KGN and NIH/3T3 cells. Atrazine induced binding of SF-1 to chromatin and mutation of the SF-1 binding site in ArPII eliminated SF-1 binding and atrazine-responsiveness in H295R cells. Out of 55 chemicals examined, only atrazine, simazine, and benzopyrene induced luciferase via ArPII. Atrazine bound directly to SF-1, showing that atrazine is a ligand for this “orphan” receptor. CONCLUSION: The current findings are consistent with atrazine’s endocrine-disrupting effects in fish, amphibians, and reptiles; the induction of mammary and prostate cancer in laboratory rodents; and correlations between atrazine and similar reproductive cancers in humans. This study highlights the importance of atrazine as a risk factor in endocrine disruption in wildlife and reproductive cancers in laboratory rodents and humans

ノロウイルス ニ ヨル カンセンセイ イチョウエン ノ シュウダン ハッセイヨボウ ニ ムケタ トリクミ ノ ゲンジョウ トクベツ ヨウゴ ロウジンホーム ニ キンム スル カイゴ ショクイン ノ インタビュー チョウサ カラ

特別養護老人ホームで高齢者ケアに従事する介護職員がノロウイルスの集団感染予防のために実践しているケアの現状を明らかにすることを目的とし、特別養護老人ホーム2施設の介護職員4名にインタビュー調査を行った。その逐語記録を記述資料とし、介護職員が感染性胃腸炎の集団発生予防のために実践しているケアを示すコードを抽出し、類似性に沿ってまとめ、カテゴリー化した。結果、66コードから5カテゴリーが抽出された。5つのカテゴリーは【マニュアル化している対策を常時確実に実践する】【経験の少ない職員の指導を重視する】【施設内研修がマンネリ化しないよう工夫する】【高齢者の送迎時の健康状態を観察し相談する】【介護職員自身の健康状態も看護職員に相談する】であった。その結果の中に、感染経路を遮断するための最重要項目である介護職員自身の手指衛生の徹底が明示されなかった。介護職員と看護職員との連携を強化し、その感染経路を遮断して感染拡大を防止することの重要性が示唆された。今後更に例数を増やし研究を進めたい。The interview survey was conducted, as a pilot study, in 4 nursing care staff working for 2 facilities of intensive nursing care homes for the elderly in order to reveal current situations of nursing care that they provide for the elderly in those facilities to prevent epidemic outbreak of norovirus infection. Using a verbatim record as a descriptive material, we extracted codes which represented the cares provided by the nursing care staff to prevent epidemic outbreak of infectious gastroenteritis and categorized them according to similarity. As a result, 5 categories were extracted from 66 codes. These categories were as follows: The nursing care staff are to“ constantly assure that they take a manualized measure”“, put a focus on education of staff who do not have adequate experiences”“, make an effort so that facility-based training would not become a tedious routine”“, observe and consult on health status of the elderly during transportation” and“ consult with nurses on their own health stats”. However, the most important item, namely, thorough hand hygiene of nursing care stuff themselves, was not clearly indicated in those categories.This suggests that it is crucial to reinforce collaboration between nursing care staff and nurses, and control the spreadof infection by blocking the route of infection. In the next study, the number of interview cases should be increased to assure the quality of this research

抗原誘発性Th1・Th2サイトカイン産生に対する性ホルモンの影響の性差

The incidence, severity and prognosis of asthma can be affected by a number of factors, including the patient\u27s age and sex. Clinical observations and epidemiologic studies indicate that the prevalence and severity of asthma is higher among boys than girls, but that the ratio inverts after puberty. The reversal of the male/female prevalence of asthma at puberty strongly suggests a role of sex hormones. However, the mechanisms underlying the gender differences in the prevalence of asthma are not clear. Recently, we suggested that the sex differences were due to those in not only sex hormones but also lymphocyte functions based on findings in a murine model of allergic asthma. Therefore, we investigated the effect of sex hormones on antigen-induced cytokine production by lymphocytes to further investigate these gender differences. Splenocytes from ovalbumin (OVA)-sensitized female mice produced more IL-5, Th2 cytokine, than those from OVA-sensitized male mice, upon simulation with OVA. Progesterone decreased the production of IFN-g, Th1 cytokine, by splenocytes from both sensitized male and female mice. 17β-estradiol had no effect on Th1 and Th2 cytokine production by splenocytes from both mice. However, 5a-dihydrotestosterone decreased the production of Th2 cytokines by splenoytes from sensitized female mice but not these from male mice. Our findings suggest that lymphocytes from males and females have different sensitivities to sex hormones in antigen-induced cytokine production

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead