ショウガッコウ コウガクネン ジドウ ノ スイミン カクセイ リズム ト ジリツ シンケイ カツドウ ノ カンケイ : 6ジレイ ノ ホウコク

The purpose of this study was to clarify the relationship between sleep-wake rhythms and autonomic nerve activities using actigraphy and heart rate variability（HRV）analysis. Subjects were comprised of six children who were in the fourth to sixth grade levels of elementary school（four boys and two girls）. The study was conducted between January and December 2015. The data collection procedure was performed following the Private Information Protection Law, with approval from Tokushima University Hospital Ethics Board（approval number 2021）. These subjects were evaluated in an Attentive-Care-Needed stress state based on the PSI（Public Health Research Foundation Type Stress Inventory）and PSQI-J（Pittsburgh Sleep Quality Index, Japanese Version）. In analyzing their sleep-wake rhythms, autonomic nervous activities were determined using an actigraph and HRV through RR interval sequence electrocardiography. The results of actigraph data of sleep efficiency in Subject Number 6 was low（76.47％）. Regardless, the subject experienced subjective sleep satisfaction. However, Subject Number 2, insisted that she could not easily wake up in the morning because of being sleepy. Low Frequency（LF）/High Frequency（HF）data indicated sympathetic nervous activity showing that all subjects had significantlyhigher LF/HF value during wakefulness than when asleep. HF data indicated parasympatheticactivity of five out of the six children showing significantly higher value during sleep than when awake. Subject number 3 expressed that he was sleepy and could not get up in the morning,and also had trouble going to and maintaining sleep. However, this subject’s results of the PSQI-Jindicated that he had no problem expressing subjective sleep satisfaction. Furthermore, in the actigraph and HRV analysis, findings showed that subjects had good sleeping patterns. These findings strongly signify the importance of determining the sleep-wake rhythms of school children based on data from subjective and physiological evaluation methods

精神科病院の看護職員の獲得のための魅力ある職場環境の特徴

Purpose: The purpose of this study is to identify characteristics of work environments in psychiatric hospitals which are appealing to nurses. Understanding characteristics of work environments of psychiatric hospital nurses can lead to attracting nurses to work in this environment, thereby increasing human resources and alleviating nurse-staffing problems. Methods: Questionnaire copies focusing on staffing shortages of nurses in psychiatric hospitals were provided to 277 psychiatric hospital nurse administrators in Japan from May-April 2016. Data analyses included descriptive and multivariate statistics. Factor analysis together with the Kaiser-Meyer-Olkin and the Bartlett’s test of Sphericity were used to assess adaptive validity. Factor loadings were set at 0.4 or more for the configuration of items, while internal consistency and reliability of the assessment data scores were done using Cronbach’s alpha coefficient. Mean factor points were calculated and student's t-test and one-way analysis of variance were performed. Significance probability level was set at 0.001. Results: Factor analysis revealed nine factors: (1) Educational system, (2) Reputation at hospitals, (3) Support system for acquisition of certificate of clinical nurse specialist/certified nurse, (4) Reputation at hospitals as places of employment, (5) Knowledge of nursing philosophy and of culture of working places, (6) Reputation of teaching for students’ clinical practice, (7) Working hours and leave privileges, (8) Salary and other allowances, (9) Support system for license acquisition. Data revealed that nurse administrators who employed new graduate registered nurses found their hospitals' attractive points were: educational system, support system to acquire certificate of clinical nurse specialist, reputation of hospital as place of employment, knowledge of nursing philosophy and culture of working places, teaching students' clinical practice, and salary and other allowances. Conclusion: Nurse administrators who have no difficulty recruiting nursing staff recognized that their hospital environments were considered appealing based on working hours and leave privileges

施設に入所中の認知症高齢者の自律神経活動の特徴

This study clarified the characteristic autonomic nervous activity of institutionalized elders diagnosed with dementia using Hasegawa’s Dementia Scale-Revised. Twenty-six healthy adult persons (HPs) in their 20 s - 40 s met the inclusion criteria, and 16 persons (27.6 ± 8.2 years old) completed the research procedure. Of 70 persons with dementia (PDs) residing at the one geriatric health services facilities, only 24 persons met the inclusion criteria, and only nine (N = 9, 83.44 ± 9.45 years old) completed the procedure. Actigraph and ambulatory electrocardiographic instruments measuring autonomic nervous activity were attached to the subjects for 24 hours. Activities and behaviors of PDs and HPs were observed by clinically experienced staff nurses and care workers. High frequency (HF) power indicating parasympathetic activity and LF/HF ratio indicating sympathetic activity were calculated. When awake, PDs’ LF/HF ratio was significantly lower than HP’s (Z = −2.60, p < 0.01), showing significant differences in the LF/HF ratios between waking and sleeping, more than those of the PDs (p < 0.001). Similarly, when awake, significant positive correlations were observed in the LF/HF ratio and actigraph activity count (AC) in 11 HPs and 3 PDs (range r = 0.17 to 0.49, p < 0.05); however, significant negative correlation was found in HF and AC of 12 HPs and 3 PDs (range r = −0.55 to −0.18, p < 0.05). While sleeping, significant positive correlations were observed in LF/HF and AC of 3 HPs and 1 PD (range r = 0.35 to 0.42, p < 0.05) and significant negative correlation was found in the HF and AC of 1 HP (r= −0.32, p < 0.001) and 1 PD (r = −0.32, p < 0.05). The mean value of LF/HF in a wakeful state was significantly lower for PDs than HPs. Combined results of behavioral observation, actigrapy and heart rate variability (HRV) analyses suggested that PDs showed positive correlations between LF/HF and AC in a wakeful state. Compared to those who showed no positive correlation, they did not require much nursing care

Efficacy of surgical management for recurrent intrahepatic cholangiocarcinoma: A multi-institutional study by the Okayama Study Group of HBP surgery

Background The prognosis of intrahepatic cholangiocarcinoma (ICC) has been poor, because of the high recurrence rate even after curative surgery. This study aimed to evaluate the prognostic impact of surgical resection of recurrent ICC. Patients and methods A total of 345 cases of ICC who underwent hepatectomy with curative intent in 17 institutions were retrospectively analyzed, focusing on recurrence patterns and treatment modalities for recurrent ICC. Results Median survival time and overall 5-year recurrence-free survival rate were 17.8 months and 28.5%, respectively. Recurrences (n = 223) were classified as early (recurrence at 1 year, n = 92). Median survival time was poorer for early recurrence (16.3 months) than for late recurrence (47.7 months,p<0.0001). Treatment modalities for recurrence comprised surgical resection (n = 28), non-surgical treatment (n = 134), and best supportive care (BSC) (n = 61). Median and overall 1-/5-year survival rates after recurrence were 39.5 months and 84.6%/36.3% for surgical resection, 14.3 months and 62.5%/2.9% for non-surgical treatment, and 3 months and 4.8%/0% for BSC, respectively (p<0.0001). Multivariate analysis identified early recurrence, simultaneous intra- and extrahepatic recurrence, and surgical resection of recurrence as significant prognostic factors. In subgroup analyses, surgical resection may have positive prognostic impacts on intra- and extrahepatic recurrences, and even on early recurrence. However, simultaneous intra- and extrahepatic recurrence may not see any survival benefit from surgical management. Conclusion Surgical resection of recurrent ICC could improve survival after recurrence, especially for patients with intra- or extrahepatic recurrence as resectable oligo-metastases

Surveys of full–coverage restorations made of titanium at Matsumoto Dental University Hospital

Considering the presence of metal allergies and the sharp rise in the prices of precious metals, full–coverage restorations made of titanium have been covered by Japanese insurance since June 1, 2020. The clinical application of these restorations is expected to increase in the future. However, due to its high melting point and high affinity to oxygen at high temperatures, titanium has not been widely used in prosthetic clinical practice. This study aimed to survey the actual use of full–coverage metal restorations at Matsumoto Dental University Hospital. Patients who had full–coverage metal restorations placed on their molars from June 1 to December 28, 2020, were consecutively enrolled, and data on the type of metal, placement site, and time were recorded. Besides, the dentists who used titanium restorations (Ti–Rs) were given a questionnaire. We asked them to rate their impressions of Ti–Rs in comparison with full–coverage restorations made of Ag–Pd–Cu–Au alloy (Pd–R) in six categories, including occlusal adjustment, polishing, and luting operations. In all, 338 molars received full–coverage metal restorations. Ti–R was used in 33 cases and Pd–R in 305 cases; 14 upper and 19 lower, 12 first molars, 18 second molars, and 3 third molars received Ti–Rs, while 137 upper and 168 lower, 174 first molars, 174 second molars, and 3 third molars received Pd–Rs. Seven dentists responded to the questionnaire survey. Many dentists stated that Ti–R was more challenging to use than Pd–R for occlusal adjustment, polishing, and adjustment time. On the other hand, most of them stated that the luting process was similar for both. Besides, Ti–R was favorably evaluated in terms of metal allergy. The number of patients who received Ti–Rs increased during the study period, suggesting that Ti–Rs will be a commonly used metal allergy–friendly prosthetic in the future. We plan to continue the survey and study the prognosis