Interprofessional education and training for collaborative work by nurses and care-workers in a special nursing home with small-scale care units

本研究の目的は,ユニットケアに取り組む特別養護老人ホームにおいて,看護職と介護職の協働の状況を明らかにし,協働していく上で両職種が必要とする教育の方向性の示唆を得ることである｡看護職2名,介護職3名を対象に自由回答法による半構成的･個別面接を実施した｡その結果,協働の状況は, 1)両職種のユニットケアのとらえかたや取り組みは相違し,協働に向けた工夫を行っていたものの,協働関係は成立しにくい状況であった｡2)両職種は期待されている役割を担うために教育･研修を受け専門能力を高めたいと考えていた｡両職種が協働していく上で必要とする教育の方向性として,以下の示唆を得た｡1)利用者や介護職から期待される福祉施設における看護の役割と専門性を高めるために看護職が現実的な課題を解決する力の修得を目指す｡2)様々な教育背景と教育ニーズを持つ介護職が知識,技術,ケアの実践力を習得するためには,個人の学習状況とニーズに応じて学習科目を自己管理し自発的な力を高めていく｡3)両職種がお互いの専門性を認め,向上を図ることができるようにともに課題を解決し相互作用が継続できる共同研修プログラムによる研修を実施する｡The purpose of this study was to identify the interprofessional education and training necessary to achieve teamwork between nurses and care-workers in small-scale care units within special nursing homes. The study design employed an inductive qualitative method. Data were collected from two nurses and three care-workers through personal interviews. Qualitative inductive analysis was used to obtain results. The present situation regarding care in small-scale care units by the two occupational categories was clarified as followed: 1) Despite attempts to work as a team, there were persistent differences in understanding the role of each worker and approach between the two occupational categories, leaving gaps in care. and 2) the care providers in both categories were willing to receive education and training to improve their professional skills and knowledge in order to play their expected roles. For future education, the following training programs were considered to be necessary to achieve cooperation among the two groups in performing the work: 1) a program that helps nurses master practical problemsolving skills, as expertise in problem-solving is expected of nurses in special nursing homes, 2) a program that helps care-workers to enhance their abilities for self-directed study at their level and according to their needs, so that people with various educational backgrounds and needs can obtain knowledge, skills, and ability to practice care. and 3) a program in which both nurses and care-workers can develop mutual respect for the expertise required by each occupation and that will produce synergistic effects on overall care

Achievement levels of students on clinical nursing practice for chronic illness

実習目標の到達度及び実習目標間の関係を明らかにするために,74名の学生による実習目標の自己評価を分析した｡その結果,実習目標の到達度は,｢自己の看護観や自己成長を培う｣が最も高かった｡そして｢疾患の病態生理や検査･治療についての理解と看護援助｣｢セルフケアに向けた看護援助｣｢危機に直面している患者の看護援助｣などの看護実践面に関する目標が高値を示していた｡学生は目標に沿った看護を実践する中で,経験したひとつひとつのケアを意味づけたり,看護とは何かを探求していったと思われ,それが看護観の形成や自己成長につながっていったものと考えられた｡実習目標間の関係では,各実習目標との間に相関が見られ,それらは信頼性のある妥当な慢性期看護実習の目標であることが確認された｡This paper is designed to demonstrate the relationships between each objective and the students' achievement levels for the objectives of clinical nursing practice. Seventy four students evaluated their own achievement levels related to their clinical nursing practice. Evaluation scores for each objective were analyzed. The following results were obtained: The objective of cultivating the view of nursing and developing themselves had the highest score. Understanding the mechanism of disease, physical examination and treatment, and patient care, understanding nursing care toward patient's self care, and understanding nursing care for patient in crisis had high scores. The students, through their own nursing care, explored the meaning of each care (or each experience) and inquired about the nature of nursing. Their view of nursing and self development was formed from their own various experiences. Correlation among each objective was found. Each for clinical nursing practice has reliability and validity

実習記録から捉える基礎看護学実習Ⅱにおける学びの諸相 ―自分自身に関する記述から―

　本研究は、基礎看護学実習Ⅱにおける学生の学びの詳細を明らかにすることを目的とし、特に自分自身についての記述に焦点を当てて検討した。研究方法は、基礎看護学実習Ⅱに参加した68名の学生の実習記録簿－日々の記録－、述べ508シートを研究対象とし、質的分析を行った。分析の結果、自分自身に関する記述の内容は【受け持つことへの思い】【患者への対応】【患者からの支え】【知識・技術の不足】【看護に対する姿勢】【自己効力感】【残念・反省】【自己の振り返り】【達成感】【自分の成長・展望】の10のカテゴリーが生成された。それぞれのカテゴリーは、さらに33のサブカテゴリーによって詳細に説明することが出来た。また記述内容は、実習経過とともにネガティブな記述から、ポジティブな記述へと変化していた。ポジティブな記述は、受け持ち患者との関わりの中で得られた思いであった。教員は個々の学生のレベルに合わせた、つまり実習の初期に多く見られるネガティブな記述を踏まえ、「できている」という肯定感を持たせるような指導場面を設定することが重要であると考える

HT2005-72132 LARGE-SCALE QUANTUM CHEMICAL MOLECULAR DYNAMICS SIMULATIONS ON THE FORMATION DYNAMICS OF HYDROGEN BY THE CHEMICAL REACTIONS OF WATER

ABSTRACT We have successfully simulated the chemical reaction dynamics of water molecules on various Si surfaces by using our new tight-binding quantum chemical molecular dynamics method. The formation dynamics of hydrogen molecules from water molecules on Si nano-particle was observed at 300 K. Especially, we found that the surface termination of Si nanoparticle strongly influences the chemical reactions of water molecules and the non-terminated Si surface is the active site for the hydrogen generation. Moreover, we suggest that nanospace of the SiO 2 /Si interface is more active site for the hydrogen generation. INTRODUCTION Hydrogen is expected to be next-generation energy resources because it does not emit any pollutant exhaust gas. Therefore, efficient technology to produce hydrogen from water is strongly demanded in order to realize the sustainable society. A lot of experimental works for the above purpose have been carried out previously. For example, metal oxide photocatalyst such as TiO 2 semiconductor is one of the candidates for the efficient generation of hydrogen from water and many researchers investigated the photocatalytic activity of metal oxide semiconductor

Proposal of Classification Criteria for HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis Disease Activity

Human T-lymphotropic virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a rare chronic neuroinflammatory disease. While the disease usually progresses slowly without remission, there is a subgroup of patients with rapid progression and another subgroup with very slow progression. However, there have been no reports to date that have successfully determined the criteria to differentiate these subgroups. Therefore, we initially conducted a statistical modeling analysis to explore representative patterns of disease progression using data from our nationwide HAM/TSP patient registration system (“HAM-net”). The latent class mixed model analysis on the retrospective data (n = 205) of disease progression measured by the change in Osame Motor Disability Score from the onset of the disease to diagnosis demonstrated three representative progression patterns of HAM/TSP. Next, to test the effect of the progression rate at the initial phase of the disease on long-term prognosis, we divided 312 “HAM-net” registered patients into three groups (rapid, slow, and very slow progressors) based on the progression rate, then analyzed long-term functional prognosis of each group using the Kaplan–Meier method. Our data clearly demonstrated that the rapid progression at the early phase of the disease is an important poor prognostic factor. Moreover, to determine the biomarkers capable of discriminating the difference in disease activity, we compared the value of potential biomarkers of HAM/TSP among rapid (n = 15), slow (n = 74), very slow (n = 7), and controls (non-HAM/TSP patients, n = 18). The cerebrospinal fluid (CSF) levels of neopterin and C-X-C motif chemokine 10 (CXCL10) were the most valuable markers to discriminate among rapid, slow, and very slow progressors. To differentiate between rapid and slow progressors, the cut-off values of neopterin and CXCL10 were determined to be 44 pmol/mL and 4400 pg/mL, respectively. Furthermore, to differentiate between slow and very slow progressors, these values were determined to be 5.5 pmol/mL and 320 pg/mL, respectively. Notably, we found that CSF levels of these markers in very slow progressors were within the reference range. Thus, we propose a new classification criteria for disease activity of HAM/TSP that may contribute to improving the treatment algorithm for HAM/TSP

Study protocol for a multi-center, randomized controlled trial to develop Japanese denture adhesive guidelines for patients with complete dentures : the Denture Adhesive Guideline trial : study protocol for a randomized controlled trial

Background: Denture adhesives, characterized as medical products in 1935 by the American Dental Association, have been considered useful adjuncts for improving denture retention and stability. However, many dentists in Japan are hesitant to acknowledge denture adhesives in daily practice because of the stereotype that dentures should be inherently stable, without the aid of adhesives. The aim of this study is to verify the efficacy of denture adhesives to establish guidelines for Japanese users. The null hypothesis is that the application of denture adhesives, including the cream and powder types, or a control (isotonic sodium chloride solution) would not produce different outcomes nor would they differentially improve the set outcomes between baseline and day 4 post-application. Methods: This ten-center, randomized controlled trial with parallel groups is ongoing. Three hundred edentulous patients with complete dentures will be allocated to three groups (cream-type adhesive, powder-type adhesive, and control groups). The participants will wear their dentures with the denture adhesive for 4 days, including during eight meals (three breakfasts, two lunches, and three dinners). The baseline measurements and final measurements for the denture adhesives will be performed on the first day and after breakfast on the fourth day. The primary outcome is a general satisfaction rating for the denture. The secondary outcomes are denture satisfaction ratings for various denture functions, occlusal bite force, resistance to dislodgement, masticatory performance, perceived chewing ability, and oral health-related quality of life. Between-subjects comparisons among the three groups and within-subjects comparisons of the pre- and post-intervention measurements will be performed. Furthermore, a multiple regression analysis will be performed. The main analyses will be based on the intention-to-treat principle. A sample size of 100 subjects per group, including an assumed dropout rate of 10 %, will be required to achieve 80 % power with a 5 % alpha level. Discussion: This randomized clinical trial will provide information about denture adhesives to complete denture wearers, prosthodontic educators, and dentists in Japan. We believe this new evidence on denture adhesive use from Japan will aid dentists in their daily practice even in other countries

A validated proton beam therapy patch-field protocol for effective treatment of large hepatocellular carcinoma

Development of a curative local treatment for large hepatocellular carcinoma (HCC) is an important issue. Here, we investigated the dose homogeneity, safety and antitumor effectiveness of proton beam therapy (PBT) using a patch-field technique for large HCC. Data from nine patients (aged 52–79 years) with large HCC treated with patch-field PBT were investigated. The cranial–caudal diameters of the clinical target volumes (CTVs) were 15.0–18.6 cm (median 15.9). The CTV was divided cranially and caudally while both isocenters were aligned along the cranial–caudal axis and overlap of the cranial and caudal irradiation fields was set at 0–0.5 mm. Multileaf collimators were used to eliminate hot or cold spots. Total irradiation doses were 60–76.4 Gy equivalents. Irradiation doses as a percentage of the prescription dose (from the treatment planning system) around the junction were a minimum of 93–105%, a mean of 99–112%, and a maximum of 105–120%. Quality assurance (QA) was assessed in the cranial and caudal irradiation fields using imaging plates. Acute adverse effects of Grade 3 were observed in one patient (hypoalbuminemia), and a late adverse effect of Grade 3 was observed in one patient (liver abscess). Child–Pugh class elevations were observed in four patients (A to B: 3; B to C: 1). Overall survival rates at 1 and 2 years were 55 and 14%, respectively, with a median overall survival of 13.6 months. No patients showed local recurrence. Patch-field PBT supported by substantial QA therefore is one of the treatment options for large HCC

Occupational risk factors for Parkinson's disease: a case-control study in Japan

<p>Abstract</p> <p>Background</p> <p>The evidence for associations between occupational factors and the risk of Parkinson's disease (PD) is inconsistent. We assessed the risk of PD associated with various occupational factors in Japan.</p> <p>Methods</p> <p>We examined 249 cases within 6 years of onset of PD. Control subjects were 369 inpatients and outpatients without neurodegenerative disease. Information on occupational factors was obtained from a self-administered questionnaire. Relative risks of PD were estimated using odds ratios (ORs) and 95% confidence intervals (CIs) based on logistic regression. Adjustments were made for gender, age, region of residence, educational level, and pack-years of smoking.</p> <p>Results</p> <p>Working in a professional or technical occupation tended to be inversely related to the risk of PD: adjusted OR was 0.59 (95% CI: 0.32-1.06, <it>P </it>= 0.08). According to a stratified analysis by gender, the decreased risk of PD for persons in professional or technical occupations was statistically significant only for men. Adjusted ORs for a professional or technical occupation among men and women were 0.22 (95% CI: 0.06-0.67) and 0.99 (0.47-2.07), respectively, and significant interaction was observed (<it>P </it>= 0.048 for homogeneity of OR). In contrast, risk estimates for protective service occupations and transport or communications were increased, although the results were not statistically significant: adjusted ORs were 2.73 (95% CI: 0.56-14.86) and 1.74 (95% CI: 0.65-4.74), respectively. No statistical significance was seen in data concerning exposure to occupational agents and the risk of PD, although roughly a 2-fold increase in OR was observed for workers exposed to stone or sand.</p> <p>Conclusion</p> <p>The results of our study suggest that occupational factors do not play a substantial etiologic role in this population. However, among men, professional or technical occupations may decrease the risk of PD.</p

Long survival case of trisomy 13 mosaicism in a 7-year-old male

Trisomy 13 is a complication of various congenital abnormalities of the heart, brain, etc. Regarding the vitalprognosis, many die within a year from birth. We herein report on the case of a 7-year 1-month-old boywith mosaicism trisomy 13 with the two considerations mentioned below as the cause for long-term survivalin this case. The first is that there were no serious associated abnormalities to the heart, brain, or otherorgans, and the second is that a tracheotomy was carried out on a repeated respiratory infection with respiratoryfailure. Long-term in-home care was possible for the child and he was observed playing with toys bytouching them. Trisomy 13 has a poor vital prognosis, so some argue that active treatment should be restrained.However, for cases with no severe associated abnormalities, long-term survival may be possiblewith active treatment

Alcohol drinking and risk of Parkinson's disease: a case-control study in Japan

<p>Abstract</p> <p>Background</p> <p>Although some epidemiologic studies found inverse associations between alcohol drinking and Parkinson's disease (PD), the majority of studies found no such significant associations. Additionally, there is only limited research into the possible interactions of alcohol intake with aldehyde dehydrogenase (ALDH) 2 activity with respect to PD risk. We examined the relationship between alcohol intake and PD among Japanese subjects using data from a case-control study.</p> <p>Methods</p> <p>From 214 cases within 6 years of PD onset and 327 controls without neurodegenerative disease, we collected information on "peak", as opposed to average, alcohol drinking frequency and peak drinking amounts during a subject's lifetime. Alcohol flushing status was evaluated via questions, as a means of detecting inactive ALHD2. The multivariate model included adjustments for sex, age, region of residence, smoking, years of education, body mass index, alcohol flushing status, presence of selected medication histories, and several dietary factors.</p> <p>Results</p> <p>Alcohol intake during peak drinking periods, regardless of frequency or amount, was not associated with PD. However, when we assessed daily ethanol intake separately for each type of alcohol, only Japanese sake (rice wine) was significantly associated with PD (adjusted odds ratio of ≥66.0 g ethanol per day: 3.39, 95% confidence interval: 1.10-11.0, <it>P </it>for trend = 0.001). There was no significant interaction of alcohol intake with flushing status in relation to PD risk.</p> <p>Conclusions</p> <p>We did not find significant associations between alcohol intake and PD, except for the daily amount of Japanese sake. Effect modifications by alcohol flushing status were not observed.</p