A ケン ニ オケル ホウモン カンゴ ステーション ノ 24ジカン オンコール タイセイ ノ ジッタイ : カンリシャ ヘノ アンケート チョウサ カラ

背景 近年, 看護職において, 長く働き続けられる環境づくりを進めるために, ワーク・ライフ・バランスの実現に向けての取り組みが行なわれている. 目的 A県における訪問看護ステーションのオンコール体制の実態を明らかにし, ワーク・ライフ・バランスを検討するための基礎的資料とすることを目的とした. 方法 A県にある70か所の訪問看護ステーションの管理者宛てに, 無記名自記式質問紙調査を送付し, 39か所 (55.7%) から有効回答を得た. 結果 A県にある39か所のステーションにおける1事業所当たりの平均看護師数は6.0±5.6人であり, 全国平均の4.2人と比べると多く, 規模別においては, 中規模事業所が77%を占めていた. 24時間対応体制加算は, 34か所 (87%) が取られているが, オンコール体制に関する規約や手当がない事業所もあった. また, オンコール体制はほとんどが常勤職員で担っており, 管理者の待機日数は, 大規模事業所に比べて小規模および中規模事業所の方が多かった. 考察 オンコール体制が, 在宅看護の重要な機能として捉えている一方で, 訪問看護師の高い離職率や人材確保の難しさの一因となっていることが考えられた. 今後は, 法的根拠に基づいた規約の整備が望まれる. また, 管理者個人が意識化し, 個々のステーションでワーク・ライフ・バランスの取り組みが必要である. 結論 オンコール体制のあり方や職員への指導等を考える資料を得ることができたので, 待機手当のないステーションに手当を提案し, 継続した調査を行う.Background As for the nurse, an action for the realization of the work-life balance is carried out to push forward the making of environment where it is continued acting on for a long time.Purpose To study the actual conditions of home-visit nursing care stations that extend services on an on-call around-the-clock basis, and to make the investigation results available for study of the workers\u27 work-life balance.Methods nvestigations were made by means of sending questionnaires to managers of 70 nursing care stations located in Prefecture A, of which 39 managers, 55.7%, responded on an anonymous basis.Results The average number of nurses per station at 39 nursing care stations in Prefecture A was 6.2, more than the national average of 4.2.Middle-size nursing care stations occupied 77% of the total respondents. Thirty-four stations, or 87%, adopted an additional payment system for around-the-clock services, but there were some that had no internal regulations or additional service charge system for around-the-clock services. Most stations used full-time nurses for around-the-clock services. As for the number of days when managers were on duty for around-the-clock services, small-sized and middle-sized stations had more days than large-sized stations.Discussion The around-the-clock on-call service is an important factor for functioning home-visit nursing care. However, it is also a reason for which home-visit nurses tend to leave the job after a short period and it is getting more difficult to obtain capable nurses. Stipulating legally effective work regulations to improve the working conditions for home-visit nurses is desired in the near future. It is also necessary for each care manager to realize the importance of improving the work-life balance of nurses

Slc3a2 Mediates Branched-Chain Amino-Acid-Dependent Maintenance of Regulatory T Cells

Foxp3+ regulatory T (Treg) cells, which suppress immune responses, are highly proliferative in vivo. However, it remains unclear how the active replication of Treg cells is maintained in vivo. Here, we show that branched-chain amino acids (BCAAs), including isoleucine, are required for maintenance of the proliferative state of Treg cells via the amino acid transporter Slc3a2-dependent metabolic reprogramming. Mice fed BCAA-reduced diets showed decreased numbers of Foxp3+ Treg cells with defective in vivo proliferative capacity. Mice lacking Slc3a2 specifically in Foxp3+ Treg cells showed impaired in vivo replication and decreased numbers of Treg cells. Slc3a2-deficient Treg cells showed impaired isoleucine-induced activation of the mTORC1 pathway and an altered metabolic state. Slc3a2 mutant mice did not show an isoleucine-induced increase of Treg cells in vivo and exhibited multi-organ inflammation. Taken together, these findings demonstrate that BCAA controls Treg cell maintenance via Slc3a2-dependent metabolic regulation

Invasive behavior of ulcerative colitis-associated carcinoma is related to reduced expression of CD44 extracellular domain: comparison with sporadic colon carcinoma

<p>Abstract</p> <p>Background</p> <p>To elucidate relations of invasion of ulcerative colitis (UC)-associated carcinoma with its prognosis, the characteristics of invasive fronts were analyzed in comparison with sporadic colonic carcinomas.</p> <p>Methods</p> <p>Prognoses of 15 cases of UC-associated colonic carcinoma were compared with those of sporadic colon carcinoma cases, after which 75 cases of sporadic invasive adenocarcinoma were collected. Tumor budding was examined histologically at invasive fronts using immunohistochemistry (IHC) of pancytokeratin. Expressions of beta-catenin with mutation analysis, CD44 extracellular domain, Zo-1, occludin, matrix matalloproteinase-7, laminin-5γ2, and sialyl Lewis X (Le^X) were immunohistochemically evaluated.</p> <p>Results</p> <p>UC-associated carcinoma showed worse prognosis than sporadic colon carcinoma in all the cases, and exhibited a tendency to become more poorly differentiated when carcinoma invaded the submucosa or deeper layers than sporadic carcinoma. When the lesions were compared with sporadic carcinomas considering differentiation grade, reduced expression of CD44 extracellular domain in UC-associated carcinoma was apparent. Laminin-5γ2 and sialyl-Le^Xexpression showed a lower tendency in UC-associated carcinomas than in their sporadic counterparts. There were no differences in the numbers of tumor budding foci between the two lesion types, with no apparent relation to nuclear beta-catenin levels in IHC.</p> <p>Conclusions</p> <p>UC-associated carcinoma showed poorer differentiation when the carcinoma invaded submucosa or deeper parts, which may influence the poorer prognosis. The invasive behavior of UC-associated carcinoma is more associated with CD44 cleavage than with basement membrane disruption or sialyl-Lewis-antigen alteration.</p

シンセツ カンゴ ガクブ ニ オケル カンゴ ジッセン ノウリョク イクセイ ノ タメ ノ カンゴ ギジュツ コウモク ノ ケントウ

背景 高齢化社会や医療の高度化の到来から, 看護学生の看護実践能力の強化の必要性が重要課題となっている. 目的 新設看護学部において看護実践能力が高い学生を育成するために必要と考えられる看護技術項目を明らかにすることを目的とした. 方法 各看護学領域代表者で技術項目検討委員会をもち, 本学部の教育理念に従って, 既存文献を参考にしながら, 項目を追加修正し, 各看護学領域が講義・演習・実習のどこで学習するかを確認した. 結果 学生の看護実践能力を育成する為の看護技術項目は19項目の大項目, 131の中項目, 160の小項目と整理し, 看護技術項目のシートを作成した. 結論 作成したシートは, 各看護学領域で学習する内容を講義の教材として活用し, 学生・教員・実習の指導者の3者間で, 個々の学生の看護技術の習得に有効であると考える. またそれは, 学生の看護実践能力の強化へと期待できる.Background With the aging of society and the advances in medical care technologies, it is increasingly important and necessary for nursing students to be able to use their nursing knowledge and skills in a practical setting. Educational institutions are therefore urged to provide the students with such training.Purpose The purpose of this paper is to clarify what skills are actually necessary and useful for students to become effective in their practice as nurses, and what training should be given at the new nursing department in order to enhance the practical nursing skills of students.Methods First, scholars and representatives of nursing-related fields formed a committee where skills required for achieving the purpose stated above were redefined in accordance with the university\u27s educational objectives. In revising the existing skills items, published information was also used as a reference. How each of the skills is learned, either in lectures, classroom training, or practical training, was confirmed by the committee.Results The nursing skills identified by the committee were classified into 19 skills of major importance, 131 skills of medium importance and 160 skills of less importance. The committee summarized them as a list of nursing skills.Conclusion The list can be used as teaching materials in the class, and can be used not only by teachers and advisors in the training but also by students. Students would refer to the list when learning nursing skills. Such use of the list may reinforce students\u27 ability to apply the obtained skills in their nursing performance

Clozapine and Antipsychotic Monotherapy

Background: Although clozapine is effective for treatment-resistant schizophrenia (TRS), the rate of clozapine prescription is still low. Whereas antipsychotic monotherapy is recommended in clinical practice guidelines, the rate of antipsychotic polypharmacy is still high. There is little evidence on whether a clozapine prescription influences changes in the rate of monotherapy and polypharmacy, including antipsychotics and other psychotropics. We therefore hypothesized that the rate of antipsychotic monotherapy in patients with TRS who were prescribed clozapine would be higher than that in patients with schizophrenia who were not prescribed clozapine. Methods: We assessed 8306 patients with schizophrenia nationwide from 178 institutions in Japan from 2016 to 2019. We analyzed the psychotropic prescription data at discharge in patients diagnosed with TRS and with no description of TRS (ND-TRS) based on the diagnosis listed in the discharge summary. Results: The rate of antipsychotic monotherapy in the TRS with clozapine group (91.3%) was significantly higher than that in the TRS without clozapine group (45.9%; P < 2.0 × 10−16) and the ND-TRS without clozapine group (54.7%; P < 2.0 × 10−16). The rate of antipsychotic monotherapy without any other concomitant psychotropics in the TRS with clozapine group (26.5%) was significantly higher than that in the TRS without clozapine group (12.6%; P = 1.1 × 10−6) and the ND-TRS without clozapine group (17.0%; P = 5.9 × 10−6). Conclusions: Clozapine prescription could be associated with a high rate of antipsychotic monotherapy. Patients will benefit from the correct diagnosis of TRS and thus from proper clozapine prescription

Organized and Sustainable Education Program for Drug Abuse Prevention by Yogo-teachers

　学校における喫煙・飲酒・薬物乱用防止教育の充実には，問題行動が顕在化する中学校期だけでなく小学校期 における指導の推進が重要であり，系統的な指導計画を立て，指導者や時間の確保，教材作成などに組織的に取 組み，継続可能なプログラム開発を行う必要がある。そこで，地区内12 校の養護教諭が協働して，発達段階に応 じた系統的・組織的かつ継続可能な地区共通の指導計画を開発し，各校の教育課程・年間計画に位置付けた実践 研究を行った。その結果，指導計画の実施状況は，小学校11 校中，学級活動10 校，ミニ保健指導10 校，長期 休業前指導6 校，広報活動9 校となり，特別支援学校1 校では広報活動のみを行うことができた。小学校におけ る喫煙・飲酒・薬物乱用防止教育の推進には，学校保健活動の中核的役割を担う養護教諭が専門性を活かし協働 して，系統的な指導計画を各校の教育課程に位置付け組織的で継続可能なプログラムとする取組が有効であった

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

Usefulness of cytological scoring method by breast fine needle aspiration cytology on breast duct dilatation and cystic lesions

Aim: The objective of this study was to apply a scoring method to fine needle aspiration cytology on breast duct dilatation and cystic lesions, to set an optimum cut-off value to differentiate between benign and malignant cases, and to identify features useful for cell judgment. Materials and Methods: Samples were 23 preparations of specimens (12 benign and 11 malignant cases) suspected with intraductal lesions or cystic change by ultrasonography or mammography and cytology. The scoring system comprised the following 10 items, and each item was scored 1–3, with a total score of 10–30. Three items were concerning structural atypia: 1, scattered epithelial cells; 2, uneven irregular cluster edge; and 3, overlapping nuclei of epithelial cells, and seven items were concerning cellular atypia: 4, irregular nuclear size; 5, irregular nuclear morphology; 6, deep dyeing chromatin; 7, chromatin granularity; 8, chromatin distribution; 9, nucleolus; and 10, absence of myoepithelial cells. Results: (1) Scoring cut-off value: malignancy is to be suspected when the score is 20.75 or higher (diagnostic accuracy: 95.7%). (2) Findings useful for cancer judgment: the sensitivity of the following four findings was high: uneven irregular cluster edge, irregular nuclear overlapping, chromatin granularity, and absence of myoepithelial cells. (3) Correlation among the findings: the findings correlated with malignancy were as follows: scattered epithelial cells versus uneven irregular cluster edge (rs = 0.8). Conclusion: Cytological evaluation by scoring lesions accompanied by intraductal dilatation and cystic change was a useful method capable of differentiating between benign and malignant cases at a high accuracy

Establishing a New System of Training Teaching Assistants in Japan: An Attempt in Hiroshima University

Teaching assistantships were introduced to Japanese universities in 1992. It was suggested teaching assistantships be used for educating graduate students to be good university faculty, with proficiency in teaching as well as excellence in research. However, teaching assistants have received less responsibility and less payment. This presentation will explain the current situation concerning teaching assistantships in Japan and show our attempt to establish a systematic training course of teaching assistants that fits the Japanese background