Development and Validation of the Self-care Agency Scale for Cancer Patients under Treatment

学位記番号：保博甲10

Self‐efficacy and its impact factors of outpatients suffering from hematological malignancies

血液腫瘍は悪性腫瘍の中でも予後が悪い疾患であり，寛解後も長期にわたる外来通院やセルフケアが必要となる．このセルフケアの実践や継続には患者自身の自己効力感が重要である．そこで本研究では外来通院中の血液腫瘍患者の看護を検討するために自己効力感とその影響要因を明らかにした．２つの大学病院の血液外来において，研究参加の承諾が得られた２０歳以上の患者に対し調査を行い，有効回答の得られた１１０名について分析した．質問票の主な内容は一般的背景，自己効力感，情緒的支援ネットワーク，疾病・治療の理解，セルフケアの獲得状況，看護師との関わりである．また，治療に関する情報は診療録から得た．自己効力感得点は平均３１．５点，標準偏差５．３点であり，男性の方が女性よりも高い値を示し，性格型では内向型より活動的で感情が安定している外向型の方が高かった．自己効力感に影響を与えると思われる要因は，性別，性格型，Performance Status，家族内の情緒的支援ネットワーク，疾病・治療の理解の「健康管理の必要性の理解」，「症状の理解」，「薬の作用・副作用の理解」とセルフケアの「休息と睡眠への配慮」の８要因であった．この８要因について重回帰分析を行った結果３４％が説明でき，以上の結果より，自己効力感を高めるためには影響要因への援助も含め，生理的・情動的状態の安定に向けた看護が重要である。また，他患者からのプラスの影響である代理的経験，看護師の言語的説得，遂行行動の達成が累積できる看護システムを検討し構築していくことの重要性が示唆された．The object of this study is to reveal the self‐efficacy and its impact factors of outpatients suffering from hematological malignancies. The subjects of investigation were picked out from outpatients of two university hospitals. The １１０ outpatients who gave consent and valid answers were chosen. In the items of investigation, cancer patient self‐efficacy scales with possible scores of ０‐４０, YG personality checkup, emotional support network scales, etc. were employed. As a result, the average score of self‐efficacy scales was ３１．５. Principally extraversion men had high self-efficacy. In addition, sex, performance status, personality, understanding of one’s disease/treatment, acquirement of self‐care behavior, and emotional support network were found to be impact factors. The results above suggest the importance of constructing a nursing system concerning vicarious experience, physiological and affective states, verbal persuasion, and enactive attainment

Three-dimensional observation and analysis of remineralization in dentinal caries lesions

The remineralization mechanism in dental caries lesions is not completely understood. This study reports on ultrastructural and chemical changes observed within arrested caries lesions. Carious human teeth were observed using scanning electron microscopy (SEM) and focused-ion-beam (FIB)-SEM. The crystals detected in the caries lesions were characterized by transmission electron microscopy (TEM), along with chemical element mapping using energy-dispersive spectroscopy (EDS)-STEM. FIB-SEM 3D reconstructions revealed a severely damaged dentin surface abundantly covered by bacteria. Although the dentin tubules were clogged up to a depth of 100 mu m, bacterial invasion into dentin tubules was not observed. TEM crystal analysis and EDS-STEM revealed the presence of Ca and P, as well as of Mg within the HAp crystals deposited inside the dentin tubules. It was concluded that extensive remineralization with deposition of Mg-HAp crystals had occurred in dentin tubules of caries-arrested dentin. Understanding the natural remineralization process is thought to be helpful for developing clinical biomimetic remineralization protocols

Effects of midazolam on acquisition and extinction of conditioned taste aversion memory in rats.

Some intravenous anesthetic agents such as midazolam are known to induce anterograde and retrograde amnesia. We analyzed the effect of midazolam by the conditioned taste aversion (CTA) acquisition and retention. After the rats were offered 0.1% sodium saccharin (Sac) as conditioned stimulus (CS), an intraperitoneal (i.p.) injection of several concentrations (5-30mg/kg) of midazolam was followed by an i.p. injection of 0.15M LiCl (2% of body weight) as unconditioned stimulus (US). The rats, which acquired CTA by every CS-US paradigm, strongly avoided Sac on the 1st test day after conditioning and maintained the avoidance for 3 days. We have already reported that Sac intake abruptly increased on the 2nd test day and the almost complete extinction occurred on the 3rd test day after conditioning by injection of subhypnotic dose of propofol before LiCl-injection. In contrast, we found that subhypnotic dose of midazolam suppressed not only CTA acquisition, but also CTA retention. On the other hand, an alpha2-adrenergic blocker, yohimbin (1mg/kg) suppressed only the CTA retention. These results suggest that the subhypnotic doses of midazolam firstly affect the acquisition mechanism of the CTA memory (CTAM), resulting the suppression of the retention of CTAM

General tendencies of stable isotopes and major chemical constituents of the Dome Fuji deep ice core (scientific paper)

Stable isotope compositions of water and major chemical constituents of the Dome Fuji ice core are analyzed and the data sets over the entire depth of the 2503-m core are presented in appropriate time resolution as consecutive series of average value in definite terms. These results based on the first stage analyses allow a temporal climatic dividing of the three glacial-interglacial cycles present in the records. A Comparison of the climatic and environmental characteristics of these climate stages is presented

Comparison in the views of life and death between nurses and docters of a University Hospital

医師と看護師の死生観とその影響要因の相違をふまえ，質の高い緩和ケアチームについて検討することを目的とした．A 大学病院に勤務する医師と看護師に死生観について質問紙調査を行った．平井らが開発した死生観尺度（▯＝０．８８，７因子２７項目）を用いた．有効回答は医師１２０名（医師群）と看護師３４７名（看護師群）であった。統計処理については危険率５％未満を有意差とした．分析にはSPSS１１．０J for Windows（SPSS社製）を用いた．倫理的配慮は倫理審査会の承認を得た後，対象者へは参加の自由とプライバシーの保護を保証した．①「死への恐怖・不安」と「人生の目的意識」の因子には群間で有意差は認められなかった．②「死後の世界観」，「解放としての死」，「死からの回避」，「死への関心」や「寿命観」の５因子において両群間で有意に看護師群の方が高かった．③年齢などの各要因と死生観尺度との関係は両群者ともに年齢と「寿命観」で有意差が認められた．④死を迎える時に，希望する場所と死生観尺度得点に有意差が認められた．医師と看護師の死生観は「死後の世界観」などの因子得点で有意差が認められ，緩和ケアチームを効果的に展開していくためには双方の死生観の理解と，ケアへの活用の必要性が示唆された．A high quality palliative care team has been examined considering the differences between doctors and nurses in their views of life and death and its influential factors. A survey has been conducted on doctors and nurses employed at A University Hospital in their views of life and death. “Rinroshiki Syakudo”, a scale developed by Hirai et al（▯＝０．８８，７ factors，２７ items）, has been used as a scale of their views. The results of １２０ doctors and ３４７ nurses were analyzed by t-test, and significant difference was defined as a risk below ５％. SPSS １１．０J for Windows（by SPSS）was used for the analysis. After an approval of an audit for an ethical consideration, participants were ensured their freedom to participate and privacy protection. １） No significant differences have been found in factors “death anxiety” and “life purpose” in scales of views of life and death ２） However ５ factors， “after life belief”， “death relief”，“death avoidance”， “death concern” and “supernatural belief” were significantly high in nurses. ３） There was also a significant difference between the age and their “supernatural belief” in both doctors and nurses. ４） There were also significant differences in “where they want to die” and the total score of the scale, when facing own death. There being differences in factors such as “afterlife belief” between doctors’ views and those of nurses, the result suggested the need to understand both of the views and reflect them to palliative care