The research on the problems of health care and living of the aged (Pursuing the cases of home treatment given to the elderly patients for one year after their discharge)

退院後の生活に目を向けた適切な退院指導がなされることは、高齢患者が安心して在宅療養を送る上で、重要な意味を持つ。そこで病院から在宅療養に移行した70歳以上の高齢者の抱える問題を4回に渡って1年間調査し、これまでに退院時、3ヵ月後、6ヵ月後の調査結果を報告した。本稿では1年を通じて回答のあった53名について健康と生活上の問題の変化を分析し、考察した。在宅療養に移行した高齢者の健康状態と生活上の問題は、ほぼ一致して退院後6ヵ月から1年後までに変化を認め、特に日常生活上の問題は著しく増加した。その原因として病状の悪化との関連が考えられた。また、高齢者の問題についての意識は、研究者の専門的な問題意識に比べて低かった。従って入院中に退院後の生活を予測することには限界があり、今後は退院指導の充実と伴に在宅サービスとの連携が重要であることを認めた。We planned to make emerge the problems felt by the elderly patients of 70 years and over given home treatment. As a means of our research, four times a year we sent a questinnaire to the aged who had been discharged. After collecting the answers of the questionnaires, we decided to focus on the 53 elderly patients who answered all four questionnaires, and then tried to make their problems emerge. The contents of the questionnaires were about their health care in a year and how their daily life changed. We can see that the condition of the elderly patients under home treatment and their living problems have changed almost without exceptions six months to a year after their discharge. Especially the number of the problems in their daily life increased remarkably. These results might be considered to be caused by the aggravation of their diseases. In addition, the elderly patients are not as conscious of their own problems as a specialist with a critical mind. Therefore, there is a limit to estimating the change in lifestyle of a discharged patient while they remain hospitalized. We consider it essential to get full discharge-care closely connected with home service for elderly patients

患者による受け持ち学生の技術に対する評価と期待

学生が実習で受け持った入院患者が，学生の実習態度や看護技術をどう評価しているのか，学生にどのような態度や技術を期待しているのかを明らかにする目的で調査を行った．対象は，慢性期看護実習で学生が５週間継続して受け持った患者のうち，研究への同意が得られた１９名の患者である．本稿では，看護技術のうち，コミュニケーション技術および観察技術について報告する．調査の結果，学生のコミュニケーション技術および観察技術に対する患者の評価はおおむね良好であり，それらの技術に対する患者の期待は高いことが明らかになった．しかし，少数ではあるものの否定的な評価や学生には全く期待しない患者もおり，看護者としての姿勢に対する教育，受け持ち患者決定における条件などについては，今後さらに検討の必要性があることが示唆された．As part of the clinical nursing experience, nursing students were assigned to take care of patients requiring treatment for chronic health conditions for five consecutive weeks. The study was conducted to ascertain how １９ consenting patients assessed the attitudes and communication and observation skills of nursing students. Patients were also asked about their expectations of the students. Results showed that patients expected nursing students to demonstrate a high level of skills ; the communication and observation skills of the nursing students were generally assessed favorably. However, a few patients gave negative assessments of the students' attitudes and skills and stated that they did not expect anything from them. Our results suggest that it is necessary to further investigate the attitudes of nursing students and the conditions for their clinical assignments

ロートを用いた客観的な簡易とろみ評価方法の開発

Some patients with dysphagia are prone to aspiration of low-viscosity liquids. Thickened liquids are often used in attempts to prevent aspiration. The patients should be given thickened liquids with suitable thickness, and the thickness should be constant at all time. While rotational and cone-and-plate viscometers are used for the evaluation of thickened liquids, they are high-precision and expensive equipment. To control the thickness of liquids, a simple and objective evaluation method is thus necessary. We developed a method to evaluate thickened liquids using funnels, and verified the appropriateness of this method. We measured the outflow times of five thickened liquids through funnels. One of the thickened liquids was a commercially available nutritional supplement, another was made with a thickening agent that contained guar gum, and all others were made with a thickening agent that contained xanthan gum. Four funnels with different stem sizes were tested. We found that the outflow time of thickened liquids through a funnel depended on their viscosities at a shear rate between 10 and 50 s–1, when the average inner diameter of the stem was in the range of 5.3–9.0 mm, and the volume of the liquid poured into the funnel was 30 mL. The correlation coefficient between the value of the sensory evaluation and the outflow time of the funnel with an average stem ID of 5.3 mm was 0.946. Therefore, this method may be useful in hospital and nursing home kitchens for evaluating thickened liquids

Orange Juice and Its Component, Hesperidin, Decrease the Expression of Multidrug Resistance-Associated Protein 2 in Rat Small Intestine and Liver

We investigated the effects of orange juice (OJ) or hesperidin, a component of OJ, on the pharmacokinetics of pravastatin (PRV) and the expression of both protein and mRNA of multidrug resistance-associated protein 2 (Mrp2) in the rat small intestine and liver. Eight-week-old male Sprague-Dawley rats were used in this study. OJ or a 0.079% hesperidin suspension was administered orally for 2 days. Tap water was given as a control. A single dose of PRV at 100 mg/kg p.o. was administered after 2 days of OJ, hesperidin, or tap water ingestion. The AUC, Cmax, and t1/2 values of PRV were significantly increased in OJ group. Mrp2 protein and mRNA levels in the small intestine and liver, respectively, were significantly decreased after the ingestion of OJ. The same results were obtained with hesperidin. These results suggest that the changes in PRV pharmacokinetic parameters and the decrease in Mrp2 expression caused by OJ are due to hesperidin in the juice

Decrease in size of azoxymethane induced colon carcinoma in F344 rats by 180-day fermented miso

The present study was designed to investigate the effects of fermented miso (fermented soybean paste) on the induction of colon tumors by azoxymethane (AOM) in male F344 rats. A total of 91 rats, 6 weeks of age, were divided into 5 groups and given weekly subcutaneous injections of AOM (15 mg/kg body wt) for 3 weeks. The animals were placed on diets one week before the first AOM dose: commercial normal control MF diet or a diet containing 10% 2-year, 180-day fermented, or 3-4-day fermented miso. There were no differences in body and organ weights, and no aberrant crypt foci (ACF) among carcinogen-treated groups at week 25. The rates of tumor incidence were 45%, 85%, 75% and 60% with the 2-year, 180-day, and 3-4-day fermented miso and MF, respectively, and those for colon tumors were 34%, 55%, 60% and 55%, respectively. The size of well-differentiated adenocarcinomas and total (well differentiated and signet ring cell) adenocarcinomas in the 180-day fermented miso group was significantly smaller than that in the 2-year fermented miso and MF+AOM groups. Nuclear staining of beta-catenin in colon tumors was increased for the 3-4-day fermented miso compared to the 180-day fermented miso. Cdx2 staining tendency was decreased in colon tumors and adenocarcinomas compared to normal mucosa and ACF, which stained in 100% of cases. In addition, the PCNA index was significantly reduced in the 180-day group compared with those groups receiving the 3-4-day fermented miso and MF diet. The germinal region was also decreased. The present results indicate that dietary supplementation with 180-day fermented dietary miso could act as a chemopreventive agent for colon carcinogenesis