40歳未満の勤務助産師の職務満足度調査 : 病院・診療所・助産所の比較

【目的】40歳未満助産師の就業場所と職務満足度との関連を明らかにする． 【方法】研究デザインは職務満足度を従属変数とする相関関係型量的研究．東京，神奈川の病院・診療所・助産所勤務 の40歳未満の助産師423名に無記名自記質式質問紙調査を郵送法で実施．期間は平成23年9月6日～30日．職務満足 度調査の内容は労働条件・人間関係・業務内容・やりがいと自律の4つをカテゴリーとした．国際医療福祉大学の倫理 委員会で承認を得た． 【結果】病院142人診療所26人助産所31人計199人の有効回答を分析（回答率47％）．職務満足度は助産所，診療所，病 院勤務助産師の順に高かった．また，カテゴリー別でみると，人間関係（相関比η0.553），業務内容（相関比η0.735）， やりがい（相関比η0.605）で，関連性がみられ，平均点はすべてにおいて助産所が高かった． 【考察】施設毎で職務満足度に相違があり，その要因に自律した助産業務が関係することから，助産師が主体的に働 くための業務の見直しが必要であると考える． (Purpose) The principal aim of the present study was to clarify the relationship between the workplace and the degree of job satisfaction among working midwives younger than 40 years. (Methods) The study was designed as a correlational and quantitative study using the degree of job satisfaction as the dependent variable.　An anonymous self-administered questionnaire was mailed to 423 midwives younger than 40 years who were working in hospitals, clinics, or birthing centres in the Tokyo Metropolis or Kanagawa Prefecture.　The study period was from September 6 to 30, 2011.　The content of the degree of work satisfaction survey was categorized into four categories: working conditions, human relationships, work duties, and sense of fulfilment and autonomy.　The present study was approved by the institutional review board of the International University of Health and Welfare. (Results) A total of 199 valid responses (hospitals: 142 responses; clinics: 26; birthing centres: 31) were analysed (valid response rate: 47％).　The degree of job satisfaction among working midwives was highest in birthing centres, followed by clinics and then hospitals.　Furthermore, an examination by category revealed a relationship between human relationships (correlation ratio: η0.553), work duties (correlation ratio: η0.735), and sense of fulfilment (correlation ratio: η0.605); the mean score of all categories was highest for birthing centres. (Discussion) Because there were differences in the degree of job satisfaction for each facility and autonomous midwifery work was a related factor, it is the authors' opinion that it is necessary to review the work of midwives to allow them to work more autonomously

Successful local treatment for repeated hepatic recurrences of cholangiolocellular carcinoma: a report on a long-term survivor

Abstract Background Cholangiolocellular carcinoma (CoCC) is a rare liver tumor arising from the canals of Hering found between the cholangioles and interlobular bile ducts. Although morphologically CoCC mimics intrahepatic cholangiocarcinoma (ICC), CoCC exhibits a unique intermediate biologic behavior between hepatocellular carcinoma (HCC) and ICC. Curative resection is required for prolonged survival in patients with CoCC. However, effective therapy for postoperative hepatic recurrence has not yet been standardized. Case presentation A 40-year-old man had an asymptomatic liver mass found during a regular medical examination. Contrast-enhanced computed tomography revealed a well-enhanced mass, 15 cm in diameter, in the right liver. He underwent right hemihepatectomy at a local hospital under the preoperative diagnosis of hepatocellular carcinoma. Pathologic examination confirmed a moderately differentiated tubular adenocarcinoma, leading to a diagnosis of ordinary ICC. Twelve months after surgery, he was referred to our hospital due to three hepatic recurrences in the left medial segment. He underwent partial hepatectomy for the recurrence, followed by adjuvant chemotherapy using gemcitabine alone. After the second hepatectomy, hepatic recurrences developed an additional seven times. The numbers and sizes of the recurrent tumors were very limited at each recurrence, satisfying the standard criteria for percutaneous radiofrequency ablation (RFA) for the treatment of HCC. All lesions were treated by percutaneous RFA, although this was an exceptional approach for ICC. He is now alive without evidence of disease 9.2 years after the first hepatectomy. Because his clinical outcome was satisfactory and not compatible with the typical negative outcomes of ordinary ICC, we re-reviewed the histological findings of his tumor. The tumor was composed of small gland-forming cells proliferating in an anastomosing pattern; the cell membrane was strongly immunoreactive for epithelial membrane antigen. These findings were in accordance with the typical features of CoCC, revising his final diagnosis from ICC to CoCC. Conclusions This case report demonstrates a satisfactory outcome using repeated local treatments, such as hepatectomy and RFA, for hepatic recurrences of CoCC, suggesting that a localized treatment approach can be considered to be a therapeutic option. We should be careful in making a definitive diagnosis of ICC and ruling out CoCC because the diagnosis potentially dictates the treatment strategy for recurrences