Impact of surgical adhesion barrier on significant adhesion during a repeat cesarean section

　Background: Post-cesarean adhesions are associated with delayed infant delivery and infertility. In this retrospective study, we analyzed the effects of hyaluronic acid- carboxymethylcellulose (HA/CMC) membranes on postoperative adhesion during cesarean section.　Methods: Sixty-seven patients were divided into the surgical adhesion barrier used (n = 28) and not-used group (n = 39). We compared the severity of adhesion at the repeat cesarean section, as well the following variables: operation and incision delivery time, blood loss, and postoperative infection between both groups. The severity of adhesion was analyzed using the Zühike’s adhesion score between the abdominal wall and uterine corpus, and the Steinleitner’s uterine adhesion score.　Results: We found that the Zühike’s adhesion score between the abdominal wall and corpus of the uterus in the surgical adhesion barrier used group was significantly lower than that of the not-used group (0.46 ± 0.2 and 1.0 ± 0.2, respectively) (p = 0.04). The Steinleitner’s uterine adhesion score of the surgical adhesion barrier used group was lower than that of the not-used group (0.5 ± 0.3 and 1.3 ± 0.3, respectively), but not significantly (p = 0.07).　Discussion: We concluded that the surgical adhesion barrier was effective in preventing postoperative adhesion formation during cesarean sections. However, further investigations are necessary to reveal the usefulness of the surgical adhesion barrier during cesarean section, including its cost-effectiveness

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

川崎医科大学におけるブース形式診療科別説明会の学内開催

川崎医科大学は,中核市の倉敷市内と政令指定都市の岡山市内に二つの附属病院を有している。両病院の卒後臨床研修プログラムは独立しているが,研修は両方の病院の診療科から選択することが可能である。平成27年7月,初めて川崎医科大学生を対象にした大学附属病院診療科の説明会をブース形式で学内開催した。研修プログラム説明会とは趣を異にし,各診療科の特徴や業務内容を広報することを目的とした。1年生から6年生までの学生が参加し,アンケート調査に回答した52名全員が将来の研修病院の選択に役に立ったと答え,うち27%は非常に役立ったと高い満足度を示した。また,研修医だけで計画した学生向けのミニシンポジウムも同時に開催し,来場した約70%の学生が参加し貴重な情報収集の場となった。次年度以降も改善を加えながら,学生が身近に附属病院スタッフや先輩研修医と交流できるイベントとして育てていきたい。Kawasaki Medical School has one hospital in Kurashiki City, a core city, and another in Okayama City, an ordinance-designated city. These hospitals have independent postgraduate clinical training programs. However, departments of both hospitals can be selected for training. In July 2015, a boothtype meeting regarding Kawasaki Medical School Hospital departments was held for Kawasaki Medical School students for the first time. The intent of the meeting differed from that of other training program meetings, and its goal was to provide information on the characteristics and tasks of each department. First- to sixth-year students participated in the meeting. All 52 students who responded to a questionnaire survey answered that the meeting was useful in helping them select a hospital for their future training, and 27% of them reported that the meeting was very useful and showed high levels of satisfaction. A mini symposium for students planned only by residents was also held at the same time. About 70% of visiting students participated in the symposium and were given a valuable opportunity to gather information. By making improvements, we will cultivate the meeting as an event in which students can have contact with hospital staff and junior residents from the next year

副詞の動詞修飾に関する一考察

序 / I 文構造と副詞の機能 / I-1 統語上の分布と作用域 / I-2 文の意味構造から見た副詞の機能 / II く副詞＋動詞〉における意味的な整合性 / III 結

Comparison of uterine artery waveforms during uterine contractions induced by oxytocin and prostaglandin

　Background: Uterine artery waveforms are used as indicators of fetal growth restriction and pregnancy-induced hypertension; however, the findings of most reports were recorded when contractions were absent, leaving the dynamics during labor unclear. This present study aimed to investigate the effects of prostaglandin F2α (PGF2α) and oxytocin administrations on uterine artery resistance and pulsatility.　Methods: This study was approved by the Ethics Committee of Kawasaki Medical School (3632) and was conducted in accordance with the ethical guidelines. The duration of the study was five years from the date of Ethics Committee approval.The participants included were 30 perinatal pregnant women who had no maternal or fetal complications admitted for delivery. The method used in inducing labor was randomly chosen (PGF2α and oxytocin were used in 15 cases each). Transabdominal ultrasonography was performed by a single experienced person to measure the uterine artery pulsatility index (PI) and resistance index (RI). The participants were divided into 3 subgroups based on cervical dilation (2-6 cm, 6-10 cm, and 10 cm to delivery). A univariate analysis was performed to evaluate the mean uterine artery PI and RI, and changes in labor stage were analyzed. The relationship between uterine artery RI and umbilical cord arterial pH was evaluated.　Results: Vaginal delivery occurred in 15 and 11 cases in the oxytocin and PGF2α groups, respectively. Four babies with abnormal fetal heart rates were delivered via emergency cesarean section. There were no differences between the two groups concerning the duration of labor, bleeding during labor, placental weight, birth weight, or in cases of fetal asphyxia based on the Apgar score. No significant differences were observed in PI between the oxytocin and PGF2α groups in any of the three stages of labor(p > 0.05). In the oxytocin group, uterine arterial blood flow in terms of both RI and PI tended to be the highest at a cervical dilation of 6-10 cm. However, while a similar trend was observed for PI in the PGF2α group, RI was highest at a cervical dilation of ≥ 10 cm. No orrelations were found between RI and pH at any of the cervical dilation phases(p > 0.05).　Conclusion: The results of our study showed that the type of labor-inducing agent had no effect on maternal circulation. The total infusion volume of PGF2α was larger than that of oxytocin; thus, it may be preferable to use oxytocin as a conventional induction method