地域における看護提供システムモデル事業「まちの保健室」：その構想と実践をとおした一考察

少子高齢化の進展は、それに伴うライフスタイルや疾病構造の変化を余儀なくさせ、「高齢慢性疾患障害者型」社会ともいうべき今日を迎えている。健康ニーズと「よりよく生きる」ための高まりは、家族や地域を含めてそのあり方が模索されているといえる。地域における看護提供システム「まちの保健室」は、学校に保健室があるように、心や身体についてのさまざまな気がかりや問題を気軽に相談できる場を地域に開設し、住民や他の機関と共に運営していく場である。日本看護協会では、平成12年度から「まちの保健室」を実際に開設するアクションモデルを公募し、平成14年度には、24都道府県から新潟県を含む10件が選考された。厚生連魚沼病院は、新潟で初めての「まちの保健室」モデル事業として「介護予防」をテーマに取り組んだ。その実践をとおし、「まちの保健室」の機能と課題について述べた。We should recognize that developments due to reduced birth rates and the ageing of society, and the inevitablechanges in disease structure and lifestyle that follow, have lead to the point where there is a pattern of elderlydisabled by chronic disease in today\u27s society. Interest in health needs and ways to better life is part of the search forthe ideal in the family and community. Much like a school dispensary, the regional nursing system Town Dispensary establishes a place in thecommunity where consultation is readily available concerning various problems and concerns about both mind andbody, and is operated in concert with the residents and organizations of the community. In 2000, the Japanese Nursing Association announced an action model for the establishment of Town Dispensaries, and in 2002, out of twenty-four prefectures, ten, to include Niigata, were selected. As the first Town Dispensary model project in Niigata prefecture, Uonuma Hospital began work on the theme of preventive care. This paper details the functionsand tasks of the Town Dispensary based on what was put into practice there

Physical and Mental Burden on Nursing Staff Engaging Palliative Care in the General Ward : Its Degree and Related Factors

We carried out a questionnaire survey among women nurses in the general ward at eight hospital institutions on the topic of physical and mental burden and the factors influencing it, focusing on the nurses' relationship with patients who are taking palliative care and their families, and with the doctors. The burden was evaluated on a five-point scale regarding “distress”, “painfulness”, “escape”, “helplessness”, “sleeplessness”, “fatigue”, and “frustration”. Overall, high ratings were given to “feeling fatigue after finishing work for the day” and “distressed at how to get along with patients”. The younger generation showed a tendency of higher levels of burden. As factors influencing the physical and mental burden, three lower level scales were picked out according to logistics regression analysis. “Workplace environment”, and “Experience of communication with patient " “A way to live” had a strong influence. In addition, it was believed that the physical and mental burden of the nurses was intensified by the agony that they cannot find meanings and values in the fate of dying patients, wondering how to respond to the spiritual questions they asked, such as "How long can I survive?" The necessity for the promotion of education on palliative care, the working environment in which the care can be fully provided, and the effective operation of a team approach were suggested for lightening the physical and mental burden of nurses.８施設の一般病棟の看護師を対象に、緩和ケアを受ける患者・家族、医師との関わりを中心に心身の負担度とその影響要因について質問紙調査を行った。心身の負担度は、「悩み」「辛さ」「逃避」「無力」「不眠」「疲労」「イライラ」とし、５段階で評価した。心身の負担度は、全体では「一日の仕事を終え疲労を感じる」「患者とどのように関わっていいのか悩む」が高かった。若い年代ほど負担度が高い傾向にあった。心身の負担度に影響する因子は、ロジスティック回帰分析より３つの尺度の影響因子が抽出された。「職場環境」「患者との関わり体験」「生き方」が強く影響していた。また、患者が「後どのくらい生きられるか」と聞いてきたなど、患者のスピリチュアルな問いに対し、どのように答えるのか、死にゆく患者の運命に、意味や価値を見いだせない苦悩が看護師の心身の負担を強くしていると考えられた。看護師の心身の負担軽減には、緩和ケア教育の推進、緩和ケアを十分に提供できる職場環境、チームアプローチの効果的運用の必要性が示唆された

Clinical Course before and after Cataract and Glaucoma Surgery under Systemic Infliximab Therapy in Patients with Behçet's Disease

www.karger.com/cop This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 License (www.karger.com/OA-license), applicable to the online version of the article only. Distribution for non-commercial purposes only

Polyclonal Immunoglobulin Recovery after Autologous Stem Cell Transplantation Is an Independent Prognostic Factor for Survival Outcome in Patients with Multiple Myeloma

We retrospectively analyzed multiple myeloma (MM) patients who underwent autologous stem cell transplantation (ASCT) without maintenance therapy to assess the impact of recovery of normal immunoglobulin (Ig) on clinical outcomes. The recovery of polyclonal Ig was defined as normalization of all values of serum IgG, IgA, and IgM 1 year after ASCT. Among 50 patients, 26 patients showed polyclonal Ig recovery; 14 patients were in ≥complete response (CR) and 12 remained in non-CR after ASCT. The patients with Ig recovery exhibited a significantly better progression-free survival (PFS, median, 46.8 vs. 26.7 months, p = 0.0071) and overall survival (OS, median, not reached vs. 65.3 months, p < 0.00001) compared with those without Ig recovery. The survival benefits of Ig recovery were similarly observed in ≥CR patients (median OS, not reached vs. 80.5 months, p = 0.061) and non-CR patients (median OS, not reached vs. 53.2 months, p = 0.00016). Multivariate analysis revealed that non-CR and not all Ig recovery were independent prognostic factors for PFS (HR, 4.284, 95%CI (1.868–9.826), p = 0.00059; and HR, 2.804, 95%CI (1.334–5.896), p = 0.0065, respectively) and also for OS (HR, 8.245, 95%CI (1.528–44.47), p = 0.014; and HR, 36.55, 95%CI (3.942–338.8), p = 0.0015, respectively). Therefore, in addition to the depth of response, the recovery of polyclonal Ig after ASCT is a useful indicator especially for long-term outcome and might be considered to prevent overtreatment with maintenance therapy in transplanted patients with MM

The dual origin of the peripheral olfactory system: placode and neural crest

<p>Abstract</p> <p>Background</p> <p>The olfactory epithelium (OE) has a unique capacity for continuous neurogenesis, extending axons to the olfactory bulb with the assistance of olfactory ensheathing cells (OECs). The OE and OECs have been believed to develop solely from the olfactory placode, while the neural crest (NC) cells have been believed to contribute only the underlying structural elements of the olfactory system. In order to further elucidate the role of NC cells in olfactory development, we examined the olfactory system in the transgenic mice Wnt1-Cre/Floxed-EGFP and P0-Cre/Floxed-EGFP, in which migrating NC cells and its descendents permanently express GFP, and conducted transposon-mediated cell lineage tracing studies in chick embryos.</p> <p>Results</p> <p>Examination of these transgenic mice revealed GFP-positive cells in the OE, demonstrating that NC-derived cells give rise to OE cells with morphologic and antigenic properties identical to placode-derived cells. OECs were also positive for GFP, confirming their NC origin. Cell lineage tracing studies performed in chick embryos confirmed the migration of NC cells into the OE. Furthermore, spheres cultured from the dissociated cells of the olfactory mucosa demonstrated self-renewal and trilineage differentiation capacities (neurons, glial cells, and myofibroblasts), demonstrating the presence of NC progenitors in the olfactory mucosa.</p> <p>Conclusion</p> <p>Our data demonstrates that the NC plays a larger role in the development of the olfactory system than previously believed, and suggests that NC-derived cells may in part be responsible for the remarkable capacity of the OE for neurogenesis and regeneration.</p

Role of the Carboxy-Terminal Region of the GluRε2 Subunit in Synaptic Localization of the NMDA Receptor Channel

AbstractThe synaptic localization of the N-methyl-D-aspartate (NMDA) type glutamate receptor (GluR) channel is a prerequisite for synaptic plasticity in the brain. We generated mutant mice carrying the carboxy-terminal truncated GluRε2 subunit of the NMDA receptor channel. The mutant mice died neonatally and failed to form barrelette structures in the brainstem. The mutation greatly decreased the NMDA receptor–mediated component of hippocampal excitatory postsynaptic potentials and punctate immunofluorescent labelings of GluRε2 protein in the neuropil regions, while GluRε2 protein expression was comparable. Immunostaining of cultured cerebral neurons showed the reduced punctate staining of the truncated GluRε2 protein at synapses. These results suggest that the carboxy-terminal region of the GluRε2 subunit is important for efficient clustering and synaptic localization of the NMDA receptor channel