日本でのJALS-ECC研究によるリスク予測を適用した心血管イベントの一次予防におけるプラバスタチンの経済的評価

Yoshie Onishi, Shiro Hinotsu, Yoko M. Nakao, Hisashi Urushihara, Koji Kawakami, Economic Evaluation of Pravastatin for Primary Prevention of Coronary Artery Disease Based on Risk Prediction from JALS-ECC in Japan, Value in Health Regional Issues, Volume 2, Issue 1, May 2013, Pages 5-12, ISSN 2212-1099, http://dx.doi.org/10.1016/j.vhri.2013.02.003.(http://www.sciencedirect.com/science/article/pii/S2212109913000162)京都大学0048新制・課程博士博士(社会健康医学)甲第18192号社医博第53号新制||社医||8(附属図書館)31050京都大学大学院医学研究科社会健康医学系専攻(主査)教授 今中 雄一, 教授 木村 剛, 教授 横出 正之学位規則第4条第1項該当Doctor of Public HealthKyoto UniversityDFA

COPING ATTITUDE & MENTAL ADJUSTMENT TO CANCER

Objective Purpose is to examine the relationship between older persons with cancer coping attitudes and patterns of mental adjustment during treatment. Methods : Coping attitudes and patterns of mental adjustment were measured using an original questionnaire and the Mental Adjustment Cancer Scale (MAC) in 193 patients with cancer aged 65 or over under treatment with surgical therapy, chemotherapy, or radiotherapy. Results : The mean scores for “Do my best to cope with cancer” ,“Make my own decisions on treatment” in coping attitudes showed a significant positive correlation with [fighting spirit] scores in MAC, and “Cancer is just a part of my life”, “At my age, no complaint about cancer development”, “Face cancer in an easy-going manner”, “Do my best to cope with cancer” “Be anxious about my future” were significantly correlated with [fatalism] scores. Conclusions : In conclusion, [fighting spirit] [fatalism] were shown to form the basis for elderly’s mental adjustment. [Fatalism] was shown to be a main component of mental adjustment for elderly to develop affirmative coping skills based on their life experiences. In addition, [fighting spirit] was also essential to fulfill their lives, and it may be necessary to support them to keep [fighting spirit] to the end of their lives

Characterization of Empathic Attitudes of Nurses from the Perspective of End-stage Cancer Patients with Fatigue

本研究は，倦怠感を有する終末期がん患者が，「倦怠感のある自分を分かってもらえた」と認識する看護師の共感的態度を明らかにすることを目的としている．倦怠感を有する終末期がん患者６名に対し，参加観察法と半構造化面接法を用いてデータ収集し，質的記述的分析を行った． 分析した結果，144のコードが得られ，最終的に18のサブカテゴリーから，【さりげなく自分の意思や自尊心を大事にしてくれる】【気力を奪う今後の成り行きへの不安に寄り添ってくれる】【言い辛い本心を汲み取って代弁してくれる】【どんな時でも一生懸命に気遣ってくれる】【多くを話さなくても倦怠感の変化を理解してくれる】【専門的な知識と経験から責任あるケアをしてくれる】の６つのカテゴリーが抽出された． これより，看護師の共感的態度の特徴として，“苦痛が重ならぬように取り除こうとする専心” と“緩和ケアゆえの熟練した看護実践力” が推察された．The purpose of this study was to characterize nurses’ empathic attitudes towards end-stage cancer patients with fatigue. Data were collected from six end-stage cancer patients with fatigue through participant observation and semi-structured interviews, and qualitatively and descriptively analyzed. Through analysis, 144 codes and 18 subcategories were identified, which were classified into six categories :［ respecting patients’ will and self-esteem in a natural manner］,［ being considerate of patients’ anxiety about the future that drains their energy］, ［sympathizing with patients’ true feelings that are difficult to express and speaking for them］, ［caring about patients as much as possible at all times］, ［understanding changes in patients’ conditions even without much complaint from them］, and［ providing responsible care based on one’s professional knowledge and experience］. Based on these categories, nurses’ empathic attitudes may be characterized as “dedication to try to remove the pain so that it does not overlap” and “high nursing competence based on palliative care experience”

テンイ ノ アル コウレイ ガン カンジャ ノ チリョウ ニ タイスル ナットク ノ ヨウソ

本研究の目的は，転移のある高齢がん患者の治療に対する納得の要素を明らかにすることである．本研究では，納得とは「高齢がん患者が治療に対して，能動的に認知的かつ感情的に受容した状態」と定義する．研究方法は質的記述的研究デザインで、がんに対して治療を選択した現在治療過程にある65 歳以上の転移のある高齢がん患者20名を対象に半構造化面接法を実施した．結果，転移のある高齢がん患者の治療に対する納得の要素として，【自分を救おうとする強い意志】【生きるための治療であるとの確信】【治療の可能性への期待】【信じて任せられる最善の治療であるとの判断】【周りへ報いたいとの希求】【治療を含めて生ききる人生の受け容れ】の6つのカテゴリーが抽出された．これらの転移のある高齢がん患者の治療に対する納得の要素の特徴として，1 つは患者自身の価値が治療状況に反映していることが示唆された．2つ目として，自己の利害にとらわれずに周りの人達の気持ちを察し，それを自分の気持ちや意志として汲み取る特徴が推察できた．3つ目として，治療だけでなく，自分の人生に対するあり方や生き方も含めた今の状況に対する受け容れでもある特徴が示唆された．それは，病期が進んだ状況でのライフサイクル最終段階にある高齢者のもつ特徴が表れていた．また，これらの要素は転移のある高齢がん患者が生きてきた中で培われたものでもあり，その人の生き様や今の状況に患者がコミットできるように支援することも納得に導いていく看護となることが示唆された．The objective of this study was to identify elements of how older patients with metastatic cancer become “nattoku” with treatment. In this study, nattoku was defined as “a state of cognitive and emotional acceptance of treatment” by older cancer patients. A qualitative descriptive study was employed, and semi-structured interviews were carried out with 20 metastatic cancer patients aged 65 years or older who were currently undergoing cancer treatment on their own volition. We extracted six elements that involve becoming nattoku with treatment: a strong intention to save oneself, certainty that the treatment was required in order to live, expectations of the potential of treatment, trusting that they chose the optimum treatment, the desire to give something back to those around them, and accepting to live life to the fullest, even while undergoing treatment. Our results suggested that the values of patients themselves were affected by their treatment status. Also, patients were not solely concerned with their own interests, but sensed the feelings of those around them and took them into consideration. A third characteristic suggested by our findings was their acceptance of treatment, and their attitude towards life and the way in which they have lived. This was characteristic of older patients with advanced illness who were in the final stage of life. These elements were fostered during the lives of older patients with metastatic cancer, and our study suggested that support that encourages patients to commit to a lifestyle and their current circumstances may help them become nattoku with treatment

Developing a model influencing hope

Aim Postoperative patients with lung cancer have a high recurrence rate and poor prognosis; hence, we aimed to identify the factors affecting hope to help develop a care-oriented perspective focused on the levels of hope in postoperative patients with lung cancer. Methods In the study, we included postoperative patients with lung cancer and collected data for treatment-related symptoms, coping, and support-related factors as the primary variables. We used the Herth Hope Index, Quality of Life Questionnaire Lung Cancer Module (QLQ-LC13) of the European Organization for Research and Treatment of Cancer, Japanese version of the Coping Inventory for Stressful Situations (CISS), and Social Support Scale for Cancer Patients. Results For the 82 patients included in our study, 55% of the variance in the level of hope was explained using a model that included the following: (1) symptoms of dyspnea, sore mouth, and chest pain; (2) support, including satisfaction with postoperative symptom control by healthcare providers, satisfaction with the amount of information provided by healthcare providers, and the trust in nurses during treatment and recovery; and (3) task-oriented and social diversion coping behaviors. Conclusion As a result of this study, the support-related factors had no direct influence on hope, but they did have a significantly negative influence on treatment-related symptoms, with improved symptoms also having influencing hope

Postoperative Discomfort and Its Influence on Daily Life in Patients with Lung Cancer : A Study Concerning the Period from Hospital Discharge to 6 Months After Surgery

本研究の目的は，肺がん手術後の身体的不快症状の実態とそれらが生活に及ぼす影響について，退院時から術後6 カ月までの経時的推移を明らかにすることである．術後肺がん患者41 名（平均年齢67.0 歳）を対象とし，自記記入式質問紙法と診療録からデータ収集を行った． 分析の結果，肺がん手術後6 カ月を経過しても約6 割の患者が2 つ以上の不快症状を抱えていた．創部に関連する不快症状は，退院時は創部表面の訴えが最も多く，術後1 カ月以降は創部内部の訴えへと変化した．創部以外の不快症状は，術後1 カ月以降では半数以上の患者に術後の息苦しさが出現しており，経時的変化はみられなかったが，術式や喫煙経験により日常生活への影響の程度に関連がみられた．また術後1 カ月が経過しても，術後術側急性肩部不快症状が約17％の患者に存在し，術後6 カ月が経過しても約半数の患者に咳嗽が出現していた． 以上より，患者へ術後出現する可能性のある不快症状の回復過程やその機序に関する情報提供を行い，患者自身に不快症状に対するセルフモニタリングの実施を促し，自らの症状に対する認識を深めることで，セルフケア支援へと繋げる必要がある．今後は，患者の不快症状体験を加味した周手術期肺がん看護プログラム開発の必要性が示唆された．The purpose of this study was to evaluate changes in discomfort over 6 postoperative months in patients with lung cancer and determine the influence of this discomfort on their daily life. Data was collected from 41 patients who underwent surgery for non-small cell lung cancer (mean age 67.0 years) through a self-administered questionnaire and medical records. The results indicated that approximately 60% of patients experienced two or more symptoms of discomfort, even at 6 months after surgery. The most common wound-related discomfort was at the wound surface at the time of hospital discharge and inside the wound 1 month after surgery. In addition, choking was a common complaint in > 50% of patients 1 month after surgery and its incidence did not change over time, although the influence on the patientsʼ daily life varied depending on the type of surgical procedure and smoking history. Furthermore, acute shoulder discomfort on the operated side remained in approximately 17% of patients 1 month after surgery, while coughing was experienced by approximately 50% patients at 6 months after surgery. These results suggest that surgeons should educate patients with lung cancer about the recovery process and possible postoperative discomfort and encourage self-monitoring to gain a better understanding of symptoms and promote self-care. Perioperative nursing programs should be established for these patients in the future

Learning effect and problem by a base of Orem nursing theory in undergraduate students in gerontological nursing course

本研究は，オレム看護理論を導入したことによる学生に対する学習効果と教育上の課題を明らかにすることを目的に紙上事例を用いた看護過程演習に対する学生の自己評価を分析した．分析対象はA 看護系大学生２年生の２００３～２００６年の３年間に在籍した２０４名のうち同意が得られた１８３（８９．７％）名の看護過程演習に対する自己評価とした．看護過程演習に対する自己評価は１１項目の演習目標の達成度を自己評価するものと「オレム看護理論を基盤にした看護過程演習において難しかったこと」について自由記述で構成されている．そのデータを単純集計及び内容分析を行った．その結果，〈よくできた〉及び〈普通〉と回答した学生が多く，〈非常によくできた〉と〈よくできた〉を合わせて６０％を超えた項目は“グループ討論に積極的に参加した”や“自己学習して臨んだ”“事例の健康障害と治療の特徴を理解できた”であった．一方，〈非常によくできた〉と〈よくできた〉を合わせて４０％以下であった項目は，“セルフケア行為（エージェンシー）の確定”と“高齢者の発達上の特徴を健康問題の解決過程に考慮する”であった．自由記述による「難しかったこと」は，【セルフケア理論より患者をとらえること】【看護診断の過程】【演習記録用紙の書き方】【他の講義で使用する理論との違い】【“看護上の問題／看護診断”の表現】【具体的な看護援助方法】【情報収集の限界がある紙上事例】【事例の病態生理や特徴を把握すること】【具体的な看護援助方法】【看護計画の立案】【グループワークでの意見調整】【学習テーマ】の１１のカテゴリーが抽出された．学生にとって高度な思考を必要とする看護過程は難易度の高い学習である上に，オレム看護理論の理解が求められることから，さらに難しい学習となっていることがわかった．基礎教育の学生にとって看護過程に必要な統合的な思考力を促進するためにはオレム看護論の理解はもとより，事例の提示方法やアセスメント用紙の形式などの工夫，改善を通して学生の到達度や理解度を高めていく必要が示唆された．Purpose : Aging is characterized by a combination of mental maturation and physical decline. For students in a gerontological nursing course, we trialed the instruction of an “Orem’s Self-Care Theory”. The purposes of this research were to clarify students learning effects and, educationd problems resulting from the introduction of Orem’s Theory to the nursing process. Methods : Over three consecutive years we analyzed １８４ students （８９．７％ response rate）who consented to our research. Data were collected after group sessions held to discuss patients with chronic disease ; students were asked to evaluate their performance on a questionnaire according to a five-grade scale ranging from “very good” to “extremely poor”. Data were analyzed from １８４ respondents by means of descriptive statistics and simple content analyzes. Findings : The proportion of the students who evaluated their performance in various items as “very good” or “good” were as follows： “to have understood the patients’ conditions and the characteristics of the treatment” （６０％ or more），“to have determined behavioral potentials of self-care” （４０％ or less）and “to have considered the developmental characteristics of the elderly in the process of resolving their health problems（４０％ or less）. Also, findings showed that eleven main categories emanated from the data； 【the Arrest a patient than Self-Care Theory】，【the nursing diagnosis process】，【the form of the paper】， 【the difference with the theory to use by other lectures】，【the expression as the“Nursing problem/ nursing diagnosis”】，【the paper patient that there is a limit for intelligence】 【the grasp condition of a patient physiology and the characteristic of the paper patient】 【the concrete nursing support】 【the drafting of nursing care plan】 【the opinion adjustment by the group】 and 【the theme of the learning】． Discussion : We found that students could understand the characteristics of elderly patients but experienced difficulties in the overall process from assessing a patient’s conditions to forming a care-plan. For further promotion of nursing students’ thinking abilities, it was suggested that a） nursing students need to understand Orem’s Nursing Theory, and b）tutors need to improve the assessment forms and their presentation of clinical case