ロウネン カンゴ ガク ジッシュウ ニ オケル カンゴ ガクセ ノ ニンチショウ コウレイシャ ニ タイスル カンケイ ケイセ ノ カテイ : ガクセイ イッジレイ ノ ブンセキ

背景 老年看護学実習において, 看護学生 (以後学生) が認知症高齢者を理解し, 良い関わりを持つことが困難であると報告されている. しかし, それらは学生の記録に基づいたものであり, 学生の観察の視点や無意識の行動は含まれていない. そこで, 学生がどのように認知症高齢者を理解し関わっていくかという関係形成の過程を明らかしたいと考え本研究に着手した. 目的 介護老人福祉施設における老年看護学実習で, 学生の認知症高齢者に対する関係形成の過程を明らかにする. 方法 対象は, 介護老人福祉施設で認知症高齢者を受け持った学生1名である. データ収集は, 認知症高齢者 (以後A氏) に関わる学生の観察者としての参加観察と半構成質問紙による学生への面接および学生の実習記録とした. 分析方法は, 参加観察, 面接, 記録のデータから, 学生のA氏への関わりに関連する場面を再構成し, 学生のA氏に対する関係が形成された場面を抽出した. 結果 学生が認知症高齢者に対する関係形成に関連した場面は, 次の6つの場面であった. (1)関わる方法がわからず, A氏の表情を観察しその意思を読み取ろうとした. (2)教員のアドバイスによりA氏に関わる手段を発見した. (3)A氏との関わりから得た情報と施設からの情報により, 抱いていた印象が変化し, A氏の理解を深めた. (4)無意識にA氏の行動を観察し, A氏の状態に応じた生活機能を高める看護ケアを行った. (5)A氏の施設における生活目標を理解し, 自立支援をした. (6)レクレーションでのA氏の自発的な行動から, その情報を活用して筋力訓練を指導した. 結論 学生は, 実習初日の認知症高齢者に対する戸惑いをきっかけに思考し, 教員や施設の情報を意識的に取り入れてより良い関わりを模索しながら, 認知症高齢者の生活機能を高める看護を積極的に提供していることがわかった. そのため, 教員は学生の認知症高齢者への関係形成の過程をよく観察し, 学生の思考過程に注目しながらを指導することが必要であると考える.Background We do not use these symbols in English During geriatric nursing practicums, nursing students are reported to experience difficulties understanding and relating to how to provide care for the elderly, especially the elderly with dementia. However, previous reports have not examined the thoughts and unconsciousness behavior of students. As nursing educators, we studied here how a nursing student understood and started to provide care for a elderly with dementia.Purpose To clarify the process of how, in a geriatric nursing practicum, a student established a connection with the elderly with dementia at elderly welfare facilities.Methods This qualitative study that collected data through participant observation and semi-structured interview, focusing on one nursing student. The student\u27s practicum records were referenced as needed. The participating student on a geriatric nursing practicum provided consent to be the subject of this study. The involvement of the student with an elderly individual with dementia for whom she was responsible was the target of study. The method of analysis was to reconstruct from the data obtained from participant observation, interview, and practicum records the situations where the student starting providing care to the elderly person with dementia.Results The results showed that the student established a connection in the following six situations; 1) when not understanding what was needed, trying to understand the intention of the elderly person from facial expressions; 2) finding a way to become involved with the elderly person based on nurse educators\u27 advice; 3) deepening understanding of the elderly person by requesting that staff allow access to official records; 4) supporting the elderly person to enhance her functioning in daily life by confirming the validit

カイゴ ロウジン フクシ シセツ ニ ニュウキョスル ヨウカイゴ コウレイシャ ニ タイスル カンゴ ガクセイ ノ エンジョ カテイ ニ オケル チャクガンテン

背景 看護基礎教育カリキュラムの改正が行われ,老年看護学では,学生が高齢者及びその生活機能を理解し,高齢者への看護実践能力を高める指導が求められている.そこで,学生が高齢者と関わる時間や生活援助の機会が多いと思われる生活の場としての「介護老人福祉施設」で,学生が高齢者と関わる過程を分析することで,実習指導の示唆を得たいと考えた.目的 介護老人福祉施設における老年看護学実習で,学生の要介護高齢者への援助過程における着眼点を明らかにする.方法 研究デザインは,質的帰納的研究である.対象は,研究に同意の得られた介護老人福祉施設で老年看護学実習を行った学生6(男子1)名である.データ収集は,高齢者に関わる学生を参加観察(観察者として)し,実習終了後に半構成質問紙による面接を行った.分析は,参加観察と面接および学生の実習記録を統合して行った.結果 得られたデータは,学生6名が高齢者8名に関わった38場面であった.実習経過では,初日の学生は,高齢者との関わりに戸惑い,その関わりを模索していた.3日目は,記録や教職員の助言等を参考に,高齢者の看護ニードを把握し援助した.最終日は,学生が主体的に高齢者の自立を支援した.これらの援助過程には,学生が高齢者への援助の関わりに着眼した視点があり,その類型を分類したところ,1)高齢者の残存機能に働きかける,2)高齢者との人間関係を重視する,3)高齢者の生活行動を重視する,4)高齢者の健康的な反応を引き出す,5)高齢者の感情を重視する,の5類型が抽出された.結論 学生が高齢者を援助する着眼点は,5類型が認められた.指導者は,抽出された学生の高齢者への援助の類型を活用して,教育的支援を行うことが重要と考える.Background Following revisions of the curricula for basic nursing education,students in geriatric nursing receive instruction on understanding elderly individuals and their daily functioning,and enhancing their nursing skills when working with them.And we sought to determine which suggestions are necessary for practicum instruction by analyzing the processes of students when interacting with elderly care recipients at a nursing home in geriatric nursing practicum. Purpose To explore the opinions of nursing of students interacting with elderly care recipients at a nursing home in a geriatric nursing practicum. Methods This study employed a qualitative and inductive study design.Participants were six students (one male) who consented to participate and who were completing their geriatric nursing practicum at a nursing home for the elderly. Data were collected through participatory observations of the students interacting with the elderly care recipients and semi-structured interviews after practicum completion.For analysis,we created transcripts by integrating materials from the observations,interviews,and practicum records. Results/Discussion We obtained data from 38 scenes where the six students interacted with eight care recipients.In terms of processes,on the first day they tended to be confused and struggled in their interactions with the individuals. On Day 3,they were likely to look at records and seek advice from their instructors,and attempted to understand the nursing needs of the care recipients and assist them.On the final day of their practicum,the students were actively supporting the independence of the care recipients.In the processes of assistance,we extracted five categories of particular perspectives the students had while assisting the care recipients :( 1) working on the care recipients\u27 remaining functions,(2) emphasizing interpersonal relationships with them,(3) emphasizing their daily living behaviors,(4) eliciting healthy reactions from them,and (5) valuing their feelings. Conclusion There were five categories of the student opinions of nursing for elderly.We suggest that instructors utilize these categories in their provision of educational support

ニュウイン コウレイシャ ニ タイスル カツドウセイテイカ ヨボウケア ノ ジッシジョウキョウ ト ソノ エイキョウ ヨウイン : ロウネンカンゴガク ジッシュウ ヲ ウケイレテイル イッパンビョウトウ カンゴシ ヲ タイショウ ニ

背景 一般病院における入院患者に占める高齢者割合が今後ますます高くなることが推測され, 看護師の高齢者に対する活動性低下予防の実践力向上が必要となる. そこで, 老年看護学実習を実施している一般病棟看護師の入院高齢者に対する活動性低下予防を意識した看護の実施状況とその影響要因を明らかにしたいと考えた.目的 本研究の目的は, 老年看護学実習を受け入れている一般病棟看護師の入院高齢者に対する活動性低下予防ケアの実施状況とその影響要因を明らかにすることである.方法 研究同意が得られた16病院の看護管理者に調査を依頼し, 老年看護学実習病棟経験3年以上の看護師を対象とし, 属性, 看護学生と関わる立場, 看護上重視する視点, 野崎らが開発した 「入院高齢者の日常生活における活動性低下予防ケア実施度」 の尺度を用いて調査し, 統計解析により分析した.結果 調査対象は270名で女性が91.5%であった. 活動性低下予防ケアの実施度は, 平均77.9士21 (138点満点) ,ケア項目 (スコア3～0) では, 「環境整備」 2.37, 「移動・移乗の介助・指導」 2.32, 「認知刺激」 2.16, 「運動実施の援助」 と 「エネルギー管理」 が1.68であった. 経験年数, 看護学生と関わる立場との有意差はなく, 高齢者の 「発達段階」, 「もてる力」, 「入院前の生活」, 「患者の価値観」,に有意差 (p<0.001～p<0.05) を認め,高齢者への視点の有無が活動性低下予防ケアに影響していた.結論 高齢者看護実習病棟看護師の活動性低下予防ケアの実施には, 高齢者の 「発達段階」, 「もてる力」, 「入院前の生活」 , 「患者の価値観」 が影響していた.Background The proportion of elderly patients is expected to increase in general hospitals, and thus nurses need to improve preventive care for decreased activity among these patients. However, the current status of the implementation of such care by nurses on general wards that conduct gerontology nursing training is unclear, and influencing factors need to be identified.Objective The purpose of this study is to ascertain the situation of implementation of preventive care for decreased activity among elderly inpatients by nurses on general wards that conduct gerontology nursing training, as well as the factors influencing such implementation.Methods Sixteen teaching hospitals agreed to participate. The nursing administrator of each hospital surveyed nurses with≧3 years\u27 experience working on a gerontology training ward. Data was collected on nurse attributes, position in relation to student nurses, and key considerations in nursing. Nozaki\u27s scale for assessing the degree of implementation of preventive care for decreased activity in daily life of elderly inpatients was used, and data were statistically analyzed.Results Of the 270 participants, 91.5% were women. Mean implementation score was 77.9±21 (total score: 138). Care score(3-0) was "Environment adjustment" 2.37, "Assist/guide movement" 2.32 an

カイゴ ロウジン フクシ シセツ ニュウショ ニ ヨル セイカツ カンキョウ ヘンカ ニ テキオウスル タメノ ヨウイン コウキ コウレイシャ ノ インタビュー チョウサ ヨリ

背景 近年,要介護状態の後期高齢者は急増し,施設利用を自ら選択する意向もみられる.しかし 高齢者にとって施設入所による環境変化は,重大なリスクにつながる.目的 介護老人福祉施設入所による後期高齢者の生活環境変化に適応するための要因を明らかにする.方法 同意が得られた介護老人福祉施設に入所8カ月の94歳の対象Cさんに,インタビュー調査を行った.そして逐語録を作成した後,KJ法の手法を用いて質的に分析した.結果・考察 KJ法の結果66個のラベルが取り出され,ラベルは20個の島に分類された.またこれらの島から11個の表札を抽出した.これらの分析より,生活環境への適応状態には【生活の知恵や判断力に基づいて対処行動がとれる】【自分の居場所が決められる】【職員のケアが適切である】【静かで自然を感じる環境がある】【家族が支えになっている】の5つの要因が関連していることが明らかになった.結論 介護老人福祉施設入所による後期高齢者の生活環境への適応状態を質的に分析した結果, 5つの適応要因の関連が明らかになった.Background As the aging of society progresses rapidly in Japan,the number of elderly with care needs is rising sharply.Yet,living in a facility brings about a change in environment,which can have serious risks for the elderly. Objective The purpose of this study was to reveal the status of adapting to the living environment among the very elderly in special nursing homes.Methods The 94-year-old woman living at a special nursing home for the elderly in Prefecture A for 8 months was interviewed after providing consent to participate.Verbatim transcripts of the interview were made,and the content was qualitatively analyzed using the KJ method.Results/Discussion The total of 66 labels were extracted from the analysis, and the labels were classified into 20 islands.From these islands,11 nameplates were extracted.The analysis revealed that the 94-year-old womanhad adapted to her living environment,and this adaptation was correlated with the following five factors: "can adopt coping behavior based on wisdom regarding living and judgment," "can make decisions about where to live," "care provided is appropriate," "presence of a natural environment in which one can live at peace and quiet," and "family is a source of support." Conclusions We analyzed using the KJ method adaptation to the living environment among the very elderly in special nursing homes.The 94-year-old woman had adapted to her living environment,and this adaptation was correlated with the five factors

Table_1_DSP-0509, a systemically available TLR7 agonist, exhibits combination effect with immune checkpoint blockade by activating anti-tumor immune effects.xlsx

TLR7 is an innate immune receptor that recognizes single-stranded RNAs, and its activation leads to anti-tumor immune effects. Although it is the only approved TLR7 agonist in cancer therapy, imiquimod is allowed to be administered with topical formulation. Thus, systemic administrative TLR7 agonist is expected in terms of expanding applicable cancer types. Here, we demonstrated the identification and characterization of DSP-0509 as a novel small-molecule TLR7 agonist. DSP-0509 is designed to have unique physicochemical features that could be administered systemically with a short half-life. DSP-0509 activated bone marrow-derived dendritic cells (BMDCs) and induced inflammatory cytokines including type I interferons. In the LM8 tumor-bearing mouse model, DSP-0509 reduced tumor growth not only in subcutaneous primary lesions but also in lung metastatic lesions. DSP-0509 inhibited tumor growth in several syngeneic tumor-bearing mouse models. We found that the CD8+ T cell infiltration of tumor before treatment tended to be positively correlated with anti-tumor efficacy in several mouse tumor models. The combination of DSP-0509 with anti-PD-1 antibody significantly enhanced the tumor growth inhibition compared to each monotherapy in CT26 model mice. In addition, the effector memory T cells were expanded in both the peripheral blood and tumor, and rejection of tumor re-challenge occurred in the combination group. Moreover, synergistic anti-tumor efficacy and effector memory T cell upregulation were also observed for the combination with anti-CTLA-4 antibody. The analysis of the tumor-immune microenvironment by using the nCounter assay revealed that the combination of DSP-0509 with anti-PD-1 antibody enhanced infiltration by multiple immune cells including cytotoxic T cells. In addition, the T cell function pathway and antigen presentation pathway were activated in the combination group. We confirmed that DSP-0509 enhanced the anti-tumor immune effects of anti-PD-1 antibody by inducing type I interferons via activation of dendritic cells and even CTLs. In conclusion, we expect that DSP-0509, a new TLR7 agonist that synergistically induces anti-tumor effector memory T cells with immune checkpoint blockers (ICBs) and can be administered systemically, will be used in the treatment of multiple cancers.</p

DataSheet_1_DSP-0509, a systemically available TLR7 agonist, exhibits combination effect with immune checkpoint blockade by activating anti-tumor immune effects.docx

TLR7 is an innate immune receptor that recognizes single-stranded RNAs, and its activation leads to anti-tumor immune effects. Although it is the only approved TLR7 agonist in cancer therapy, imiquimod is allowed to be administered with topical formulation. Thus, systemic administrative TLR7 agonist is expected in terms of expanding applicable cancer types. Here, we demonstrated the identification and characterization of DSP-0509 as a novel small-molecule TLR7 agonist. DSP-0509 is designed to have unique physicochemical features that could be administered systemically with a short half-life. DSP-0509 activated bone marrow-derived dendritic cells (BMDCs) and induced inflammatory cytokines including type I interferons. In the LM8 tumor-bearing mouse model, DSP-0509 reduced tumor growth not only in subcutaneous primary lesions but also in lung metastatic lesions. DSP-0509 inhibited tumor growth in several syngeneic tumor-bearing mouse models. We found that the CD8+ T cell infiltration of tumor before treatment tended to be positively correlated with anti-tumor efficacy in several mouse tumor models. The combination of DSP-0509 with anti-PD-1 antibody significantly enhanced the tumor growth inhibition compared to each monotherapy in CT26 model mice. In addition, the effector memory T cells were expanded in both the peripheral blood and tumor, and rejection of tumor re-challenge occurred in the combination group. Moreover, synergistic anti-tumor efficacy and effector memory T cell upregulation were also observed for the combination with anti-CTLA-4 antibody. The analysis of the tumor-immune microenvironment by using the nCounter assay revealed that the combination of DSP-0509 with anti-PD-1 antibody enhanced infiltration by multiple immune cells including cytotoxic T cells. In addition, the T cell function pathway and antigen presentation pathway were activated in the combination group. We confirmed that DSP-0509 enhanced the anti-tumor immune effects of anti-PD-1 antibody by inducing type I interferons via activation of dendritic cells and even CTLs. In conclusion, we expect that DSP-0509, a new TLR7 agonist that synergistically induces anti-tumor effector memory T cells with immune checkpoint blockers (ICBs) and can be administered systemically, will be used in the treatment of multiple cancers.</p

Table_2_DSP-0509, a systemically available TLR7 agonist, exhibits combination effect with immune checkpoint blockade by activating anti-tumor immune effects.xlsx

TLR7 is an innate immune receptor that recognizes single-stranded RNAs, and its activation leads to anti-tumor immune effects. Although it is the only approved TLR7 agonist in cancer therapy, imiquimod is allowed to be administered with topical formulation. Thus, systemic administrative TLR7 agonist is expected in terms of expanding applicable cancer types. Here, we demonstrated the identification and characterization of DSP-0509 as a novel small-molecule TLR7 agonist. DSP-0509 is designed to have unique physicochemical features that could be administered systemically with a short half-life. DSP-0509 activated bone marrow-derived dendritic cells (BMDCs) and induced inflammatory cytokines including type I interferons. In the LM8 tumor-bearing mouse model, DSP-0509 reduced tumor growth not only in subcutaneous primary lesions but also in lung metastatic lesions. DSP-0509 inhibited tumor growth in several syngeneic tumor-bearing mouse models. We found that the CD8+ T cell infiltration of tumor before treatment tended to be positively correlated with anti-tumor efficacy in several mouse tumor models. The combination of DSP-0509 with anti-PD-1 antibody significantly enhanced the tumor growth inhibition compared to each monotherapy in CT26 model mice. In addition, the effector memory T cells were expanded in both the peripheral blood and tumor, and rejection of tumor re-challenge occurred in the combination group. Moreover, synergistic anti-tumor efficacy and effector memory T cell upregulation were also observed for the combination with anti-CTLA-4 antibody. The analysis of the tumor-immune microenvironment by using the nCounter assay revealed that the combination of DSP-0509 with anti-PD-1 antibody enhanced infiltration by multiple immune cells including cytotoxic T cells. In addition, the T cell function pathway and antigen presentation pathway were activated in the combination group. We confirmed that DSP-0509 enhanced the anti-tumor immune effects of anti-PD-1 antibody by inducing type I interferons via activation of dendritic cells and even CTLs. In conclusion, we expect that DSP-0509, a new TLR7 agonist that synergistically induces anti-tumor effector memory T cells with immune checkpoint blockers (ICBs) and can be administered systemically, will be used in the treatment of multiple cancers.</p

Intravenous administration of the selective toll-like receptor 7 agonist DSR-29133 leads to anti-tumor efficacy in murine solid tumor models which can be potentiated by combination with fractionated radiotherapy.

Strategies to augment anti-cancer immune responses have recently demonstrated therapeutic utility. To date clinical success has been achieved through targeting co-inhibitory checkpoints such as CTLA-4, PD-1, and PD-L1. However, approaches that target co-activatory pathways are also being actively being developed. Here we report that the novel TLR7-selective agonist DSR-29133 is well tolerated in mice and leads to acute immune activation. Administration of DSR-29133 leads to the induction of IFNα/γ, IP-10, TNFα, IL-1Ra and IL-12p70, and to a reduction in tumor burden in syngeneic models of renal cancer (Renca), metastatic osteosarcoma (LM8) and colorectal cancer (CT26). Moreover, we show that the efficacy of DSR-29133 was significantly improved when administered in combination with low-dose fractionated radiotherapy (RT). Effective combination therapy required weekly administration of DSR-29133 commencing on day 1 of a fractionated RT treatment cycle, whereas no enhancement of radiation response was observed when DSR-29133 was administered at the end of the fractionated RT cycle. Combined therapy resulted in curative responses in a high proportion of mice bearing established CT26 tumors which was dependent on the activity of CD8(+) T-cells but independent of CD4(+) T-cells and NK/NKT cells. Moreover, long-term surviving mice originally treated with DSR-29133 and RT were protected by a tumor-specific memory immune response which could prevent tumor growth upon rechallenge. These results demonstrate that DSR-29133 is a potent selective TLR7 agonist that when administered intravenously can induce anti-tumor immune responses that can be further enhanced through combination with low-dose fractionated RT