Home nursing skills of the registered visiting nursing stations

本研究の目的は，T県内の訪問看護ステーション（以下ステーション）に所属する看護師が実施している看護技術の実態を明らかにすることである．研究対象は，T県において登録されているステーション５７ヵ所の管理者であった．調査票の郵送により４段階の選択肢による回答を求め，以下のことが明らかになった． １）回答のあった４１ヵ所のステーションで１ヵ月に１度以上実施していた項目は「日常生活援助技術」では，関節可動域訓練，歩行介助，移動の介助，寝衣交換などの衣生活援助であった．「適切な医療ケアを支援する技術」ではバイタルサインの観察であった．「安全・安楽援助技術」では適切な体位の保持であった． ２）「日常生活援助技術」では，回答のあったステーションの９０％以上が１ヵ月に１度以上実施していた項目は，療養生活環境調整，排便を促す援助，オムツ交換，体位変換，移乗の介助，部分浴，入浴介助，清拭，陰部ケア，整容，洗髪，口腔ケアであった． ３）「適切な医療ケアを支援する技術」では，８０％以上のステーションが１ヵ月に１度以上実施していた項目は褥瘡ケア（予防も含む），創傷処置，経口薬の服薬方法の説明，外用薬の使用方法の説明，パルスオキシメータであった． ４）「安全・安楽援助技術」では，８０％以上のステーションが１ヵ月に１度以上実施していた項目は療養生活の安全確保，転倒・転落・外傷予防，マッサージであった． ５）救命・救急に関する項目については実施頻度が低かった． 教育上の課題としては，実施頻度が高い項目においては，訪問先の状況に応じた実施ができるように学内演習を進める必要がある．また，臨地での経験が困難と予測される項目や救急時の技術，高度な医療技術項目については視聴覚機器を活用し，知識面での理解を深める必要があると考えられた．Purpose : The purpose of this study was to investigate the study items of home nursing skills of the registered Visiting Nursing Stations（VNS）. Method : The questionnaire survey was mailed to fifty seven managers of registered VNS in T prefecture. Results : The effective answer rate was ７１．９％（n＝４１）．The nursing skills in the three domains that were carried out at least once or more in a month by nurses who belong to all VNS are as follows : １）In the domain of daily life support skills, four items of “range of motion exercises”，“walking assistance”， “assistance of transferring”, and “changing night clothes” were identified. ２）In the domain of skills for helping effective medical care，“check-up of vital signs” was identified. ３）In the domain of skills for safety/ comfort， “maintaining comfortable positions” was identified. And nursing skills that were required in emergency medical care/treatments were observed in a very low frequency in the same domain. Discussion : The nursing faculty should provide exercises in the university settings for the students to acquire these fundamental nursing skills, so that they can perform adequate nursing care at the time of home visits. In addition, it might be necessary for the faculty to utilize an audiovisual aid effectively in order to promote a better understanding of the students on the nursing skills/knowledge that would be rarely experienced during their clinical training, such as emergency clinical care and advanced therapeutic technologies. In order to build the effective study support system for the nursing students, we need to develop a collaborative education system between the University and the VNS

Dedifferentiated Endometrial Carcinoma Could be A Target for Immune Checkpoint Inhibitors (Anti PD-1/PD-L1 Antibodies)

Dedifferentiated endometrial carcinoma (DDEC) is defined as an undifferentiated carcinoma admixed with differentiated endometrioid carcinoma (Grade 1 or 2). It has poor prognosis compared with Grade 3 endometrioid adenocarcinoma and is often associated with the loss of mismatch repair (MMR) proteins, which is seen in microsatellite instability (MSI)-type endometrial cancer. Recent studies have shown that the effectiveness of immune checkpoint inhibitor therapy is related to MMR deficiency; therefore, we analyzed the immunophenotype (MMR deficient and expression of PD-L1) of 17 DDEC cases. In the undifferentiated component, nine cases (53%) were deficient in MMR proteins and nine cases (53%) expressed PD-L1. PD-L1 expression was significantly associated with MMR deficiency (p = 0.026). In addition, the presence of tumor-infiltrating lymphocytes (CD8+) was significantly associated with MMR deficiency (p = 0.026). In contrast, none of the cases showed PD-L1 expression in the well-differentiated component. Our results show that DDEC could be a target for immune checkpoint inhibitors (anti PD-L1/PD-1 antibodies), especially in the undifferentiated component. As a treatment strategy for DDEC, conventional paclitaxel plus carboplatin and cisplatin plus doxorubicin therapies are effective for those with the well-differentiated component. However, by using immune checkpoint inhibitors in combination with other conventional treatments, it may be possible to control the undifferentiated component and improve prognosis

Lynch Syndrome-Related Clear Cell Carcinoma of the Cervix: A Case Report

Lynch syndrome, a hereditary cancer syndrome, occurs because of germline mutations in at least one of four DNA mismatch repair genes (MutL Homolog 1 (MLH1), MutS Homolog 2 (MSH2), MutS Homolog 6 (MSH6), and PMS1 Homolog 2 (PMS2)). The disorder is associated with colorectal, endometrial, and other epithelial malignancies, but not cervical cancer. We report a woman with Lynch syndrome with synchronous cervical cancer. This is the first report of Lynch syndrome-related clear cell carcinoma of the cervix, which indicates the possibility of an association between cervical cancer and Lynch syndrome. Suitable genetic tests are required to determine whether common genetics can account for synchronous or subsequent malignancies in Lynch syndrome patients and their families. Such knowledge will also enhance our understanding of the genetic mechanisms governing the development of apparently unrelated cancers