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  • 1
    Language: Japanese
    In: Palliative Care Research, 2015, Vol.10(1), pp.901-905
    Description: 当医療圏では,在宅医主導で,PCA(patient-controlled analgesia)ポンプを使用して疼痛緩和を行うための連携システムが構築されておらず,在宅でオピオイド持続注射を実施することが困難であった.在宅緩和ケア中に内服困難となった乳がん患者に対して,病院緩和ケアチームが協力しオピオイド持続皮下注を開始した症例の経験と,医師会在宅医グループ勉強会での討論を踏まえ,システムの検討を行った.その結果,1)オピオイドは在宅医が処方,2)がん性疼痛看護認定看護師が訪問看護師に同行し,患者宅でアセスメントし,薬液を交換,3)ポンプレンタルは在宅医,消耗品は病院が負担,4)在宅医が在宅悪性腫瘍患者指導管理料,病院が共同指導管理料・訪問看護指導料をそれぞれ算定,というシステム「在宅PCAらくらくパック」を構築した.約2年間で6例の患者にこのシステムを適用した.システムを利用した在宅医,訪問看護ステーションにアンケート調査を行い,おおむね有益であるとの評価を得た.
    Description: In our medical district, home care physician-led liaison system has not yet been established for pain relief using a patient-controlled analgesia(PCA)pump. Therefore, it has been difficult to perform continuous opioid infusion at home. We investigated the liaison system based on our experience with breast cancer patients in whom oral drug administration became difficult during palliative care at home and thus continuous opioid subcutaneous infusion was started in cooperation with a palliative care hospital team and based on the discussion among home care study group physicians of the medical association. Based on the results of our study, we established the system called“Home PCA Raku-raku(Easy)Pack”that are characterized by the following:(1)opioids are prescribed by a home care physician;(2)a certified cancer pain management nurse accompanies a nurse to visit the patients’ home, assesses their conditions, and changes the drug solution;(3)the pump rental fee is paid by the home care physician, and the cost of consumables is paid by the hospital;and(4)the home care physician calculates the fee for home management of malignant tumors, and the hospital calculates the collaborative medical management fee and the visiting nursing management fee. This system was applied to 6 patients during a period of approximately 2 years. The result of a questionnaire survey for home care physicians and visiting nurse stations using this system showed that the system was generally beneficial.
    Keywords: 在宅医療 ; 皮下注入 ; オピオイド ; PCA ; 医療施設連携 ; Home Based Medical Care ; Subcutaneous Infusion ; Opioid ; Patient-Controlled Analgesia ; Medical Facilities Network
    ISSN: 1880-5302
    ISSN: Palliative Care Research
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  • 2
    Language: Japanese
    In: Palliative Care Research, 2013, Vol.8(2), pp.240-247
    Description: 〈b〉【目的】〈/b〉看護師のがん看護に関する困難感を測定, 評価するための尺度を作成し, 尺度の信頼性・妥当性を検証することを目的とした. 〈b〉【方法】〈/b〉東北大学病院でがん看護に携わる看護師を対象に, 自記式質問紙調査を行った. 〈b〉【結果】〈/b〉探索的因子分析の結果, 6ドメイン49項目が同定され, 尺度全体のCronbachのα係数は0.68, ドメイン別は0.69~0.74であり十分な内的一貫性が示された. Multitrait Scaling分析の結果, 構成概念妥当性が認められ, 尺度化成功率はすべて100%であった. 緩和ケア病棟看護師とそれ以外のがん看護に携わる看護師の得点の比較により, 既知集団妥当性が示された. 〈b〉【考察】〈/b〉看護師のがん看護に関する困難感尺度が十分な信頼性と妥当性を有することが確認された. 本尺度の活用により, 病院内のがん看護の現状アセスメントや教育支援体制の検討が可能となる. また, 教育支援の前後に用いて効果の検証にも活用できると考えられる.
    Description: 〈b〉Purpose〈/b〉: This study was to develop a scale to measure difficulties encountered by cancer care by nurses and to evaluate the reliability and the validity of the scale. 〈b〉Methods〈/b〉: Self-reported questionnaires were administered to nurses who are engaged in cancer care in Tohoku University Hospital. 〈b〉Results〈/b〉: Of 512 questionnaires distributed to nurses, 356 were completed and returned 70%. We selected 49 items in 6 domains, including "communication" "knowledge and skill" "collaboration with doctor" "disclosure and explanation of disease" "hospital system and regional alliances" and "death and dying" using explanatory factor analysis. Cronbach's α coefficient was 0.68 across domains and ranged from 0.69 to 0.74 for each domain. Construct validity was demonstrated and the scaling success rates were 100% for all domains on multitrait scaling analysis. In terms of the known groups validity, the score for the nurses in the palliative care unit was significantly lower than for nurses on the general wards. 〈b〉Conclusion〈/b〉: This study showed that the scale has sufficient reliability and validity. This scale may contribute to cancer nursing by assessing hospital nurses' perception of cancer care and as a method of determining outcomes of educational or organizational interventions.
    Keywords: がん ; 看護 ; 困難感 ; 尺度 ; 緩和ケア ; Cancer ; Nursing ; Difficulty ; Questionnaire ; Palliative Care
    ISSN: 1880-5302
    ISSN: Palliative Care Research
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  • 3
    Language: Japanese
    In: Palliative Care Research, 2014, Vol.9(3), pp.158-166
    Description: 〈b〉【目的】〈/b〉東北大学病院のがん看護に携わる看護師の困難感の実態とその関連要因を明らかにする. 〈b〉【方法】〈/b〉無記名の自記式質問紙調査. 東北大学病院でがん患者のケアに携わる病棟で働く看護師を対象とした. 〈b〉【結果】〈/b〉512人に調査票を配布し, 有効回答は344人であった(67%). 患者・家族とのコミュニケーションに対する困難感が非常に高く, システム・地域連携に関する困難感, 自らの知識・技術に対する困難感が高かった. また, 医師の治療や対応に関する困難感, 告知・病状説明に対する困難感, 看取りに対する困難感にも改善の余地が示された. がん看護に関する困難感は一般病棟で高く, 過去1年に経験したがん患者のケアの合計人数が多い看護師は低かった. 〈b〉【考察】〈/b〉今後はコミュニケーション・スキルの向上や, 特にがん看護の経験が少ない看護師に対する教育, 緩和ケアチームの関わりの増加, 退院支援や地域連携などのシステムの再構築などが課題である.
    Description: The purposes of this study were to describe nurses’ difficulty with cancer care and explore factors related to the difficulty of cancer care. Self-reported questionnaires were distributed to 512 nurses who are engaged in cancer care at Tohoku University Hospital. Responses from 344 (67%) nurses were subjected to analysis. The results revealed that nurses felt that “communication” was the most difficult aspect of cancer nursing followed by “hospital system and regional alliances” and “knowledge and skill.” Nurses did not feel that “collaboration with doctors” “disclosure and explanation of disease” or “death and dying” had particularly high levels of difficulty, however, their levels of difficulty could be improved. Greater difficulty with cancer care was reported by nurses working on the general ward and nurses with limited cancer care experience in the last year. Communication skill training,education (especially for less experienced nurses), expansion of palliative care, and restructuring of discharge planning and regional collaboration systems might contribute to decreasing nurses’ difficulty with cancer care.
    Keywords: がん看護 ; 看護師 ; 困難感 ; 関連要因 ; 大学病院 ; Cancer Nursing ; Nurse ; Difficulty ; Related Factor ; University Hospital
    ISSN: 1880-5302
    ISSN: Palliative Care Research
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  • 4
    Language: Japanese
    In: Palliative Care Research, 2012, Vol.7(1), pp.526-529
    Description: がん性腹膜炎による腹水貯留が原因の腹部膨満感が, 超音波ガイド下両側腹直筋鞘ブロックにより軽減した症例について報告する. 【症例】59歳, 男性, 胃がん. 腹膜再発による腹水貯留に対し利尿剤投与, 腹水ドレナージ, オピオイド投与が行われたが腹部膨満感に対する効果は限定的であった. 超音波ガイド下に両側腹直筋鞘ブロックを施行したところ, 腹部膨満感がNRS(6段階評価; 0~5)で5から1に軽減した. その後, 両側腹直筋鞘後葉にカテーテルを留置し, 週3回の0.25%ロピバカイン投与を永眠されるまで20日間継続し, その間に腹部膨満感の訴えは認めなかった. 【考察】腹水貯留から起きるさまざまな症状のうち, 腹部膨満感に対して両側腹直筋鞘ブロックが症状緩和の一助となる可能性がある.
    Description: We report a case in which feelings of abdominal distension and discomfort of the abdominal wall caused by malignant ascites were relieved by ultrasound-guided rectus sheath block. 〈b〉Case report〈/b〉: A 59-year-old man developed gastric cancer with malignant ascites and experienced feelings of abdominal distension, but no nausea, dyspnea, poor mobility, or limb edema. Symptom control was inadequate with diuretic therapy and abdominal paracentesis. Feelings of distension improved temporarily with ultrasound-guided rectus sheath block. A percutaneous catheter was then used to administer an infusion of 0.25% ropivacaine triweekly until his death 20 days later. 〈b〉Conclusion〈/b〉: Feelings of abdominal distension is one of various symptoms of severe ascites and is difficult to manage. Ultrasound-guided rectus sheath block can be used to relieve this symptom on a case-by-case basis.
    Keywords: 腹直筋鞘ブロック ; 超音波ガイド下神経ブロック ; 腹部膨満感 ; がん性腹水 ; Rectus Sheath Block ; Ultrasound-Guided Nerve Block ; Abdominal Distension ; Malignant Ascites
    ISSN: 1880-5302
    ISSN: Palliative Care Research
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  • 5
    Language: Japanese
    In: Palliative Care Research, 2011, Vol.6(1), pp.313-315
    Description: 骨盤内腫瘍増大による神経障害性疼痛に対し従来の薬物療法では十分な除痛が得られず, エコーガイド下坐骨神経ブロックで良好な鎮痛が得られた症例を経験したので報告する. 【症例】60歳代, 男性. 骨盤内腫瘍による神経圧迫が原因の痛みに対しフェンタニル貼付剤10.5mg, ガバペンチン1,600mg/日, エトドラク400mg/日, アミトリプチリン30mg/日まで増量したが, 眠気が増加するのみで十分な鎮痛効果が得られなかった. エコーガイドで坐骨神経に0.1%ロピバカイン5ml/時で持続投与することで痛みが軽減し, フェンタニル貼付剤8.4mg, ガバペンチン800mg/日, アミトリプチリン10mg/日まで減量が可能となり, 眠気も軽減することができた. 従来の末梢神経ブロックと異なりエコーを使用することで安全かつ確実に鎮痛が得られるため, 全身状態が悪い状況であっても神経ブロックの選択が可能となる. Palliat Care Res 2011; 6(1): 313-315
    Description: We report a case whose left lower limb neuropathic pain accompanied by pelvic tumor invasion was remarkably eliminated by ultrasound-guided sciatic nerve block. 〈b〉Case report〈/b〉: The subject was a sixty year old male. Pharmacological therapy was given according to the WHO analgesic ladder, but his left lower limb pain failed to respond to drugs. His intractable lower limb neuropathic pain was alleviated by ultrasound-guided sciatic nerve block. Drug delivery can be achieved with a percutaneous catheter and a disposable infusion pump. Infusions were run at 5mlh〈SUP〉-1〈/SUP〉 with 0.1% ropivacaine. 〈b〉Conclusion〈/b〉: Neuropahic pain is sometimes hard to be controlled only by opioids or adjuvant analgesics, but there is a possibility of providing pain relief by combination use with nerve blocks. Interventional techniques can be highly effective but also have the potentiality to produce significant adverse effects. Many patients have factors which would be considered a near absolute contra-indication to the use of nerve blocks such as immuno-compromise or impairment of coagulation. Skillful application of peripheral neural blockade with ultrasound imaging broadens the options for providing optimal pain management. Palliat Care Res 2011; 6(1): 313-315
    Keywords: 神経障害性疼痛 ; エコーガイド下神経ブロック ; がん疼痛 ; 鎮痛補助薬 ; Neuropathic Pain ; Ultrasound-Guided Nerve Block ; Cancer Pain ; Adjuvant Analgesics
    ISSN: 1880-5302
    ISSN: Palliative Care Research
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