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京都府立医科大学医学部看護学科, 京都府立医科大学附属病院看護部, 京都府立医科大学看護実践キャリア開発センター, 京都府立医科大学附属病院地域医療推進部, School of Nursing, Kyoto Prefectural University of Medicine, Department of Nursing, University Hospital Kyoto Prefectural University of Medicine, Kyoto Prefectural University of Medicine, Career Development Center for Nursing, Promotion Division of Regional Medicine, University Hospital Kyoto Prefectural University of Medicine, 本研究の目的は、「緩和ケア実践看護師養成コース（以下Aコース）」「在宅緩和ケア推進看護師養成コース（以下Bコース）」を受講した修了者とその上司への調査からプログラム評価および看護実践への活用状況を指標にしてプログラムを評価することである。【方法】平成27～31年度の間に京都府立医科大学看護実践キャリア開発センターが開催する「緩和ケアを推進する看護師教育プログラム」のAコースまたはBコースを受講した修了者25名のうち、調査時点で受講時と同じ施設・病院で就労を継続している21名（Aコース14名、Bコース7名）、とその上司21名（Aコース14名、Bコース7名）を研究対象者とした。修了生の施設・病院に質問紙を郵送し、令和3年7月～8月に無記名の自記式質問紙調査を行った。調査項目は、基本属性、カリキュラムについて、教育目標について、受講内容の適切性について、学習内容の臨床での活用について、とした。なお所属する大学の医学倫理審査委員会の承認を得て実施した（ERB-E-444）。【結果】回答者は、Aコース修了者9名、Aコース上司7名、Bコース修了者5名、Bコース上司3名であった。受講した修了者の評価においては、プログラムの内容についてAコースの8割以上が、Bコースの全員が（とても・まあまあ）適切としている。自己能力の発揮状況について、Aコースは4～6割、Bコースについては4～8割ができているとしている。 上司からの評価では、両コースとも受講した講義・演習・実習が7割程度現在の看護実践に役立っていると答えた。期待される能力については両コースとも8割以上が現在の看護活動に活きていると答えた。【結論】平成27年度から開始された「緩和ケアを推進する看護師教育プログラム」に対して、受講した修了者とその上司に，研修が有用であったかを問うたところ、受講した修了者はプログラムの内容が看護の実践で活かされていると実感していることが明らかとなった。さらに、上司は、受講した修了者が研修を踏まえた看護実践ができていると評価していることが明らかになった。修了者、上司の評価からプログラムの効果を評価することができた。

Objective In palliative care hospitals in Japan, mechanical bathing is conducted to maintain cleanliness. However, the physiological and psychological influence of mechanical bathing on patients has not been sufficiently studied. The objective of this study was to assess, using physiological and psychological indices, the effects of mechanical bathing care for patients in the terminal stage of cancer. Methods Mechanical bathing was performed using a Marine Court SB7000 in a supine or semi-seated position. The heart rate variability analysis method was used to measure autonomic nervous system function. The patients' state of anxiety was assessed using the State-Trait Anxiety Inventory (STAI), a psychological index, and patients' verbal responses were also collected after mechanical bathing. Results Twenty-four patients were enrolled in this study. Their sympathetic and parasympathetic nervous activity did not differ before and after bathing. A significant difference was found between pre- and post-bathing anxiety, as evaluated by STAI (P < 0.0001). In the patient's verbal responses that was collected, the most frequently mentioned descriptors were 'comfortable' and 'relaxed'. Patients were more relaxed after mechanical bathing according to STAI evaluation and their verbal responses. Conclusions The findings suggest that the method of bathing used in this study is safe and pain-relieving for terminal stage cancer patients. It is thus possible to provide safe and comfortable care for terminal stage cancer patients using mechanical baths.

Patients with head and neck cancer often suffer from breathing, speaking, and eating deficits, which negatively affect their quality of life. These patients are often observed to repeatedly contract aspiration pneumonia, resulting in prolonged hospital stays. To help prevent aspiration pneumonia, enteral nutrition is often provided. Although this method helps avoid pneumonia, patients need to give up eating by mouth. Because oral intake of food is closely related to patient quality of life, abandoning eating results in a strong internal conflict. This report describes the case of a cancer patient who experienced repeated aspiration pneumonias after neck surgery. The patient required enteral nutrition to avoid repeated bouts of pneumonia. However, the patient opted for laryngeal closure surgery to regain the ability to take food orally, at the expense of his voice. The patient's choice caused an ethical conflict for the attending medical professionals, highlighting the need for physicians to communicate with their patients to understand their patients' sense of values.

To identify predictive factors requiring high-dose transdermal fentanyl in opioid switching from oral morphine or oxycodone to transdermal fentanyl in patients with cancer pain.The participants were 76 hospitalized terminal cancer patients who underwent opioid switching from oxycodone or morphine sustained-release tablet to transdermal fentanyl at our hospital between January 2009 and June 2010. The conversion dose was calculated as transdermal fentanyl (25 μg/h)/oral morphine (60 mg) or oxycodone (40 mg)=1. The response evaluated was the dose conversion ratio [transdermal fentanyl/oral morphine or oxycodone (conversion dose to fentanyl)]=Y and was taken to be 0 for Y≤1, 1 for 1Y≤2, 2 for 2Y≤3, and 3 for 3Y. Predictors evaluated were factors potentially impacting pain. Ordered logistic regression analysis was carried out to identify the predictive factors requiring high-dose transdermal fentanyl in opioid switching.Breast cancer [odds ratio (OR)=8.218; 95% confidence interval (CI), 1.219-55.407; P=0.0305], total protein level (OR=0.630; 95% CI, 0.408-0.974; P=0.0377), alanine aminotransferase level (OR=1.017; 95% CI, 1.001-1.033; P=0.0390), advanced age (OR=3.700; 95% CI, 1.360-10.063; P=0.0104), and male sex (OR=3.702; 95% CI, 1.355-10.115; P=0.0107) were found to be significant predictive factors requiring high-dose transdermal fentanyl in opioid switching.Our study indicates that breast cancer, total protein, alanine aminotransferase, advanced age, and male sex are significant predictors of a need for higher dose transdermal fentanyl in opioid switching. Our results are considered likely to contribute to the establishment of evidence-based medicine in pain relief and palliative care.

SUMMARY Crayfish showed avoidance reactions when mechanical stimulation was applied to their tailfan. The response pattern of the avoidance reaction was dependent on crayfish size. Small crayfish showed an escape-like dart response while larger crayfish displayed a defensive-like turn response. We show that the response pattern to the same sensory stimulus changed with social status in the small crayfish. Crayfish are territorial animals and a dominant–subordinate relationship was determined when two previously unacquainted animals were paired. This winner–loser hierarchy was observed in pairs of small crayfish. Before fighting, all crayfish showed a dart response following mechanical stimulation of the tailfan. However, the probability of occurrence of a turn response increased significantly in the crayfish that won a fight. This behavioural transition from dart to turn response occurred immediately and was maintained for at least 3 days even if a dominant crayfish was isolated again with no opponent.

Electrical stimulation of sensory neurons that innervate receptors on the tailfan of crayfish evokes a reflex response of motor neurons that produce movements of the blades of the tailfan, the uropods. We analyzed the modulatory effects of nitric oxide (NO) on the spike frequency of the reflex response. Bath application of L-arginine and SNAP, which elevate endogenous and exogenous NO levels, increased the frequency of the evoked response, whereas the application of L-NAME and PTIO, which reduce NO levels, decreased the frequency of the response. To determine through what pathway and target NO exerted these effects we bath applied ODQ, an inhibitor of soluble guanylyl cyclase (sGC), which decreased the frequency of response, and 8-br-cGMP, which increased the spike frequency of response. To provide further evidence that NO acts via sGC, we elevated NO levels with L-arginine while simultaneously inhibiting sGC with ODQ. This application reduced the response to control levels, indicating that NO in the terminal ganglion of crayfish acts via sGC to modulate cGMP levels, which in turn regulate the responses of the uropod motor neurons.