看護理工学会誌 5巻1号
目次
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巻頭言
原著
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超音波検査とスケッチ技法を用いた末梢静脈カテーテル留置時の観察研究超音波検査とスケッチ技法を用いた末梢静脈カテーテル留置時の観察研究
- 東京大学大学院医学系研究科健康科学・看護学専攻老年看護学/創傷看護学
- 東京大学大学院医学系研究科社会連携講座アドバンストナーシングテクノロジー
- テルモ株式会社
末梢静脈留置カテーテルの複数回穿刺後の良くない留置状況と留置継続困難時の浮腫を伴う血栓を質的スケッチ技法と超音波検査を用いて記述した.結果,7カテゴリー,2つのストーリーラインが見出された.1つ目のストーリーラインは,複数回穿刺の状況下で<刺入血管の目視>が困難ななか,尺側等の<刺入部位>を選び<刺入時の姿勢>が【穿刺のためのねじれた肢位を伴う姿勢】であった.矢状面に平行な<カテーテルの向き>が実現できず【血管走行と一致しないカテーテル方向】が超音波検査上で確認された.2つ目のストーリーラインは,橈側等の留置は【良肢位で刺入した姿勢】ではあるが,<ドレッシングによる固定>でメッシュ部がコネクター部にかかり<固定に付随するハブコネクター周辺の状態>で皮膚にめり込むような【コネクター部の圧迫による皮膚のくぼみ】があり,超音波検査画像で【血管上方向に位置するカテーテル先端】であった.複数回穿刺時には,留置時の肢位と固定方法により機械的刺激が加わり血栓・浮腫が形成される可能性が示唆された.
末梢静脈カテーテル,留置継続困難,超音波検査,質的スケッチ技法,看護技術Observational study at the time of peripheral venous catheter placement using the ultrasonography and qualitative sketching method- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo
- Terumo Corporation
This study aimed to describe the relationship between inappropriate conditions due to multiple puncture attempts for catheterization and thrombus formation with subcutaneous edema at catheter failure by qualitative analysis and ultrasonography. Seven categories were extracted, and two stories were identified using qualitative-descriptive analyses. First, when attempting multiple insertions, <puncture sites> were chosen, such as the ulnar side and dorsum of the hand, while <visual judgment of target vein> was difficult, and the <posture at insertion> was contorted. The catheters were not inserted parallel to the sagittal plane, and the echo image confirmed that <intravascular position of catheter tip> were not parallel to the vessels. Second, with IV cannulation on the radial side, during manipulation of the <securement by dressing films>, the mesh part of the IV dressing covered the connector area and caused it to sink into the patient’s skin in the <peripheral condition of the hubs/connectors attached to the apparatus>. These phenomena were observed in many echo images in which the tip of the catheter was placed in the upstream direction of the blood vessels. Our results suggested that the posture of the body during insertion and the securement methods could affect thrombus and edema formation, since mechanical stimuli affected the blood vessels and subcutaneous tissue.
peripheral intravenous catheter,complication,ultrasonography,qualitative sketching method,catheterization technic -
電動義手制御に向けた手関節角度推定のための前腕皮膚表面における長軸方向の筋隆起位置変化の利用電動義手制御に向けた手関節角度推定のための前腕皮膚表面における長軸方向の筋隆起位置変化の利用
- 早稲田大学創造理工学研究科
- 早稲田大学次世代ロボット研究機構
- 科学技術振興機構さきがけ
- 早稲田大学理工学術院
本研究では,上肢切断者が関節角度を意図どおりに操作可能な電動義手を開発するために,筋収縮時の筋肉の機械的な変形を捉える皮膚表面上の筋隆起位置を用い,精確かつ簡単に関節角度を推定可能な手法を提案している.本論文では,手関節角度推定における筋隆起位置の有用性検証として,非切断者5名において手関節屈伸動作時の関節角度に対する筋隆起位置の信号特性を明らかにし,手関節角度の推定を行った.その結果,筋隆起位置は手関節角度に対する1次近似により0.94と高い決定係数を示したことから,両者の関係は直線による近似が可能であることが分かった.さらに1次近似により得た関数を用いて手関節角度を推定した結果,全体の手関節角度推定誤差は平均8.05[°]となり,表面筋電位を用いる手法と同程度の推定誤差を得た.この結果を用いて,今後は,上肢切断者において筋隆起位置に基づく手関節角度推定手法を用いた電動義手制御手法を検討する.
電動義手,関節角度推定,筋隆起位置,生体信号解析Wrist joint angle estimation using the muscle bulge movement along longitudinal direction of the forearm for controlling the powered prosthetic hand- Graduate School of Creative Science and Engineering, Waseda University
- Future Robotics Organization, Waseda University
- JST PRESTO
- Faculty of Science and Engineering, Waseda University
Estimate intentional joint angle easily and accurately is important for developing a powered prosthetic hand which can realize upper limb amputee’s intentional motion. We proposed the joint angle estimation method using the muscle bulge movement on the forearm skin surface derived from the deformation of the muscle while muscle contraction. We hypothesized a simple relationship between the muscle bulge movement longitudinally along a muscle and the corresponding joint angle, because the muscle contraction causes the change in the joint angle. In this paper, we evaluated the feasibility of the muscle bulge movement for wrist joint angle estimation by confirming the signal characteristics of the proposed signal. From the experimental results with five non-amputated subjects, we extracted a linear relationship from the raw data with a high determination coefficient as 0.94. Using the function eared from the raw data, we achieved the joint angle estimation error as 8.05[°]which is similar to that of using surface EMG in related work. We will develop a joint angle control method using the muscle bulge movement for a powered prosthetic hand with upper limb amputee.
powered prosthetic hand,joint angle estimation,muscle bulge movement,bio signal analysis -
(英文論文)Influences of different wiping methods cleaning agent removal on the effectiveness of skin dirt removal:A quasi-experimental study (拭き取りによる洗浄剤除去方法が皮膚汚れ除去効果に及ぼす影響)拭き取りによる洗浄剤除去方法が皮膚汚れ除去効果に及ぼす影響
- 金沢大学医薬保健研究域保健学系臨床実践看護学講座
- 金沢大学医薬保健研究域附属健康増進科学センター
- 金沢大学大学院医薬保健学総合研究科保健学専攻健康発達看護学講座
- 金沢大学附属病院看護部
- 金沢大学大学院医薬保健学総合研究科保健学専攻臨床実践看護学講座
- 金沢大学新学術創成研究機構
皮膚汚れ除去に最も効果的な拭き取りによる洗浄剤除去方法を明らかにすることを目的とし,健康成人女性の前腕部を対象に準実験研究を実施した.洗浄剤により皮膚表面の汚れを浮かせたあと,3種類の異なる拭き取り方法により皮膚汚れおよび皮膚洗浄剤を除去した(WIPE A:末梢から中枢方向,WIPE B:中枢から抹消方向,WIPE C:中枢から外側へ円を描く).皮膚汚れとして油性口紅を使用し,汚れ塗布部位とその周囲合計5ヵ所において,拭き取り前後の皮膚色の差を算出することで,皮膚汚れ除去効果の指標とした.拭き取り方法間で統計学的有意差を認めた場合にその回数を数え,評価部位5ヵ所の統計学的有意差の合計数(Total score)が最も高いものを最も皮膚汚れ除去効果の高い方法とした.結果としてWIPE CはWIPE AおよびWIPE Bにくらべて高い5ヵ所のTotal scoreを示した.本研究における3種類のなかでは,中枢から外側へ円を描く拭き取り方法が最も皮膚汚れ除去効果が高いことが明らかになった.
洗浄剤,皮膚汚れ残余,拭き取り,皮溝,皮膚色Influences of different wiping methods cleaning agent removal on the effectiveness of skin dirt removal:A quasi-experimental study- Department of Clinical Nursing, School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University
- Wellness Promotion Science Center, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University
- Department of Health Development Nursing, Division of Health Science, Graduate School of Medicine, Kanazawa University
- Department of Nursing, Kanazawa University Hospital
- Department of Clinical Nursing, Division of Health Science, Graduate School of Medicine, Kanazawa University
- Institute for Frontier Science Initiative, Kanazawa University
This quasi-experimental study aims to determine the effectiveness of different cleaning agent removal methods in removing skin dirt from the forearms of healthy women. After removal of skin dirt, the detergent was removed in three different methods, i.e., wiping off from the periphery to the center(WIPE A), from the center to the periphery(WIPE B), and in circular motions shifted outward from the center(WIPE C). A total of five sites, of which one site included an area where oil-based lipstick was applied as a dirt substitute, were evaluated. The effectiveness of skin dirt removal by the different methods, involved determining the difference(Δa* values)calculated between pre and post-intervention skin colours. The number of significant differences between the four-cleaning agent removal methods at each measurement site was counted, and the total number of participants for each cleaning agent removal methods was calculated as a total score. The WIPE C method demonstrated a higher total five-site scores than the WIPE A and WIPE B methods. Among the procedural variations of the wiping methods, circular motions shifting outward from the centre spread less dirt and was most effective in skin dirt removal.
cleaning agent removal,skin dirt removal,wipe,sulcus cutis, skin color -
(英語論文)Factors associated with severe skin disorder after extravasation of intravenously infused antineoplastic agents(抗がん剤の点滴静脈内注射の血管外漏出後の重症皮膚障害の発生要因)抗がん剤の点滴静脈内注射の血管外漏出後の重症皮膚障害の発生要因
- 金沢医科大学看護学部
- 東京大学大学院医学系研究科社会連携講座アドバンストナーシングテクノロジー
- テルモ株式会社
- 金沢医科大学医学部腫瘍内科学
- 金沢医科大学病院
- 金沢大学新学術創成研究機構革新的統合バイオ研究コア先端的ヘルスケアサイエンスユニット
- 東京大学大学院医学系研究科健康科学・看護学専攻老年看護学/創傷看護学分野
抗がん剤の血管外漏出後の重症皮膚障害の発生要因の抽出を目的とした.2014年4~9月に抗がん剤の点滴静脈内注射を受けた256件のうち漏出した25名を対象とした.滴下中にサーモグラフィーによる皮膚温度の測定と肉眼的観察を行った.重症群を再来時に硬結もしくは水疱があると定義し,重症群(12件)と軽症群(13名)に分け両群の要因を比較した.金沢医科大学倫理委員会の承認を得た.重症皮膚障害が発生した対象の特徴は,サーモグラフィーで血管外漏出を示唆する低温領域出現後の壊死性薬剤もしくは炎症性薬剤の投与時間が長い(重症群28分,軽症群6分,P=0.017),投与時の腫脹なし(重症群92%,軽症群46%,P=0.03),年齢が低い(重症群59.4歳,軽症群71.2歳,P=0.037),であった.抗がん剤の血管外漏出後の重症皮膚障害の発生要因として,肉眼で腫脹が認識されないことによる長時間の漏出が示唆された.
血管外漏出,サーモグラフィー,抗がん剤,硬結,水疱Factors associated with severe skin disorder after extravasation of intravenously infused antineoplastic agents- School of Nursing, Kanazawa Medical University
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo
- Terumo Corporation
- Department of Medical Oncology, Graduate School of Medicine, Kanazawa Medical University
- Kanazawa Medical University Hospital
- Advanced Health Care Science Research Unit Innovative Integrated Bio-Research Core Institute for Frontier Science Initiative Kanazawa University
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo
This study examined factors associated with severe skin disorders after extravasation. Among 256 patients who received intravenous drip infusion of antineoplastic agents from April through September 2014, the 25 patients who experienced extravasation were analyzed. Measurements of skin temperature by thermography and macroscopic observation were performed during drip infusion to each patient. The severe group(12 patients)was defined as patients showing induration or blistering at the next hospital visit. The remaining 13 patients constituted the mild group. Various factors were compared between groups. All study protocols were approved by the Kanazawa Medical University Ethics Committee. The severe group was characterized by longer administration of vesicant or irritant agents after appearance of a thermographic low-temperature region suggesting extravasation(severe group, 28 min;mild group, 6 min;P=0.017), lack of swelling during administration(severe group, 92%;mild group, 46%;P=0.03), and lower age(severe group, 59.4 y;mild group, 71.2 y;P=0.037). The results of the present study suggest that the factor associated with severe skin disorder after extravasation was a long duration of extravasation due to a lack of recognition of swelling after the first appearance of symptoms.
extravasation,thermography,antineoplastic agents,induration,blister -
ロボット支援腹腔鏡下前立腺摘出術を受けた患者の体験ロボット支援腹腔鏡下前立腺摘出術を受けた患者の体験
- 岡山大学病院看護部
- 滋賀医科大学医学部臨床看護学講座(小児)
- 滋賀医科大学神経難病研究センター
手術支援ロボットによる腹腔鏡下前立腺摘出術(Robot Assisted Laparoscopic Radical Prostatectomy:RALP)を受けた患者の体験を分析し,先進医療に対し,どのような期待や不安を感じ,受け止めているのかを明らかにするために前立腺癌でRALPを受けた患者8名に半構成的面接を実施した.患者とその家族は,体験談やネットの検索など,積極的に情報収集を行い,先進医療を受け入れていた.RALPの低侵襲性,正確性,根治性に期待をもっており,その術後早期回復を実感することで,想像以上の満足感を得ていた.短い入院期間のなか,患者との信頼関係を確立し,質の高い看護の提供するために,患者の視点に立った情報提供,患者の背景に目を向けたかかわりが求められていることが示唆された.
前立腺癌,ロボット手術,患者,体験Experiences of patients who underwent robot assisted laparoscopic radical prostatectomy- Nursing Department, Okayama University Hospital
- Department of Clinical Nursing, Shiga University of Medical Science School of Medicine
- Molecular Neuroscience Research Center, Shiga University of Medical Science
The purpose of this study is to analyze the experiences of the patients who underwent Robot Assisted Laparoscopic radical Prostatectomy(RALP)and to clarify their expectation and anxiety about the advanced medicine for prostate cancer. A semi-structured interview was conducted on 8 patients who underwent RALP for prostate cancer. Through the analyses of the records, these findings were obtained. Patients and their families accepted the advanced surgical treatment, with hearing their friends’ experiences and getting information through the internet. They expected its minimally invasiveness, accuracy and high curability. They were satisfied with the earlier recovery from the surgical procedure than their prediction. In the short hospitalization period to build up a relationship of trust with patients, such information from the patients’ point of view will provide important findings to provide high-quality nursing. It is suggested that a hands-on individual consultation and understanding degrees is required.
prostate cancer,robotic surgery,patients,experiences -
(英語論文)Confirming the placement of nasogastric tubes by hand-carried ultrasonography device(携帯型超音波装置を用いた経鼻胃管の位置確認の検討)携帯型超音波装置を用いた経鼻胃管の位置確認の検討
- 東京大学大学院医学系研究科健康科学・看護学専攻看護管理学/看護体系・機能学
- 東京大学大学院医学系研究科健康科学・看護学専攻老年看護学/創傷看護学
- 東京女子医科大学看護学部看護管理学
背景:経鼻胃管を使用する際の問題の一つに気道への誤挿入があげられる.経鼻胃管の位置の確認方法として,聴診法などの簡便な方法が用いられているが,それらの方法は正確性に欠ける.また胸部レントゲンは最も正確な方法であるが,簡便性に欠ける.そこで本研究では,簡便かつ正確に経鼻胃管の位置を確認する方法として携帯型超音波装置を用いて経鼻胃管の描出が可能か検討を行った.方法:携帯型超音波装置を用いて,10名の患者の経鼻胃管の位置の確認を頸部および上腹部で行った.超音波画像の視認性を向上させる目的で,必要に応じて胃内容物の吸引および左側臥位への体位変換を実施した.結果:10名すべてで頸部もしくは上腹部で経鼻胃管が確認された.頸部および上腹部のそれぞれの描出率はともに80%であった.また8Frから12Frの小径な経鼻胃管も確認することができた.結論:携帯型超音波装置が経鼻胃管の位置の確認方法として有用であることが示された.
経鼻胃管,胃管留置,超音波検査法,携帯型超音波装置Confirming the placement of nasogastric tubes by hand-carried ultrasonography device- Department of Nursing Administration and Advanced Clinical Nursing, Graduate School of Medicine, The University of Tokyo
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo
- Department of Nursing Administration, Graduate School of Nursing, Tokyo Women’s Medical University
Background:One of the most serious complications of nasogastric tubes(NGTs)is inaccurate placement. A number of easy techniques have been developed to confirm accurate NGT placement;however, these methods are lacking in accuracy. Chest x-rays are the most accurate method of confirming NGT placement, yet x-rays are often inconvenient. In this study, we examined whether a hand-carried ultrasonography device(HUD)could provide an accurate and convenient method for confirming the placement of NGTs. Methods:We used HUD to confirm NGT placement in a series of 10 patients. NGT positioning was evaluated in both the neck and epigastric regions. Visibility was improved by aspirating stomach contents while imaging both the neck and epigastric regions and placing the patient in the left decubitus position while imaging the epigastric region. Results:In all 10 patients, the placement of the NGT was verified. In 80% of patients(8/10), the NGT was visualized in the neck. In 80% of patients(8/10), the NGT was visualized in the epigastric region. HUD was able to visualize even small-bore NGTs, with sizes ranging from 8-Fr to 12-Fr. Conclusions:The hand-carried ultrasonography device is a reliable and convenient method for confirming placement of NGTs.
nasogastric tube,tube placement,ultrasonography,hand-carried ultrasonography device -
(英語論文)Development of a distribution analysis method for metalloproteinase activity by combining wound blotting and zymography techniques:A pilot study in mice(創面ブロッティング法とザイモグラフィ技術を組み合わせた細胞外基質分解酵素活性の分布解析法の開発:マウスを用いたパイロットスタディ)創面ブロッティング法とザイモグラフィ技術を組み合わせた細胞外基質分解酵素活性の分布解析法の開発:マウスを用いたパイロットスタディ
- 東京大学大学院医学系研究科社会連携講座スキンケアサイエンス
- 東京大学大学院医学系研究科附属グローバルナーシングリサーチセンター
- 東京大学大学院医学系研究科老年看護学/創傷看護学分野
細胞外基質分解酵素(MMPs)は,創傷治癒の進行と阻害にかかわる酵素であり,その活性は創部炎症状態を反映するバイオマーカーとして期待される.しかし,状態の異なる部位が混在する慢性創傷において,MMP活性の分布を可視化する技術は開発されていない.そこで,本研究では創面ブロッティング技術とザイモグラフィ技術を組み合わせて,MMP活性分布解析法の開発を試みた.マウス全層欠損創において,創作成後3,7,10日目に創面ブロッティングを実施し,ゼラチンゲルと反応させた.ゲルのタンパク質染色イメージは画像解析により,従来の電気泳動ザイモグラフィにくらべて感度は低いものの,MMP活性の分布イメージが得られた.MMP活性は創作製後3日目には創縁に分布し,その後創底シグナルに変化するパターンと創縁シグナルが継続するパターンがみられ,シグナル分布パターンが創部炎症状態を反映している可能性が示唆された.
細胞外基質分解酵素,マウス,創面ブロッティング,創傷治癒Development of a distribution analysis method for metalloproteinase activity by combining wound blotting and zymography techniques:A pilot study in mice- Department of Skincare Science, The University of Tokyo
- Global Nursing Research Center, The University of Tokyo
- Department of Gerontological Nursing/Wound Care Management, The University of Tokyo
The activity of matrix metalloproteinases(MMPs)associated with progression and inhibition of wound healing is expected to be a biomarker to reflect the wound inflammatory status. However, a method has not been developed to visualize the activity distribution of MMPs. In this study, we developed a novel distribution analysis method by combining wound blotting and zymography techniques. Wound blotting samples were collected from full thickness wounds of mice. A gelatin gel was reacted with the wound blotting sample, and then stained. Image processing of gel images clearly showed the distribution of MMP activity, although the detection sensitivity of MMP activity was lower than in conventional electrophoretic zymography. The distributions of MMP activity were observed on the wound edge and bed. These results suggest that the different distribution patterns of MMP activity, which translocates from the wound edge to bed, and the continuous distribution on the wound edge during the healing period reflect different wound inflammatory statuses.
matrix metalloproteinase,mouse,wound blotting,wound healing -
(英語論文)Comparative study on high-frequency ultrasonography and histological structure of the skin:Relationship between collagen/elastin content and echogenicity(高周波超音波診断装置を用いた皮膚イメージングと皮膚内部組織の比較:コラーゲン・エラスチン量とエコー輝度の関係)高周波超音波診断装置を用いた皮膚イメージングと皮膚内部組織の比較:コラーゲン・エラスチン量とエコー輝度の関係
- 金沢大学医薬保健研究域附属健康増進科学センター
- 金沢大学医薬保健研究域保健学系看護科学領域臨床実践看護学講座
- 金沢大学大学院医薬保健学総合研究科保健学専攻
- 金沢大学男女共同参画キャリアデザインラボラトリー
- 浅ノ川総合病院
- 金沢大学新学術創成研究機構革新的統合バイオ研究コア先端的ヘルスケアサイエンスユニット
背景:高周波超音波診断装置(エコー)は皮膚の非侵襲的イメージングに用いられているが,実組織との関係を検討した知見は少ない.本研究の目的は,エコー画像と実際の皮膚組織に着目し,手術の際に除去される帝王切開痕を用いて比較することである.方法:本研究では,書面によるインフォームドコンセントを得られた12名の妊婦を対象とした.出産前に瘢痕部と周囲皮膚をエコーで撮影した.反復帝王切開時,産科医によって瘢痕組織が採取され,コラーゲン・エラスチン染色に供された.染色画像を用いてコラーゲン量とエラスチン量の定量を行った.結果:瘢痕部は密な構造であったが,低エコーであった.エコー輝度とエラスチン陽性面積に有意な相関が認められたが,コラーゲン陽性面積とは有意な相関は認められなかった.結論:エコー輝度はコラーゲンの量や密度よりはむしろ,エラスチンの量とより相関することが明らかとなった.
超音波診断,コラーゲン,エラスチン,真皮,瘢痕Comparative study on high-frequency ultrasonography and histological structure of the skin:Relationship between collagen/elastin content and echogenicity- Wellness Promotion Science Center, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University
- Department of Clinical Nursing, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University
- Department of Clinical Nursing, Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University
- Career Design Laboratory for Gender Equality, Kanazawa University
- Asanogawa General Hospital
- Advanced Health Care Science Research Unit, Innovative Integrated Bio-Research Core, Institute for Frontier Science Initiative (InFiniti), Kanazawa University
Background:High-frequency ultrasonography is used to non-invasively visualize the skin. However, few studies have focused on the association between ultrasound images and actual histology. Here we focused on the comparison of high-frequency ultrasound images and their actual histology using Cesarean scar tissue removed during delivery. Methods:This study included 12 pregnant women who provided a written informed consent. The ultrasound images of scars were captured prior to delivery using a high-frequency ultrasound device. Scars were sampled by an obstetrician, and collagen and elastin staining were performed on the samples. The amount of collagen or elastin was estimated by an intensity analysis using immunohistochemistry images. Results:Only low-echogenicity signals were observed in the scar tissue, although a tight structure was present. Echogenicity was significantly correlated with the elastin-positive area but not with the collagen-positive area. Conclusion:The echogenicity of ultrasound images appeared to be more closely associated with the amount of elastin than with the amount and/or density of collagen fibers.
ultrasonography,collagen,elastin,dermis,scar -
胎児と母は決定論的カオスである:サロゲート法による解析胎児と母は決定論的カオスである:サロゲート法による解析
- 日本赤十字九州国際看護大学
- 医療・福祉基盤研究所
- 大阪大学大学院医学系研究科
はじめに:ヒトの生体が決定論的カオスであることが多くの研究によって示されているが,ヒトの胎児と母では明らかになっていない.方法:4人の母とその胎児を対象に妊娠11週から36週まで,超音波ドップラー法で母児の心音を同時測定し,カオス解析を行った.Random shuffle,Fourier shuffle Period-shuffleのサロゲートを行い,母児のデータのランダム性を検証した.最大リアプノフ指数(λ1)の計算,アトラクターの抽出を行った.結果:相関次元は5次元であった.3種のサロゲート法すべてにおいて母児データのランダム性が棄却された.母児のλ1は正であり,両者のアトラクターが抽出できた.これらのことから胎児と母は決定論的カオスであることが示された.考察:本結果は妊娠初期から後期にわたって胎児と母が決定論的カオスであり,非線形相互作用する自己組織化能力を備えていることを明らかにした.
胎児と母,決定論的カオス,自己組織化,サロゲート法Fetus and mother are a deterministic chaos:Analysis of surrogate data method- Women’s Health & Reproductive Health, The Japanese Red Cross Kyushu International College of Nursing
- Institute for Basic Medical and Welfare Research
- Division of Health Sciences, Osaka University Graduate School of Medicine
INTRODUCTION:Many studies have shown that human organs are a deterministic chaos. However, it remains unclear whether this is true for the human fetus and mother. We aimed to clarify whether the fetus and mother are a deterministic chaos or not. METHODS:We measured heart sounds of four human fetuses and their mothers during 11th-36th week of gestation using an ultrasonic Doppler apparatus. We investigated non-linearity of the data using the surrogate method. Data modified by three surrogate methods:Random shuffle, Fourier shuffle and Period-shuffle, were used in the study. We conducted a chaotic analysis to recognize the largest Lyapunov exponents(λ1)and the attractor. RESULTS:The result of calculation of correlation dimension is five. λ1 of the original data was significantly different from that of each surrogate data. Fetuses and mothers showed positive λ1 from 11th to 36th week of gestation. Moreover, the attracters were clearly recognized for fetuses and mothers. The results indicate these data deterministic chaos with nonlinear dynamics. DISCUSSION:These results indicate that fetus and mother are a deterministic chaos, and that fetus and mother showed the self-organization ability to interact nonlinearly.
fetus and mother,deterministic chaos,self-organization,surrogate data method
実践報告
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セル看護提供方式採用病棟における看護業務実施場所からみた業務改善調査セル看護提供方式採用病棟における看護業務実施場所からみた業務改善調査
- 株式会社ケア環境研究所
- 飯塚病院
製造における生産方式であるセル生産方式にヒントを得て,看護提供方式に展開し業務改善を具体化した事例を取り上げる.セル生産方式はベルトコンベアで多数の工員が細分化した単純作業を行うライン生産方式と異なり,1人,もしくは小集団にて製品組み立てから検査までの工程すべてを受け持つ.セル看護提供方式では日単位に勤務看護師に対し担当病室を割り振り,担当病室における患者に対するすべての業務を受け持つ.加えてスタッフステーションを起点とした情報収集・共有,カンファレンスなどの従来型の業務運用ではなく,病室・病室前の廊下を起点とした業務運用を基本としている.結果,患者の気配を察し,先取りケア実践が実現され,ナースコール呼出回数の減少を,さらに看護師のスタッフステーションに情報収集,物品を取りに戻るなどの業務動線の短縮を狙っている.当調査では位置検知システムの利用により把握可能な看護師従事場所情報を利用しセル方式導入効果を整理した.
セル看護提供方式,先取りケア,ナースコール,位置検知システム,看護師モチベーションCase of nursing activity improvement from viewing of the place of work with cell nursing system- Care environmental laboratory CO., LTD
- Iizuka Hospital
This study is improvement of nursing care providing system from cell nursing system that is taken from the cell production system in manufacturing. Cell production system is different from line production system as belt conveyor system. One worker or one group operate all of production process. Under the cell nursing system nurses are assigned patients’ rooms in charge for all caring tasks on daily bases. In addition, other tasks such as information gathering and sharing, and conference are carried out in patients’ rooms rather than at staff station. As a result of being closer to patients, nurses are able to catch sings from patients easily, and then are able to provide forestalling care to patients. Some of positive impacts are the reduced number of Nurse Call Volumes. In this paper are discussed based on data of the Location Detecting System.
cell nursing system,initiative care,nurse call,location detection data,motivation of nurse
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