学会誌

多重課題条件下における歩行中の並進運動に対する課題の種類と加齢の影響

著者

村上　唯¹ 正源寺　美穂² 渡辺　哲陽³

所属

1. 金沢大学大学院自然科学研究科機械科学専攻
2. 金沢大学医薬保健研究域保健学系高齢者・リハビリテーション看護学分野
3. 金沢大学理工研究域フロンティア工学系

要旨

本研究の目的は，多重課題条件下において歩行中の3軸方向の身体の揺れを調査し，転倒リスクに関する課題の種類と加齢の影響を評価することである．腰に取り付けられた単一の3軸加速度センサで身体の揺れを測定した．10人の健康な若年者と11人の高齢者が実験に参加した．課題条件は，1）通常の歩行，および以下の追加タスクを伴う歩行を行った．2）視覚課題，3）聴覚課題，4）計算課題，5）視覚課題と計算課題，6）聴覚課題と計算課題である．高齢者と若年者の間で，条件5の左右方向の身体動揺と条件3の前後方向の身体動揺の有意差がみられた．これらの結果は，若年者と比較して，高齢者の姿勢制御は，より視覚的に依存していること，および音声刺激に基づく経路変更は高齢者に対し負荷が大きいことを示す．

キーワード

歩行解析，転倒リスク評価，腰部加速度

Effects of task type and aging on translational body movements while walking under multiple task conditions

Author(s)

Yui Murakami¹ Miho Shogenji² Tetsuyou Watanabe³

Affiliation

1. Department of Mechanical Science and Engineering, Kanazawa University
2. Department of Health Sciences, Kanazawa University
3. Faculty of Frontier Engineering, Institute of Science and Engineering, Kanazawa University

Abstract

The aim of this study was to investigate body sway in 3 axial directions while walking under multitask conditions to assess the effects of task type and aging associated with the risk of falling. Body sway was measured with a single 3-axis acceleration sensor attached to the hip. Ten healthy young and 11 elderly individuals participated the experiment. The task conditions were 1) normal walking, walking with the following additional tasks: 2) a visual task, 3) an auditory task, 4) a calculation task, 5) visual and calculation tasks, and 6) auditory and calculation tasks. Significant differences in left-right direction body sway in condition 5 and forward-backward direction body sway in condition 3 were observed between elderly and young people. These results imply that, compared to young people, postural control in elderly individuals is more visually dependent and route changes based on sound prompts lead to excessive attentional load in elderly individuals.

Keyword

gait analysis, fall risk assessment, hip acceleration

足底部背屈可能な短下肢装具による歩行への影響の分析

著者

井上　淳¹ 林　敏熙² 花崎　泉²

所属

1. 東京電機大学工学部
2. 東京電機大学未来科学部

要旨

著者らは，片麻痺患者が早期から自然な歩行訓練をできる補助機器を開発してきた．そのなかで，本研究では従来の形状とは異なる短下肢装具を開発した．これは足底部を3層に分け，中央の層に凹凸を作ることで，反発力のないMP関節を反発なく背屈可能にした短下肢装具である．本論文ではそれが歩行に与える影響について検討するために，裸足歩行と平面型の足底部パーツ，足底部に関節のある2種類の足底部パーツをつけた短下肢装具での歩行の計4条件で，下肢装具の足底部形状が歩行に与える影響を5m歩行持間と足底圧中心の移動範囲の2点から比較した．その結果，足底部に関節のある下肢装具のほうが平面型の下肢装具よりも速度が速い歩行が可能であることと，足底圧中心移動が自然にできることが分かった．また，足底部に設ける関節位置が人間のMP関節と一致していることが歩行速度によい影響を与えることを明らかにした．

キーワード

歩行解析，福祉機器，足底圧力分布，下肢装具

Analysis of the effects on gait by ankle foot orthosis which soleplate dorsiflexible

Author(s)

Jun Inoue¹ Toshihiro Hayashi² Izumi Hanazaki²

Affiliation

1. School of Engineering, Tokyo Denki University
2. School of Science and Technology for Future Life, Tokyo Denki University

Abstract

The authors have developed an assistive device that allows patients with hemiplegia to train natural walk in early after injury. In this study, we develop a lower limb orthosis with a joint that can dorsiflex the MP joint without elasticity by dividing the sole into three layers and making a cut in the middle layer. In this paper, we compared normal walk and walking with a short leg brace that had two types of plantar parts with joints on the sole and a flat type. We first measured the time taken to walk 5 meters, and then measured the range of movement of the sole pressure center. As a result, it was found that the lower limb orthosis with joints in the sole can walk faster than the flat type lower limb orthosis, and that the center of foot pressure can be moved naturally. In addition, it was clarified that the joint position provided on the sole of the foot matches the human MP joint to produce efficient walking.

Keyword

gait analysis, assistive technology, sole pressure distribution, lower limb orthosis

足底部背屈可能な短下肢装具による歩行への影響の分析

著者

田原　裕希恵¹ 綿貫　成明²

所属

1. 千葉大学大学院看護学研究科健康増進看護学分野生体看護学専門領域
2. 国立看護大学校看護学部老年看護学

要旨

【目的】転倒予防に使用される離床センサーは，患者に苦痛を与えていたと報告されている．本研究は離床センサーを使用している患者の反応に関する看護師の認識を明らかにすることを目的とした．【方法】全国の一般病院211施設の看護師を対象に，離床センサーを使用している患者の表情や発言の印象的な場面について自由記述で調査し，計量テキスト分析を行った．【結果】77病院から調査協力が得られ，有効回答であった498部を解析し，文書全体の患者の反応に関するおもなテーマとして「離床センサーから逃れようとする行動」「離床センサーの拘束感や苦痛に対する不快感の表出」「自分では呼んでいないのに看護師が訪室することに対する不思議そうな様子」「何度も看護師が訪室することへの申し訳なさの表出」が分類された．【結論】離床センサーが患者に苦痛を与える可能性を看護師の共通認識とする教育や，多職種が連携して転倒予防を行うシステム構築が重要である．

キーワード

離床センサー，患者の反応，看護師の認識，計量テキスト分析

Recognition of nurses for patient reactions to bed exit alarms in general wards

Author(s)

Yukie Tahara¹ Shigeaki Watanuki²

Affiliation

1. Department of Nursing Physiology, Graduate School of Nursing, Chiba University
2. Gerontic Nursing, School of Nursing, National College of Nursing, Japan

Abstract

【Objective】Previous case studies reported that bed exit alarms used for fall prevention cause uncomfortable feelings and emotions in patients. This study aimed to identify the recognitions by nurses for the reactions of patients under the bed exit alarm system.【Methods】Author-developed questionnaires were distributed to registered nurses and licensed practical nurses working at 211 general hospitals in Japan. The participating nurses were asked about notable experiences with patients in terms of facial expressions and verbalizations in reaction to bed exit alarms. For text analysis, free-text responses were analyzed using morphological analysis software.【Results】A total of 77 hospitals participated in this study. Of the returned responses, 498 valid responses were analyzed. These responses were categorized into 4 categories:“trying to escape from the bed exit alarm,”“unpleasant expression following the bed exit alarm,”“it looks strange that a nurse visits a room without a patient calling for one,”and“apologizing for nurses that frequently visit the rooms.”【Conclusions】It is important to educate nurses about that bed exit alarm can cause distress to patients as a common understanding and to build a system of fall prevention by collaborative care.

Keyword

bed exit alarm, patient reaction, recognition of nurse, text analysis

成人女性の性周期に伴うn-back課題遂行能の変化と影響要因の検討－月経前症候群の有無による比較－

著者

青木　真希子^{1, 2} 鈴木　雅登³ 岡山　久代⁴

所属

1. 筑波大学大学院人間総合科学研究科博士後期課程
2. 神奈川工科大学健康医療科学部
3. 兵庫県立大学大学院物質理学研究科
4. 筑波大学医学医療系

要旨

本研究は，成人女性の性周期に伴うワーキングメモリの変化をPMS症状の有無で比較するとともに影響要因を検討することを目的とした．PMS症状を有する群（n＝15）では，黄体期に実施した2-back課題の正答率が，PMS症状を有さない群（n＝26）と比較して有意な傾向で低かった（p＝.07）．さらにProfile of Mood Statesの結果，Total Mood Disturbance得点と「抑うつ－落ち込み」にPMS有群とPMS無群で有意な違いが認められた（p＝.006, p＝.043）．一方，Self-rating Depression Scaleと性ホルモン濃度には違いが認められなかった．以上よりワーキングメモリ機能を評価する課題の1つであるn-back課題の遂行能がPMS症状を有する女性において黄体期に低下し，その要因は負の気分に由来する可能性が示唆された．

キーワード

月経前症候群，認知機能，ワーキングメモリ，月経周期

Assessing n-back task performance of menstrual adult women: Comparison with and without premenstrual syndrome

Author(s)

Makiko Aoki^{1, 2} Masato Suzuki³ Hisayo Okayama⁴

Affiliation

1. Graduate School of Comprehensive Human Sciences, University of Tsukuba
2. Faculty of Health and Medical Sciences, Kanagawa Institute of Technology
3. Graduate School of Material Science, University of Hyogo
4. Faculty of Medicine, University of Tsukuba

Abstract

Women with premenstrual syndrome (PMS) regularly experience mental and physical symptoms that negatively affect their quality of life. An association between PMS and working memory deficits in premenstrual women has been suggested but remains unclear. The present study assessed the effects of PMS on working memory in 15 women with and 26 without PMS. To assess working memory performance, candidates were asked to perform n-back (0-, 1-, and 2-back) tasks in the luteal and follicular phases of their cycle. In the 2-back task, the correct response rate in the PMS group was 85.9±2.0%, which was marginally lower than the without PMS group (p=.07). In the Profile of Mood States questionnaire, there were significant differences in the total mood disturbance (p=.006) and“depression-dejection”(p=.043) scores between the groups. There were no significant differences in self-rated depression scale scores or sex hormone levels between these groups during the luteal and follicular phases. Our findings suggest that the negative mood in the luteal phase may be a trigger for reduced working memory performance in women with PMS.

Keyword

premenstrual syndrome, cognitive function, working memory, menstrual cycle

逆流防止弁付き末梢静脈留置カテーテルによる血液への 恐れの変化と看護師の留置技術に及ぼす影響

著者

三橋　美野¹ 村山　陵子^{2, 3} 間平　珠美¹ 内田　美保⁴ 大江　真琴³ 真田　弘美^{3, 5} 小見山　智恵子¹

所属

1. 東京大学医学部附属病院看護部
2. 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
3. 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
4. 公立小松大学保健医療学部看護学科
5. 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

要旨

逆流防止弁付き末梢静脈留置針の使用により，血液への恐れや留置の困難感が軽減するか，穿刺・留置の成功につながっているかを明らかにすることを目的とした．都内大学病院4部署を2群に分け，介入前後を比較した．穿刺時の主観的な経験，STAI（State-Trait Anxiety Inventory），留置成功までの穿刺回数，静脈留置針の操作性などを質問紙にて調査した．対照群26名（307件），介入群25名（292件）が分析対象となった．血液への恐れや焦りは導入前後で軽減したが，STAIの状態不安は導入前後ともに，群間に差はなく，穿刺回数の減少も差は認められなかった．カテーテルの操作性は，介入群で有意に評価が悪い項目があった．しかし血液曝露への恐れ，チューブ接続時の汚染への恐れは軽減していた．カテーテルの操作性の改善は求められたが，逆流防止弁付きカテーテルによって血液への恐れや焦りは軽減しており，感染防止の観点から，穿刺時の血液曝露の予防，接続する際の感染予防に効果がある可能性が示唆された．

キーワード

末梢静脈留置針，血液曝露，主観的経験

Effect of using a peripheral intravenous catheter with a backflow prevention valve on the operator〓s fear level and venipuncture success

Author(s)

Yoshino Mitsuhashi¹ Ryoko Murayama^{2, 3} Tamami Mahira¹ Miho Uchida⁴ Makoto Oe³ Hiromi Sanada^{3, 5} Chieko Komiyama¹

Affiliation

1. Department of Nursing, The University of Tokyo Hospital
2. Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo
3. Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo
4. Department of Nursing, Faculty of Health Sciences, Komatsu University
5. Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo

Abstract

This study aimed to clarify whether the use of a peripheral intravenous catheter with a backflow prevention valve reduces the operator〓s fear level or catheterization difficulty and contributes to venipuncture success. We performed an interventional study at an urban university hospital. The participants were nurses who completed a questionnaire that included questions about the number of puncture attempts, their subjective experience of venipuncture, and the State-Trait Anxiety Inventory (STAI). The control group comprised 26 nurses who performed patient catheterizations with a conventional catheter (307 catheterizations), while the intervention group comprised 25 nurses who performed catheterizations with a peripheral intravenous catheter with a backflow prevention valve (292 catheterizations). The intervention group felt less fear and discomfort associated with venipuncture than the control group. There were no significant differences between the intervention and control groups in the STAI and the number of puncture attempts. Several evaluations of catheter manipulation were worse in the intervention group than in the control group. However, the subjective experiences of fear of blood exposure and fear of contaminating the catheter junction were reduced in the intervention group. Our findings suggest that using the catheter with a backflow prevention valve reduced the participants〓 level of fear and discomfort, and that the effectiveness of such catheterization may help prevent infection, although catheter manipulation requires improvement.

Keyword

peripheral intravenous catheter, blood exposure, subjective experience

プローブ固定装置を用いた超音波ガイド下末梢静脈穿刺と従来の末梢静脈穿刺の比較検証－シングルケース実験研究－

著者

巻野　雄介¹ 宮川　ミカ² 甲斐　倫明³

所属

1. 日本赤十字豊田看護大学看護学部
2. 大分記念病院看護部
3. 大分県立看護科学大学看護学部

要旨

本研究では，著者らが以前開発したプローブ固定装置を用いた超音波ガイド法（USG法）が，従来の方法（STD法）と比較して臨床の看護師が実施する末梢静脈穿刺の成功率を向上させるかどうかを検証した．静脈モデルを用いた実験のあと，単一事例実験の処遇交代デザインにてUSG法とSTD法の成功率を比較した．一般病院に勤める看護師5名を対象とし，可視性のある静脈がない患者に対してUSG法とSTD法をそれぞれランダムに1回ずつ含むセッションを9回行ってもらった．主要アウトカムとして各方法における穿刺の成否を確認した．その結果，2名の看護師がUSG法にて有意に成功していた．また，ロジスティック回帰分析によりオッズ比3.48（95％信頼区間：1.33-9.14）でUSG法が有意に高い結果となった．これらの結果から日本の臨床現場においてもUSG法は穿刺がむずかしい対象者に対して優れた末梢静脈穿刺法であることが示唆された．

キーワード

超音波ガイド下末梢静脈穿刺，プローブ固定装置，目視困難な静脈，成功率，看護

Validation of ultrasound-guided peripheral intravenous catheterization with a probe holder compared to the traditional technique: A single-case experimental study

Author(s)

Yusuke Makino¹ Mika Miyagawa² Michiaki Kai³

Affiliation

1. School of Nursing, Japanese Red Cross Toyota College of Nursing
2. Department of Nursing, Oita Memorial Hospital
3. School of Nursing, Oita University of Nursing and Health Sciences

Abstract

This study aimed to determine whether ultrasound (US) guidance with an originally developed probe holder improved the success rate of peripheral intravenous (IV) access among clinical nurses compared to the standard techniques. After confirming that clinical nurses could perform simulated IV access for difficult veins using US guidance with the probe holder, we examined the difference in success rates between US-guided IV (USGIV) access with probe holder and the standard method in a single-case alternate-treatment design. Five nurses who worked in a general hospital participated. For patients without visible veins, they performed 5 standard IV accesses in the baseline phase and also underwent 9 sessions that included two methods per session. The primary outcome was the overall and first-attempt success rate of each IV access. The randomization test revealed that the possibility of success of USGIV access was significantly higher than that of the standard method in 2 out of 5 nurses. Logistic regression analysis showed that the odds ratio was 3.48 (95% confidence interval: 1.33〓9.14) and USGIV access was higher than by the standard method. These results suggest that the USGIV access with the probe holder was superior to the standard method in Japanese clinical settings.

Keyword

ultrasound-guided peripheral intravenous access, probe holder, invisible vein, success rate, nurse

入院治療中の女性がん患者に対するタクティールマッサージの睡眠効果の検証

著者

坂井　恵子¹ 松井　優子² 森河　裕子¹ 杉森　千代子¹ 宮永　葵子¹ 堀　有行³ 北本　福美³

所属

1. 金沢医科大学看護学部
2. 公立小松大学保健医療学部
3. 金沢医科大学医学部

要旨

タッチケアの一種であるタクティールマッサージが，入院治療中の女性がん患者の睡眠に及ぼす効果を明らかにする．方法：対象は，入院治療中の女性がん患者11名（58.5±23.2歳）であった．タクティールマッサージ30分間を，行わない未介入日（介入前）と，タクティールマッサージ介入日（介入後）で，アクチグラフによる睡眠・覚醒の定量データ，ピッツバーグ睡眠質問票（PSQI）を，Wilcoxon符号付き順位検定比較を行った．結果：介入によって，覚醒時間帯の仮眠回数の増加（p＜0.05），睡眠時間帯の中途覚醒時間の減少（p＜0.05），睡眠効率の上昇（p＜0.05）に有意差が認められた．PSQI総得点は介入によって有意に減少（p＜0.05）した．結論：入院治療中の女性がん患者に対するタクティールマッサージは，睡眠の改善をもたらすことがアクチグラフ，PSQIによって示された．

キーワード

タクティールマッサージ，看護介入，睡眠効果，入院がん患者，アクチグラフ

Effect of tactile massage on sleep of inpatient female cancer patients

Author(s)

Keiko Sakai¹ Yuko Matsui² Yuko Morikawa¹ Chiyoko Sugimori¹ Aiko Miyanaga¹ Ariyuki Hori³ Fukumi Kitamoto³

Affiliation

1. School of Nursing, Kanazawa Medical University
2. Faculty of Health Sciences, Komatsu University
3. School of Medicine, Kanazawa Medical University

Abstract

Objective: To elucidate the effect on sleep that tactile massage, a form of tactile therapy, has on female cancer patients undergoing in-hospital treatment. Methods: The participants were 11 cancer patients (mean age: 58.5±23.2 years) undergoing in-hospital therapy. The participants did not receive a massage (non-intervention days=pre intervention). Then, thirty-minute tactile massages were performed daily (intervention days=post intervention). Quantitative data on the participants’ sleep and wakefulness were obtained using actigraphy and their Pittsburgh Sleep Quality Index (PSQI) scores were compared using the Wilcoxon signed-rank test. Results: Intervention significantly increased the number of naps taken during wakeful periods of time (p<0.05), decreased wake time after sleep onset (p<0.05), and increased sleep efficiency (p<0.05). Investigation of the total PSQI scores indicated that that intervention caused significant decreases (p<0.05). Conclusion: The use of actigraphy and the PSQI indicated that tactile massage intervention performed on female cancer patients undergoing in-hospital treatment improved the patients’ sleep.

Keyword

tactile massage, nursing intervention, sleep effect, hospitalized patients with cancer, actigraphy

高齢糖尿病患者の血糖自己測定手技獲得時の困難さに影響する要因とその看護の実態

著者

阿部　麻里¹ 大江　真琴² 池田　真理³ 村山　陵子^1,4 小見山　智恵子⁵ 真田　弘美^4,6

所属

1. 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
2. 金沢大学医薬保健研究域保健学系
3. 東京女子医科大学看護学部看護管理学領域
4. 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
5. 東京大学医学部附属病院看護部
6. 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

要旨

高齢の糖尿病患者数の増加に伴い，高齢者に適した血糖自己測定（SMBG）の教育やデバイスのニーズは高い．そこで，高齢者がSMBGの手技獲得時の困難さに影響する要因と看護の実態を検討した．方法：SMBGの教育を行う看護師にフォーカス・グループ・インタビューを行い，質的帰納的に分析した．結果・考察：高齢者のSMBG手技獲得時の困難さに影響する要因は＜身体の機能低下や反応＞，＜新しい技術習得時の適応力の低下＞，＜教育環境の不備＞，＜デバイスとのミスマッチング＞，であることが明らかとなった．看護師は［手技獲得時の困難さに影響する要因への看護］，［手技獲得時の困難さへの看護］，［手技獲得時の困難さにより生じるものへの看護］をしていた．困難を繰り返し経験すると，苛立ちや悲嘆，手技獲得の意欲低下など＜負の感情＞が生じる可能性があり，学習目標の設定，評価に患者の参加を促すことや，自己効力感を高める看護の必要性が示唆された．

キーワード

高齢者,糖尿病,教育,血糖自己測定

Factors affecting blood glucose self-monitoring skill acquisition: Nursing interventions for elderly individuals with diabetes

Author(s)

Mari Abe-Doi¹ Makoto Oe² Mari Ikeda³ Ryoko Murayama^1,4 Chieko Komiyama⁵ Hiromi Sanada^4,6

Affiliation

1. Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo
2. Department of Clinical Nursing, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University
3. Department of Nursing Administration, School of Nursing, Tokyo Women’s Medical University
4. Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo
5. Department of Nursing, The University of Tokyo Hospital
6. Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo

Abstract

Purpose: With the increase in the number of elderly patients with diabetes, there is a need for education of self-monitoring of blood glucose (SMBG) skills, as well as for the device development for SMBG suitable for the elderly. This study aims to explore the nursing care given and the factors affecting SMBG skill acquisition for elderly patients. Methods: Focus group interviews with nurses was conducted for data collection, and an inductive analysis was performed. Results: The following parameters were reported as factors influencing the acquisition of the SMBG skills: physical response or deterioration (such as eyesight, hearing ability, and dexterity), adaptability to acquiring a new skill, inadequacy of the educational environment, and a person-device mismatch. The clinical nurses provided care for (1) difficult factors in acquiring SMBG skills, (2) difficulties in acquiring the SMBG skill, and (3) challenges produced by difficulties in acquiring the SMBG skill. Repeatedly facing difficulties might lead to the manifestation of negative emotions, such as frustration, sorrow, and a decreased motivation to learn the SMBG skill. Conclusions: It is important to encourage patients to participate in planning education or evaluation, and provide nursing care to enhance their self-efficacy.

Keyword

elderly, diabetes, education, self-monitoring of blood glucose

末梢静脈カテーテル留置が眼科入院患者の睡眠の質に及ぼす影響：観察研究

著者

村山　陵子^1,2 阿部　麻里¹ 木暮　貴政³ 高橋　聡明⁴ 菅野　智穂⁵ 石垣　真理⁶ 真田　弘美^2,5

所属

1. 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
2. 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
3. パラマウントベッド株式会社パラマウントベッド睡眠研究所
4. 東京大学大学院医学系研究科ライフサポート技術開発学（モルテン）寄附講座
5. 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
6. 東京大学医学部附属病院看護部

要旨

末梢静脈カテーテル留置中は，患者の睡眠を含むさまざまな日常生活が妨げられる．本研究は末梢静脈にカテーテルが留置されることによる，睡眠への影響を明らかにすることを目的とした．大学病院の眼科病棟に入院し，翌日に手術予定で就床前に末梢静脈カテーテルが留置された患者を「留置群」（53人）とし，「非留置群」（55人）とともに，睡眠状態を観察した．睡眠パラメータの測定にはシート型体振動計，主観的睡眠感の調査には質問票を使用した．留置群，非留置群の間で，睡眠の質に違いは認められなかった．留置群の36.5％はカテーテルが気になり中途覚醒し，覚醒の理由で最も多かったのは「動きに伴う痛み」（63.2％）であった．留置群のサブグループ解析をしたところ，動きに伴う痛みを感じていた者は，感じていなかった者よりも，睡眠の断片化指標が有意に高く（p＝0.004），主観的睡眠感が悪くなっていた．カテーテル留置群と，非留置群とを比較した場合，睡眠の質に違いは認められなかったが，カテーテルによって体動に伴う痛みを感じていた患者の睡眠の質には影響していた．

キーワード

末梢静脈カテーテル留置，睡眠パラメータ，睡眠質問票

The influence of peripheral intravenous catheterization on the sleep quality of ophthalmic inpatients: An observational study

Author(s)

Ryoko Murayama^1,2 Mari Abe-Doi¹ Takamasa Kogure³ Toshiaki Takahashi⁴ Chiho Kanno⁵ Mariko Ishigaki⁶ Hiromi Sanada^2,5

Affiliation

1. Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo
2. Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo
3. Paramount Bed Sleep Research Laboratory, PARAMOUNT BED CO., LTD.
4. Department of Life Support Technology (Molten), Graduate School of Medicine, The University of Tokyo
5. Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo
6. Department of Nursing, The University of Tokyo Hospital

Abstract

Peripheral intravenous catheterization hinders various daily activities, including sleeping. We aimed to examine the relationship between peripheral intravenous catheter placement and sleep quality by assessing sleep parameters including body movement and subjective sleep quality. An observational study was conducted at an ophthalmic ward of a university hospital in Tokyo. Participants were catheterized in preparation for a surgical procedure the following day (catheterization group). Sleep parameters were observed using a sheet-shaped body vibrometer device, and a sleep quality questionnaire was completed; 53 and 55 participants were present in the catheterization and non-catheterization groups, respectively. No significant differences were noted in sleep parameters or subjective sleep quality between the two groups. However, 36.5% of participants in the catheterization group awoke during the night and worried about their inserted catheter, primarily because of 'pain associated with movement' (63.2%). According to the subgroup analysis, the fragmentation index was higher in participants who experienced pain than in participants who did not experience pain associated with movement (p=0.004), and three of the five subjective sleep quality factors were lower in those experiencing pain compared with the other participants. The comparison of the catheterization and non-catherization groups revealed that peripheral intravenous catheter placement did not reduce sleep quality. Catheter placement influenced the sleep quality of patients who experienced pain associated with body movement due to stimulus from the catheter.

Keyword

peripheral intravenous catheter placement, sleep parameter, sleep quality questionnaire

雇用状況による妊娠中の座位行動の変化

著者

川尻　舞衣子¹ 中村　康香¹ 吉田　美香子¹ 武石　陽子¹ 伊藤　直子² 跡上　富美³ 吉沢　豊予子¹

所属

1. 東北大学大学院医学系研究科ウィメンズヘルス・周産期看護学分野
2. 東北大学病院看護部
3. 久留米大学医学部看護学科

要旨

目的：雇用状況による妊婦の身体活動（PA）と座位行動（SB）の変化を明らかにする．方法：健康な初妊婦を対象とする縦断的研究を実施した．PAとSBは，妊娠24～27週（T1）および32～35週（T2）の約1週間，加速度計を用いて測定した．参加者は，T1およびT2の雇用状況に基づき “専業主婦群”，“就労継続群”，“就労中断群” の3群に分類した．結果：34名の妊婦（年齢33.6±4.8歳，非妊時BMI21.6±2.9kg/m2）から，2時点のPAおよびSBデータが収集された．SB累積時間の変化は3群間で有意差を認め（F＝3.34，p＝0.049），就労中断群は就労継続群と比較しSB累積時間は増加する傾向を認めた（F＝4.16，p＝0.056）．1回のSB継続時間の変化では，就労中断群は中時間SBの頻度がT1からT2にかけて有意に減少し（11.9-10.2回/日，t＝3.18，p＝0.008），長時間SBの頻度が有意に増加した（4.2-4.7回/日，t＝2.85，p＝0.015）．結論：妊娠中の座位行動の変化は雇用状況によって異なり，仕事をやめることはSB増加のリスク因子であることが示された．

キーワード

妊娠，座位行動，産業衛生，活動量計，身体活動

Changes in sedentary behavior during pregnancy depending on employment status

Author(s)

Maiko Kawajiri¹ Yasuka Nakamura¹ Mikako Yoshida¹ Yoko Takeishi¹ Naoko Ito² Fumi Atogami³ Toyoko Yoshizawa¹

Affiliation

1. Department of Women’s Health Nursing & Midwifery, Tohoku University Graduate School of Medicine
2. Department of Nursing, Tohoku University Hospital
3. School of Nursing, Kurume University

Abstract

Aim: To clarify changes in physical activity (PA) and sedentary behavior (SB) among pregnant women according to employment status. Methods: A prospective study was conducted on healthy primiparous women. PA and SB were measured by an accelerometer for about one week during weeks 24〓27 (T1) and 32-35 (T2) of gestation. The participants were classified into three employment status groups during both trials; “Full-time housewives,” “currently working,” and “stopped working.” Results: Thirty-four women (mean age 33.6±4.8 years; pre-pregnancy BMI 21.6±2.9 kg/m2) provided two points of activity data. Changes in the cumulative SB time were significantly different among the three groups (F=3.34, p=0.049): the cumulative SB among the stopped-working group tended to increase compared with the currently-working group (F=4.16, p=0.056). In the stopped-working group, the frequency of medium SB duration significantly decreased from T1 to T2 (11.9 to 10.2 times/day, t=3.18, p=0.008), while the frequency of long SB duration significantly increased (4.2 to 4.7 times/day, t=-2.85, p=0.015). Conclusion: Changes in SB during pregnancy differed depending on employment status and stopping work was a risk factor for increased SB.

Keyword

pregnancy, sedentary behavior, occupational health, activity monitor, physical activity

操作経験のない学生による超音波診断装置を使用した皮下組織厚測定の妥当性の検証

著者

松井　優子¹ 坂井　恵子² 宮永　葵子²

所属

1. 公立小松大学保健医療学部
2. 金沢医科大学看護学部

要旨

皮下注射や筋肉内注射において，皮下組織厚の正確な測定は重要である．本研究の目的は，操作経験のない対象による超音波診断装置による皮下組織厚測定の妥当性の検証である．看護大学生を用手法群23名と超音波群23名に無作為に割り付け，健康成人23名の三角筋の皮下組織厚を測定した．超音波診断装置の操作に熟練した研究者が測定した基準値，超音波群，用手法群の中央値は，0.8（0.5〓2.0），0.9（0.5〓1.6），2.0（1.3〓5.5）cmであった．基準値との球内相関係数（95％CI）は，超音波群ρ＝.86（.69〓.97），用手法群ρ＝.40（.01〓.69）であった．基準値yの回帰式は，超音波群はy＝1.232x-0.218（R2＝.809），用手法群はy＝0.235x＋0.411（R2＝.296）であった．超音波診断装置は，初心者が正確に皮下組織厚を測定する機器として有用である．

キーワード

超音波診断装置，皮下組織厚，測定，妥当性，初心者

Validation of subcutaneous thickness by students with no experience in ultrasonography

Author(s)

Yuko Matsui¹ Keiko Sakai² Aiko Miyanaga²

Affiliation

1. Faculty of Health Sciences, Komatsu University
2. Department of Nursing, Kanazawa Medical University

Abstract

Accurate measurement of subcutaneous thickness is important for correctly performing subcutaneous and intramuscular injections. The objective of the present study was to confirm the validity of subjects with no experience in ultrasonography measuring subcutaneous thickness using an ultrasound device. Subjects were 46 nursing university students, randomly assigned to a manual group (n=23) and an ultrasonic group (n=23). Subcutaneous thickness over the deltoid muscle in 23 healthy adult volunteers was measured manually and using ultrasonic measurements. Subcutaneous thickness as measured by a researcher with expertise in operating ultrasound devices was used as the criterion value. Median values for the criterion value, ultrasonic group, and manual group were 0.8 cm (0.5〓2.0 cm), 0.9 cm (0.5〓1.6 cm), and 2.0 cm (1.3〓5.5 cm), respectively. Intraclass correlation coefficients (ICCs) of the criterion value compared to the ultrasound group and manual group were .86 (.69〓.97) and .40 (.01〓.69) respectively. Linear regression equations of the criterion value compared to the ultrasound group and manual group were y=1.232x-0.218 (R2=.809) and y=0.235x+0.411 (R2=.296), respectively. An ultrasound device is therefore an effective device for inexperienced students to accurately measure subcutaneous thickness in clinical practice.

Keyword

ultrasonography, subcutaneous thickness, measurement, validity, beginner

CIE DE2000色差式を用いた尿検査用試験紙の色比較手法と尿自動分析装置との判定結果の比較

著者

稲垣　圭吾¹

所属

1. 浜松医科大学医学部看護学科

要旨

尿自動分析装置の導入がむずかしい開業医や小規模検診施設などでは，尿検査用試験紙を目視で判定する際，色票を用いて，個々の主観による判定がされており，客観的に評価する方法は確立していない．本研究では，尿検査用試験紙の色を客観的に判断するため，スマートフォンのカメラで撮影した画像を用いて，CIE DE2000色差式による色比較プログラムを開発した．本手法では，判断基準表とマウスで選択した画像の部分との色差を色比較プログラムによって計算し，色差が最も小さい色を判定結果として出力した．本手法と尿自動分析装置の判定結果を比較したところ，尿定性検査用コントロールlevelⅠを使用した陰性の判定は，すべての項目が一致した．LevelⅡを使用した陽性の判定は，ブドウ糖，潜血，クレアチニンの項目以外はすべて一致した．本結果より，安価で簡便なスクリーニング検査の可能性が示された．

キーワード

色差，尿検査用試験紙，画像解析，客観的評価

Comparison of judgment results between the color comparison method of urine analysis test papers using the CIE DE2000 color-difference formula and the automatic urine analyzer

Author(s)

稲垣　圭吾¹

Affiliation

1. 浜松医科大学医学部看護学科

Abstract

In general practice and small-scale health screening centers where the introduction of an automatic urine analyzer is difficult, the urine analysis test papers are judged visually and, therefore, the observer makes a subjective judgment. No method has so far has been established for objective visual evaluation of urine analysis test papers. In this study, we developed a color comparison program using the CIE DE2000 color-difference formula using images taken with a smartphone camera to objectively judge the color of the urine analysis test paper. The color difference between the standard color sample and the part of the image selected by the mouse was calculated using the color comparison program. The color with the smallest color difference was output as the judgment result. The results of the color comparison program were compared with the results of the automatic urine analyzer. On the judgment of the normal values using the urine qualitative control solution level I, all items of comparison were consistent between the two methods. The judgment of abnormal values using level II was consistent except for the items of glucose, occult blood, and creatinine. In conclusion, we validated the possibility of developing an inexpensive and simple screening test.

Keyword

color difference, urine analysis test paper, image analysis, objective evaluation

ウェアラブルカメラの動画解析による基礎看護技術評価の試み －ベッドメイキング技術の熟練度の縦断的な検討－

著者

土屋　守克^1,2 伊藤　幸太³ 柳田　徳美⁴ 藤田　文子⁵ 髙橋　誠一⁶ 渡邊　裕見子⁷ 齋藤　孝子⁴ 坂上　貴之⁸ 眞邉　一近^1,9

所属

1. 日本大学大学院総合社会情報研究科
2. 日本医療科学大学保健医療学部看護学科
3. 大阪大学人間科学研究科生物人類学分野
4. 帝京平成大学ヒューマンケア学部看護学科
5. 目白大学看護学部看護学科
6. 埼玉医科大学総合医療センター看護部
7. 東京医科大学医学部看護学科
8. 慶應義塾大学
9. 日本大学生物資源科学部

要旨

ベッドメイキングの動作を対象として，動画に基づく活動量（以下，動画活動量）を測定したうえで，熟練者と初心者の縦断的変化や相違について比較し，対象者の熟練度の評価における有用性を検討することを目的とした．方法：熟練者1名と初心者8名を対象とした．対象者は，胸部にウェアラブルカメラを装着したうえで，ベッドメイキングを行った．動画活動量の算出には，オプティカルフローを使用し，累積動画活動量や動画活動量のエントロピーなどの算出や階層クラスタ分析を行った．結果：累積動画活動量や動画活動量のエントロピーは，いずれも2回目に減少する初心者が多かった．熟練者は，1回目，2回目いずれにおいても，動画活動量のエントロピーが最も低値であった．結論：動画活動量から算出した値において，経時的な変化や，初心者と熟練者の相違が認められた事実から，看護技術の「熟練度」の指標としての可能性が示唆された．

キーワード

オプティカルフロー，ウェアラブルカメラ，基礎看護技術，活動量，エントロピー

Assessment of basic nursing skills by video analysis of wearable cameras: A longitudinal examination of proficiency in bed-making techniques

Author(s)

Morikatsu Tsuchiya^1,2 Kohta Ito³ Narumi Yanagida⁴ Ayako Fujita⁵ Seiichi Takahashi⁶ Yumiko Watanabe⁷ Takako Saito⁴ Takayuki Sakagami⁸ Kazuchika Manabe^1,9

Affiliation

1. Graduate School of Social and Cultural Studies, Nihon University
2. Department of Nursing, Faculty of Health Sciences, Nihon Institute of Medical Science
3. Laboratory of Biological Anthropology, Department of Human Sciences, Osaka University
4. Department of Nursing, Faculty of Health Care, Teikyo Heisei University
5. Department of Nursing, Faculty of Nursing, Mejiro University
6. Nursing Office, Saitama Medical Center, Saitama Medical University
7. School of Nursing, Faculty of Medicine, Tokyo Medical University
8. Keio University
9. College of Bioresource Sciences, Nihon University

Abstract

The purpose of this study was to compare the longitudinal changes and differences between skilled and novice bed-makers by measuring the amount of activity based on video (hereinafter referred to as“video activity”), and to evaluate the usefulness of the video activity in assessing the subject’s level of skill. METHODS: One expert and eight novices were included in the study. The subject wore a wearable camera on her chest and performed bed making. In order to calculate the video activity, we used optical flow, cumulative video activity and entropy of video activity, as well as hierarchical cluster analysis. RESULTS: Both cumulative video activity and video activity entropy decreased in many beginners on the second occasion. Skilled participants had the lowest entropy of video activity in both the first and second sessions. CONCLUSION: The fact that there were changes over time and differences between novices and experts in the values calculated from the amount of video activity suggested that the video activity has potential as an indicator of“proficiency”in nursing techniques.

Keyword

optical flow, wearable camera, basic nursing skills, activity, entropy

圧迫時に身体から生じる反力を用いた組織間液の存在状態の定量化の試み

著者

多鹿　理絵¹ 築田　誠² 石井　豊恵³ 岡田　志麻⁴ 川名　裕治⁵ 野口　藍子⁶ 佐藤　百恵⁶ 谷浦　葉子⁶ 平野 方子⁷ 浅田　久子⁸ 居村　晴美⁸ 大野　悦子⁸

所属

1. 神戸大学大学院保健学研究科博士課程前期課程
2. 兵庫県立大学看護学部
3. 神戸大学大学院保健学研究科
4. 立命館大学理工学部
5. 神戸大学大学院保健学研究科博士課程後期課程
6. 大阪大学医学部附属病院看護部
7. 大阪大学大学院医学研究科保健学専攻博士課程後期課程
8. パナソニック健康保険組合松下介護老人保健施設はーとぴあ

要旨

浮腫の重症度を評価するために，圧痕深度を測定する．圧痕深度は，身体から生じる反力の大きさに影響される．体表を圧迫した際に生じる反力から，組織間液の存在状態を定量化する方法を考案した．反力の検出には圧力センサーを使用した．対象は，高齢者群27人，および若者群12人であった．圧力センサーはマンシェットで下肢に固定され，徐々にマンシェットに送気された．低い圧力で加圧した際の反力の増加量の平均値は，高齢者群で2.15N，若者群で1.09Nであった（P＜0.01）．中等度の圧力で加圧した際の反力の増加量の平均値は，高齢者群で1.92N，若者群で1.38Nであった（P＜0.01）．高い圧力で加圧した際の反力の増加量の平均値は，高齢者群で1.91N，若者群で1.61Nであった（P＝0.14）．以上より，圧力センサーが感知する反力の変化は，組織間液の存在状態を反映することが示唆された．

キーワード

浮腫，体組成，定量化，高齢者

Attempt to quantify the presence of interstitial fluid using the counterforce generated from body during compression

Author(s)

Rie Tajika¹ Makoto Tsukuda² Atsue Ishii³ Shima Okada⁴ Yuji Kawana⁵ Aiko Noguchi⁶ Momoe Satoh⁶ Yoko Taniura⁶ Masako Hirano⁷ Hisako Asada⁸ Harumi Imura⁸ Etsuko Oono⁸

Affiliation

1. Master’s Course, Graduate School of Health Sciences, Kobe University
2. College of Nursing Art and Science, University of Hyogo
3. Graduate School of Health Sciences, Kobe University
4. Ritsumeikan University, College of Science Engineering
5. Doctor’s Course, Graduate School of Health Sciences, Kobe University
6. Division of Nursing, Osaka University Hospital
7. Doctor’s Course, Division of Health Science, Graduate School of Medicine, Osaka University
8. Heartpia, Matsushita Long-Term Care Health Facility, Panasonic Health Insurance Association

Abstract

To evaluate edema, the depth of surface imprint is measured. The depth is influenced by the amount of the counterforce generated by the body. We devised a method to quantify the presence of the interstitial fluid using the counterforce generated from the body surface during compression. This study used a pressure sensor to detect the counterforce. The “elderly group” comprised 27 elderly people, and the “young group” comprised 12 young people. The pressure sensor was strapped on the legs with a cuff. Air was gradually pumped into the cuff, and the counterforce received by the pressure sensor was output. The increase in the counterforce at lower pressures was 2.15 N in the elderly group and 1.09 N in the young group (P<0.01). The increase in the counterforce at medium pressures was 1.92 N in the elderly group and 1.38 N in the young group (P<0.01). The increase in the counterforce at higher pressures was 1.91 N in the elderly group and 1.61 N in the young group (P=0.14). All values are average values. Our findings indicate that it is possible to quantify the presence of the interstitial fluid by observing the counterforce generated from the body surface during compression.

Keyword

edema, body composition, quantification, elderly people

磁気共鳴（MR）画像により作成した指導用動画を用いた産後女性に対する骨盤底筋体操の効果検証

著者

内藤　紀代子^1,2 二宮　早苗³ 森川　茂廣⁴ 遠藤　善裕⁵ 岡山　久代⁶

所属

1. びわこ学院大学教育福祉学部
2. 筑波大学人間総合科学研究科看護科学専攻博士後期課程
3. 大阪医科大学看護学部
4. 滋賀医科大学神経難病研究センター
5. 滋賀医科大学医学部看護学科
6. 筑波大学医学医療系

要旨

本研究は，産後の女性に対し，骨盤底筋群の随意収縮時に膀胱頸部の挙上が明確に確認できる磁気共鳴画像により作成した動画（MR動画）を用いた骨盤底筋体操の効果を検証することを目的とした．経腟分娩後3～6ヵ月の女性74名を，介入しない観察群，パンフレットで骨盤底筋体操を指導した従来体操群，MR動画で骨盤底筋体操を指導したMR動画群の3群に無作為に振り分け，従来体操群とMR動画群には研究者が指導後，12週間在宅で骨盤底筋体操を実施するよう依頼した．介入前後に体外式バイオフィードバック装置を用いて骨盤底筋群の最大収縮力および収縮持続時間を測定し比較した．結果，いずれの群も12週間後に骨盤底筋群の最大収縮力および収縮持続時間は有意に上昇したが，MR動画群の最大収縮力は，観察群および従来体操群にくらべて有意に強かった（いずれもP＜0.001）．これにより，骨盤底筋訓練の指導におけるMR動画の有用性が示唆された．

キーワード

骨盤底筋体操，MR画像，骨盤底筋群の機能評価

The effect of pelvic floor muscle training using a magnetic resonance image-based video clip in postpartum women

Author(s)

Kiyoko Naito^1,2 Sanae Ninomiya³ Shigehiro Morikawa⁴ Yoshihiro Endo⁵ Hisayo Okayama⁶

Affiliation

1. Department of Childhood Care, Faculty of Education Welfare, Biwako Gakuin University
2. Doctoral Program Nursing Science, University of Tsukuba
3. Faculty of Nursing, Osaka Medical College
4. Molecular Neuroscience Research Center, Shiga University of Medical Science
5. Department of Nursing, Shiga University of Medical Science
6. Faculty of Medicine, University of Tsukuba

Abstract

The purpose of this study was to investigate the effect of pelvic floor muscle training (PFMT) in postpartum women using a magnetic resonance (MR) image-based video clip that can clearly confirm the elevation in the position of the bladder neck during voluntary contraction of pelvic floor muscles. Seventy-four women, who had vaginal delivery 3〓6 months earlier, were randomized into 3 groups: observation group without intervention (A), conventional PFMT group using a leaflet (B), and the group using an MR video clip (C). Women in groups B and C continued PFMT at home for 12 weeks after receiving instructions concerning the PFMT. We compared the maximum force and duration of contraction of the pelvic floor muscles, measured using an external biofeedback device, before and after the 12-week intervention. The maximum force and duration of contraction were significantly increased in three groups after the intervention. Moreover, the maximum contraction force in group C was significantly stronger than that in groups A and B (P<0.001 in both groups). The MR video clip might be a useful instructive tool for PFMT.

Keyword

pelvic floor muscle training, magnetic resonance images, functional evaluation of the pelvic floor muscles

目視困難な末梢静脈可視化のための最適な近赤外光波長と狭帯域光法

著者

木森　佳子¹ 山下　大揮² 小嶋　菊乃³ 中嶋　知世¹

所属

1. 石川県立看護大学基礎看護学講座
2. 公立松任石川中央病院看護部
3. 石川県立中央病院看護部

要旨

本研究の目的は，末梢静脈穿刺の成否と静脈穿刺関連合併症の発生に影響する目視困難な静脈を可視化する装置の開発に向け，最適な近赤外光波長帯を選択し，狭帯域光法の有効性を検討することである．対象は20歳から39歳の健常成人女性の目視困難静脈とした．近赤外光波長帯を同等の強度で照射するハロゲンランプで目視困難静脈に照射し，近赤外光波長帯に同等の感度をもつハイパースペクトルカメラで撮像した．獲得した700-1100nmの画像で主観的，客観的に静脈の有無を評価した．静脈ありと判断した近赤外光画像で目視困難な静脈部分と周囲皮膚部分の輝度情報で算出したコントラスト比を光波長ごとに算出した．その結果，可視化率は75.8％で，最適な光波長帯はおおむね950-1000nm，その光波長帯をピークとして狭波長帯とすると，目視困難な静脈部分と周囲皮膚部分のコントラストが高まることが期待できると分かった．

キーワード

末梢静脈穿刺，近赤外光，可視化技術

Optimal wavelength selection and narrow bands for the visualization of invisible veins in venipuncture

Author(s)

Keiko Kimori¹ Hiroki Yamashita² Kikuno Kojima³ Tomoyo Nakashima¹

Affiliation

1. Department of Fundamental Nursing, Ishikawa Prefectural Nursing University
2. Nursing Department, Public Central Hospital of Matto Ishikawa
3. Nursing Department, Ishikawa Prefectural Central Hospital

Abstract

Detection of veins is a very important technique in the medical practice. Recently, vein visualization using near-infrared (NIR) imaging have been used to detect veins. Different researchers have set different wavelengths for the process. We explored the most suitable near-infrared light wavelengths and the effectiveness of using narrow bands for visualizing invisible peripheral veins for venipuncture. An observational study was performed on the invisible veins of healthy female volunteers in the age range 20-39. We then acquired images of invisible veins using a halogen lamp and hyperspectral camera. We analyzed 4,640 images of 58 invisible veins acquired using light in the range 700-1100 nm; image analysis software was used for the analysis. The optimal wavelength for the visualization of invisible veins according to the contrast ratio between the invisible veins and the surrounding skin tissue was approximately 950-1000 nm; a narrow band of light in that range was effective for the average contrast ratio. We expect that a device based on a narrow band in the wavelength range 950-1000 nm will be useful for the visualization of invisible veins.

Keyword

peripheral intravenous access, near-infrared light, visualization

Pseudomonas aeruginosa，Escherichia coli，Proteus mirabilisおよびKlebsiella pneumoniaeの増殖および運動性への人工尿の抑制効果は培養中に促進的効果に変化する

著者

Sofoklis Koudounas^1,2 峰松　健夫^1,2 麦田　裕子³ 冨田　早苗³ 中井　彩乃³ 仲上　豪二朗^1,3 真田　弘美^1,3

所属

1. 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
2. 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
3. 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

要旨

失禁関連皮膚炎（IAD）は，尿・便の繰り返しの曝露によって引き起こされ，生活の質を低下させる．しかしその発生メカニズムに関する知見は乏しい．本研究では，尿路感染症の一般的な病原体の増殖と運動性に及ぼす尿の影響を調査した．さまざまな濃度の人工尿を添加したLuria-Bertani培地で緑膿菌，プロテウス・ミラビリス，大腸菌，肺炎桿菌を37℃で24時間培養し，細菌の増殖および運動性を経時的に観察した．その結果，すべての細菌で培養初期に増殖抑制が見られ，その後増殖促進に転じた．プロテウス・ミラビリス，肺炎桿菌における増殖促進効果は濃度依存的であった．運動性についてはプロテウス・ミラビリスにおいてSwimmingの抑制効果が認められた．本研究の結果は，新鮮尿と感染尿の細菌に及ぼす影響の違いを示唆しており，尿によるIAD発生メカニズムの基盤的知見として重要である．

キーワード

失禁関連皮膚炎，人工尿，尿失禁，尿路感染症

Inhibiting effect of synthetic urine on the growth and mobility of Pseudomonas aeruginosa, Escherichia coli, Proteus mirabilis and Klebsiella pneumoniae shifts to a promoting effect during culture

Author(s)

Sofoklis Koudounas^1,2 Takeo Minematsu^1,2 Yuko Mugita³ Sanai Tomida³ Ayano Nakai³ Gojiro Nakagami^1,3 Hiromi Sanada^1,3

Affiliation

1. Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo
2. Department of Skincare Science, Graduate School of Medicine, The University of Tokyo
3. Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo

Abstract

Incontinence-associated dermatitis (IAD) is caused from the repeated exposure to urine/faeces and reduces quality of life. However, the underlying mechanisms are poorly understood. This study explored the effects of urine on the growth and motility of common uropathogens. Pseudomonas aeruginosa, Proteus mirabilis, Escherichia coli and Klebsiella pneumoniae were grown for 24 hrs at 37℃ in Luria-Bertani (LB) medium supplemented with various concentrations of synthetic urine. Bacterial growth was monitored over time by measuring absorbance at 600nm. Swimming, swarming, and twitching motilities were determined in cultures of LB with (1:1 ratio) and without synthetic urine. Results demonstrated that bacterial growth was inhibited during early phase (0-6 hrs), and enhanced after 8 hrs. For P. mirabilis and K. pneumoniae, the increase in growth was in a dose-dependent manner. Swimming motility of P. mirabilis was inhibited. This study suggested the different effect of fresh and infectious urine on the bacterial growth, which is important to understand the mechanisms of IAD development due to urine incontinence.

Keyword

incontinence-associated dermatitis, synthetic urine, urinary incontinence, urinary infections

多重課題条件下の歩行中において課題の種類と加齢が腰からみた肩回転運動に与える影響

著者

村上　唯¹ 正源寺　美穂² 渡辺　哲陽³

所属

1. 金沢大学大学院自然科学研究科機械科学専攻
2. 金沢大学医薬保健研究域保健学系老年・リハビリテーション看護学分野
3. 金沢大学理工研究域フロンティア工学系

要旨

本研究の目的は，多重課題条件下での歩行中の腰を起点とした体幹軸の3軸周りの身体の回転を調査し，転倒リスクに関する動揺，動揺が起こる軸，課題条件，加齢の影響の関係を明らかにすることである．2つのInertia Measurement Unitセンサを被験者の腰部と肩部に取り付け，腰から見た肩の回転を測定した．10人の若年健常者と11人の高齢者が実験に参加した．課題条件は，①通常歩行，②視覚課題と歩行，③聴覚課題と歩行，④計算課題と歩行，⑤視覚，計算課題と歩行，⑥聴覚，計算課題と歩行である．高齢者と若年者の歩行路変更を含む課題条件下の歩行を比較したとき，体幹のひねり・前後回転方向の少なくとも二方向にて加齢の影響がみられた．高齢者と若年者のおのおので通常歩行と多重課題条件下の歩行を比較したとき，高齢者では少なくとも前後回転方向・左右回転方向の二方向において有意差が表れたが，若年者では三重課題条件下のみで単回転方向に有意差が表れた．

キーワード

歩行解析，転倒リスク評価，肩部回転角度

Effects of task type and aging on shoulder rotational movement with respect to the hips while walking under multiple task conditions

Author(s)

Yui Murakami¹ Miho Shogenji² Tetsuyou Watanabe³

Affiliation

1. Department of Mechanical Science and Engineering, Kanazawa University
2. Department of Health Sciences, Kanazawa University
3. Faculty of Frontier Engineering, Institute of Science and Engineering, Kanazawa University

Abstract

The aim of this study is to investigate body rotation around the three trunk axes with respect to the hip while walking under multitask conditions, and to clarify the relationship between body sway and the influence of the axis in which the sway occurs, task conditions, and aging. The Inertia Measurement Unit sensors were attached to the hip and shoulder of the subjects and the shoulder rotation with respect the hip was examined. Ten healthy young and 11 older individuals participated the experiment. The task conditions were 1) normal walking, 2) walking with a visual task, 3) walking with an auditory task, 4) walking with a calculation task, 5) walking with visual and calculation tasks, and 6) walking with auditory and calculation tasks. When comparing the gait of older people and young people under task conditions including the change of walking path, the aging effects were observed in at least two directions: trunk twist and front-back rotation. When comparing walking under multiple tasks with normal walking for older people and young people separately, older people showed significant differences at least in the forward-backward and left-right rotation, while the younger showed significant differences appeared in the single rotation direction only under triple task conditions.

Keyword

gait analysis, fall risk assessment, shoulder rotation angle

ロボットもしくは介助による起立前後の心拍数の変動および自律神経指標の変化

著者

浅野　美礼¹

所属

1. 筑波大学医学医療系

要旨

起立を介助する方法の違いが血圧と自律神経活動にどのような影響をもたらすのか調べることを目的とした．健康な11人の若年者と14人の高齢者に椅子から①通常の能動的起立，②他者の全介助による起立，③パワーアシストロボット（HAL）装着での起立をしてもらい，起立前後の血圧と心拍数を記録した．心拍数の変動から高速フーリエ変換で求めたパワースペクトルの低周波と高周波の成分を用いて，自律神経活動の指標とした．平均血圧の変動に年齢あるいは起立方法による差はなく，周波数成分の変動は交感神経活動の上昇を示し，起立性低血圧を防いでいると考えられた．高齢者の心拍変動係数は，安静時には若年者より小さいが起立後には差がなくなり，起立前後の血圧や自律神経指標の変動を説明できなかった．HALによる起立は従来の起立介助の方法と比較したとき循環動態の面で有利な可能性があると考えられた．

キーワード

介助ロボット，起立介助，起立性低血圧，自律神経活動指標

Heart rate variability and changes in autonomic nervous system indicators before and after standing with aid from a robot or other person's support

Author(s)

Yoshihiro Asano ¹

Affiliation

1. Faculty of Medicine, University of Tsukuba

Abstract

Aim: This study compared changes in autonomic nerve indicators of high frequency (HF) norm and low frequency (LF)/HF ratio among young and elderly participants before and after standing: when actively standing up, when passively standing up with assistance from others, and when standing up with the aid of a lower-limb power-assisted robot (HAL) from a sitting position on a 40 cm-high chair. Methods: The sample comprised 11 healthy young and 14 elderly individuals aged 20〓26 years (mean: 22.5±2.2) and 66〓77 years (mean: 70.3±3.5), participants were asked to stand up under 3 different conditions and electrocardiogram measurements and blood pressure were measured. Results and Conclusion: Young and elderly participants showed decreased RRI across all conditions and no significant differences in average blood pressure were found before or after standing. Decreased HF norm and increased LF/HF ratio showed excitation of the sympathetic nerves, increasing blood pressure to compensate for and prevent orthostatic hypotension. Such compensation was likely not due to age although significant differences were found in the coefficient variance of RRI between young and elderly participants. HAL standing proved to have a marginal impact on young and elderly persons' circulatory dynamics.

Keyword

hybrid assistive limb, assisted standing, orthostatic hypotension, autonomic nervous activity

ロボットもしくは介助による起立前後の心拍数の変動および自律神経指標の変化

著者

土屋　守克^1,2 伊藤　幸太³ 柳田　徳美⁴ 藤田　文子⁵ 髙橋　誠一⁶ 渡邊　裕見子⁷ 坂上　貴之⁸ 眞邉　一近^1,9

所属

1. 日本大学大学院総合社会情報研究科
2. 日本医療科学大学保健医療学部看護学科
3. 大阪大学人間科学研究科生物人類学分野
4. 帝京平成大学ヒューマンケア学部看護学科
5. 目白大学看護学部看護学科
6. 埼玉医科大学総合医療センター看護部
7. 東京医科大学医学部看護学科
8. 慶應義塾大学
9. 日本大学生物資源科学部

要旨

目的：ベッドメイキング技術を対象として，動画に基づく活動量（以下，動画活動量）とともに加速度を測定したうえで，熟練者と初心者の相違について比較し，動画活動量の特性について検討することを目的とした．方法：熟練者（看護学科教員1名）と初心者（看護学科学生3名）を対象とした．対象者は，胸部にウェアラブルカメラとスマートフォンを装着したうえで，ベッドメイキングを行った．動画活動量の算出にあたっては，オプティカルフローを使用した．結果：動画活動量および加速度は，熟練者が少なく，作業時間は熟練者が短かった．動画活動量および加速度のエントロピーは，熟練者が最も低値であり，熟練度との対応関係があった．結論：動画活動量や加速度から算出された値が，初心者と熟練者の間に相違が認められた事実から，看護技術の「熟練度」の指標としての可能性が示唆された．

キーワード

オプティカルフロー，ウェアラブルカメラ，活動量，加速度，エントロピー

Assessment of basic nursing skills by activity based on wearable camera video: Comparison between expert and novice nurses in bed-making

Author(s)

Morikatsu Tsuchiya^1,2 Kohta Ito³ Narumi Yanagida⁴ Ayako Fujita⁵ Seiichi Takahashi⁶ Yumiko Watanabe⁷ Takayuki Sakagami⁸ Kazuchika Manabe^1,9

Affiliation

1. Graduate School of Social and Cultural Studies, Nihon University
2. Department of Nursing, Faculty of Health Sciences, Nihon Institute of Medical Science
3. Laboratory of Biological Anthropology, Department of Human Sciences, Osaka University
4. Department of Nursing, Faculty of Health Care, Teikyo Heisei University
5. Department of Nursing, Faculty of Nursing, Mejiro University
6. Nursing Office, Saitama Medical Center, Saitama Medical University
7. School of Nursing, Faculty of Medicine, Tokyo Medical University
8. Keio University
9. College of Bioresource Sciences, Nihon University

Abstract

Purpose: This study aims to assess video-based activity (hereinafter referred to as“video activity”) and acceleration for bed-making techniques simultaneously and compare the differences between expert and novice participants. It also investigates the characteristics of video activity. Methods: An expert nurse (nursing faculty member) and three novices (nursing students) were included in the study. The subjects used a wearable camera and smartphone on their chest and were asked to perform bed-making. Optical flow was used to calculate the video activity. Results: Video activity and acceleration were lower in skilled participants, and work time was shorter in the expert participant. The entropy of video activity and acceleration was the lowest for the expert participant, and a level of proficiency was exhibited by the novice participants. Conclusion: The values calculated from video activity and acceleration differed between expert and novice participants. It was suggested that this could be used as an indicator of proficiency in nursing techniques.

Keyword

hybrid assistive limb, assisted standing, orthostatic hypotension, autonomic nervous activity

ラベンダー精油を内包したマイクロカプセルを塗布したシートの睡眠の質に対する効果：パイロットスタディ

著者

横野知江¹ 内山美枝子¹ 坂上百重² 柏　美智² 田口佳成³ 久保泰雄⁴

所属

1. 新潟大学大学院保健学研究科
2. 新潟大学医学部保健学科
3. 新潟大学大学院自然科学研究科
4. アロマジャパン

要旨

目的：ラベンダー精油を内包したマイクロカプセルを塗布したシートが睡眠の質を高めるかどうか評価を行った．方法：被験者の睡眠パターンをモニタリングするために，参加者の自宅で前後比較研究を実施した．コントロールとして平日5日間を，つぎに本シートによるアロマセラピーの介入として，平日5日間を追跡した．プライマリアウトカムは，睡眠潜時，入眠後の覚醒時間，睡眠効率，浅い睡眠について客観的に評価した．セカンダリアウトカムは，「寝つきのよさ」と「熟眠感」について5件法にて主観的に評価した．結果：対象者は15名であった．客観的指標に統計学的有意差はなかったが，主観的指標である「寝つきのよさ」と「熟眠感」では統計学的有意差があった．本研究で示された客観的指標における効果量はd＝0.20－0.39であり，必要なサンプルサイズは54－207であった．結論：本シートは睡眠の質向上に有効な可能性があり，サンプルサイズを拡大した検証が求められる．

Effect of fabrics with attached lavender oil microcapsules on sleep quality: A pilot study

Author(s)

Tomoe Yokono¹ Mieko Uchiyama¹ Momoe Sakagami² Michi Kashiwa² Yoshinari Taguchi³ Yasuo Kubo⁴

Affiliation

1. Graduate School of Health Sciences, Niigata University
2. School of Health Sciences, Faculty of Medicine, Niigata University
3. Graduate School of Science and Technology, Niigata University
4. Aroma Japan

Abstract

Objective: To evaluate whether fabrics with attached lavender oil microcapsules effectively increase the sleep quality. Methods: A before-after comparative study was conducted at the participants’ homes to monitor their sleep patterns. Five consecutive weekdays were followed as the control, and the following five consecutive weekdays were followed as the aromatherapy intervention using fabrics attached with lavender oil microcapsules. Primary outcomes were objective measures of sleep qualities, such as sleep latency, waking time after sleep onset, sleep efficiency, and light sleep. Secondary outcomes were subjective measures of sleep qualities, such as“ease in falling asleep”and“feeling of deep sleep”scored from 1 (“very bad”) to 5 (“very good”). Results: A total of 15 participants were analyzed. The difference in objective parameters was not statistically significant, whereas“ease in falling asleep”and“feeling of deep sleep”as subjective parameters were statistically significant. Effect sizes showed in this study were found from d=0.20 to 0.39, and the required total sample sizes were found from 54 to 207 in objective parameters. Conclusions: Since this sheet may be effective in improving sleep quality, verification with expanded sample size is required in the future.

冷えの自覚がある若年女性の深部温度較差の実態と簡易的な冷え評価方法の提示：予備研究

著者

鏡（関塚）真美¹ 船藤万誉² 大貝和裕¹ 根本　鉄¹

所属

1. 金沢大学医薬保健研究域保健学系
2. 金沢大学大学院医薬保健学総合研究科博士前期課程修了生

要旨

【目的】若年女性の中枢と末梢の深部温度較差の実態と冷えの自覚との関連を明らかにすること，さらに客観的かつ簡易的な冷え評価方法を提示することである．【方法】2018年7月から10月の期間に，若年女性24名を対象に深部温度と皮膚表面温度を測定した．冷えの自覚がある群（冷え群）と自覚がない群（非冷え群）で前額部と足背の深部温度較差を比較した．さらに足背のサーモグラフィ画像から特定温度以下のピクセル割合を算出した．【結果】冷え群は9名，非冷え群は15名であった．冷え群の深部温度較差は非冷え群とくらべ有意に大きかった（p＝0.030）．また，深部温度較差と足背の31.0度以下のピクセル割合には有意な正相関がみられた（rs＝0.869，p＜0.001）．【結論】サーモグラフィを用いて測定した足背の低温領域の割合を基に，深部温度較差が大きい女性を簡易的にスクリーニングできることが明らかとなった．

Deep temperature difference in young women with hie (cold sensation) and demonstrating a simple method for hie evaluation: A pilot study

Author(s)

Naomi Sekizuka-Kagami¹ Maho Funato² Kazuhiro Ogai¹ Tetsu Nemoto¹

Affiliation

1. Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University
2. Completed the Master’s Program, Graduate School of Medical, Pharmaceutical and Health Sciences, Kanazawa University

Abstract

Objective: This study aimed to determine the differences between the core body and peripheral temperatures of young women with hie using deep temperature, and to demonstrate an objective and simple method for hie evaluation. Methods: This study measured the deep body and skin temperatures of 24 young women from July to October 2018. We divided the participants into two groups: a hie group who has awareness of cold sensation and a non-hie group. We compared the deep temperature difference between the forehead and the instep in the two groups. We calculated the ratio of the number of pixels below a specific temperature to the total number of pixels in the instep based on a thermographic image. Results: Nine participants were in the hie group and 15 were in the non-hie group. The deep temperature difference of the hie group was significantly larger than that of the non-hie group (p=0.030). The temperature difference positively correlated with the ratio of pixels for the temperature distribution 〓31.0 ℃ on the instep (rs=0.869, p<0.001). Conclusion: Young women with a large deep temperature difference can be simply screened by thermography based on the ratio of the low-temperature region of the instep.

乳がん患者における抗がん剤治療中の頭皮の厚みの変化：ケースレポート

著者

玉井　奈緒^1,2 峰松　健夫^2,3 真田　弘美^2,4

所属

1. 東京大学大学院医学系研究科社会連携講座イメージング看護学
2. 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
3. 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
4. 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

要旨

目的と方法：抗がん剤は，正常な頭皮の毛母細胞や神経線維，基底細胞にもダメージを与え，痛みや痒みを引き起こす．われわれは，頭皮の痛みや痒みの予測として頭皮の厚みの変化に着目した．本研究では，乳がんで抗がん剤治療を受けている患者の頭皮の厚みの変化と痛み・痒みの関係を予備的に調査した．頭皮の厚みの測定は，in vivo共焦点レーザー顕微鏡を用いた．結果：症例1）33歳女性．抗がん剤開始時から24週後まで頭皮の痒みを訴え，抗がん剤投与中に頭皮の厚みの減少を認めた．症例2）37歳女性．抗がん剤投与3週後に頭皮の痛みと痒みが生じた．抗がん剤投与中に頭皮の厚みは減少した．症例3）44歳女性．脱毛中に頭皮の痛みと痒みを訴え，頭皮の紅斑と糜爛が発生した．頭皮の厚みは抗がん剤投与中に減少していた．結論：抗がん剤投与中の頭皮の厚みと頭皮の痛みや痒みの関係を経時的に観察できた．in vivo共焦点レーザー顕微鏡は非侵襲的であり，頭皮の症状を予測に役立つ可能性が示唆された．

Changes in scalp epidermal thickness using in vivo reflectance confocal microscopy in breast cancer patients undergoing chemotherapy: A case series

Author(s)

Nao Tamai^1,2 Takeo Minematsu^2,3 Hiromi Sanada^2,4

Affiliation

1. Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo
2. Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo
3. Department of Skincare Science, Graduate School of Medicine, The University of Tokyo
4. Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo

Abstract

Aims and methods: Chemotherapy agents cause damage to the scalp, including hair matrix cells, an inflammatory response activating c-fibers, or basal cells, and induce pain and itching on the scalp. We preliminarily investigated the relationship between epidermal thickness and scalp pain and itching in breast cancer patients undergoing chemotherapy. Epidermal thickness was measured as the depth from the top level of the stratum granulosum using in vivo reflectance confocal microscopy (RCM). Results: Case 1: A 33-year-old Japanese woman complained of scalp itching from baseline to 24 weeks later. Her epidermal thickness decreased during chemotherapy. Case 2: A 37-year-old Japanese woman exhibited scalp pain and itching three weeks later. Her epidermal thickness decreased during chemotherapy. Case 3: A 44-year-old Japanese woman complained of scalp pain and itching during hair loss. Erythema and eczema simultaneously appeared on her scalp. Her epidermal thickness decreased during chemotherapy. Conclusion: This study confirmed the relationship between epidermal thickness and scalp pain and itching during chemotherapy. RCM measurements are non-invasive methods and may be useful in predicting scalp symptoms.

夫婦のコミュニケーションを促進する夫教育をデザインしたスマートフォンアプリケーション開発の評価

著者

小宮山　春美¹

所属

1. 人間総合科学大学保健医療学部看護学科

要旨

夫婦が主体的に出産準備を行うために，夫婦のコミュニケーションを促進する装置を開発した．装置は，2つの専用スマートフォンアプリケーションと1つのデータベースで，妊婦が入力した情報を夫が共有する．本稿では，そのプロトタイプを使って評価調査を行い，夫婦のコミュニケーションを促進したかについて評価した．評価調査は，2018年4月25日～2019年1月13日，4組の初産婦とその夫に対して行い，妊娠中の生活のなかでプロトタイプを自由に使ってもらった．評価はそのうちの2組の夫婦に対して15～18週間の使用後に，インタビューと質問紙調査を行い質的に評価した．その結果，夫の意識や行動は妊婦寄りに変化し，それが妊婦の精神衛生に影響していた．また，夫の知識取得のツールや会話の糸口となっていたことが分かった．そして，本ケースにおける夫婦のコミュニケーションは促進したと考察された．

Evaluation of smartphone applications designed in husband education that promotes communication between couples

Author(s)

Harumi Komiyama¹

Affiliation

1. Department of Nursing, Faculty of Health Sciences, University of Human Arts and Sciences