震災直後の被災者の受療行動からみた震災時医療圏域の設定に関する研究

1995年1月17日の兵庫県南部地震(阪神・淡路大震災)を契機に、現在、中央省庁をはじめ様々な都道府県あるいは市町村単位での震災への対応が検討されているが、その過程において、震災直後の応急体制について、実際の震災直後の被災者の受療動向がつかめていないために、どういう医療施設のネットワ-クが組まれるべきかの詳細な検討ができない、等という議論がなされている。本研究は、この震災直後の被災者の受療行動を明らかにすることを目的にしている。調査は、まず筆者らが震災直後に実施した22の医療施設を対象にして詳細なデ-タの収集を行った(デ-タが収集できたのはその内の6施設である)。また、消防局の患者搬送デ-タ、避難所での保健所やボランティアによる医療行為を収集した。現在これらのデ-タについて集計した。一方、震災時を想定した住民へのアシケ-ト調査を行い(愛知県の3地域を対象)、震災直後には、通常医療圏とは異なり、より近い医療施設を選択する傾向が見られるという結果が得られ、これらから震災時の患者の受療行動を明らかにした。科学研究費補助金 研究種目:基盤研究(B)(1) 課題番号:09555183 研究代表者:山下 哲郎 研究期間:1997-1998年度research repor

Curative remnant total pancreatectomy for recurrent pancreatic acinar cell carcinoma: A case report

application/pdfIntroduction and importance Acinar cell carcinoma （ACC） of the pancreas is a rare pancreatic cancer subtype （incidence, 0.5–2%） with unclear epidemiology and prognosis. Sometimes, repeat resection including total pancreatectomy is required for recurrence. We report a case of ACC recurring in the remnant pancreatic head after distal pancreatectomy that was successfully cured by remnant pancreatic resection following combination therapy with nab-paclitaxel （nab-PTX） and gemcitabine （GEM）. Case presentation A 64-year-old woman was referred for pancreatic tumour treatment. CT revealed a 46-mm tumour in the pancreatic body, and endoscopic ultrasonography-guided fine needle aspiration （EUS-FNA） indicated ACC. Distal pancreatectomy was performed, and the final diagnosis was ACC. CT 18 months later showed a 34-mm tumour in the remnant pancreatic head revealed as ACC by EUS-FNA. Portal vein invasion was apparent, so neoadjuvant chemotherapy with nab-PTX and GEM was administered, and remnant pancreatic resection （total pancreatectomy） was performed. No recurrence or distant metastasis was present more than 6 months later. Clinical discussion Mean survival time for ACC is 18–47 months, and prognosis is good compared with pancreatic ductal adenocarcinoma （PDAC）. ACC tends to extend and grow along the main pancreatic duct, which increases the recurrence rate to 50–60%. EUS and EUS-FNA were useful for evaluating tumour extension and diagnosis. Repeat pancreatic resection that included total pancreatectomy was feasible and could be performed safely. Conclusion ACC has a better prognosis than PDAC but with a higher recurrence rate. Aggressive surgical resection that included remnant total pancreatotomy with chemotherapy was useful in treating ACC

Observation of the ηc(2S) in Exclusive B→KKSK-π+ Decays

journal articl

非文字資料研究センター 新刊のご紹介・主な研究活動・編集後記・表紙紹介

othe

共有された半球を書く ―アジア＝オーストラリア小説の近年の動向―

departmental bulletin pape

フェノールフタレインとフルオレセインのニトロ化による新しい酸塩基指示薬の合成

departmental bulletin pape

Measurement Conditions of Mossbauer Effect Ⅰ : Backscatter Method

Mossbauer effect has been applied in many fields of solid state physics and chemistry and usually the experiments were carried out by absorption method. On the other hand backscatter method was not used so commonly because of its experimental difficulties. However the method has many advantages in studying solid surfaces. In the present paper the measurement procedure of the backscatter method is discussed.departmental bulletin pape

Study on the effects of Advance Care Planning for cancer patients

application/pdfアドバンス・ケア・プランニング（ACP）とは、将来の意思決定能力の低下に備えて、今後の治療･療養について患者・家族と医療者とがあらかじめ話し合うプロセスである。本研究では国内外で行われたACP研究について文献レビューを行い、ACPの方法や時期について検討した。そしてACPを行うことが、患者・家族と医療者にもたらす効果を検討するために、進行婦人科がん患者を対象に、がん看護専門看護師による定期的なACPを実践し、その効果を質的・量的側面から検討を行った。Advance Care Planning (ACP) is a process of communication between individuals and their healthcare agents to understand, reflect on, discuss and plan for future healthcare decisions for a time when individuals are not able to make their own healthcare decisions. In this study, we researched ACP for cancer patients on the methods and the timings through literature reviews. An interventional study on ACP was performed using a mixed method design.　The purpose of this study was to clarify the effects of ACP on patients, their families, and their healthcare agents. 　The participants were advanced gynecological cancer patients, and each of them discussed their anxieties with a CNS (Certified nurse specialist in oncology) in ACP, when they had tri-weekly chemotherapy. Participants’QOL (FACIT-Sp) and Self-Efficacy for Advanced Cancer patients (SEAC) were observed, and participants and their healthcare agents were interviewed about their feelings about the ACP process by researchers.2013年度～2015年度科学研究費補助金(基盤研究(C))研究成果報告書25463405research repor