Akiko Yamada

Patients with hematological malignancy experience physical and psychological pain, such as a sense of isolation and confinement due to intensive chemotherapy in a protective isolation unit (PIU). We examined whether the intervention of a robotic puppy, aibo (manufactured by Sony), could improve patients' mental health as an alternative therapy for pet therapy, which is not feasible in PIU. This study included 21 patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) (n = 16) or autologous HSCT (n = 5). The patients were randomly divided into the aibo and control groups. Psychological effects were regularly assessed by measuring the levels of salivary stress hormone chromogranin A (CgA), serum oxytocin, and serum cortisol and the quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR) scores. The aibo group demonstrated a significant decrease in CgA level, while the control group showed the opposite trend. In addition, changes in serum oxytocin and cortisol levels indicated that aibo helped reduce stress. There was no significant difference in the QIDS-SR scores between the two groups; however, the psychomotor activity in the aibo group improved significantly. These findings suggest that aibo intervention during a stay in a PIU can improve the mental health of patients with hematological malignancies who have undergone HSCT.

Accurate staging and evaluation of therapeutic effects are important in managing plasma-cell neoplasms. Diffusion-weighted imaging with body signal suppression magnetic resonance imaging (DWIBS-MRI) allows for acquisition of whole-body volumetric data without radiation exposure. This study aimed to investigate the usefulness of DWIBS-MRI in plasma-cell neoplasms. We retrospectively analyzed 29 and 8 Japanese patients with multiple myeloma and monoclonal gammopathy of undetermined significance, respectively, who underwent DWIBS-MRI. We conducted a histogram analysis of apparent diffusion coefficient values. The correlations between each histogram parameter and staging, cell maturation, prognosis, and treatment response were evaluated. We found that the apparent diffusion coefficient values in patients with monoclonal gammopathy of undetermined significance were lower than those in patients with multiple myeloma. Pretreatment apparent diffusion coefficient values of immature myeloma were lower than those of mature myeloma. Moreover, these values decreased in proportion to stage progression in Durie-Salmon classification system but showed no significant correlation with other staging systems or prognosis. Patients were stratified as responder, stable, and non-responder based on the International Myeloma Working Group criteria. The magnitude of changes in apparent diffusion coefficients differed significantly between responders and non-responders (0.154 ± 0.386 ×10–3 mm2/s vs. -0.307 ± 0.424 ×10–3 mm2/s, p = 0.003). Although its usefulness has yet to be established, DWIBS-MRI combined with apparent diffusion coefficient measurement allowed for excellent response evaluation in patients with multiple myeloma. Furthermore, apparent diffusion coefficient analysis using DWIBS-MRI may be useful in predicting cell maturation and total tumor volume.

目 的 分娩を取り扱う助産所助産師が認識している産後ケアとはどのようなものか，地域における助産所の役割をどのように捉えているのかを明らかにすることである。 対象と方法 A県内において，妊娠・分娩・産後ケアを扱う助産所助産師8名を対象とし，産後ケア実践への認識および助産所の存在について，半構造化面接を実施した。得られたデータは質的帰納的に分析した。 結 果 8名の助産所助産師の認識している産後ケアは，【健康な母子・家族を支える関わり】として1コアカテゴリー，≪産後の母親を支援することは不変の関わり≫≪継続的な個別性ある全人的関わり≫≪母親の意思を尊重し母子にとって健康的な授乳方法を支援する≫≪母乳育児を育児の自信や楽しさにつなげる≫≪親子・家族関係を支える≫の5カテゴリーから構成された。地域における助産所の役割は，【切れ目ない子育てを支援する場】として，1コアカテゴリー，≪助産所で出産する母親は健康的で自立している≫≪いつでも誰でも安心して来られる場所≫≪子育てコミュニティの形成≫≪個別的支援≫≪地域における多職種連携≫≪専門職としての発展≫の6カテゴリーから構成された。 結 論 助産所助産師にとって，産後の母親を支援することは必然であり，不変の関わりであることが示唆された。助産所助産師は，現行の産後ケア事業について「一時的なもの」ととらえ，助産師が本来行ってきた母親のニーズに沿った産後ケアとは異なると認識していた。助産所助産師は，産後の関わりにおいては，出産場所に関係なく，母親は妊娠期から出産という一連の流れの中にあることを意識しながら，母子の心身の健康を支援していることが明らかになった。助産所は，助産師の専門性を発揮しうる実践場所であるだけでなく，産後の母子を切れ目なく支援していくことが可能な地域における子育て支援の基盤となりうることが考察された。