Previous studies on sociology and cultural anthropology insist that it is impossible to provide sufficient autonomy to clients who enroll for group care at care facilities. The purpose of this study is to analyze the nature of nursing assistant care at the national Hansen's disease sanatorium in Japan. Semi-structured interviews were conducted with 39 nursing assistants and 6 head nurses who cared for physically and socially challenged residents at this sanatorium. The investigation revealed that as a result of facing huge conflicts in the caring process, the nursing assistants had learned to appreciate the inherent life and history of residents. Thus, the nursing assistants and residents were bound together by mutual trust with a view to maximize the “autonomy of the life field.” Conflict had not stunted the self-affirmation of nursing assistants; moreover, mutual trust had reorganized the “relevant system pertaining to care” for nursing assistants, which consisted of “the unification of care” and “the equality of care.” It is suggested that group care at this sanatorium promotes the “autonomy of the life field” by valuing conflicts between nursing assistants and residents.
The causes of skin ulcers in collagen vascular diseases are complicated, and involve peripheral vascular complications, vasculitis, and thrombosis. It is necessary to determine the treatment, such as oral medication, infusion, ointment and surgery after careful consideration of its causes. This review shows skin manifestations of various collagen vascular diseases and the causes of skin ulcers in these diseases.
Mycobacterium tuberculosis (MTB) is an intracellular pathogen that has evolved strategies to enable growth in macrophages. The bacterium is able to inhibit fusion of phagosomes with lysosomes through secretion of some bacterial components and modulation of host intracellular signaling pathways. Furthermore, it has been shown that phagositosed MTB is killed within macrophages after treatment with IFN-γ in vitro. However, virulent MTB is capable of surviving in macrophages in vivo and persists in host even after acquired immunity has developed. These data suggest that MTB has developed a sophisticated immune evasion mechanism. In this issue, the strategies of MTB for intracellular survival and immune evasion, which have been unraveled so far, are shown and the mechanisms are discussed.
At this sanatorium, the number of foot bottom ulcer patients/was 13. and the tenure of the foot bottom ulcer was average 11 years. According to the treatment that was not unified, we thought about the cause of the prolongation. Therefore, we made evaluation and care method sheet (“foot care sheet”) of the ulcer for the unification. We used the foot pressure measurement system (F-scan) to 4 patients for the pressure dispersion of the ulcer. We devised the protection law of the ulcer, and an ulcer did not require pressure more than 5kilos/cm2. We recorded the size of the ulcer, weight of the liquid from ulcer, a photograph to care sheet once a week. I performed ulcer protection law and management with the foot care sheet to 4 patients for average 4 months As a result, the ulcers of 3 patients out of 4 patients became small.
The pathophysiology of chronic wounds differ from that of acute wounds, and the etiology has various, for example decubitus, diabetes, insufficient venous circulation, radiation, et al. Now, for diabetic foot ulcers with/without PAD, internist (diabetologist, interventionalist), radiologist, vascular surgeon, orthopedic surgeon, dermatologist, plastic surgeon tackle this difficult problem respectively. But it is far from total medical care as a team medicine. In this mini-review, I want to introduce our project for diabetic foot ulcers and gangrene with/without PAD, presenting our cases. I shall be happy if I can be of any help to any neurogenic foot problems in Hansen's disease.