JOURNAL OF THE JAPANESE ASSOCIATION OF RURAL MEDICINE

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　Drug therapy is necessary to treat metastatic and recurrent breast cancer. In Japan, two types of cyclin-dependent kinases (i.e., CDK4/6 inhibitors) are covered under the national healthinsurance system: palbociclib (since December 2017) and abemaciclib (since November 2018). Although there are many reports on the use and side effects of palbociclib in clinical practice, there are few such reports on abemaciclib. Therefore, we investigated the rate of neutropenia and associated background factors in patients taking abemaciclib. Of the 39 patients taking abemaciclib recruited for the study, 22 satisfied the inclusion criteria. Of these, 7 developed Grade 3 or higher neutropenia and had a significantly lower body weight and body mass index (BMI). Furthermore, the white blood cell and neutrophil counts before administration were significantly lower in the expression group compared with the non-expressing group. To predict the development of Grade 3 or higher neutropenia, the receiver operating characteristic (ROC) curve was used to calculate a BMI cut-off value of 23.9 (specificity 85.7%, sensitivity 73.3%, area under the ROC curve 0.80). Based on this cut-off value, BMI was divided into two groups (<23.9 and ≥23.9) and Fisher's exact test was performed. Patients with a low body mass index were more likely to develop Grade 3 or higher neutropenia as a result of increased dosage per kilogram body weight, while among patients with BMI < 25, those with BMI < 23.9 were at high risk of developing Grade 3 or higher neutropenia. Accordingly, caution is required in the treatment of such patients.

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　The purpose of this study was to clarify the thoughts of nurses who served as facilitators in an action program designed to improve the quality of nursing records, as well as to identify related issues. The action program aimed to improve the quality of nursing records for training and auditing by specifying when, where, and how records would be handled and by whom. In this program, the facilitator appointed by the person in charge of each unit played a central role by carrying out the training, auditing the records, and conducting unit review meetings with supervisors and unit members. In this study, semi-structured interviews were conducted with six facilitators who had participated in the program and consented to participate in the study. The results were analyzed using a qualitative integration method (i.e., the KJ method), and the following were identified: “disadvantages for facilitators”, “benefits for facilitators”, “results as facilitators”, “need to improve the learning environment”, “need to change the recording format”, and improvement of the action program”. The program did not incorporate facilitator education, so there were undeniable differences in the readiness of each facilitator that led to certain disadvantages. However, taking on the role of facilitator not only helped the nurses acquire knowledge but also resulted in the creation of a cooperative system within the unit. For nurses to further develop as facilitators, it is necessary for supervisors to consider measures to facilitate train and support facilitators.

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