We studied sympathetic skin response (SSR) on the back for investigating the influence of the postural change upon sympathetic nerve.
Subjects were 18 healthy volunteers. We applied several electrodes to the palm and back of the subjects and recorded SSR in a supine position and a lateral position by the stimulation of the right median nerve at the wrist. The localized pressure was added on the lower side in a lateral position.
We could recorded SSR in the back. The ratio of the amplitude (the amplitude of the left side/the right side) increased in a right lateral position and decreased in a left lateral position compared to a supine position. The amplitude of the lower side in a lateral position became smaller than in a supine position. The mean percentage of the decreased amplitude were about 50-70%. The latency of the lower side in a lateral position was slower than in a supine position. The mean percentage of the delay was about 12-16%.
We revealed for the first time that SSR could be recorded in the back quantitatively, and showed that the activity of sympathetic nerve was reduced in the lower side of a lateral position compared to a supine position.

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Evaluation of the subjective quality of life in patients with Parkinson's disease Hiroaki Takeuchi, MD, PhD, Michiko Mino, RN, Hiroko Kunikata, RN Satoshi Fujimoto, RN, Hisae Ito, RN

Subjective quality of life (QOL) is increasingly recognized as an important outcome variable of medical care, particularly for chronic neurological diseases such as Parkinson's disease (PD). Subjective well-being was evaluated in 67 PD outpatients (age: 67.2±7.0 S.D., range 49-83 years) using a 27 item QOL rating scale, newly developed by the Ministry of Health and Welfare of Japan. A activities of daily life (ADL) was also assessed by the Barthel Index (B.I.). Patient's utilization of the social resource services consisting of 15 items such as "day care" and "home help" was scored as 0, 1, or 2 points according to degree of utilizaion. The following results were obtained. The mean QOL score was 31.7±10.3 S.D. (54)*, and the mean B. I. score was 91.5±17.3 S.D.(100)* (B. I. 100, n=36, less than 100, n=31).
The number of patients receiving a utilization score of 2 points was comparatively high for several items such as "patients' organization" (56.7%), "official note of disabilities" and "house adaptation". Social resource services utilization scores for disabled patients (11.7±5.4 S.D.) were significantly higher than those for non-disabled patients (8.8±4.8 S.D., p<.05). These scores also showed a high correlation with disease duration (r=.48, p<.0001).
QOL scores for non-disabled patients (34.6±11.5 S.D.) were significantly higher than those for disabled patients (28.4±7.7 S.D., p<.05). QOL scores significantly decreased with increased in the Hoehn & Yahr Staging Scale (p<.05).
The overall scores, current age, onset age, disease duration, Barthel Index, social resource services utilization score, Hoehn & Yahr Staging Scale, and QOL score were statistically analyzed. Forward stepwise regression analysis revealed that the multiple regression function: (QOL scores)=39.004-5.808 (Hoehn & Yahr Staging Scale)+0.59 (social resource services utilization score) was useful for estimating the QOL score in PD (F-to-Enter 4.000, Adjusted R Squared.19, p=.0004). The results of this study indicate that physical impairment and social resource services are important impact factors affecting the subjective QOL outcomes in PD.

　* Maximal score possible on this scale.

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To meet the needs of student in clinical learning, evaluating behavior that is appropriate for the stage of learning which the student has reached is crucial. This study was conducted to identify students' behavior patterns in the clinical learning process in order to obtain cues for developing reliable instruments for evaluation of student growth and development. 23 university nursing students were observed for ten months in a clinical setting using the anecdotal record. From the 215 recorded acts, 54 were identified as characteristic of learning behavior and grouped into 26 behavior patterns. To test reliability of these 26 behavior patterns, a five-point rating scale and a learning stage questionnaire were mailed to 476 nurse educators. The responses of all the nurse educators were weighted with Fehring's Diagnostic Content Validity method.
The result indicated that 12 behavior patterns were relevant to the beginning stage of learning, 2 patterns were relevant to the intermediate stage of learning, and 5 behavior patterns were relevant to the advanced stage of learning. 1 behavior pattern was identified as to be relevant to all stages of learning. 6 behavior patterns were deemed to have no relevance to any learning stage.
In view of these findings, it can be said that in clinical learning ; 1) student behavior patterns are uniquely related to the stage of the learning process, and 2) changes in student behavior patterns occurring during clinical learning are the product of growth and development through learning.

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An evaluation of effectiveness of Clinical Practice Studies was made objectively by a content analysis of 472 written reports. These reports were written in free form by 48 first year students and 50 second year students after finishing the practice at each of 5 institutions. The analysis was carried out by using the JSORT program which classifies and groups language by breaking down Japanese sentences by vocabulary level, and the BGREP program which searches for certain words and selected kanji (Chinese characters used in Japanese). Words which indicate strong expressions of learning such as '大切 (valuable)', '必要 (necessary)' and '重要 (important)' were extracted from the relevant sentences.
The results show that the 17 of the top 20 words most frequently encountered were shared between first and second year students. The differences are seen as an expression of the characteristics of each grade level. The words found relating to'valuable', 'important' and 'necessary' are closely associated with nursing skills, responsibility of nurses, the patients to nurses relationship, understanding of basic knowledge, etc. It was also found that the high frequency words in report were characteristic of the learning content at each institution. Thus, this results suggest that evaluation of free form reports by this analytic method can be used successfully.

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