Effective learning of basic nursing techniques is important for nursing student to obtain good clinical skills. We introduced portfolio assessment to new nursing students to facilitate their self-assessment, agenda and goal setting, and action planning. This study aimed to clarify the characteristics of the learning using the portfolio and to evaluate its effectiveness on student development.
We collected recorded portfolios and anonymous self-administered questionnaires concerning the portfolio learning from 84 second-year nursing students in a university. Portfolio entries were qualitatively analyzed and categorized into different types of action planning. Portfolio entries were observed at three points：pre-course, and at the midpoints of course one and two.
Students’goals increased in depth as the semester progressed. Prior to the middle of semester 1, 45% were classified as“simple/superficial goals”and 52% as“setting detailed learning goals”．Later, these became 21% and 76% respectively, showing the same tendency after the midpoint of semester 2. The majority of students（69%）deepened their learning over time. Student evaluation of the portfolio assessment was 3.5 and over on a five-point scale on most of the question items, indicating student satisfaction.
The portfolio effectively facilitated self-reflection and encouraged a positive approach to learning.
This study examines liver cirrhosis（LC）patients’backgrounds and clinical courses to clarify the effectiveness of specialized institutional intervention. The early intervention group, examined prior to symptom manifestation, had a higher proportion of cases caused by HCV, and the purpose of the examination was to investigate abnormalities in liver function and the extent of pre-existing cirrhosis. Otherwise, the late intervention group, examined after symptom manifestation, had a higher proportion of cases caused by alcohol, and often patients only sought medical care after experiencing gastrointestinal variceal bleeding or other symptoms. The early group’s Child-Pugh scores remained low over long periods and lived for long durations without incident. The late group, by contrast, had high scores and only showed short-term improvement. Specialized intervention in cases of LC is effective, but must take place early on to improve the prognosis. Also, promoting patient referrals and coordinated medical care continue to be important.
Cleft lip and cleft palate are some of the most frequent body surface malformations, occurring in about 1 per 600 births in Japan. Herein, we report a clinico-statistical investigation of 72 patients with cleft lip and / or cleft palate in the past 10 years. The patients were primary（non-surgical）cases at the Department of Oral and Maxillofacial Surgery, Yamaguchi University Graduate School of Medicine. The numbers of patients with cleft lip and cleft palate, cleft palate, submucous cleft palate and cleft lip were 28（38.9%），18（25.0%），9（12.5%）and 17（23.6%），respectively. There were a total of 34 male and 38 female patients. Associated complicating malformations and / or disorders were observed in 12 patients（16.7%）and were more frequently detected in the patients with cleft palate. Chromosomal disorders were found in 6 patients（8.3%），with a high percentage for those with submucous cleft palate. Incidence of familial recurrence was 12.5%, with a high percentage for patients with cleft lip.
We report herein a case of NSAIDs-induced multiple small intestinal ulcers complicated by multiple perforation. A 59-year-old woman was received total hysterectomy for uterine myoma at another hospital November in 2016. She was administered loxoprofen against post-operative pain for about a week. She was transferred to our hospital because of presence of abdominal pain and fullness. CT revealed much of ascites and free air in abdominal cavity, so we made the diagnosis of a gastrointestinal perforation. Partial resection of the jejunum was performed and 7-8 punched out perforation holes were found in the resected specimen. We made a jejunostomy to avoid leakage of anastomosis. Pathological findings showed non-specific inflammation in the resected specimen, so loxoprofen was suspected as the cause of perforations. After 2 weeks from the initial operation, exploratory laparotomy was performed and several new perforations were found in the ileum, so we abandoned the anastomosis of small intestine. The recognition of NSAIDs-induced small intestinal injury is important and we should administer NSAIDs very carefully in post-operative patients.
We experienced a case of synchronous double cancer of the breast and rectum. A 67-years old woman had melena and visited to internal medicine of our hospital. She also had been noticed a left small breast mass since last year. Endoscopic examination of the colon demonstrated a type 2 cancer in 2cm from the anal verge. Cytology of the tumor was diagnosed in group 3. The tumor was 3cm and observed at D region in left breast by mammography and breast ultrasound. Needle biopsy demonstrated as scirrhous carcinoma in histologically. PET/CT showed abnormal accumulations and swellings of lymph nodes around internal iliac artery and left dorsal lesion of the rectum. PET showed a slight accumulation in left adrenal gland which couldn't be denied the possibility of a metastasis. Therefore, we diagnosed synchronous double cancer of the breast and rectum. We performed partial mastectomy with sentinel lymph node biopsy and sigmoid colostomy. Subsequently, she had been treated in neoadjuvant chemotherapy and radiation therapy to rectal cancer. The tumor and lymph nodes were remarkably decreased, and the evaluation of treatment was partial response. One month later, rectal amputation was performed. After that, we performed the radiation therapy to left residual mammary glands. She had also received in adjuvant chemotherapy, and she is alive without recurrence. In a case of synchronous double cancer, we should make a radical treatment plan for both cancers by taking into account of tumor progression, QOL, ADL, timing for an operation, and side effects of chemotherapy, respectively.
We encountered a case of intestinal endometriosis with difficulty in preoperative diagnosis. Here we report the case with some literature review. The patient was a 49-year-old woman. She visited a nearby doctor due to the positive result of fecal occult blood test at a medical check-up. She was referred to our department for detailed examination and received treatment because a type 1 tumor was suspected in the rectum Rs by lower gastrointestinal endoscopy. Three times of endoscopic exams performed in our hospital revealed that submucosal tumor-like appearance was seen in the rectum, however biopsy did not lead to definitive diagnosis. Since the possibility of malignancy could not be denied and the patient strongly desired to receive operation, laparoscopic high anterior resection was performed. In the intraoperative findings, the pelvic cavity was white tone and the endometrium was firmly adhered to the rectum. The resected specimen showed a submucosal tumor, and intestinal endometriosis was confirmed with pathological diagnosis.
We report herein the case of invasive perianal Paget’s disease. An 8X-year-old man suffered from the eruption with itching of perianal region. He treated with ointment medicines at a dermatologic clinic. The symptom was not improved and the clinic doctor performed the biopsy of the eruption. Skin biopsy revealed Paget cells. The patient was admitted to our hospital. Imaging examinations could not detect any sign of rectal and anal cancers. Abdominoperineal resection was performed because of the long infiltration of Paget’s cell in the rectal mucosa. Histological examination of the resected specimen revealed proliferation of Paget cells, but no evidence of primary anorectal cancer was found. Although immunohistochemical findings were not typical, the final pathologic diagnosis was primary invasive perianal Paget’s disease. Both immunohistochemical findings and detection of nearby occult cancers are necessary to diagnose between perianal Paget’s disease and Pagetoid spread. Sometimes, it is difficult to differentiate two diseases in preoperative examinations.