カテコラミンは半減期が短いため血中濃度を低下させないようシリンジ交換を行う必要がある. 本研究の目的は, カテコラミン投与時の患者の血圧によってクリティカルケア病棟の看護師が選択する手動シリンジ交換法について実態を調査し検討することである. 東海北陸地域のクリティカルケア病棟に勤務する看護師にオンラインアンケート調査を実施し, すべての質問に回答した144人を分析対象とした. 医師から指示された患者の血圧目標値から20mmHg以上の場合を高血圧, 20mmHg以下を低血圧とし, カテコラミン投与時の患者の血圧によって1台法, クイック法, ダブル法の中から手動シリンジ交換法を回答してもらった. 結果は, 高血圧時には1台法45.2％, ダブル法33.3％, クイック法20.1％の順で, 低血圧時にはダブル法83.3％, クイック法11.8％, 1台法4.2％の順だった. クリティカルケア病棟の看護師は, カテコラミン投与時のシリンジ交換に伴う血圧変動を最小限にするために手動シリンジ交換法を適切に選択していたが, 看護師の30％以上が高血圧時にカテコラミンが重複投与となるダブル法を行うことが判明した.

A “health support pharmacy” is a home pharmacy that provides counseling and support services to help maintain and improve health in the community. In this study, we performed a questionnaire survey on pharmacies in Gifu city to clarify the services provided as “health support pharmacy,” the status and factors of implementation, and the awareness of pharmacy managers about the services. The questionnaire investigated pharmacy attributes, services provided, pharmacy manager's awareness about the services, etc. The results indicate that, regardless of pharmacy attributes, many pharmacies provide“ counseling about the proper use of medicines such as the ways to take and use medicines” and “medication management of the elderly and people requiring care such as the prevention of leaving and forgetting to take medicines” (respectively 72.9% and 71.6%), and pharmacy managers consider that the importance, urgent necessity and feasibility of those services are high. A few pharmacies provide “health support to prevent drug and alcohol abuse and dependence” and “an approach for improvement of the response rate of medical examinations” (respectively 25.3% and 27.1%), which is dependent on pharmacy attributes. Pharmacy managers do not consider that the importance, urgent necessity and feasibility of those services are high. The services provided differ because of different pharmacy attributes and pharmacy manager's awareness, therefore it is important to announce and inform the community about the services so that people can understand and select appropriate services.

In response to the “Pharmacy Vision for Patients in Japan,” the family pharmacist system began in 2016. Gifu Pharmaceutical University, in collaboration with the Gifu Prefectural Pharmaceutical Association, investigated the correspondence situation of pharmacies one year after the system commenced. Items surveyed in this study were dispensing fees, prescription checking fees, and so forth. We divided the pharmacies into family pharmacies (certified as a family pharmacist), and control (not certified as a family pharmacist) groups. The dispensing fees and prescription checking fees, such as preventing duplicate administration and drug interactions, were significantly higher in the family pharmacy group. We also investigated the awareness of the function and role of pharmacists. Most pharmacists in the family pharmacy group recognized the role of pharmacists as consultants for residents. Findings suggest that family pharmacies fulfill the function required by the pharmacy vision for patients, and have a high awareness of community health consultation.

　日本の医療提供体制には地域格差があり、在宅看取り数や平均在院日数に地域間の差異が見られている。医療介護資源の少ない地域は、看護師が行う在宅療養支援は試行錯誤の状態であることが推察されるが、その現状は明らかにされていない。本研究で、地方圏の中で医療介護資源の少ない地域にある地域包括ケア病棟（以下、包括病棟）で、看護師が取り組む在宅療養支援の現状について事例報告する。

　地方圏の3県3病院の包括病床で在宅療養支援を行っている看護師3名に、半構造化面接を行い、質的帰納的に分析した。その結果、【今後の療養継続に向けた早期介入】【ADL促しと介護者へのケア指導】【多職種による進捗状況の評価】【円滑な連携を考えた情報提供】【患者・家族の持てる力での在宅療養を見守る】【家族に現状を受け入れてもらう関わり】【上手く今後の療養継続に向ける支援】【在宅療養支援の実践力向上】【今後の在宅療養支援への思案】の9カテゴリーが抽出された。

　包括病棟はADLの低下した高齢者が多く、在宅復帰に向け準備期間を取りつつ、入院の長期化による弊害を防止しなければならない難しい在宅復帰支援である。そのため、看護師は院内多職種や地域のケアチームと協働しながら在宅療養支援を行っており、多職種連携が重要であることが示唆された。

Construction of regional inclusive care system is being promoted and pharmacists are required to implement multidisciplinary collaboration in order to provide appropriate pharmaceutical care to patients. However, there are few studies on collaboration between medical facilities and community pharmacies. In this study, we conducted a questionnaire survey of community pharmacies in Gifu City, which assessed the experience and attitudes regarding collaboration with other medical facilities. The survey items are: I. Participation in regional care meetings, II. Case discussion conferences, III. Joint workshops/study conferences, IV. Community service, V. Sharing information through medical cooperation network, and VI. Accompanying community pharmacists at home medical care. For the implementation of collaboration, the percentage of “not implemented” were as high as 70% or more in II, IV, V and VI. Regarding the attitudes toward collaboration, more than half of pharmacies answered that they wanted to implement in all items. In the comparison by the number of pharmacists, pharmacies with two or more pharmacists had significantly higher implementation ratios than pharmacies with one pharmacist in IV and V. Regarding the attitudes toward collaboration, pharmacies with two or more pharmacists had significantly higher ratios of considering implementation than pharmacies with one pharmacist in I and VI. Based on the results of this survey, there were many items that were not implemented as collaboration with other medical facilities at community pharmacies. However, many community pharmacies are planning to collaborate with other medical facilities in the future.

目的：地域包括ケア病棟看護師が高齢者に対して実践している退院支援の状況を自己評価から明らかにし，関連する個人的要因や職場環境要因を明確化することを目的とした．

方法：

結果：587人（回収率60.6％）から回答があり，584人（有効回答率60.3％）を有効回答とした．DPWN合計得点の平均点は100.31点であった．DPWN合計得点を目的変数として重回帰分析を行った結果，DPWN合計得点に関連する要因は，［仕事意欲］（β＝0.268, p＜0.001），［職位“有”］（β＝0.099, p＜0.01），［高齢者の家族介護経験“有”］（β＝0.101, p＜0.05），［退院支援に関して院内での研修“有”］（β＝0.091, p＜0.05），［退院調整カンファレンス以外に多職種と情報共有する機会“有”］（β＝0.093, p＜0.05）であった．

考察：仕事意欲を高めることや役職者からの教育や意識づけ，院内外の多職種と情報共有する環境を組織的に整備することや研修に参加しやすい体制を整えることが，高齢者に対する退院支援実践の向上に寄与すると考えられる．

〔目的〕看護師における情動知能と倫理的行動との関係を明らかにすることである。

〔方法〕看護師2,000名を対象に質問紙調査を実施し、統計解析は基本統計量の算出および相関分析、重回帰分析を行った。

〔結果〕331件を分析対象とした。情動知能尺度得点は4.59±0.65、倫理的行動尺度得点は4.43±0.49であった。重回帰分析の結果、情動知能の4つの下位因子による調整済み決定係数は【リスク回避】が.124、【善いケア】が.238、【公正なケア】が.087であった。【リスク回避】に対しては【自己の情動評価】（β=.151, p=.012）、【善いケア】に対しては【他者の情動評価】（β=.221, p<.001）で標準偏回帰係数が最大であった。

〔考察〕情動知能の倫理的行動への影響度には下位因子ごとに差がみられ、【他者の情動評価】と【情動の利用】を高めることで倫理的行動につながることが示唆された。

　地域医療研修は2004年に卒後臨床研修制度が開始されて以来, 必修分野として現在に至っている. 研修の現場は, へき地や遠隔地の診療所から市街の保健所まで多岐におよんでいる. 地域医療研修を充実させ, よりよい研修医を育てるためには, プログラム責任者の役割が重要である. 震災被災地での地域医療研修や, 北海道と鹿児島の研修医の交換研修などユニークな研修も行われている. 充実した地域医療研修は, 地域でもとめられ世界的にも注目される, 持続可能で新しい日本の保健医療システムをつくるための人材育成に不可欠である.

In recent years, multi-occupational collaboration aiming at patient-centered care is required to provide high-quality medical care. However, there are few studies on collaboration between hospitals or clinics and community pharmacies. In this study, we conducted a questionnaire survey to clarify the present conditions and awareness of hospitals or clinics in Gifu City regarding collaboration with community pharmacies. The following activities with community pharmacies were examined in the survey: “I. Participation in regional care meetings,” “II. Case discussion conferences,” “III. Workshops/study conferences,” “IV. Community service,” “V. Sharing information through medical cooperation network,” “VI. Accompanying community pharmacists at home medical care” and future plans for these items. The percentage of non-implementation was 80％ or more in Items I, IV and IV in the hospital and 80％ or more in items other than III in the clinics. The percentage of respondents who were not planning to implement Item VI was over 70％ in the hospital, and the percentage of respondents who were not planning to implement Items I, IV, VI was over 70％ in the clinic. In the comparison between the hospital and the clinic, the proportion of current collaboration is significantly higher for II and III in the hospital. For collaboration in the future, the proportion of respondents who were planning to implement these items other than VI was significantly higher in the hospital. Many hospitals and clinics currently do not collaborate with community pharmacies. And more hospitals are considering collaboration with community pharmacies than clinics.

2020年4月の診療報酬改定により，「静脈圧迫処置（慢性静脈不全によるもの）」が新設された．施設認定の状況や診療報酬算定の実態，現状の問題点などを把握するためアンケート調査を行った．【方法】日本静脈学会会員約1200名と弾性ストッキング・圧迫療法コンダクター約2000名を対象に調査した（研究期間2020年4月～2021年7月）．【結果】285施設から回答があった．施設認定取得施設が123施設（回答施設の44%，全認定施設の59%に相当）で，今後取得予定が80施設（27%）．施設認定取得施設での5カ月間の算定件数は1–10件が最も多く（67施設54%），次いで未算定28%であった．一施設あたりの算定数は平均8.2件，中央値3件，1症例あたりの算定数は1–3回が最も多く早期治癒が得られていると思われた．自由記載では対象患者の拡大を希望する意見が最も多かった．【結語】静脈圧迫処置が徐々に多くの施設で施行され，静脈性潰瘍の治療が適切に行われている実態が明らかとなった．

Pharmacists working in collaboration with doctors are mainly involved in proposals and inquiries of prescription. At such times, belief conflicts are expected to deteriorate teamwork and induce stress. However, there is no strong evidence for this. To clarify factors resulting in belief conflicts, we conducted a survey among 594 pharmacists working at medical institutions in Gifu City and belonging to Gifu Pharmaceutical Association or Gifu Prefectural Society of Hospital Pharmacists between January 2019 and April 2019. The items of the survey were gender, place of employment, pharmacist working experience (years), awareness of “professional competencies for pharmacists” stated in Model Core Curriculum for Pharmacy Education —2015 version—, whether each item of “professional competencies for pharmacists” is applicable to himself/herself or not, whether teamwork deteriorates and stress occurs due to proposals and inquiries of prescription or not, and Assessment of Belief Conflict in Relationship-14 (ABCR-14). The recovery rate of the questionnaire was 50.3% and the valid response rate was 77.6%. Multiple logistic regression and Bayesian network analyses revealed that “I can empathize with a patient's feelings and emotions, but I experience difficulty with unfair criticism” commonly resulted in teamwork deterioration due to proposals of prescription. “Pharmacist working experience years (more than 10 years)” and “The other staff make unreasonable demands of me in the work” commonly resulted in stress. Thus, belief conflicts in therapeutic relationships result in teamwork deterioration and stress in prescription proposals.

The administration of narcotic injections is an effective method of palliative pharmacotherapy for pain management in patients with terminal-stage cancer. Tokuhisa-chuo Pharmacy is therefore involved in supporting narcotic-injection administrations for patients receiving home care medicine. The present study is based on the intervention of our pharmacy from April 2013 to March 2016 through a survey on the status of pharmacist intervention for 99 patients with cancer who were already deceased. The results indicate that in the administration of narcotic injections for 60 patients receiving home care medicine, the median period of narcotic injection was 4 days. The chief reasons for the introduction of narcotic injections were pain management and dyspnea management. The survey was comprised of intervention details and intervention frequencies of pharmacists. The results show that the pharmacists fulfilled a variety of roles, including formulation planning (97％), administration route planning (27％), guidance for patients and their caregivers (97％), and sterile preparations (60％), among others. The present study revealed the active participation of the pharmacy in administering narcotic injections for patients receiving home care medicine. This report constitutes a case study of the handling of home palliative care support by a single health insurance pharmacy.

Terminal cancer patients receiving home care medicine require emergency home visits by a medical professional during sudden changes in symptoms. However, the actual situation of these visits by health insurance pharmacists is yet to be clarified. Therefore, in this survey, we retrospectively analyzed the actual situation of emergency home visits to terminal cancer patients by the Tokuhisa-chuo Pharmacy during a 1-year period in 2020. We included 134 emergency home visits conducted for 76 terminal cancer patients. Results indicated that emergency home visits tended to be more frequently performed closer to the patient’s end-of-life stage. Patients’ symptoms during emergency home visits were predominantly pain, dysphagia, fever, and respiratory and gastrointestinal symptoms. Drugs such as opioids, gastrointestinal drugs, antimicrobials, and antipyretic analgesics were frequently used to control these symptoms. In particular, the number of emergency home visits intending to manage pain and provide opioids significantly increased in the week before death. This survey clarified the need for emergency home visits by health insurance pharmacists in cancer patients receiving home care medicine in their dying stages.