著者

北 啓一朗 高瀬 義祥 齋藤 麻由子 黒田 萌 黒田 格 黒岩 麻衣子 山城 清二

出版者

一般社団法人 日本プライマリ・ケア連合学会

雑誌

日本プライマリ・ケア連合学会誌 (ISSN:21852928)

巻号頁・発行日

vol.44, no.4, pp.147-156, 2021-12-20 (Released:2021-12-25)

参考文献数

18

被引用文献数

2

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目的:医師が日常診療で方言をどのように捉え対応しているのかを量的・質的に検討する.方法:北信越地方のプライマリ・ケア医31名を対象にアンケート調査を行い,Steps for Coding and Theorization(SCAT)で質的に分析した.結果:71%は出身地以外で勤務していた.うち81.8%は患者が話す方言が理解できず困ったことがあり,36.3%が方言の意味を取り違えたことがあった.頻出方言として「ウイ」「テキナイ」が挙げられ,様々な症状と解釈されていた.SCATからは①症状を表す方言は文脈により語義が決定し次第に多義的になる②医師は方言を語り直しにより医学用語に変換している③医師は患者との心理的距離に応じて方言を用いていることが示唆された.結論:医師は方言の特徴を理解し状況に応じて適切に使うことで,患者とのコミュニケーションの質をより高められると思われる.

著者

斎藤 清二 北 啓一朗 桜井 孝規

出版者

一般社団法人 日本心身医学会

雑誌

心身医学 (ISSN:03850307)

巻号頁・発行日

vol.31, no.7, pp.587-590, 1991-10-01 (Released:2017-08-01)

被引用文献数

1

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A long-term course of physical and psychological treatment on a patient with laxative abuse was described in this report. A 52-year-old woman was referred to our hospital because of chronic diarrhes, hypokaremia, and general weakness with unexplained cause. Laboratory data showed hypokaremia and high value of plasma renin, angiotensin and aldosterone, which indicated pseudo-Bartter syndrome. Multiple diagnostic procedures on digestive organs including endoscopy and barium study revealed no organic abnormalities. A room search showed a package of laxative tablets (containing bisacody1), and the diagnosis of surreptitious laxative abuse was confirmed. Guide lines of management for this patient were introduced as follows; (1) The target of treatment should not be diarrhea but constipation and abdominal distention. (2) Confrontation regarding laxative use should be avoided until good physician-patient relationship would develope. (3) Psychotherapy would be introduced in a regular shedule. The patient could stop laxative use during the first admission. After laxative withdrawal, severe constipation and idiopathic edema developed. Supportive treatment fron both physical and psychological aspect was continued throughout several admissions and at the outpatient clinic. The patient has been free of laxative and diuretics ato the time 5 years after initial admission. Diagnosis and treatment of laxative abuse are usually difficult because patients often deny their laxative use. Another difficulty is to manage water retention and constipation after withdrawal of laxative. Long-term energetic support from both somatic and mental aspect seem to be essential help the patient give up laxative abuse.

著者

山田 洋子 岡本 祐子 斎藤 清二 筒井 真優美 戸田 有一 伊藤 哲司 戈木クレイグヒル 滋子 杉浦 淳吉 河原 紀子 藤野 友紀 松嶋 秀明 川島 大輔 家島 明彦 矢守 克也 北 啓一朗 江本 リナ 山田 千積 安田 裕子 三戸 由恵

出版者

立命館大学

雑誌

基盤研究(A)

巻号頁・発行日

2008

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質的研究とナラティヴ(語り・物語)アプローチによって、ウィーン、ロンドン、ハノイ、シカゴ、海外4都市の大学において、多文化横断ナラティヴ・フィールドワークを行った。心理学、医学、看護学による国際的・学際的コラボレーション・プロジェクトを組織し、多文化横断ナラティヴ理論および多声教育法と臨床支援法を開発した。成果をウェッブサイトHPで公開するとともに、著書『多文化横断ナラティヴ:臨床支援と多声教育』(やまだようこ編、280頁、編集工房レィヴン)を刊行した。

著者

斎藤 清二 北 啓一朗 桜井 孝規

出版者

一般社団法人日本心身医学会

雑誌

心身医学 (ISSN:03850307)

巻号頁・発行日

vol.31, no.7, pp.587-590, 1991-10-01

被引用文献数

1

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A long-term course of physical and psychological treatment on a patient with laxative abuse was described in this report. A 52-year-old woman was referred to our hospital because of chronic diarrhes, hypokaremia, and general weakness with unexplained cause. Laboratory data showed hypokaremia and high value of plasma renin, angiotensin and aldosterone, which indicated pseudo-Bartter syndrome. Multiple diagnostic procedures on digestive organs including endoscopy and barium study revealed no organic abnormalities. A room search showed a package of laxative tablets (containing bisacody1), and the diagnosis of surreptitious laxative abuse was confirmed. Guide lines of management for this patient were introduced as follows; (1) The target of treatment should not be diarrhea but constipation and abdominal distention. (2) Confrontation regarding laxative use should be avoided until good physician-patient relationship would develope. (3) Psychotherapy would be introduced in a regular shedule. The patient could stop laxative use during the first admission. After laxative withdrawal, severe constipation and idiopathic edema developed. Supportive treatment fron both physical and psychological aspect was continued throughout several admissions and at the outpatient clinic. The patient has been free of laxative and diuretics ato the time 5 years after initial admission. Diagnosis and treatment of laxative abuse are usually difficult because patients often deny their laxative use. Another difficulty is to manage water retention and constipation after withdrawal of laxative. Long-term energetic support from both somatic and mental aspect seem to be essential help the patient give up laxative abuse.

著者

三原 弘 廣川 慎一郎 伊井 みず穂 若杉 雅浩 帯田 孝之 石木 学 岸 裕幸 北 啓一朗 関根 道和 足立 雄一

出版者

日本医学教育学会

雑誌

医学教育 (ISSN:03869644)

巻号頁・発行日

vol.52, no.3, pp.187-192, 2021-06-25 (Released:2021-07-22)

参考文献数

10

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コロナ禍で集合型の医行為訓練が困難となり, 新入生蘇生講習会と基本的診療技能実習をビデオ学修・評価とICTを利用して対面指導なしで実施した. 蘇生講習会は自宅でビデオ学修後に, マネキンを用いて自身の実施を撮影し, 後日Zoomでグループ・ピア評価を行ったところ, 自己評価の有意な上昇が観察された. 基本的診療技能実習もビデオ学修をしながら自身のペースに合わせて実施を撮影し, 後日教員がビデオ評価, フィードバックを行った. 例年四肢脊柱実習は実施できていなかったが, 対面指導がないために, 逆に可能となった. 今後, 学生による動画登録と教員による動画評価のタイミングのずれの調整や更なるシステム構築が必要である.

著者

斎藤 清二 北 啓一朗 高木 由夏 田口 恭仁子 黒田 昌弘 初瀬 リマ 大澤 幸治 渡辺 明治 Paulo R Souza Antonio F.N Magalhaes

出版者

一般社団法人 日本心身医学会

雑誌

心身医学 (ISSN:03850307)

巻号頁・発行日

vol.34, no.6, pp.463-471, 1994-08-01 (Released:2017-08-01)

被引用文献数

1

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Some patients complain of continuous or reccurent abdominal pain associated with high serum levels of pancreatic enzymes but without definite signs of chronic pancreatitis on various examinations including ERCP. CT and US. This condition has been called clinically suggested chronic pancreatitis (CSCP) . In this report, we propose a new pathophysiologic hypothesis and a strategy for the treatment of CSCP based on the viewpoint of system theory and phenomenology. A psychosomatic vicious cycle consisting of the following three processes is often observed in CSCP : 1) A depressive mood and anxiety induce hypersecretion of the pancreatic juice. 2) An elevation of the intraductal pressure resulting from the pancreatic hypersecretion causes abdominal pain and increases in the serum levels of pancreatic enzymes. 3) Exacerbation of the symptoms and the information of the abnormal examination results aggravate the depressive mood and anxiety of the patient. This vicious cycle is considered to exacerbate and prolong the disease in the presence of the constitutional factor of hyperreactivity of the pancreatic exocrine function. On the basis of this pathophysiologic hypothesis, we formulated the following therapeutic strategy from a viewpoint of system theory, focusing particularly on the physician-patient relationship. ( I ) Sufficient medical interview and physical examination ; ( 2 ) examinations needed to exclude malignancies ; ( 3 ) proper explanation of the disease ; ( 4 ) setting control of symptom as the goal of the treatment ; and ( 5 ) administration of anti-depressants, if necessary. In this report, the clinical courses of two cases of CSCP, a 39-year-old female and a 32-yearold male, treated according to this strategy are described phenomenologically, and the validity of the hypothesis and the therapeutic strategy is evaluated.