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We have developed ACTce‑CCM̶ Analysis and Coordination Tools of Clinical Ethics in Critical Care Medicine. The preparation process was carried out in four stages:construct setting and prototype creation, application of prototype version to fictitious cases, clarification of the construct based on focus group interviews, and a fact-finding survey on ethical issues and ethical adjustment. The completed version of ACTce-CCM consists of information organization and assessment frameworks, problem analysis and integration, problem lists, goals, care practices, and ethical adjustment. There are six frameworks for information organization and assessment:pathology and treatment, QOL and QOD, patient intention, family psychosocial situation, medical team situation, and the surrounding situation. The problem lists include those related to the patient, the family, and the medical staff. Goals include those of the medical team and the expected outcomes for the patient/family. Care practices and ethical adjustment consist of three aspects: direct patient care, direct family care, and medical team adjustment.

A 38-year-old woman was referred to our hospital with a complaint of left buttock pain. Contrast-enhanced computed tomography and magnetic resonance imaging showed a 7cm smooth mass on the anterior sacrum adjacent to the small intestine and mesentery. The mass was suspected to be a gastrointestinal stromal tumor of the small intestine;however, a definitive diagnosis from radiological and clinical findings was impossible. Laparoscopic visualization revealed that there was no lesion in the small intestine;the mass situated in the retroperitoneally, in contact with the anterior sacrum around the aortic bifurcation. With a diagnosis of retroperitoneal tumor, laparoscopic resection was performed simultaneously. An incision was made in sigmoid mesentery, and the tumor was detached and resected preserving the anterior fascia of the hypogastric nerve. Intraoperatively the surface of the tumor was confirmed to be smooth, and there was no infiltration around the tumor, which facilitated handling and manipulation of the tumor for resection. The patient was discharged without any complications and the pathological diagnosis was benign schwannoma. Anterior sacral retroperitoneal schwannomas are rare and difficult to diagnose preoperatively. In this case, successfully management was achieved via simultaneous laparoscopic observation and resection.

This study aimed to clarify outcome of the public health nursing practice conducted under the influence of COVID-19. A self-administered anonymous questionnaire survey was performed for 4th grader students at University from 2018 through 2020. The investigation items consisted of basic attributes, impression of public health nurse activity, learning motivation and learning target items. We compared shortened clinical practice and online practice enforced in 2020 and before. For 217 effective answers,＂A public health nurse was involved in practice sufficiently＂ was significantly low. In top learning achievement scores of 2020 included many of the items from the the learning target＂Process of public health nursing activity＂ and ＂Role and function of public health center and municipalities. In 2018 and 2019, learning achievement degrees were over 80% in 94.3% of 53 items while on the other hand it was only 32.1% in 2020. Learning achievement degrees were less than 60% in no items in 2018 and 2019 while it was 15.1% in 2020. For the techniques of health service and health practice for which the learning achievement degree were low in 2020, it is necessary to support students so that they can acquire them as a public health nursing practice ability.

A 52-year-old-man visited hospital with right lower abdominal pain. We diagnosed acute appendicitis and intraperitoneal abscess. We decided to perform interval appendectomy and started antibacterial treatment. Antibacterial treatment was successful and the patient was discharged. Laparoscopic appendectomy was performed six month later. Only thickening of appendix mucosa was found in the specimen, but postoperative pathological diagnosis revealed goblet cell adenocarcinoma(GCA)of appendix. There was a risk factor associated with invasion depth T4, we performed ileocecal resection(D3)one month after the first surgery. The postoperative pathological examination result was pT4aN0M0 pStageⅡ.Recurrence has not been observed 18 months later. This case was an appendiceal GCA which was accidentally found in a specimen after interval appendectomy and treated by additional surgery. Infrequently, there are some reports of acute appendicitis associated with appendiceal tumor. In clinical practice, it is difficult to perform interval appendectomy for all appendicitis cases after conservative treatment, but it is suggested that for complicated appendicitis, we should perform interval appendectomy in consideration of age, ADL, and social background.

Abdominal incisional hernia is a frequent complication of open abdominal surgery. We herein report a rare case in which the left lateral segment of the liver prolapsed as the contents of an abdominal incisional hernia.The patient was a woman in her 80s whose chief complaint was abdominal protrusions. She had undergone abdominal surgery for gallstones 30 years ago. Computed tomography revealed abdominal incisional hernias in the upper abdomen, from which the left lateral segment of the liver and the transverse colon had prolapsed. Laparoscopic hernia repair surgery was performed under general anesthesia. The intraoperative findings showed the adhesion of the round ligament of the liver to the abdominal wall and transverse mesocolon. The prolapsed left lateral segment of the liver appeared as if being pulled upward by the round ligament of the liver and the poor formation of the triangle ligament. Two hernia orifices were repaired using two meshes. Recently, laparoscopic hernia repair surgery is increasing. Laparoscopic hernia repair surgery is useful to observe the abdominal cavity, details of hernia orifice and content, and the check of repair’s completion.

現在, 通信制課程の高校および生徒は増加傾向にある。1990年代以降, 通信制課程においては, 既存の高校教育の教育システムや教育方針を変える新しい教育の模索が行われている。通信制課程の実態を把握することは, 入学者受け入れを見直す上において重要と考え, 全日制課程との比較から通信制課程の進路選択を把握した。結果, 通信制課程の生徒は, 他者との比較の中で生じる能力アイデンティティの揺らぎや自己意識が高校卒業後の進路希望に影響せず, 大人の勧め等の影響を受けながら「高等学校卒業」という目的に向けて自分が選択した学びを進めているようすが明らかになった。

この度, 第51回中国四国大学保健管理研究集会を, 同研究集会当番校として, 本学で8年振りに開催した。昨年の第50回研究集会に続きコロナ禍での開催となり, 医学部附属病院オーディトリアムを配信会場としてのハイブリッド開催という形式で行った。多くの方々の参加・協力を得て, 無事開催することができたので報告する。

山口大学生の日常生活における二酸化炭素排出量を共通教育の「環境と人間」の授業課題からアンケート調査により集めた。電気, ガス, 水道, 燃料, 廃棄物等のエネルギー消費量を基に換算係数を用いて二酸化炭素排出量を算出した結果, 平均値は1.9t-CO2/(年・人)であった。生活に伴う二酸化炭素排出量の電気及びガス項目からの合計は80％以上を占めた。エネルギー総量について学生生活の10 年間の差, 学部による差, 男女の差は, 多少見られたがエネルギー項目に特徴が見られた。1 人暮と家族暮では, 家族暮らしの方がエネルギーを多く消費する事が判明した。また, 家族暮では燃料として灯油, ガソリンの割合が大きく山口大学の立地条件から移動手段として車が多用されている事が考えられる。我が国の家庭部門の二酸化炭素排出量は1.32t-CO2/(年・人)であり(2020年度), 本調査結果の1.86t-CO2/(年・人)は約40％大きいが, 車を使った移動による燃料分を考慮すると妥当であることが確認できた。また電力の換算係数値が10年で約10%の減少に伴い, 二酸化炭素排出量が減少することが確認できた。本調査から山口大学生の生活の二酸化炭素排出量の実態が確認できた。

山口大学留学生センターでは, 学部1年生対象の教養コア系列キャリア教育分野科目「知の広場」において「海外留学」に関する講義を行っており, 2021年度は1000名以上が受講した。受講後に学生が作成したコメントをKH Coderで分析し, コロナ禍における学部1年生の海外留学への意識を探った。その結果, 先行研究で留学の阻害要因と指摘されている費用・留年・語学力といった項目について講義で情報を得, さらに海外留学経験者の体験談にふれることで留学の希望を明確にする例や, 留学はしないが国内の身近な環境での国際交流や新たな経験に言及する例など, 1 年生の段階で留学に関する情報提供を行うことの有用性が示唆された。