Hospital malnutrition is a therapy dependent disadvantage for the senior patients. However the disease status should resume to normal, patients nutritious status changed into PEM (protein energy malnutrition), and that induce seldom or never sudden death. NST in Showa Hopital assessed the patient nutritional status by checking triceps skinfold thickness (TSF), mid arm circumference (MAC), body weight, body mass index (BMI), total lymphocyte count (TLC), serum total protein, and serum albumin. NST intervention become 65 patients, 42 patients were continued from pervious NST, and 23 patients were newly welcomed. Food taken strategies were 32 from PEG, 14 from PE, 7 from nasal stomach tube, 22 from orally. Male 20 and female 45, Average 82 years old, male 74.5 and female 84.7 years old. Prognostic nutritional index (PNI: PNI=10 x Alb+0.005 x TLC) increased 49 (75.3 %), 22 patients gradated from NST support, and 18 patients dyed, each datum came out of 65 patients cared. NST activity increased the patient status effectively.
In the post-acute phase rehabilitation ward, what is client doing everyday is the rehabilitation. Therefore, we had to grasp their physical and mental stresses all the day. We gave the clients questionnaire, and their results indicated that, they complained the sense of "sleepy", "heavy foot", and "pain" after rehabilitation. We recognized the necessity of post-rehabilitation aftercare. We performed foot care for their complain reduction. The 5 female patients were chosen to receive foot care. They could understand our commands. Their complains came out by walking training with supporting instrument. Two patients administered sleeping tablets before sleep. All 5 clients felt free from stress, and their temperature was warm up until sleep. Two patients who took sleeping tablets could take enough sleep without tablets. We realized that foot care relaxation was effective against their QOL and increased their motivation.
We cared terminal cancer patient who had stoma trouble. A man 63 years old patient had remnant stomach cancer, who could not accept his own stoma. His nursing care trouble #1. No recognition of stoma as stool outlet, Trouble #2. No knowledge about stoma care, Trouble #3. Skin trouble caused by watery stool. Care #1. We toot him to understand stoma as outlet of stool Care #2. We made a sheet of manual. for stoma care. Care #3. We changed the stoma harness and used the gel to protect from skin erosion, thus he observed the skin condition and leaking stool.. As results, he received a stoma. And he made efforts to be independent from the stoma care.
An ALS patient in our hospital had difficulties to communicate because of their progressive deteriorations of speaking and writing. He complained, "Wanna die." and "I would rather die." We tried to talk with a patient using communication software "DENnoSHIN" with a foot-writing sensor. We describe here about DENnoSHIN made not only nurses and wife possible to communicate, but also took a walk to see cherry blossom. Mr. S. M., 77years complained muscle power loss, dysphagia, and dysarthria, those symptoms led diagnosis as ALS at Yamaguchi University Medical School in October 2001. PEG in October 2003, respiratory care after tracheotomy in August 2004. CPAP care at daytime, and SIMV care at night. Before middle of March, he lost his left foot writing because of his lower extremity pain appeared, there after he could not communicate with staff and his wife saying "Wanna die, to be free from this life." We decided to use DENnoSHIN that made us to communicate with him. So we planned to see cherry blossom, as for the first step simulation, we set a portable aspirator for suction sputum on rehabilitation floor, and then he moved in by wheel chair, and tried tracheal sputum suction. On that day of scheduled event, he enjoyed inmates' singing songs and dancing of affiliated nursery school under full cherry blossoms, and his wife felt happy with smiles and saying "We never thought of going out to cherry park hill."
We performed terminal care to a patient at her home with her family. Her name is M, age 90, Care level 4, Aplastic anemia, High blood pressure, Bladder carcinoma suspicion. She was bedridden daylong. The remaining days was one week. We cared her for eight days from November 2 to October 25 in 2007. She lived eldest daughter family. Eldest daughter and second daughter took care of mother by turns for three hours. We coped for 24 hours. 1. Control of pain with many symptoms. 2. Reduction of mental pain for a patient and her family. 3. Support of social economic problem. 4. Spiritual care, about loneliness, separation by death. As a result, we found at-home terminal care need family cooperation. And the family falls into a panic. We got rid of the uneasiness of the family. We did telephone support for 24 hours and let a family feel relieved.
In April 2006, the part of rehabilitation law and the part of temporary nursing at home law were revised. Therefore we started house visit rehabilitation at October 2006. Case report #1. Woman. 70's yo. Cerebral infarction. Right hemiplegia. Stages of finger, upper and under limb were IV grade. ADL-FIM scores was 73 points at preadmission, 109 points at discharge, 115 points at visit rehabilitation respectively. She could not self-excretion at her home since discharge. Therefore, we were training her walk muscle and stability of postural control. And we investigated her house layout. Hence we set up portable toilet at her bed from distance 5m. As a result, she got self-excretion.
Showa Hospital had been opened Power rehabilitation from October 2005. All stuff except us had no knowledge about what to do and how to do with machines for power rehabilitation. We taught preferential 1 nurse and 3 assistances the course of actions, usage and purpose of each power rehabilitation machine. For the client's safety, we put the increased stuff in the support needed place. We also set the room circumstance free of obstacles, and arranged the power rehabilitation flow as Previous, Main, and Afterward sessions. Previous session consisted questionnaire, health check, greeting, and attention-&-explanation. Main session performed warm-up exercises, stretch, machine training, and post rehabilitation physical exercises. For the Afterward session, we held a meeting between a client and stuff. As a result, users increased to total 181 (44.0 persons / day) from total 74 (21.6 persons / day), and nobody fall and no accident until now.
Occupational Therapist in Showa Hospital rehabilitated a 74 years old patient with higher brain dysfunction after cerebral infarction recovery. He desired enthusiastically to go fishing, because he had lost the processes, visual knowledge and technique for fishing. We assessed his state of the higher brain dysfunction and performed occupational therapy. The 1st approach: we watched his apraxia and understood his tendency of errors. The 2nd approach: we showed him the fishing pictures in correct order, and carefully explained them. Then we visualized the knot of fishing line 2 dimensionally. He was capable of understanding 2D illustrations easily; there after he almost returned to a fisherman he used to be.
We cared long-term lying in bed life patient who had disuse syndrome. A man 88 years old, past history is multiple sclerosis, diabetes, ASO, cognitive and paropsis. She has lower extremity sensory disturbance and visual disturbance by diabetes. Thus she cannot do complex workings. Therefore we lessen the burden of her movements and cared that she was able to take a meal independent. Nursing care #1. We introduced a wheelchair with the leg rest and stabilized her posture. #2. We used the anchor support to prevent her unstable sacral. #3. We introduced a cutout table. As results. She can eat a meal neatly without our help. And she regained confidence. And then, she enjoyed a mealtime, she become talkative with smile, And she challenged rehabilitations.
Patients diagnosed their oral intake possibility after video fluorography survey, divided into 2 groups. The 24 patients belonged to eating group and 11 patients belonged to no eating orally group even after rehabilitation. The succeeded to eat group began rehabilitated within 3 months after their causal disease onset, and mostly did not suffered from pneumonia and dementia. No succeeded group mostly suffered from dementia and/or aspiration pneumonia, and 60 % of them delayed their rehabilitation onset to 6 months after their causal disease. The causal disease itself and ages had almost no effect. The important points we noticed were for 1) early onset of rehabilitation, for 2) rapid and correct diagnosis by video fluorography. and for 3) appropriate teaching of oral eating.
We introduced concentrate dental treatment in the general anesthesia. We could perform concentrate radical treatment in a short term by the general anesthesia method. This method does not have to restrict a patient. Therefore, the general anesthesia is one of a superior method in a medical ethic for patients needing restriction. Case I. 24yo. Man. Top right corner molar, lower right molar. And mental retardation by the cerebral palsy. The first operation used the general anesthesia. Inlay restoration formation / impression / bite taking. The second operation used the general anesthesia too. Photo polymerization composite resin restoration / inlay setting. Case II. 52yo. Man. Upper jaw front tooth, lower left molar tooth. And both above knee amputation by Berger disease. The first, general anesthesia. Crown preparation / impression / bite taking / pulpectomy / root canal filling / abutment construction / back teeth extraction operation. The second, general anesthesia too. Bridge setting / casting crown setting. Case III. 48yo. Man. Top right corner premolar. And intellectual level decline by anoxic brain injury. The first, general anesthesia. Management of infected root canals / root canal filling / root amputation / abutment construction / crown preparation / impression / bite taking / extraction operation. The second, no anesthesia. Casting crown setting. Case IV. 51yo. Man. Upper jaw front tooth, lower left molar tooth. And Mental retardation. The first, general anesthesia. Crown preparation / impression / bite taking. The second, general anesthesia too. Bridge wearing.
We started central management of medical equipment from September 2004 at SHOWA hospital. Especially the pumps for medical usage were our target in this report. There are two basic classes of pumps. Large volume pumps can pump nutrient solutions large enough to feed a patient. Small-volume pumps (syringe pump) infuse hormones, such as insulin, or other medicines, such as dopamine. We gave easily understandable lecture about the usage and principle of infusion and syringe pumps. Our effort made possible to improve medical safety and quality. On July 2005, we purchased 5 more infusion solution pumps total 8 and 2 more syringe pumps, total 3. We controlled these intensively. And we gained equal profit the 18 infusion solution pumps.
A hospitalized patient suddenly complained nausea and abdominal pain at 21 o'clock on December 6, 2006. Physical examination indicated that nonlocalized abdominal dull pain, full frat and soft abdomen. At the beginning we treated these symptoms were not acute abdomen, while there was a possibility of mesenteric thrombosis induced by dehydration,, we treated Lactate Ringer with Na+ 131mEq, K+ 4mEq, Ca2+ 3mEq, Cl- 110mEg, and Lactate- 28mEq by adding 25mg of thiamine disulfide, 50mg of pyridoxine hydrochloride, and 0.5mg of acetyl hydroxy cobalamin .and 100mg of Glutathione, the main purpose ware to activate pentose phosphate pathway by inducing less adhesive blood level. Five hours had passed, she complained severe abdominal pain, followed a tumor appeared at the lower right side with a fluttering abdomen might induced by intra-abdominal bleeding.. The operation performed to cut off 1m of jejunum by using laparotomy.
67-year-old man who has a smoking history (25 cigarettes per day for 50 years) with no history of pulmonary disease was admitted to our hospital because of exacerbating exertional dyspnea. Chest X-ray (CXR) on admission revealed reticular opacities with ground-glass attenuation throughout the entire lung fields, and chest computed tomography (CT) showed diffuse reticular opacities and ground-glass attenuation in Transbronchial lung biopsy from right B3 and B8 showed cellular nonspecific interstitial pneumonia (NSIP) pattern. Treatment with high dose intravenous methylpredonisolone (mPSL, 1g per day) for 3days followed by oral PSL (1mg/kg body weight) resulted marked improvement of symptoms, CXR and chest CT findings.
Stimulation of the focused gene by a medicine or a functional protein and to detect mRNA expression levels were very useful not only for the biologically but also for the progress of medical therapy. Furthermore, mRNA transcription suppression by antisense also clearized and made possible the speedy result of the cell biological investigation. We created primer design protocol using fuzzy deducing theory, because the most of the invented computer protocol succeeded less than 20% that was orally been tradition. The 90% of our primers functioned after checking (1. GC Contents Check; 2. Homologous Check: [versus a.: GAPDH, b: Pro-filin, c: Beta-actin]; 3. Self-Homology Check;). We also added 4: 5'-, & -3' homology checking, and 5: gene family checking to target into a real mRNA out of similar sequences. Fuzzy deducing checking protocol made possible to select real VEGF mRNA from gene family in which had to show many similar sequences during alcoholic rat liver fibrogenesis.
Diabetes mellitus, hypertension, hyperlipidemia, and hyperuricemia are called lifestyle related disease. Gene Expression programming might be one of the best programming methods to reconstruct disease tissue histology. The arteriosclerosis represents the terminal state of vascular degeneration depending on long never-ending diabetes, hypertension, and hyperlipidemia. Histological reconstruction might induce the more better disease situation. We created 5 basic commands to control vascular atherosclerosis. One:Beta-oxidation, 2:Activate PPP, and 3:Inhibition of collagen synthesis, those are introduced from Biochemical Expression Programming (BEP). Four: digest collagen is introduced from Gene expression Programming (GEP). Five: Suspend embolism is an example of medicine-expression programming (MEP). We succeeded to decrease the hypotensives by GEP programmed to clean up atherosclerotic blood vessels.
Actin-myosin system in muscle is considered as a nano-size machine. In order to understand the principle of the movement, many theories have been proposed. Among these, we propose new model of Stochastic Inclined Rods Model(DS-SIRM). The features are DS-SIRM are as follows. It has many inclined rods stood out from its body and it moves always forward to one direction whenever those rods are independently vibrating. DS-SIRM can convert the thermal noise to the one directional motion by using stochastic resonance and inclined rods in random open fields. Our aim in this paper is to show directly that the our new improved SIRM model (DS-SIRM), which is proposed in this paper, does agree with the recent experimental data by Yanagida et al. Moreovere, we attempt to explain a role of ATP hydrolysis and a energy consumption.. On the basis of these findings, we discuss on the control and management of the motion in action-myosin system. We discuss first the structure and mechanism of the movement, then show the importance of the manage-ment system of the motion, Finally We estimated concretely the physical characteristics of DS-SIRM as a con-ceptual model of actin-myosin system. Especially the mass, and spring constants and its used energy.
We developed a catheter drive with two rotors that pinch an aspiration catheter between them and incline along the perpendicular of the catheter axis at mutually opposite angles. Rotors are driven with the same torque in opposite directions to minimize residual torque devolving on the patient being treated. The catheter drive enables a flexible 4 mm diameter plastic catheter to be inserted into and withdrawn from a respiratory cannula over 200 mm long at a constant speed of 30 mm/s accompanying catheter rotation. The catheter drive is about 30 g mass, including ajoint to a ventilator and ajoint to a vacuum resource for aspiration. Aspiration tests of 5 types of dummy sputum confirmed the feasibility of aspiration by the catheter drive we developed.
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