Purpose: Prevention of pneumonia in the elderly is an important health issue, and pneumococcal vaccination is thought to be effective in preventing pneumonia. We investigated the effects of pneumococcal vaccination among the elderly living on two islands.
Methods: We conducted a comparison study before and after vaccination. The study subjects (123 men and 229 women) were elderly (age ≥ 70 years), and were living on two islands of Hagi City, Yamaguchi Prefecture. They were vaccinated between December 2008 and February 2009. The pre-vaccination period was from January 1, 2008 to the date of vaccination, and the post-vaccination period, from 4 weeks after vaccination to December 31, 2009. The number of patients who required emergency transportation and outpatient consultation related to upper respiratory infections was recorded, and the numbers were compared between the pre- and post-vaccination periods.
Results: The emergency transportation rate was 0.023/year in the pre-vaccination period and 0.026/year in the post-vaccination period, but the difference was not significant (p = 0.80). The outpatient consultation rate was lower in the post-vaccination period than in the pre-vaccination period (0.49/year and 0.32/year, respectively), but again, the difference was not statistically significant (p = 0.059).
Conclusion: Pneumonia pneumococcal vaccination achieved no significant change in the emergency transportation rate or in the outpatient consultation rate of patients over 70 years of age living on islands. As our study has several limitations in its methods, further investigation of the effects of pneumococcal vaccination is needed.

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Objective: To develop an effective and safe therapeutic strategy, we studied the effect of the clinical characteristics of patients with acute drug intoxication on the duration of hospitalization.
Subjects and Methods: The subjects were 89 patients hospitalized for acute drug intoxication. They were divided into two subgroups; the short hospitalization group (duration of hospitalization < 7 days) and the long hospitalization group (duration of hospitalization ≥ 7 days). We compared age, sex, vital signs, drugs, and therapy between the two groups.
Results: There were no significant differences in sex or severity of consciousness disturbance between the short- and long-hospitalization groups. Age in the latter group was higher than that in the former, and age was significantly and positively correlated with the duration of hospitalization. Prolongation of hospitalization in patients with Japan Coma Scale (JCS) I or II is associated with psychiatric disease, and in patients with JCSIII, with physical disease. We used direct hemoperfusion (DHP) to treat patients with severe acute drug intoxication. The duration of hospitalization in patients treated by DHP tended to be shorter than those not so treated.
Conclusions: The present results suggest that aging is associated with prolongation of hospitalization and the onset of physical disease among patients with acute drug intoxication. When elderly patients with acute drug intoxication are treated in a primary-care setting, the question of whether or not physical diseases are present as complications should be considered. The appropriate use of DHP for the treatment of patients with severe acute drug intoxication requires further study.

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Objectives : Under the rapidly changing healthcare and social environments of individuals with an intractable disease, we identified the current status of supportive activities provided by public health nurses, and challenges in the implementation of seamless support and in the improvement of the quality of support provided by public health nurses.
Methods : A questionnaire survey was conducted by mail among public health nurses stationed at public health centers in Prefecture A, who work with patients with intractable diseases.
Results : The public health nurses surveyed had diverse experiences as to support and clinical care for intractable disease patients, and were in charge of a varying number of such patients within the territory covered by their respective public health stations. As far as knowledge and skill were concerned, not a few public health nurses answered that they were unfamiliar with home mechanical ventilation. They answered that they had experienced difficulties in most aspects of daily practice. Regarding mental health, 50-70% of the public health nurses had experienced difficulties in dealing with patients and their families, and with other healthcare professionals.
Conclusion : Our results suggest that the following main measures are needed to improve the quality of support by public health nurses for patients with intractable neurological diseases: (1) mutual support regarding knowledge and skill among nursing professionals; (2) care in maintaining the mental health of public health nurses; (3) a thorough review of the standard practices and methods of education for public health nurses; and (4) promotion of personnel development focusing on the cultivation of specialized nurses.

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Introduction : In the United States, computerized clinical decision support systems (CDSSs) are being adopted increasingly in primary care. Our purpose is to illustrate the functionality and validity of CDSSs, as well as to discuss the possibility of using them in Japan.
Method : The Department of Family Medicine in the University of Michigan Health System uses a flexible and user-friendly CDSS. In this four-part overview, we examine: 1) integration into work flow in the clinic, 2) response to prompts by the health professionals, 3) content and structure of prompts and reminders, and 4) performance reports.
Results : A CDSS can integrate into a single encounter form preventive and chronic care needs for best quality practice. CDSSs can readily generate clinical care quality and population management reports to support population management and verify best care practices.
Conclusion : As efforts are made to create a viable CDSS in Japan, it would be useful to look at the U.S. example of how a CDSS can both provide clinical decision-making support for evidence-based preventive services and improve the quality of medical practice.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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