Introduction : To clarify clinical features of influenza A (H1N1) pdm09, we analyzed patients admitted during the early stage of the pandemic.
Methods : Analysis covered pediatric patients hospitalized with this virus during the first 3 months of the pandemic.
Results : The patients (average age, 7.7 years) were older than those in previous analyses and were divided by the reason for admission. The group with respiratory complaints (39 patients) accounted for 40%, in contrast to 10% observed previously, and had a significantly high prevalence of bronchial asthma history (21 patients). Nine patients with dyspnea symptoms preceding fever experienced a shorter period (1.6 days) from onset to admission. These patients had elevated WBC counts (13644/µL) and longer hospitalization (6.0 days). Twenty-nine patients had false negative results in the initial rapid influenza diagnostic tests (RIDTs). Many of them belonged to the respiratory complaints group (20 patients) and developed pneumonia (15 patients). These patients required treatment other than that with anti-viral agents, e.g., oxygen therapy (18 patients), leading to longer hospitalization (4.5 days).
Conclusion : During the first 3 months of the pandemic, many patients were admitted with respiratory complaints. They had a high prevalence of bronchial asthma history. Patients with dyspnea symptoms preceding fever and those who were initially RIDT-negative required advanced treatments, resulting in longer hospitalization.

View full abstract

Purpose : To investigate the desirable communication methods, which can be used during home medical care visits of patients with intractable neurological disorders (INDs) who are unable to use any communication tools (hereinafter referred to as “communication methods”).
Methods : Interview surveys were conducted with the spouses of the patients with INDs who were unable to use any communication tools, and among bereaved family members of patients with INDs to whom home medical care had previously been provided. At the interviews, both voice recording and dictation were utilized to prepare a verbatim record, with which qualitative analyses were later conducted.
Results : In respect of communication methods, three concepts were apparent ; 1) family members who were present during home medical care visits “interpreted” and “inferred” what the patient wanted to convey to the medical care provider, 2) the family and the medical care provider conversed away from the patient in order to reduce patient anxiety and to provide reassurance, and 3) the medical care provider judged the correct timing for communication between himself/herself and the family, and exceptionally in the absence of the patient.
Conclusion : A hypothesis was formulated, which is that “communication with the patient in the presence of the family” is the basic “communication method.”

View full abstract

Introduction : The aim of this study was to determine the significance of the effects of hearing loss and different hearing abilities of both ears on mental activity and social interaction in the elderly.
Methods : Fifty-six community dwelling elderly subjects were included in this study. Hearing acuity was measured and a questionnaire was undertaken in all subjects to evaluate their mental activity and social interaction. Based on the answers, the subjects were divided into (1) 3 groups, according to the level of hearing loss, and (2) 2 groups, according to the differences in hearing.
Results : (1) When hearing by audiometric testing was compared to mental activity, no direct effects were found. Based on the questionnaire results, the subjects in the group with the greatest hearing loss were determined to be psychologically affected, and they therefore avoided social interactions. These patients were at risk of being socially isolated. (2) One group showed differences in hearing abilities of both ears, which could be a possible risk factor for loneliness and depression.
Conclusion : This study suggests that hearing loss and different hearing ability of both ears affects mental activity and social interaction in the elderly. Both depression and being socially isolated are included under the Long-Term Care Prevention Project. It is necessary to determine the degree of hearing loss by using both subjective and objective evaluations.

View full abstract

Objective : The aims of this study were to evaluate the relationship between Nichijo-seikastu-kino-hyoka (NSKH) scores, factors that influenced these scores, and discharge destinations of the patients with motor system disorders who were treated at a Kaifukuki rehabilitation ward.
Methods : The NSKH scores of 184 patients with motor system disorders who were treated in a Kaifukuki rehabilitation ward were evaluated on admission and at the time of discharge.
Results : The subjects whose NSKH scores on admission were three or less were all discharged to their homes. The scores at discharge improved to 0 in more than 50% of the subjects, but the difference in their discharge destinations, depending on their score, was not clear. Multiple logistic regressions were performed to evaluate factors that influenced the scores when the discharge destination was not to their home, which revealed that the number of family members (OR=0.428, 95% CI 0.229-0.797), and NSKH scores at discharge (OR=1.340, 95% CI 1.046-1.716) were influencing factors.
Conclusion : The results of this study suggest that the subjects whose NSKH score on admission was three or less were more likely to be discharged to their homes thereby indicating that their discharge destinations were predictable. The factors influencing their discharge destinations were the NSKH scores at the time of discharge and the number of family members.

View full abstract

Likelihood ratios (LRs) have emerged as one of the most useful means to describe the implications of probabilistic reasoning. Unfortunately, at the bedside, many clinicians have difficulty relating LRs to the more familiar concept of pretest and posttest probability. I propose an easier two-step calculation ; the first uses the prevalence of a particular disease as the pretest probability. If the pretest probability is <10%, it is chosen among 0.1%, 1%, 2%, and 5%, then multiplication by LRs of 110, 11, 5.5 and 2.2 respecively makes the probability 10%.
The second way (McGee‘s method) is to add the pretest probability of 10% to the converted probability from LRs. If the pretest probability is >10%, the second way is appropriate for calculating the probability without the first step.
I hope the simplicity of this method, with no need to use a calculating device, will increase adoption of probabilistic reasoning at the bedside

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract