Purpose : This preliminary study was aimed to investigate potentially beneficial changes in prescription of antibiotics by use of Gram staining in an otorhinolaryngology outpatient clinic.
Methods : This study was done in a single clinic. Changes in the type and amount of antibiotics prescribed, in addition to the clinical outcomes prior to and following introduction of Gram staining, were analyzed retrospectively.
Results : Following introduction of Gram staining in 2005, the costs for antibiotics per person per year decreased to about one-fifth. The number of prescriptions per 100 patients decreased from 20.9 in 2006 to 3.6 in 2012 for macrolides, from 7.9 in 2005 to 2.4 in 2012 for third-generation cephalosporins, and increased from 1.6 in 2004 to 3.9 in 2012 for penicillins. In addition, for every 50 pediatric cases of acute sinusitis, the number of patients to whom no antibiotics were prescribed increased 9-fold and the number of patients to whom 2 or more types of antibiotics were prescribed decreased from 26 to 9 cases, while the mean period in days until resolution was shortened by 6 days.
Conclusion : The results of this pilot study suggest that the use of Gram staining for diagnosis and prescription of antibiotics in an otorhinolaryngology outpatient clinic may lead to significantly improved antibiotic prescription practices. Further study through proper controlled studies are felt to be neceesary.

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Introduction : Outpatient parenteral anticoagulation is not a routine practice in Japan and its experience is limited. We have treated four cases with malignancies successfully in outpatient setting with either unfractionated heparin (UFH) or fondaparinux in patients who failed warfarin or warfarin is not suitable due to frequent need of paracentesis.
Methods : We reviewed four cases which was treated by outpatient parenteral anticoagulation between November 2007 to October 2012.
Cases : Case 1 ; 58 year-old male with pancreatic cancer with DVT/PE was treated with intravenous UFH followed by warfarin. His DVT worsened while he was on warfarin and was switched to subcutaneous (sq) fondaparinux (5mg) with improvement of the DVT. His DVT was successfully managed with outpatient fondaparinux for 23 weeks.
Case 2 : 55 year-old male with lung adenocarcinoma with DVT was initially treated with UFH followed by warfarin with recurrence of DVT. Although sq UFH (20000units twice daily) improved the DVT, hemorrhage occurred when he developed thrombocytopenia due to chemotherapy. Sq fondaparinux (2.5mg) successfully treated the DVT without hemorrhage.
Case 3&4 : 59 year-old female with pancreatic cancer with PE and 68 year-old female with primary peritoneal carcinoma with DVT/PE who needed frequent paracentesis were treated with sq fondaparinux (2.5mg ; 17 weeks) and sq UFH (10000units twice daily ; 6 weeks). They underwent frequent paracetesis without hemorrhage by maintaining the dose on the day of the procedure. The DVT/PE were managed successfully.
Conclusion : Home self-injection parenteral anticoagulation therapy seems safe in Japanese patients and would allow successful outpatient management of VTE. LMWH and fondaparinux may be preferred than sq UFH because of less hemorrhage and require no laboratory monitoring.

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Introduction : The purpose of this study was to investigate the changes in antimicrobial susceptibilities of Streptococcus pneumoniae (S. pneumoniae) to penicillin G (PCG), cefotaxime (CTX), and meropenem (MEPM) in specimens isolated from pediatric patients in comparison to those isolated from adults.
Methods : We retrospectively investigated laboratory records of 1062 strains of S. pneumoniae isolated between 2005 and 2011 at our hospital.
Results : In the strains isolated from children, there was no significant change in the percentage of penicillin-sensitive S. pneumoniae (PSSP). The rate of susceptibility to MEPM was significantly increased, and the rate of susceptibility to CTX was significantly reduced. The percentage of PSSP strains isolated from children was significantly lower than that in the stains isolated from adults.
Conclusion : In S. pneumoniae isolated from children, resistance to cephalosporins is increasing compared with resistance to penicillin and carbapenems. Even in the same region, strains isolated from children have a higher rate of resistance than those isolated from adults.

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Introduction : Japanese elderly men tend to refuse social network even if they need to use them. The objective is to explore Japanese elderly men's perceptions of social network including daycare services.
Methods : Qualitative studies using focused group and semi-structured interviews for elderly men more than seventy-five years old who live in Nagi-cho, Okayama, Japan were conducted.. All interviews were recorded and transcribed. Data analysis was done with modified grounded theory approach.
Results : Three categories were made as internal factors (role seeking, adapt aging), relationship factor (female attendance, staff communication), and external factor (transportation, economy).
Conclusion : By conducting intervention focusing on causes of relationships and external factors inclusive of day care services , it may be possible to improve social involvement of elderly men. 10 proposals were made to government.

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[in Japanese]

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Family medicine is a linchpin of most successful health systems in the industrialized world, and is increasingly being seen as crucial in the current distressed financial climate. Japan has not had a robust family medicine infrastructure, but recently has begun to develop family medicine in several locations around the country. However, few of these programs are adequately training the type of family physicians Japan needs. This article discusses the background of what family medicine entails, an example of what a successful family medicine university program can do, and the potential benefits to Japan in adopting true family medicine.

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Japan has experienced serious nuclear disaster being a country hit by atomic bombs and as well as the occurrence of recent nuclear plant accidents. On the other hand, the Japanese population is exposed to higher dose of medical radiation compared to other developed countries, which is due to increasing number of diagnostic computed tomography (CT) examinations. The correlation between low-dose radiation exposure and cancer risks has been discussed nationwide since Fukushima nuclear plant accident has occurred, whereas cancer risks due to low-dose ionizing radiation from CT scans have been evident in recent large cohort studies. Though CT scan is a valuable diagnostic tool in medical practice because of its high resolution image with speed of scanning, it is crucial to evaluate whether the use of CT is appropriate weighing the benefits and possible risks. Hospitalist is required to have core competency to improve quality of medical care of the hospital and to coordinate with other departments or co-medical workers. In this regard, we discuss how hospitalist could play a role to justify the use of CT and minimize unnecessary radiological exposure, cooperating with radiologists or radiological technologists.

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Recently, there have been many reports of monitor alarm-related accidents, and we believe this is due to alarm fatigue. To solve this problem, we established a transdisciplinary monitor alarm control team (MACT) at our hospital and conducted an intervention study for the Cardiovascular Department ward. We evaluated the number of alarms before and after the intervention and found that the number of alarms decreased from 1,263.4±453.4 before the intervention to 264.1±128.4 after the intervention.

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Introduction : One of the key challenges in promotion of medical and nursing care collaboration in long term care is the difficulty in understanding the current state of acceptance of clients with high medical acuity by local long term care service providers. This study therefore aimed to clarify the current state and issues regarding such clients.
Methods : Information was obtained via face to face interviews at 102 facilities out of 105 located in Area B in Prefecture A.
Results : (1) Most of the facilities, except Long-Term Care Health Facilities, do not have night shift nurses, making it difficult for them to accept anyone who needs a medical procedure, such as tube feedings or sputum suctioning.
(2) The number of the facilities accepting elderly clients who require sputum suctioning decreased after the current regulations came into force, due to lack of human resources to provide the time off for training of the staff, and concern regarding costs of training and equipment given the current provider business environment.
(3) Lack of understanding by physicians appears to be the largest challenge with regards to end-of-life care, and is a larger factor than lack of understanding and experience of the facilities.
Conclusion : Collaboration between medical and nursing care needs to be further enhanced based on clear understanding of roles and reality of the facilities.

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[in Japanese]

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A wide array of natural disasters are known in Japan, but by the disaster category, snow hazards are recorded as the highest or the second highest after floods in casualties in certain years. Through interviews conducted in different regions where damages due to snowfalls are potentially significant, this paper attempts to compare between municipalities as to what kind of issues local governments face in relation to regular snow removals and what approaches they take in response to such issues. Among various snow-related complaints received from the community, those regarding “snow heaps” left behind along the frontages were the biggest concerns. Other complaints included manpower shortage including fewer construction workers who actually do snow removals, insufficient resources and materials, and difficulty in transferring technical knowledge.

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[in Japanese]

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[in Japanese]

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