Cheutzfeldt-Jakob disease (CJD) is a form of prion diseases, including scrapie and bovine spongiform encephalopathy in animals, and kuru, fatal familial insomnia, Gerstmann-Straussler-Scheinker disease and variant CJD in humnans. There have been numerous iatrogenic cases through contaminated pituitary hormones, dural grafts and corneal transplants.
Not only infection control, regarded as one of the major subjects in nursing CJD patients, but other important issues must be also examined; skill improvement in nursing and caring, how to disclose the diagnosis to patients and the family appropriately, mental support for them, respect of the patients'dignity, adjustment of medical environment such as keeping necessary beds and home care medicine.
In this special issue, reviewing the nursing care of CJD patients from past to present, we will examine the way it should be according to the current medical findings. Readers will be able to learn about the latest developments in nursing skills and practical infection control so that they can provide the update information to patients and/or family.

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Creutzfeldt-Jakob disease is a fatal neurodegenerative disorder, caused by abnormal prion. The mechanism of prion disease is still unknown.
We have had first female patient with Creutzfeldt-Jakob disease and cared for her in our neurological ward. We have learned how to nurse patients with Creutzfeldt-Jakob disease. We think that it is preferable to care for each patient in a single room, and should respect the family's opinion, We need to make a practical nursing manual to care for the CJD patients.

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We accepted a woman patient with Creutzfeldt-Jakob disease (CJD) in 1997. In that year, CJD was a hot topic of the journalism, and some employees suggested their resignations in our hospital because of panic for unknown etiology of the fatal infaction, Then, we tried to establish the management manual for CJD patient and made a campaign for education to all employees. The manual indicated strict anti-infection mimicking that of viral hepatitis. In the campaign, neurologist and head nurse emphasised low efficiency of the infection and safety in routine nursing for CJD in spin of restricted manual. The patient terminated after 17 months administration to our hospital without medical accident and resigned person. Although our manual for CJD care may be strict for current standard, accurate practice produced good results to abolish the fear of the employees including the nursing and caring staffs in those days.

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We had an experience in nursing two patients with Creutzfeldt-Jakob disease (CJD). Their bleeding from oral cavity and/or urethral tract had prevented sufficient nursing because of the unknown risk of the infection. In order to break the situation, we have learned about the disease and have discussed the proper nursing care. Consequently we could provide much better care for patients without unnecessary worry about infection. In order to provide good care for patients, a practical manual for CJD nursing must be prepared, that enables all the hospital staff to share the correct information about the disease.

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We presented 3 cases of Creutzfeldt-Jakob disease (CJD), reviewed the reality of nursing using the sheets of nursing plans and studied what it should be. All cases were diagnosed at previous institutions and were introduced to us. They stayed our hospital for 12-18 months for the rest of their lives. With the first case, excessive protection was performed as the core of nursing consistently because of the lack of knowledge about CJD, and the overestimation of the risk for infection. Accumulation of cases enabled us to rationalize the protective measures and to make the nursing plans for patients' hospitality. Learning of the disease and the stance of the physician influenced the contents of nursing plans.

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We experienced three patients with Creutzfeld-Jakob disease (CJD).
Initially, a concern over prion contagion had predominated over nursing for psychological wellbeing of the patients and/or families, and the praxis against prion contagion was often excessive and complicated. After the manual of the CJD commission was revised in 2001, we changed our nursing strategy for CJD patients and prion contagion This change brought effects: the costs for contagion prevention became less, the duty of the nursing staff was reduced, and the psychological status of the patients/families became stable. Our experience indicated that the accurate knowledge of the disease was very important for the effective prevention of priors contagion, and for the good quality of the convalescent environment.

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Kumamoto prefecture has organized the medical network for intractable neurological diseases in 1999, and National Saishunso Hospital was appointed as the principal institution for these diseases with long-term hospitalization. Four CJD cases have admitted to National Saishunso Hospital since 1999, we examined the actual status and problem of nursing management and care for these CJD patients that all were bedridden state (akinetic mutism) in chronic stage. Main management and care were conservative respiratory care, nasal tube feeding, exchanging body posture, observation on urinary catheter every two hours. These nursing cares were performed always using disposable glove, if necessary sometimes using gown, glass and cap. The difficult problem was that having bath for skin care was impossible because of sharing bath with many other patients, therefore CJD patients were toweled every day. The sickroom was always required isolation private room with lavatory for disposal of infectious excretions. The running costs for disposal of infectious medical wastes were expensive 1, 200-1, 600 yen per one patient every day. In future, the practical manual against CJD infection control accepted in the public is indispensable for sake of safety hospitalization of CJD.

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Creutzfeldt-Jakob disease (CJD) is a transmissible neurological disease. Homecare of CJD has been thought to be difficult because of severity of its symptoms and the nature of transmission of abnormal prion protein. Neurology wards in National Hospitals are demanded to provide medical and nursing care for patients with CJD and to introduce homecare of them as an administrative service. We had a first experience of homecare of a patient with CJD. A 62-year-old male had been hospitalized because of Parkinsonism, apraxia, and dementia. Although peripheral leucocytes DNA test showed a familial CJD with mutation of prion gene at colon 232, his symptpms were not severe and developed very gradually comparing with those of a classical CJD. For prevention of transmission of CJD, family member were educated according to hospital CJD management manual. Care manager in local community were informed of the diagnosis and its infectivity. Homecare was successful by care giver's help. The patient could use local day care service and nursing home in short period. In order to manage his symptoms and educate his family corresponding to the stage of the disease, he had been admitted three times and its sum of the period of hospitalization was 88 days since his first admission, 2 years two months ago. Although CJD is a very intractable neurological disease, community based homecare sometimes improves quality of life of CJD patients.

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Creutzfeldt-Jakob disease (CJD) is one of the gravest infectious neurological diseases caused by abnormal prion protein. Through our experiences in caring for patients with CJD, it can be said that many issues remain unsolved, waiting for improvement in various aspects.
In order to clalify current condition and share the common understanding in nursing CJD patients, we conducted a research by sending a questionnaire to fellow national hospitals where experienced nurses specialized in chronic neurological disease are at work. The questionnaire included environmental management, patients' care such as bathing, oral hygiene and nasal feeding, how to prepare and deal with medical equipments, laundry, how to deal with infectious excrement and garbage, how to control infection and what they think is the most important in nursing CJD patients.
From the results it can be said that procedures of nursing care in CJD patients vary among national hospitals. The results indicated the necessity of awareness of current standard practice including effective infection control guidelines for nurses as well as neurologists in the neurological ward. For that purpose an organized educational training programs will be of great help,

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Creutzfeldt-Jakob disease (CJD) is a subacute neurological disease, with dementia, psychological problems, pyramidal and extrapyramidal tract signs, and cerebellar signs. With myoclonus, severe dementia, akinetic mutation later, most patients die within 2 years after onset. Most cases of infectious type of CJD are regarded as iatrogenic. Though family members who take care of CJD patients may not be suffered from CJD, CJD is infectious and adequate knowledge for preventing CJD is quite important. On the hand, excessive protections against patients with CJD must be avoided. Precautions of healthcare providers against CJD, understanding CJD itself, patients with CJD and their family are key issues in nursing care for CJD patients and their family.

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We have tried to construct a patient-oriented system by integrating electrically recorded mediacl sheets, Radiology Informatio Syste (referre t RIS) Picture Archiving & Communication System (referred to RIS) snd Radiology Reporting Syatem. These systems have brought about following resukts, such as having mutual data for electrically recorded medical sheets, improvice for patients, preventing malpractice through patients confirming system and higher productivity.

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