When subacute elderly patients are transferred from an acute hospital to a rehabilitation facility, the likelihood is that the environmental change will decrease the patients' ability to perform the basic activities of daily living (ADLs). In this study, we assessed the effects of the ambient changes on ADLs by the use of the Barthel Index, the reliability as well as validity of which is rated high for assessing the patient's fundamental ability. Our subjects consisted of the patients with hemiplegia who had undergone medical treatment of stroke and those who had been operated on for femoral neck fracture (FNF) in Toride Kyodo General Hospital. They were transferred to the convalescent rehabilitation ward (CRW) of Aida Memorial Rehabilitation Hospital, affiliated with our hospital. We compared the BI scores given to the patients by physical, occupational and speech therapists, when discharged from our hospital, and those scores given by nurses within one week after the patients moved to the CRW. Differences between BI scores given at Toride Hospital and those at the rehabilitation hospital averaged -5.9±16.0 points for stroke patients and -7.3±14.1 points for FNF patients. Spearman's rank correlation coefficient of BI scores in the acute hospital and in the CRW for stroke patients was 0.91 (p<0.001) and 0.69 (p<0.001) for FNF. There was no significant difference in changes in BI scores between stroke and FNF. However, there was a tendency for the patients' functional ability in daily living to be assessed lower in the FNF patients than in the stroke patients. This was probably because the former were older than the latter on the average. The average age of the FNF patients was 81.4 years and that of the stroke patients was 68.5 years.

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  An inquiry was made into the health of 10 one-time asbestos workers now living in the southern part of Akita Prefecture who had taken screening tests for asbestosis on a regular basis. The purpose of this study was to provide pertinent information and better health support to these people at high risk of developing asbestos-related diseases. The average number of years they served as asbestos workers was 11.1±2.12 years and 29.8±4.64 years had passed since first exposure. All the subjects were found to have had no idea about guarding against exposure to asbestos while at work. Neither had they been told to protect themselves from this fibrous mineral by their employers. What motivated them to take examinations for asbestosis was news reports provided by newspapers and other mass media about pulmonary disorders caused by earlier contact with asbestos fibers. Half of the subjects did not know anything about qualifications for receiving the health card for retired asbestos workers. They expressed apprehensions about their health. One subject said, “I may be taken ill anytime,” another said, “The psychological burden of always taking meticulous care of my health is overwhelming,” and still another said, “There is no way of knowing whether I am suffering from asbestosis because there is no symptom.” The latest statistics showed that the number of officially acknowledged victims of asbestos-related pulmonary diseases is increasing across the nation together with the incidence of mesothelioma. To allay the anxiety of former asbestos workers about their health, this study suggested that as the responsibilities of the medical profession, we should (1) get acquainted with the relief system and related laws, (2) help the patients maintain their quality of life by following up the their problems over a long period of time, and (3) continue research activities and make the results public so as to contribute to the relief of the patients.

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  Patients with dysphagia suffer from various degrees of difficulty in eating or swallowing. To improve their oral intake, meals must be provided with due consideration given to individual patient's eating ability. In this study, we examined a newly developed grading system of oral nutrition, which comprised 5 grades (I-V) based on the degree of difficulty in swallowing each formula. Grades I-III are meals suitable for swallowing training, grade IV represents meals that were enough to meet nutritional requirements, and grade V meals for the preparatory stage leading up to the changeover from liquid to solid foods.
  To assess the 5-step grading system of oral nutrition, we worked out average ingestion rates in 23 patients with dysphagia. The ingestion rate was 75±21% for patients on grade IV oral nutrition, and 74±19% for those on grade V, with a combined rate of 74±20%. This was higher than the average ingestion rate in a previous study conducted before our introduction of the grading system for oral nutrition (Journal of the Japanese Association of Rural Medicine 57: 83-88, 2008). We considered the surveillance data showed tendency to support the 5-step grading system, and in a case with dysphagia, this system actually brought about a remarkable improvement in ingestion. It has been introduced in our hospital since July 2008.

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  The purpose of this research was to clarify factors that make early hospital discharge difficult. We found that this hospital was different from other general hospitals. We repeatedly revised early discharge guidelines and were able to find factors reliable about 24% higher.
  Our findings would contribute to the shortening of hospital stay, the promotion of the efficiency of our work, the strengthening of regional alliances. What we should consider most important is the realization of the discharge that is not forced.

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  The Association of Radiologists under the umbrella of the Hokkaido Prefectural Federation of Agricultural Cooperatives for Health and Welfare (Hokkaido Koseiren) set up in 2003 a committee with the aim of improving the accuracy of mass health examinations. Recently, the committee reviewed the results of abdominal examinations by sonography performed at the eight hospitals affiliated with the Koseiren during fiscal 2006 that ended March 31, 2007. Of those individuals who underwent thorough health checkups, 91.3% had their abdomen examined by ultrasound. Something anomalous was detected in 68.1% of the examinees and 4.5% needed to undergo closer checkups, the rate of response to which was 74.5%. The detection ratio of cancer by ultrasonography was worked out at 0.048%. The ratio of patients requiring a closer exam to the total and the cancer detection ratio varied widely from hospital to hospital. The wide dispersion was ascribable to the difference in the standard of judgment for indicating closer examinations and the difference in the number of examinees so far as the cancer detection ratio was concerned, from hospital to hospital. A look at the primary findings of anomalies revealed that fatty liver topped the list accounting for 27.4% followed by cholelithiasis with 3.6%. From this, we realized that the abdominal examinations by sonography served to detect cancer and lifestyle-induced health problems as well. Organ-wise, the cancer cases found during the period from 1998 to 2009 broke down as follows: kidney (79 cases), liver (40 cases), pancreas (30 cases), gall bladder (24 cases), others (8 cases) and spleen (none). The cancer detection ratio per year ranged from 0.03 to 0.05% during the period.

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  The narcotic drug management system using drug information stored in electronic medical cards has been introduced by many medical facilities. The recording of the history of narcotics handling, such as delivery and returning, is essential for the management of narcotic drugs. However, the hitherto used system was hard to use for recording the handling history in detail. The new system developed by us was designed so as to record the handling history including the information on “drug execution (actual administration)” and “drug request (prescription)” in the electronic card with ease. Using the order number and bar code of narcotic drugs in the card, the new system made it possible to prepare the narcotic book precisely and efficiently. The introduction of this system in our hospital has brought about a significant improvement in the management of narcotic drugs.

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[Purpose] To investigate the continuation of exercise and lifestyle in patients with heart disease after cardiac rehabilitation.
[Methods] We conducted a questionnaire survey of 180 patients with heart disease (68.8±8.8 years of age;124 men and 56 women;134 cases of coronary heart disease, 30 cases of open-heart surgery, and 16 cases of chronic heart failure). They were in cardiac rehabilitation for more than 2 months during the period between September 2004 and October 2008. The items on the questionnaire were about continuation of exercise, lifestyle, and the length of hospital stay (24.0±12.3 months).
[Results] A total 138 ex-patients (77%) responded to our survey. Of them, 103 patients (75%) continued to exercise, and 58 patients (56%) were aware that exercise capacity should be improved. Forty-three patients (32%) failed to kick the drinking habit, and 8 patients (6%) were still in the habit of smoking. Nineteen patients were hospitalized again for heart disease.
[Conclusion] After cardiac rehabilitation, almost all patients continued doing home-based exercise.

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