This study was conducted to clarify the factors that contribute to the continuation of home nursing care. For this purpose, we interviewed family caregivers who had looked after dementia patients at home for more than one year. The patients had been judged to be in need of stage-2 nursing care or above. The interviewees were five family caregivers, sampled by a care support center and a visiting nurse station. They consented to be interviewed after receiving thorough information about the study. The underlying ideas which were regarded as the principal factors involved in continual caregiving from 125 codes they talked about were “a will to care obtained from persons receiving nursing care,” “a hunch that the patient's need would surely be met,” “the amount and quality of support,” “improvement of care techniques about peripheral conditions (complications?),” “acceptance of dementia,” “unpredictable response,” “difficulty in coping with peripheral conditions,” and “insufficient support in an emergency.” It was found that to continue nursing care at home, caregivers surmounted a host of obstables arising from “unpredictable response,” “difficulty in coping with peripheral conditions” and “insufficient support in an emergency” by dint of “acceptance of dementia” and “improvement of care techniques about peripheral conditions.” They were encouraged by “a will to care obtained from persons receiving nursing care” and “the quality and quantity of support” from other members of their families, relatives, neighbors and professionals. These were prime movers behind their efforts to get over the difficulties. They also had had “a hunch that the patient's need would surely be met,” which made them decide to continue home nursing care.

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  We looked into the effects of the specified health examination and health guidance, which was enforced in 2008 in place of the fundamental health examination, and found that there were plenty of problems to be addressed. The changes in the standard range of the specified health examination and checkup items seemed to have been received much more unfavorably than anticipated. In the new health scheme as compared with the previous one, the occasion to perform blood tests for anemia and electrocardiography decreased drastically;there was veritably no funduscopy (ophthalmoscopy?); and the chances that the examinees were told to receive medical treatment or to watch yourself carefully were increased by a large margin. Since the objective of the health checkup was changed greatly, emphasis was placed on the detection of metabolic syndrome in the specified health examination. We thought that the hospitals, affiliated with the Aichi Prefectural Federation of Agricultural Coopeatives for Health and Welfare, had to renew their efforts for the maintenance of the health of local residents and the prevention of disease.

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  Purpose and Background: To attain the goal of the “Operation Zero Asthma Death” implemented by the Ministry of Health, Labor and Welfare, it is essentially important to make the treatment guidelines known widely and make proper use of inhaled steroid drugs at an early stage. That said, in the area where specialists are in extremely short supply, there are limitations to the development of the operation. The Asthma Control Committee organized by the Tono Chapter of the Medical Association in Gifu Prefecture developed a four-layered system of its own for coordination between hospitals, clinics, drug stores and public care facilities. This year is the third year after the system was worked out. In the present study, we examined the results of the asthma control activities. Methods;In the first layer, hospitals and clinics jointly hold lecture meetings to familiarize the treatment guidelines through asthma cards;in the second layer, medical specialists and pharmacists held inhalation workshops for pharmacists in neighborhood drugstores; in the third layer, emergency paramedics joined forces, and in the forth layer, the aim was to build up a collaborative relationship with nursing care workers. The effects of these activities using the four-layered system on the Operation Zero Asthma Death were assessed in terms of the amount of inhaled steroid drugs prescribed and the change in the number of asthma deaths per 100,000 persons. Results: The amount of inhaled steroid drugs prescribed increased almost twice as much as before the start of these activities. It was found that the inhalation workshops were attended by almost all the druggists in the district, thus laying the foundation for the system of inhalation instruction. Through the nursing care support seminars, the collaborative relationship was established. The open lecture meeting held twice for ordinary people were very well attended, thus playing an important role in increasing the knowledge of asthma among the general public. The asthma deaths in the Tono district dramatically decreased from 4.13/100,000 persons for 1998 to 0.81/100,000 for 2008. The death ratio for 2008 was compared favorably with 1.17/100,000 in the whole prefecture for the same year. Conclusion: The results clearly indicated that the four-layered system worked out by the Asthma Control Committee could surely reduce the number of deaths from asthma even in the area where specialists are in short supply.

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Purpose: We examined the safety and efficacy of cataract surgery and postoperative management in our hospital and at the homes of the patients who live on medically underserved remote.
Patients and methods: A total of 27 patients (54 eyes), who were followed in our hospital or at their homes were enrolled in this study. Cataract surgery was performed on them between January 2009 and January 2010 and we could follow up six months postoperatively. We divided these patients into two groups:group I (GI) consisted of 13 patients who could come to our hospital regularly during both preoperative and postoperative periods, and group II (GII) consisted of 14 patients who could not come to our hospital regularly during either preoperative or postoperative periods. Cataract surgeries were performed on all the patients in GI and GII in our hospital. The patients in GI were hospitalized for three days and those in GII were for seven days. After cataract surgery, the patients in GI had their eyes checked regularly in our hospital and those in GII were in their homes where the doctor visited. Postoperative ophthalmic clinical tests were conducted to examine visual acuity, intraocular pressure and fundus.
Results: GI comprised three males and 10 females. Their age averaged 79.3. GII comprised four males and 10 females. Their age averaged 82.6. Preoperative ophthalmic examinations found that preoperative average visual acuity (LogMAR and decimal visual acuity in parentheses) and spherical equivalent in GI and GII were 0.69 (0.41), 0.80 (0.33) and -0.43 dioptors, -0.42 dioptors respectively, showing no significant differences between the two groups. Postoperative ophthalmic examinations found that, best corrected visual acuity (LogMAR) was significantly increased to 0.36 (0.66) and 0.44 (0.53) in GI and GII respectively, showing no significant differences either.
Conclusions: We concluded that we could get safe and efficient cataract surgery and postoperative management combined with prolonged hospitalization and house calls on the patients who live in the isolated islands.

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  In hopes that inpatients can enjoy meals without worrying about foodstuffs, our hospital started buying more local fresh produce in January 2005 tuning in on the popular “Buy Local Produce” movement. We, employees of a hospital affiliated with the Federations of Agriculture Cooperatives for Health and Welfare, think it very important to support the movement, contribute to the improvement of the self-sufficiency in food and maintain good relationships with rural communities. The advantage of local produce is its safety. We can use it with a sense of security. At present, 10 farmers, who are members of the JA Isehara Co-op, deliver vegetables to the hospital. Initially, the hospital bought what they offered, but recently they grow vegetables of the kind the hospital wants. Now, local produce accounts for about 30% of the total value of the vegetables the hospital buys. However, prospects do not warrant any optimism, because the average age of the producers is 56 and it is not easy to increase the number of producers now. As far as items unavailable from the present producers are concerned, we have begun to buy these items from non-member farmers.

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  A 67-year-old man was admitted to our hospital because of right lower abdominal pain. Abdominal CT scan showed swelling and hypertrophy of the appendix wall and presence of a low density area near the appendix. We thus diagnosed this case as acute appendicitis with abscess and performed an emergency operation. When laparotomy was done, we observed the swelling of the appendix, and a mass bordered on the appendix which adhered tightly to the jejunum. The patient underwent appendectomy and partial resection of the jejunum. A pathological examination revealed mucinous adenoma of the appendix. The mass bordered on the appendix was mucocele. The mucocele adhered to the jejunum and the mucus infiltrated to the muscularis propria of the jejunum. He had an uneventful post operative course and was discharged from our hospital on the 12th postoperative day. Mucinous cystadenoma of the appendix adhered to the jejunum is very rare and we report our case with some literature review.

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  This research was performed with the family assessment tool at critical and emergency care settings (CNS-FACE) as a standard tool at the ICU of Hospital A. It clarified changes in the awareness and practice of family support by staff in order to obtain clues to how to provide family support in the future.
  Initially, a briefing session was held to acquaint nurses with CNS-FACE. A total of 28 nurses assigned to the ICU were invited to the session. They were informed of the importance of using CNS-FACE to understand the family needs and coping. The staff members were requested to use CNS-FACE to obtain an objective assessment of patients' families selected at random by the nursing research members. Subsequently, questionnaires were distributed to investigate the changes in the nurses' awareness. Those who reported a change in relationship with the families after using CNS-FACE accounted for 100% of the nurses with one to three years' experience, 64% of the urses with four to six years' experience, and 50 % of the nurses with seven or more years' experience. An understanding of the 46 items in CNS-FACE was thought to lead to more positive intervention awareness. It was believed that this would result in a reduction in stress for nurses providing family nursing and to bring about a change in their awareness of family nursing, irrespective of their number of years of nursing experience. CNS-FACE gave the nurses with one to six years' experience with an objective understanding of needs and coping and changed their awareness of family nursing. A change of awareness was achieved by 50% of the nurses with seven or more years' experience. Over 60 % of the staff members recognized CNS-FACE to br effective for family nursing.

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  Recently, the medical incident reporting system has been used in many hospitals and strategies for prevent accidents from occurring are being put in place. During the period of three months from April through June 2008, a total of 36 incidents were reported in our hospital. Of the total, 15 incidents (41.6%) took place owing to personnel's inattention. Our way of taking preventive measures was reactive, and we tended to become oblivious of the latest accident over time and repeated the same mistake. In order to maintain our consciousness on accident prevention, we have recently started using 10 minutes during the morning assembly to remind ourselves of what we should do -- such as identifying patients, confirming injections and medications, and exchanging needles -- through role-play and questions and answers. Three months after this practice got started, the number of the accidents due to inattention reduced to seven cases. In response to a questionnaire survey, almost all the nurses said that the repeated practice helped raise their awareness of accident prevention. The use of 10 minutes in the morning for accident prevention enabled them to start their work with their seat belt fastened. We thought this also contributed to accident reduction.

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Purpose: We examined the effectiveness of intervention by orthoptists (ORTS) to 3-year-old infant health examination at Yanai Health Center and Shuto General Hospital to detect visual abnormalities.
Case and methods: Forty-eight children were enrolled in this study. Their parents had wanted to have the children examined by ORTS in the 3-year-old infants health examination in Yanai Health Center or in the Department of Pedeiatrics of Shuto General Hospital from July 2009 to February 2010. At the Yanai Health Center we questioned their parents about the results of their children's visual acuity test at home and other ophthalmological abnormalities. After questioning, we re-examined the visual acuity of the children who did not have enough visual acuity of 10/20 at home with the 2.5 meters visual acuity test. On the other hands, at Shuto General Hospital, we conducted the 2.5 meters visual acuity test with the test of refractive error, ocular alignment and binocular vision. After these ophthalmic examinations, we questioned the parents abour the efficacy of intervention by ORTS in the health examination.
Results: Eight children (16.6%) needed closer ophthalmic examinations. Three children with hyperopias, and one with anisometropic amblyopia were found. The parents recognized the importance of intervention by ORTS in the ophthalmic screen test. The questionnaire survey revealed that almost half of the parents were afraid of there visual acuity test by themselves at home.
Conclusion: We concluded that we find out critical ophthalmic disorder such as refract error which lead to amblyopia by the intervention of ORTS or ophthalmologists in the health screening in Yanai, Yamaguti.

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