Hyperbaric oxygen (HBO) therapy for acute carbon monoxide (CO) poisoning is performed after oxygen therapy and breathing therapy. The usefulness of HBO therapy in emergency treatment has been reported. In this study, we examined the effectiveness of HBO for CO poisoning that was performed at our hospital over the past 5 years. Subjects were 23 patients who had HBO therapy for CO poisoning in the period January 2008-November 2013. The male to female ratio of the cases was 14:9 and the mean age was 54.6±20.8 years. The cause was suicide in 39.1% of cases and accident in 60.9%. The mean number of treatments was 5.4±6.8. The atmosphere absolute was 2ATA:2.8ATA=12:11. The ratio of direct conveyance of the patient to our hospital to indirect conveyance of the patient from another hospital was 15:8. The effectiveness of HBO therapy at the time of discharge was 73.9%. However, delayed neuropsychiatric sequelae (DNS) was detected in 3 of the 23 cases of CO poisoning. No correlations were found between elapsed time after CO inhalation and various blood parameters. However, time to start of therapy is important for DNS, and our results suggest that early treatment at a hospital with a hyperbaric chamber is necessary.

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　　We investigated whether elderly patients who were treated for proximal femoral fracture and who lived with an elderly spouse in the community were able to return home and walk. We identified 85 patients aged over 65 years with proximal femoral fracture treated between January 2007 and December 2013 who were living with only their spouse. We recorded the number (proportion) of patients who were directly discharged to home and the duration of hospitalization, and their walking ability before the injury and at the time of discharge. We also investigated whether dementia and age affected the ability to return home. Thirty-two patients (36%) returned home directly from an acute care hospital, and 35 patients (83%) returned home directly from a rehabilitation hospital. The mean duration of hospitalization was 31 days (range, 17-71 days) at an acute care hospital, and 61 days (range, 5-143 days) at a rehabilitation hospital. The walking ability of all patients was worse at the time of discharge. Dementia and increasing age were each associated with not being able to return home.

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　　To determine the exact cause of dizziness and/or vertigo, 1000 outpatients were retrospectively studied. The most common diagnosis in all of the analyzed cases was cervicogenic dizziness (89%). Among these cases, 600 (67%) underwent magnetic resonance imaging of the cervical spine, and 542 of these (90%) showed presence of a narrow spinal canal. It was important to measure the anteroposterior diameter of the spinal canal in each case and to have an accurate diagnosis based on diagnostic criteria. Dizziness and/or vertigo develop because of long-term, inappropriate neck posture in the presence of some kind of cervical disease. Triggers of dizziness and/or vertigo were different in men and women and in each generation. In elderly women, the characteristic trigger was long-term farming, gardening, weeding. About 79% of the cases were accompanied by stiff neck and shoulder; therefore, selection of appropriate muscle relaxants at appropriate doses as well as proper advice to patients regarding neck posture and lifestyle are very important in the treatment of cervicogenic dizziness. The results of this study emphasize the importance of cervicogenic dizziness as a cause of dizziness and/or vertigo that are difficult to cure.

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　　We made Inaniwa noodles containing 10% wheat bran (wheat-bran noodles) and investigated their effect on postprandial blood glucose and insulin levels using commercially available conventional Inaniwa noodles (conventional noodles) as a control. In a single ingesting, crossover study of wheat-bran and conventional noodles (dried noodles, 100g), we instructed 40 healthy adult individuals (20 men, 20 women) to eat each type of noodles within 5 min and measured the preprandial and 30-, 60-, and 120-min postprandial blood glucose and insulin levels. Compared with conventional noodles, wheat-bran noodles tended to lower postprandial blood glucose levels, with a significant decrease at 60 min (P=0.0251), whereas insulin levels tended to be higher, with a significant increase at 30 min after the meal (P=0.024). These results suggest that blood glucose elevates slowly when noodles containing wheat bran are consumed. In summary, Inaniwa noodles containing wheat bran effectively suppresses the elevation of postprandial blood glucose levels and may be useful in preventing diabetes or as a staple food in medical nutrition therapy.

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　　We conducted a questionnaire survey of ≥4,000 elderly individuals living in mountainous and hilly areas about everyday situations and analyzed their responses to reveal the role of field work. 　　The analysis revealed that field work greatly influenced activities of daily living (ADL) and the Geriatric Depression Scale (GDS) score in these elderly individuals. We summarized the major results as follows: 　　 ・A group of elderly individuals who were care in the fields had many opportunities to go out, play active social roles, and participate in local activities. 　　・In the same group, improvement was observed in overall ADL scores, but particularly in instrumental ADL. 　　・Depressive tendency was less likely to be observed in elderly individuals who were cared than in those who were not cared. Such intergroup difference intensified among older age groups.

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　　Rapid technological advances in multi-detector computed tomography (MDCT) over the past decade, which now offer a greater number of slices and higher speed of rotation, have made the diagnosis and evaluation of moving organs such as the heart by CT examination possible. To minimize the extra amount of radiation dose to a patient in a CT scan, CT with Auto Exposure Control (AEC) is equipped to control the tube current (mA). However, it is not possible to use AEC for coronary Computed Tomographic Angiography (CTA) because of the complexity of post-reconstruction, and we therefore have difficulty determining the value of the tube current. For this reason, we optimized the radiation dose amount by using the relational expression (SD∝1/mAs1/2) between the radiation dose amount and standard deviation. In addition, the concept of iterative reconstruction can be added to the parts of image reconstruction that use the conventional method of filtered back projection, as a new method of exposure reduction. We anticipate that exposure reduction using this technique can be used to reduce image noise. We tried to reduce the radiation exposure dose using the iterative noise reduction filter and herein report our findings.

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　　In this study, to determine the future direction of nursing, we studied the effect of living with a sibling with a brain disorder using two internet search engines: The Japan Medical Abstracts Society website and the National Institute of Informatics site CiNii. A literature search was conducted by setting the publication time as the period between 1983 and 2015, using “brain disorder”, “nursing”, “siblings” and other terms as keywords. Analysis of 26 articles extracted in our literature search revealed that many of the studies were conducted in the fields of sociology and education and were about stress in the primary caregiver or family members of individuals with a brain disorder. On the other hand, studies focusing on the care of individuals with a brain disorder were about self-care, accidental falls, difficulties and negative feelings felt by nurses who supported individuals with a brain disorder, and caregiver satisfaction or burden scales of family members or the primary caregiver. However, none of the studies investigated siblings of individuals with a brain disorder, who live and age together and whose responsibility is different from that of parents or children, thus requiring different informational and emotional support. Taking into account the special features of individuals with a brain disorder and findings in other academic areas, we believe it is important to establish a system to support the siblings of individuals with a brain disorder, in addition to the direct family members and primary caregivers.

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75-year-old man had the right lower lobe resected because of pulmonary adenocarcinoma (stage IIB) and received 4 courses of postoperative chemotherapy 4 years earlier. Thereafter, he continued to complain of cough, sputum, and progressive exertional breathlessness. The preoperative chest CT showed ground glass opacity (GGO) at the bottom of both lung fields, and over time the GGO changed to honeycombing with traction bronchiectasis. He was administered prednisolone, clarithromycin, and pirfenidone but with little improvement. He exhibited hypoxemia (PaO₂ 56 mmHg) and was admitted. An interview revealed that he had worked in the poultry farming business for 45 years having had contact with and breeding 3,000 game fowl at the time of hospitalization. We suspected bird-related hypersensitivity pneumonitis. Results of the reaction to pigeon dropping extracts (PDE) were high, with PDE IgG 0.697 and PDE IgA 0.445. He was diagnosed with chronic bird-related hypersensitivity pneumonitis. Although the chest CT appearance was difficult to distinguish from that of idiopathic interstitial pneumonia, the test for PDE and the interview were useful for reaching a diagnosis.

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　　We report a case of an epithelioid smooth muscle tumor of low grade malignancy, known as smooth muscle tumor of uncertain malignant potential (STUMP), in a 65-year-old woman. The patient was referred to our hospital because of an abnormal result on screening of the uterus. We initially suspected leiomyosarcoma based on the findings of preoperative medical examinations and tests, so she underwent a total abdominal hysterectomy with salpingo-oophorectomy. The final diagnosis was a tumor with a low malignant potential (STUMP).

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　　A 74-year-old woman who had a past history of two pregnancies and one vaginal delivery and a history of gait disorder and a decline in the activity of daily living (ADL) due to osteoarthritis of the right hip visited a nearby clinic for incontinence. She was referred to our hospital for a cystic mass in the lower abdomen and was diagnosed with cervical cancer stage IIIb accompanied by pyometra in the complete physical examination. Despite disappearance after concurrent chemoradiotherapy (CCRT), pyometra recurred suddenly on post-CCRT day 92 and was accompanied by the hardening of the cervix. Pus was completely drained vaginally on day 92 and 97, but because of the perforation of uterus, the patient underwent emergency laparotomy on day 103. The surgical outcome was satisfactory, and the patient was discharged 7 weeks later. Based on our experience, patients with advanced cervical cancer accompanied by pyometra require careful observation. Especially after recurrence, prognosis may be poor because of the sudden worsening of pyometra and perforation of the uterus. Therefore, in addition to the vaginal drainage of pus, physicians should also proactively perform dilation of the cervical canal, and when this is not possible, it may be necessary to resect the uterus.

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　　In recent years, favorable therapeutic outcomes have been reported for arterial injection chemoradiotherapy for tongue cancer. The present case involves an 80-year-old woman in our palliative care department who had high-grade, advanced tongue cancer. Because there was a request for surgery to prevent airway occlusion due to growth of the tumor, she was referred to our department in April 2009. As a treatment policy for controlling tumor growth in high-grade, advanced tongue cancer, arterial injection chemoradiotherapy was carried out through the superficial temporal artery, with a tongue artery catheter in place on both sides. Therapeutic effect was obtained, and it was possible to avoid airway occlusion through tumor regression. Dysphagia and dysphemia were improved, which in turn improved quality of life. In this case, there was an opportunity to carry out multidisciplinary team medicine, including support from the oral care and palliative care teams as part of the process of cancer therapy. Here, we present our findings in this case.

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　　Here, we report a case of a brain abscess caused by two species of anaerobic periodontal pathogens. In June 20XX, a 45-year-old man visited a nearby clinic for weakness and abnormal sensation in the left arm. He was diagnosed with brain infarction based on head computed tomographic (CT) findings and was prescribed antiplatelet agents. However, he was subsequently referred to our department because of paralysis on the left side and underwent keyhole surgery to release the pus of a brain abscess which was diagnosed based on head magnetic resonance imaging findings. The identify of causal bacteria remains unknown in 30% of patients with an abscess due to anaerobic infection. Therefore, we collected multiple samples to identify the two species of anaerobic periodontal pathogens as the causal pathogens in the present case. The findings of this study suggest that the brain abscess was caused by a bacterial complex with a corn-cob structure that was transported to the cerebral cortex because of periodontal bacteremia in the patient, who had severe periodontal disease. Despite the difficulties in selecting antibiotics and deciding the method of administration, the outcome of a 14-week duration of postoperative antibiotics given with oral care and well-planned dental treatment was satisfactory.

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　　In 2013, the Blood Purification Center of Hospital A established a system to prevent shunt stenosis through team efforts. In addition to reinforcing the monitoring system for early detection and treatment of abnormal shunts, we created an order form for Vascular Access (VA) testing and a scoring sheet for shunt-related troubles by referring to the preexisting form. As a result, there was an increase in the number of patients undergoing contrast imaging for the early phase of shunt malfunction. Performing percutaneous transluminal angioplasty (PTA) for early shunt malfunction led to a reduction in the reconstruction of the shunt because of shunt stenosis. We plan to continue these activities for the early detection and management of shunt-related problems.

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　　We have been working to improve nursing care for patients who are receiving chemotherapy by understanding the feelings of nurses who work in the chemotherapy outpatient unit. Previous efforts to understand the feeling of nurses involved with cancer chemotherapy revealed that they felt anxious about whether their care of chemotherapy patients was sufficient. To clarify their level of anxiety and difficulties faced, structured group interview analysis was conducted in the present study. Based on our findings, a number of nurses reported anxiety and psychological burden, which were classified into four categories: “Unclear how to interact with patients and their families”, “Mental burden of nurses”, “Anxiety handling anti-cancer agents”, and “Problems with human relations”. In particular, nurses were psychologically burdened by feeling unable to provide individual nursing care to patients and their families. The findings suggest that nurses should acquire professional expertise related not only to chemotherapy nursing itself but also to palliative care. A multipronged approach based on interprofessional collaboration is also needed to satisfy the individual requirements of patients who are receiving chemotherapy and their families.

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　　Epidermal growth factor receptor (EGFR) gene mutation examination is now performed in most medical institutions in order to select the molecular targeted medicine for lung cancer. It became clear that the positive rate of the biopsy material was lower than that of the surgical sample in this hospital. The cause was attributed to false negatives due to low tumor cell content in biopsy specimens. We investigated the presence of the mutation using surgical samples and preoperative biopsy specimens from the same patients in 13 cases. Furthermore, we investigated the tumor cell content of the biopsy specimens by cell counting. Results showed that 3 of 6 biopsy specimens that were associated with positive surgical samples were judged to be negative. The tumor cell content was less than 5% in all negative cases. Regarding EGFR gene mutation examination, we should carefully determine tumor cell content when using biopsy specimens.

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　　The employee turnover rate of nurses at our hospital has been higher than the national average. To stabilize the nursing workforce and to decrease the employee turnover rate, we participated in promotion of the 2012 Work Life Balance (WLB) Program organized by the Japanese Nursing Association. In this study, we examined the work-life-study balance (WLSB), adding the activity of “study” to WLB, by evaluating the three activities over a 2-year period. Members tasked with promoting and addressing the issues of WLSB consisted of those in the operation improvement team, Partnership Nursing System (PNS) team, and labor management team. A committee supervised the progress of each team, conducted an index surveillance and a satisfaction survey, and observed changes among nurses who were complaining. A WLSB training course was held for leaders among the staff members. As a result of the PDCA (plan-do-check-act) management cycle being run every 2 months, we achieved the objectives to improve operations and the rate of fulfilling a &ldqup;no overtime day” was improved from 0% to 70-80%. In addition, a &ldqup;birthday day off” and a long vacation were taken systematically, the rate of taking paid vacation improved because of the introduction of paid half-days off, and trainees on the WLSB training course appeared to change, now finding their work worthwhile and enjoyable. The PNS was also introduced. Staff members realized that these results of actions taken were successful, and a positive work climate has been created. The actions taken likely created a comfortable work environment for nurses and accelerated the rate of feeling settled in the workplace by decreasing factors creating dissatisfaction and increasing levels of satisfaction.

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