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Volume 65, Issue 5
Displaying 1-19 of 19 articles from this issue
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REVIEW
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Hitomi SETOGUCHI, Ichiro ITOMINE2017 Volume 65 Issue 5 Pages 917-923
Published: January 31, 2017
Released on J-STAGE: March 18, 2017
JOURNAL FREE ACCESSPsychiatric care for schizophrenia has been provided mainly in protected inpatient settings, but a shift to community-based care has been encouraged in recent years. It would be important for patients with schizophrenia to reconcile themselves to living with the disease, and therefore this study reviewed the literature reporting such reconciliation in order to gain useful suggestions for intervention from nurses. A total of 38 studies written in Japanese and English 2 studies were extracted from 6 databases including the Japan Medical Abstracts Society database. The literature examining the patients’ experience of the disease and the significance of the disease showed that patients have the ability to overcome their experience, while the literature examining social stigma revealed that patients are not able to accept their own disease due to the stereotyping of schizophrenia. Also, this study demonstrated that building trusted relationships with people close around them based on understanding and accepting the disease, and thereby living as a member of society, are crucial for patients with schizophrenia to become reconciled with the disease.View full abstractDownload PDF (801K)
ORIGINAL
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Shota TANABE, Shozo YANO2017 Volume 65 Issue 5 Pages 924-931
Published: January 31, 2017
Released on J-STAGE: March 18, 2017
JOURNAL FREE ACCESSThis study investigated the incidence and risk factors for hospitalization-associated disability (HAD) in a rural general hospital. To investigate the incidence of HAD, we compared the activities of daily living (ADL) of inpatients between the time of admission to the Department of General Medicine, Ohchi Municipal Hospital and discharge. We also evaluated nutritional status, cognitive function, blood examinations, presence or absence of care certification at the time of admission, and length of hospital stay in order to analyze the relationship with onset of HAD. HAD was observed in 8 of 53 patients (15%). These 8 patients were significantly older and had lower ADL scores, poor nutritional status, cognitive function, and serum albumin levels. Nutritional status and cognitive function were independent risk factors for HAD in multivariate logistic regression analysis. In addition, all patients with HAD possessed care certification. The incidence of HAD in this study was 15%, which is lower than that reported in other countries. Poor cognitive function and nutritional status appear to be risk factors for HAD, independent of age and ADL at admission.View full abstractDownload PDF (722K) -
Toru FUNAYAMA, Toshinori TSUKANISHI2017 Volume 65 Issue 5 Pages 932-939
Published: January 31, 2017
Released on J-STAGE: March 18, 2017
JOURNAL FREE ACCESSIn a study involving 43 patients with osteoporotic vertebral fracture aged ≥ 65 years, three different therapeutic methods were designed based on a quantitative evaluation of vertebral body instability that used dynamic radiographs taken at the initial visit. Vertebral body instability was defined as the difference between the percentage ratio of vertebral collapse (%) in the standing position and that in the supine position. When the difference was ≤ 5%, no bed rest was prescribed and ambulation was permitted as soon as a Jewett-type hard corset was ready (approximately 1 week). When the difference was between ＞5% and ＜20%, 2 weeks of bed rest was prescribed, after which ambulation while wearing the corset was permitted. When the difference was ≥ 20%, 2 weeks of bed rest was prescribed followed by ambulation, but when pain persisted or rehabilitation showed no progress, treatment was changed to surgery. At 3 months after starting treatment, bone union, degree of improvement of pain, activities of daily living, and quality of life were evaluated. Findings showed that almost satisfactory treatment outcomes were achieved with all three treatment approaches. These findings suggest that while priority should be given to conservative treatment based on a quantitative evaluation of vertebral body instability, the possibility of surgery should also be considered. Particularly in cases with ≥ 20% difference in the percentage ratio of vertebral collapse, surgical intervention at a relatively early stage may help reduce to zero the potential for delayed union, pseudarthrosis, and delayed paralysis.View full abstractDownload PDF (1958K) -
Kensuke SHIZUKUDA, Yukihiko HATA, Norio ISHIGAKI, Tomoaki TAKAHASHI, Y ...2017 Volume 65 Issue 5 Pages 940-945
Published: January 31, 2017
Released on J-STAGE: March 18, 2017
JOURNAL FREE ACCESSRotator cuff repair provides favorable outcomes for range of motion of the shoulder joint and repair of the cuff. However, we often have patients for whom shoulder elevation is difficult due to failure to improve shoulder shrugging motion. This study investigated how the shoulder shrugging motion affects activity patterns of the muscles surrounding the shoulder joint. Subjects were 50 shoulders in 50 young healthy volunteers free from shoulder joint complaints (27 men, 23 women; mean age, 26.3±4.3 years). The subjects were placed in the lateral position with the dominant arm facing upwards and suspended with a sling. They performed two types of movements: forward elevation of the arm with no particular instructions (group N) and forward elevation combined with shoulder shrugging (group S). Simultaneously, the activity of the anterior, middle, and posterior fibers of the deltoid muscle and of the upper, middle, and lower fibers of the trapezius muscle of the dominant upper limb were measured by surface electromyography and compared between the two groups. In the trapezius muscle, upper fiber activity was more enhanced in group S than in group N, whereas lower fiber activity was more strongly suppressed in group S. However, the anterior and middle fiber activity of the deltoid muscle was more strongly suppressed in group S than in group N. Thus, it was observed that an elevation pattern with shoulder shrugging reduces the strength of forward flexion.View full abstractDownload PDF (1996K) -
Yasuyuki SUGIURA, Kazuhisa SAWADA, Masami OKUDAIRA, Rie INATOMI, Norio ...2017 Volume 65 Issue 5 Pages 946-955
Published: January 31, 2017
Released on J-STAGE: March 18, 2017
JOURNAL FREE ACCESSHand hygiene is the foundation of effective infection control in health care settings, including in areas designated for blood collection. However, in such areas, patients are assigned in rapid succession and hand hygiene can lapse due to time pressure. Therefore, we examined a more efficient hand hygiene technique with consideration of these time constraints. An infection control issue was noted during a blood test procedure, based on Kiken Yochi Training. Meetings were then held to discuss the issue and a study was proposed to test a more efficient hand hygiene technique as a solution. The hand hygiene technique involved (1) performing hand hygiene after glove removal, (2) wearing gloves just before directly touching the patient, and (3) concentrating on the finger and hand areas involved in glove removal when performing hand hygiene using a rapid-drying hand disinfectant. These three items were compared before and after the change of procedure using a rapid-drying hand disinfectant. The results confirmed that it is possible to practice efficient hand hygiene by recognizing the areas of the hand that are contaminated during the blood collection procedure. Difficulties involving hand hygiene in a blood collection area include thoroughness in using one glove for one patient and time constraints. We suggest that performing effective infection control is possible by unifying the timing of appropriate hand hygiene with the timing of blood collection.View full abstractDownload PDF (2781K) -
Takeshi UCHIDA, Hiroaki NETSU, Toshihiro HARA, Yoshihiro DOUSAKA2017 Volume 65 Issue 5 Pages 956-962
Published: January 31, 2017
Released on J-STAGE: March 18, 2017
JOURNAL FREE ACCESSRecently, eosinophilic chronic rhinosinusitis (ECRS) has become a very common disease in Japan. ECRS differs from other types of sinusitis in terms of clinical features, such as high rate of recurrence, olfactory disorders, ineffective macrolide therapy, and severe paranasal sinus shadow on CT imaging. The diagnosis of ECRS requires a biopsy of nasal polyps. Therefore, we tried to predict ECRS by evaluating CT images using the Lund-Mackay CT Scoring system (LMS). This retrospective study involved 105 patients who had undergone surgical treatment (ESS) between July 2011 and November 2012. These patients were divided into three groups based on patterns of pathogenesis: ECRS, fungal sinusitis (FS), and chronic sinus infection (CSI). The pathological classification of nasal polyp was graded on a 3-point scale according to the degree of eosinophilic infiltration. Total LMS score for the ECRS was 9.4±0.6 (mean±SE), which was significantly higher than for the other LMS scores (FS: 4.6±1.0, CSI: 5.8±0.2). LMS scores for the maxillary sinus were high for all three patterns of pathogenesis (ECRS: 1.4± 0.1, FS: 1.7±0.2, CSI: 1.3±0.1). The scores for the frontal and sphenoid sinus for ECRS were significantly higher than the scores for the FS and CSI (maxillary sinus, ECRS: 1.5±0.1, FS: 0.4±0.2, CSI: 0.6±0.1; sphenoid sinus, ECRS: 1.4±0.2, FS: 0.2±0.1, CSI: 0.6±0.3). We assessed for and found a positive correlation between the bilateral LMS score and eosinophilic infiltration (rs＝0.665). Therefore, ECRS can be predicted by LMS without biopsy and LMS helps determine the management of chronic rhinosinusitis.View full abstractDownload PDF (913K)
RESEARCH REPORT
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Takuya SHIRAISHI2017 Volume 65 Issue 5 Pages 963-968
Published: January 31, 2017
Released on J-STAGE: March 18, 2017
JOURNAL FREE ACCESSThe relationship between frailty and expectations for comprehensive dementia assessment were investigated in this survey study involving the elderly who required certification for longterm care provision. The participants were 29 elderly individuals who were divided into 2 groups according to whether they were frail or not. They had not been diagnosed with dementia before certification for long-term care provision. Their cognitive function was assessed and those with suspected dementia completed a questionnaire survey on their expectations for comprehensive assessment of dementia. Thirteen participants were frail and 16 were not. The findings of “suspicion of dementia” and “expectations for comprehensive assessment of dementia” showed significant difference between the groups. Frailty may be correlated with suspected dementia but not expectations for comprehensive assessment of dementia. Our study suggests that evaluating frailty in the elderly could contribute to creating a support system for those with dementia and their families.View full abstractDownload PDF (696K) -
Hiroshi NAKAGAWA, Mitsuko USHIKUBO2017 Volume 65 Issue 5 Pages 969-975
Published: January 31, 2017
Released on J-STAGE: March 18, 2017
JOURNAL FREE ACCESSThe purpose of this study was to elucidate the circumstances of patients with amyotrophic lateral sclerosis who were emergently admitted to hospital and to examine problems associated with discharge and transfer. We reviewed medical records for 3 years and identified 4 home discharged patients and 8 hospital transfer patients who had been urgently admitted to the neurology ward of Hospital A. Mean hospital stay was 77 days. All patients received 24-h noninvasive positive pressure ventilation immediately after hospitalization. After a mean 31 days of hospitalization, patients chose medical treatments and/or treatment facilities. Three patients changed to tracheostomy positive pressure ventilation and 2 patients opted for tracheostomy. Four patients had disagreements with their families and needed time to resolve their differences. Between 1 to 6 hospitals were asked to accept each patient for transfer. Decisionmaking about initiation of medical treatment for respiratory failure needs to done in the early stages of illness. Healthcare providers need cooperation between in-hospital and community services and must demonstrate excellent assessment skills to recognize the progression of illness and the patient’s acceptance of illness. In addition, it is essential that healthcare providers possess special support skills when patients are transferred from intermediate institutions to home care.View full abstractDownload PDF (817K) -
Yoshiko YAMANO, Kozue CHISAKA, Saki AMANO, Nanako SAKAI, Maki SAWADA, ...2017 Volume 65 Issue 5 Pages 976-983
Published: January 31, 2017
Released on J-STAGE: March 18, 2017
JOURNAL FREE ACCESSThe impact of health guidance is recently becoming higher quality health services, and the next task is finding ways to establish a system that delivers higher quality services. Institutions that provide health guidance need to improve their services by analyzing the lifestyle habits and health examination results (e.g., BMI and blood pressure) of their clients. This study conducted simultaneous health and dietary habit checkups so that key elements for guidance (e.g., individual dietary habits, population characteristics, and main tasks) could be shared among guidance providers and be utilized for follow-up guidance. Most subjects were in their sixties or seventies, many of whom were diagnosed with obesity and/or dyslipidemia based on health examination results. Dietary habit evaluations revealed high intake of a main dish among both men and women. Intake of a main dish and a sweet snack was particularly high among men. Many subjects who excessively take in both a main dish and sweet snack were obese with a high percentage of saturated fatty acid-derived energy, indicating that this subgroup needs to be prioritized to receive guidance. Those with an appropriate intake of both a main dish and sweet snack might have consumed inadvisable levels of other dietary components, including luxury food items. However, an individual approach is also required to address the risk associated with intake of a low percentage of protein-derived energy. Similar studies in other populations and other communities are needed to assess whether the characteristics revealed in this study are specific to this particular population.View full abstractDownload PDF (886K) -
Training into Daily RoutinesMaki HATANO, Chieko TSUZUKI, Akira SHIBUYA, Kozue CHISAKA, Saki AMANO, ...2017 Volume 65 Issue 5 Pages 984-993
Published: January 31, 2017
Released on J-STAGE: March 18, 2017
JOURNAL FREE ACCESSMuscle training is effective for improving motor function, although withdrawal within 3-6 months has been reported in many cases. Thus, we aimed to establish locomotion training recommended by the Japanese Orthopaedic Association and our own locomotive syndrome prevention training (herein after collectively referred to as “locomotive training”) as a daily routine. Subjects were 30 participants of a training course held in 2014. Nine sessions (including 1 follow-up session) were organized to repetitively teach the importance of locomotive training; participants were instructed to record daily training activities during the course. Duration of oneleg standing balance with eyes open was measured each session so that participants were aware of the effects of the training. At the time of the last session of the course and at the follow-up session, 90% and 83% of participants completed home training twice or three times a week, respectively. Participants reported physical changes such as amelioration of knee pain and ability to put on a Wellington boot while standing on one leg. Also, physical fitness tests performed before and after the course showed significant improvement on the Timed Up and Go test, 30-s chair stand test, and one-leg standing with eyes open after the training course. Furthermore, the locomotive syndrome test resulted in a decrease in the number of participants who were judged to have a possibility to suffer from locomotive syndrome. Taken together, introducing a cycle comprising the three components of motivation-building through lectures, increasing awareness by recording performance, and awareness of the training effect by measuring duration of one-leg standing balance contributed to training continuity and consequent improvement in motor function.View full abstractDownload PDF (891K) -
Naho OHTSUBO2017 Volume 65 Issue 5 Pages 994-1005
Published: January 31, 2017
Released on J-STAGE: March 18, 2017
JOURNAL FREE ACCESSThis study sought to clarify the emotional intelligence of hospital nurses and where emotional conflict control was needed in the clinical setting. Emotional intelligence was evaluated using the Emotional Quotient Scale (EQS). Subjects were around 1000 hospital nurses who were working at a general hospital in 2013, of whom 710 responded. Most of the subjects were female (93.9%) and mean age was 32.8 years (range, 20-61 years). The EQS scores were significantly higher for nurses aged 40-60 years, married nurses, and nurses with children than for other nurses. In regards to where emotional conflict control was needed in the clinical setting, 159 nurses reported that they experienced additional work that was related to shortage of manpower and/or educational opportunities. The EQS scores for these 159 nurses were significantly higher than the scores for the other nurses.View full abstractDownload PDF (837K) -
Kotaro AMEMIYA, Hironori YUZAWA, Shiho MURATA2017 Volume 65 Issue 5 Pages 1006-1010
Published: January 31, 2017
Released on J-STAGE: March 18, 2017
JOURNAL FREE ACCESSAt 22:08 on November 22, 2014, the Kamishiro Fault Earthquake occurred, with the epicenter in Hakuba-mura, Kita-azumi-gun, Nagano Prefecture (magnitude: 6.7, maximum seismic intensity: lower 6). The earthquake was a local disaster with no fatalities. The epicenter was located in the area covered by the North Alps Medical Center, a general hospital with a department of psychiatry. The center conducted activities as established by the Disaster Psychiatric Assistance Team (DPAT) on commission from the Nagano Prefectural Government. Five days after the earthquake, on November 27, the first psychiatric medical team was organized. Team members were 3 physicians, 3 nurses, 1 clinical psychotherapist, 1 psychiatric social worker, and 1 clerk and they were dispatched to safe shelters in Hakuba-mura and Otarimura, areas where collapses houses and other damage was significant. The team conducted its activities in cooperation with the local administrative agencies and health nurses; team support was provided 7 times from November 27, 2014 to January 29, 2015 and disaster mental health counseling was provided 5 times from March 19 to July 16, 2015. Team members were dispatched to locations such as shelters, damaged housing units, temporary housing, and administrative offices, providing support to 69 persons for a total of 88 times. The team provided continuous psychiatric care to victims with suspected sleeplessness, acute stress disorder, and other conditions. Although many victims had mild symptoms, acute stress disorder was confirmed. Here, we report the activities of the team that provided mental care continuously for about 1 year from the early period after the disaster and in cooperation with local communities.View full abstractDownload PDF (783K)
CASE REPORT
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Takako TOBISAWA, Miyuki FUJIMURA2017 Volume 65 Issue 5 Pages 1011-1018
Published: January 31, 2017
Released on J-STAGE: March 18, 2017
JOURNAL FREE ACCESSThe promotion of home-based measures against pressure ulcer is a critical issue in recent medical remuneration, and therefore the provision of reliable, safe, and high-quality medical care while maintaining home-based care is required even for patients with refractory pressure ulcer. This study reports 2 patients with pressure ulcer developed after spinal injury. Both cases were refractory, where assessment and treatment of the ulcer on an outpatient basis did not alleviate the condition for several years. Both patients could move into their wheelchair and drive themselves (daily life independency rank B), and thus they were responsible for ulcer care. When the new charge for management of nursing visits to patients under home-based care was introduced, a certified wound, ostomy, and continence nurse visited the 2 patients together with a visiting nurse. Their collaboration resulted in alleviation and healing of the pressure ulcer. This form of care enabled the underlying factors in daily life that delay the healing of these ulcers to be analyzed and identified, which has so far been impossible to do through outpatient treatment.View full abstractDownload PDF (1963K) -
Ryuichi OHTA, Yoshihiro MORIWAKI, Jun OTANI, Shuzo HATTORI2017 Volume 65 Issue 5 Pages 1019-1022
Published: January 31, 2017
Released on J-STAGE: March 18, 2017
JOURNAL FREE ACCESSWe encountered a case of Japanese spotted fever in Unnan City, Shimane Prefecture. A 77-year-old woman visited our hospital complaining of fatigue. Initially, we diagnosed tsutsugamushi disease based on the constellation of presenting symptoms and clinical signs including fever, systemic erythema, and an eschar. However, the eschar was submitted for polymerase chain reaction analysis and was found to be positive for Rickettsia japonica. The final diagnosis was Japanese spotted fever. To the best of our knowledge, this is the first report of Japanese spotted fever in Unnan City, and there is a possibility that the condition has spread not only in the north of the prefecture but also in the south. This may be due to the widening habitat of ticks harboring R. japonica. Interestingly, the wild boar, a suspected vector, has expanded its habitat to the south of the prefecture. Research on the ecology of the wild boar is warranted.View full abstractDownload PDF (1101K) -
Koji SHIMABUKURO, Haruka MANEYAMA, Tamami ODAI, Takanori YOSHIDA, Taka ...2016 Volume 65 Issue 5 Pages 1023-1026
Published: January 31, 2017
Released on J-STAGE: March 18, 2017
JOURNAL FREE ACCESSWe report a case of subcutaneous port-site hematoma developed on day 6 after laparoscopic left-sided salpingooophorectomy. To start the procedure, three ports were placed in the umbilicus and in each lower quadrant using bladeless trocars. No bleeding was observed at the trocar sites after insertion or withdrawal. The patient was discharged on postoperative day (POD) 3, but returned to the emergency outpatient department with acute left lower abdominal pain on POD 6. Dynamic CT revealed a port-site hematoma with active bleeding from a subcutaneous artery. Hemostasis was achieved easily by opening the trocar wound. Dynamic CT was useful to locate the bleeding vessel and enabled use of a minimally invasive procedure to control bleeding.View full abstractDownload PDF (1142K) -
Asuka IZUMI, Takeshi OGAWA, Atsushi HIRANO2017 Volume 65 Issue 5 Pages 1027-1029
Published: January 31, 2017
Released on J-STAGE: March 18, 2017
JOURNAL FREE ACCESSComplex regional pain syndrome (CRPS) is a disease characterized especially by pain, swelling, limited range of motion (ROM), vasomotor instability, and atrophy of bones in the extremities. In rehabilitation, it is important to suppress excessive sympathetic activity and break the vicious cycle of pain. This is achieved with mild ROM exercise and a mental approach. In this case, the patient had severe pain, swelling, redness, and excessive sweating of the right hand. With alternating warm and cold bath therapy, his symptoms were gradually alleviated. Alternating warm and cold bath therapy may help in the treatment of CRPS.View full abstractDownload PDF (653K)
NURSING RESEARCH REPORT
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Mari BIRUKAWA, Chiharu SATO, Yoko OBANA, Yukiko KATO, Shigeko KIJIMA, ...2017 Volume 65 Issue 5 Pages 1030-1033
Published: January 31, 2017
Released on J-STAGE: March 18, 2017
JOURNAL FREE ACCESSYuri Kumiai General Hospital is a community-based core hospital that treated approximately 14,000 patients in the emergency outpatient clinic in 2014, with approximately 7,800 walk-in patients on Saturdays, Sundays, and holidays. In April 2014, we incorporated an inhospital triage system for walk-in patients on weekends and holidays to quickly diagnose the conditions of patients in a crowded waiting room and promptly treat those requiring urgent care. Furthermore, in April 2015, we introduced the Japanese Triage and Acuity Scale (JTAS) to standardize the quality of triage care. Evaluation and analysis of 7,454 triage forms to identify future challenges revealed that the triage rate was 88% immediately after the incorporation of the JTAS, with 93 incomplete triage forms, 13 undertriage cases, and 18 overtriage cases. This showed that the severity of emergency was determined based only on subjective symptoms and complaints, with no application of objective physical assessment. We presented a list of analysis results to triage staff, further assessed undertriage cases, and provided feedback in monthly workshops. At 1 year after introduction, the rate of triage increased to 95%, with 12 incomplete forms, 9 undertriage cases, and 21 overtriage cases, and the number of cases increased where the severity of emergency was determined accurately from the entire clinical picture including vital signs and the cause of injury. These findings suggest that use of the JTAS enabled a standardized triage system to be established and that the assessment of undertriage cases and organization of continuous workshops improved the quality of triage and the skill of triage nurses.View full abstractDownload PDF (653K) -
Tomoka WATANABE, Mayu SATO2017 Volume 65 Issue 5 Pages 1034-1038
Published: January 31, 2017
Released on J-STAGE: March 18, 2017
JOURNAL FREE ACCESSThe turning on of downlights during nighttime treatment in neonatal intensive care units (NICU) rapidly increases light intensity. Therefore, at Hospital A, we investigated how a change in light intensity from low to high affected 30 premature/low birth weight infants, by turning on downlights in the NICU for 10 s and using a stress scale to compare stress levels before and after the change in light intensity. High-intensity lighting induced tachypnea and brief pauses in breathing, and significantly decreased SpO2 by 0.6% in 58% of the infants. Autonomic stress responses observed in this study were apnea, tachypnea, hiccup, distress, twitching, yawning, and sighing. Motor stress responses were stretching the arms and legs, making a fist, and opening the palm. CNS stress responses were vocalization, scowling, and eye-opening (rapid change from sleep to arousal state). These findings suggest that the change to high-intensity lighting can induce stress symptoms and temporarily suppress breathing, which shortens inspiration as well as the entire respiratory cycle, thereby decreasing SpO2, in many infants in the NICU. Our findings also suggest that a change in light intensity causes stress not only in the autonomic nervous systems but also in other body systems.View full abstractDownload PDF (628K)
REGIONAL MEETING
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2017 Volume 65 Issue 5 Pages 1039-1065
Published: January 31, 2017
Released on J-STAGE: March 18, 2017
JOURNAL FREE ACCESSDownload PDF (1220K)
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