Elderly men living alone are susceptible to loneliness, spiritual pain, and distress. However, previous studies of spirituality have been conducted mostly among women and cancer patients. Therefore, this study sought to structuralize spirituality and distress among elderly men living alone. Thirty care managers across Japan discussed the thoughts and feelings they had when providing livelihood support to elderly men living alone, and the content of discussion was structuralized. The data suggest that these elderly men struggle with loneliness, anxiety, and the need for affection, often living a bitter reality. Also, past events affect their present spirituality. However, many care managers still struggle daily to find ways to support elderly men living alone because some elderly men refuse to accept livelihood support and care managers cannot readily access condominium buildings with installed security systems.

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　　In a cohort study of 7,820 elderly residents, we explored whether the priority items of the basic checklist predict new issuance of a certificate of needed long-term care. We analyzed data using Cox’s proportional hazard regression, with new issuance of a certificate of needed longterm care as the dependent variable, need for secondary prevention services (determined by the basic checklist results) and required level of specific health guidance as independent variables, and sex, age, place of residence, and use of long-term care prevention services as moderator variables. 　　The results were as follows. The priority items of the basic checklist to assess need for secondary prevention services were useful for screening in both the younger and older elderly populations. Also, more certificates of needed long-term care were issued to those individuals who received secondary prevention services. Furthermore, partial functional impairment was also significantly associated with issuing a new certificate.

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　　Full-time dispatch of a Certified Nurse in Infection Control(CNIC) from one medical facility to another is uncommon in Japan. Therefore, at the end of a program in which a CNIC from a university hospital was dispatched full time to a municipal hospital for 2 years, we examined the evaluation of the dispatch program by staff of the accepting hospital. Anonymous self-report questionnaires were distributed to all 624 staff members of the hospital. Of 423 (67.8%) recovered forms, 297 obtained from staff who recognized that the dispatched CNIC was a fulltime employee were further analyzed. In total, 276 (93.9%) respondents stated that the program was beneficial for the hospital, 194 (65.3%) stated that the program was too short in duration, 286 (96.3%) stated that the program improved infection control in the hospital, and 234 (78.8%) stated that the program was helpful for their own work responsibilities. In contrast, 3 (1.0%) respondents mentioned that the program tended to interfere with their own work and 22 (7.4%) stated that it needed to be modified. We consider that the program may have contributed to improved infection control at the accepting facility. To confirm the effectiveness of the program, continuous monitoring at the accepting facility will be performed to ascertain whether the same level of infection control is maintained after the end of the program.

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　　The World Health Organization (WHO) recommends antimicrobial use density (AUD) as an indicator for evaluating the amount of antimicrobials used, an index that is now widely employed in many facilities. Defined daily doses (DDD) set by WHO are used for calculating AUD. However, discrepancies have been noted between other countries and Japan in the standard dosage of antimicrobials, which may cause a problem evaluating antimicrobial use with the DDD. Therefore, in this study, we calculated AUD (modified antimicrobial use density: mAUD) with the DDD (modified defined daily dose: mDDD) of our hospital for the carbapenem antimicrobial meropenem (MEPM), mAUD, and resistance rate of Pseudomonas aeruginosa. From 2010 through fiscal year 2016 (ending in March), AUD was 5.9±1.4, 7.0±2.9, 8.2±2.3, 6.8±2.1, 7.3±2.2, 7.0±2.1, and 8.0±3.0 and mAUD was 11.7±2.7, 12.0±4.9, 11.3±3.1, 11.0± 3.4, 11.4±3.5, 11.5±3.5, and 11.2±4.2, respectively. The corresponding resistance rate of P. aeruginosa was 35.1%, 37.9%, 10.0%, 6.0%, 22.6%, 10.6%, and 10.0%. A significant positive correlation was found between mAUD and the resistance rate of Pseudomonas aeruginosa (P < 0.01, r = 0.88). Our results confirm that the mAUD is an effective index for controlling resistance of P. aeruginosa.

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　　An 81-year-old woman with osteoarthritis of the right hip underwent total hip arthroplasty (THA). She recovered satisfactorily and started walking with a T-shaped cane soon after the operation. On postoperative day (POD) 9, she was moved to the regional comprehensive care ward to undergo 2 rehabilitation sessions per day (morning and afternoon, 4 sessions in total), but pain in the anteromedial part of the right tibia started on POD 22. A rehabilitation nutrition assessment indicated sarcopenia caused by aging and lack of caloric intake. As a result of the nutrition management and resistance training after weight gain, the pain around the tibia reduced and she regained the ability to walk using the T-cane. Nutrition management that considers level of physical activity, body weight, and caloric intake as well as collaboration between various divisions in the hospital is thought to be necessary for the improvement of patients' activity of daily living and quality of life.

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　　We report a case of acute renal failure after extraluminal injection of glycerin enema and discuss the side effects of glycerin enema. A woman in her sixties with anal prolapse complained of anal pain after bowel preparation for colonoscopy with administration of 120mL of 50% glycerin enema. She complained of epigastralgia and nausea 2 h after the enema. Brown urine was observed 10 h after the enema, and urine volume was 96mL/day by the next day. Laboratory data revealed evidence of hemolysis and renal dysfunction, and computed tomography showed air and edema around the rectum. Based on these findings, we made a diagnosis of acute renal failure caused by extraluminal injection of glycerin enema. Hemodialysis was performed 6 times over the course of 9 days, and haptoglobin was administered to prevent renal damage from hemolysis. Following this treatment, there was recovery of renal function and this normalized 2 months after the enema.

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　　Mushrooms that had been handpicked were butter-roasted and eaten by six neighborhood residents. All 6 individuals subsequently developed nausea within 60 min to 90 min after the meal. They requested an ambulance and were brought to our emergency department. The ambulance service staff mentioned the possibility that the ingested mushrooms were Lampteromyces japonicus. After admittance, symptomatic conservative treatment relieved the symptoms and all 6 individuals were discharged the next day. However, one patient was rehospitalized due to complaints of abdominal pain and anorexia and another patient was rehospitalized with complaints of vomiting and bloody stool 2 days after initial discharge. In the latter patient, abdominal computed tomography revealed marked wall thickening of the duodenum and jejunum. Typically, the symptoms caused by Lampteromyces japonicus are vomiting, diarrhea, and abdominal pain within 30 min to 3 h after ingestion, but intestinal edema may occur after a few days in severe cases.

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　　Mature cystic teratoma with malignant transformation is a rare disease with an incidence of about 1% among ovarian tumors. Here, we describe how we were able to diagnose pathological tissue preoperatively using colonoscopy. The patient was a 68-year-old woman (gravida 4). She presented with abdominal pain. Her general condition was poor. On examination, we found perforation of an ovarian tumor into the sigmoid colon. Lower gastrointestinal endoscopy was performed and some tissue was retrieved. Pathological analysis of the tissue revealed a diagnosis of squamous cell carcinoma.

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　　Thoracoscopic pleural biopsy is useful when other investigations have not revealed the cause of pleural effusion. We report here a case of rheumatoid pleurisy detected from multilocular pleural effusion mimicking empyema. A 65-year-old man visited our hospital for cough persisting for 1 month and arthralgia for 3 days. He was diagnosed with rheumatoid arthritis after a routine checkup. He had an exudative multilocular pleural effusion with negative cultures. Antibiotic therapy was not effective, and thoracic drainage was not successful because of the multilocular pleural effusion. We then performed diagnostic and therapeutic thoracoscopic pleural decortication. Pathological examination of parietal pleural biopsy specimens revealed only non-specific inflammatory changes. Based on histological and clinical findings, we suspected rheumatoid pleurisy and administered empirical steroid therapy. This therapy produced a complete response and thus the diagnosis of rheumatoid pleurisy was established.

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　　The Department of Plastic Surgery in our hospital uses compression stockings as a preventive measure against deep venous thrombosis (DVT). Elastic bandages are also used in patients with bone protrusion, skin lesions, or with no size-matched stockings. However, elastic bandages are associated with problems such as inconsistent compression force, ready loss of compression, and local skin lesions due to compression. Therefore, to address these problems, we developed a new bandaging technique by layering different types of bandages (multi-layer bandages), evaluated changes in compression using a measurement device, and examined skin condition after 6 h. On average, the compression of elastic bandages and multi-layer bandages decreased by 52% and 37.4%, respectively, after 6 h (t-test, P = 0.036). Skin wrinkles were finer with the multi-layer bandages. These results suggest that multi-layer bandages are less likely to loosen and that cast paddings prevent bandages from compressing the same local areas. However, because previous research warns of using elastic bandages as an easy way to prevent DVT, it is important to acquire accurate knowledge and master skills for bandaging with proper compression.

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