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Volume 67, Issue 1
Displaying 1-12 of 12 articles from this issue
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REVIEW
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Zen KOBAYASHI, Yoshiyuki NUMASAWA, Shuzo SHINTANI2018 Volume 67 Issue 1 Pages 1-8
Published: 2018
Released on J-STAGE: June 23, 2018
JOURNAL FREE ACCESSWe summarized recent findings regarding the clinical features and treatment of patients with essential thrombocythemia (ET), in particular, those with calreticulin (CALR ) mutations. CALR mutations are frameshift mutations of exon 9, which are mainly composed of a 52-bp deletion (Type 1) or 5-bp insertion (Type 2). ET with CALR mutations is associated with younger age, male sex, higher platelet count, lower hemoglobin level, lower leukocyte count, and lower incidence of thrombosis compared with ET with Janus kinase 2 (JAK2 ) mutations. There is no transformation to polycythemia vera in ET patients with CALR mutations. Patients with ET who have CALR type 1 mutations are at higher risk of thrombosis and myelofibrotic transformation compared with ET with CALR type-2 mutations. The standard treatment of CALR-mutated ET patients is currently based on the treatment algorithm of JAK2-unmutated ET patients. Further studies are necessary to clarify whether the appropriate treatment differs between type 1 and 2 mutations of CALR-mutated ET patients.View full abstractDownload PDF (729K)
ORIGINAL
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Shigeo MORI, Yasue KURUMIYA, Hikaru ONO, Masaru HASHIMOTO2018 Volume 67 Issue 1 Pages 9-19
Published: 2018
Released on J-STAGE: June 23, 2018
JOURNAL FREE ACCESSThe dysphagia diet for hospitalized patients is necessary to ensure their physical stability, and various viscous materials are used for liquid balance. The aim of this study was to evaluate time-dependent modulation of viscous material solutions, measured using the Sine Wave Vibro Viscometer. We also developed an original viscosity index based on the relationship between material concentration and stable viscosity at 5 min after mixing, as stated in the Japanese Dysphagia Diet 2013 recommended by the Japanese Society of Dysphagia Rehabilitation Dysphagia Diet Committee. Comparison of the concentration of viscous materials in the viscosity range 50-150 mPas showed that minimum and maximum concentration was 0.43% and 1.06%, respectively, and these estranged approximate twice. These results suggest that it is difficult to prepare solutions with equal viscosity using different materials, because the materials or diluent for therapeutic diets are different in each hospital. It is expected that the viscosity index will help to raise healthcare professionals’ awareness about the importance of material quantitation and that it will become one of the tools used in nutrition education, dietary intervention, and interprofessional collaboration in healthcare.View full abstractDownload PDF (1255K)
RESEARCH REPORT
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Yuko OOTSUKI, Yoshiko NAKANE, Hisae NAKADA, Hideki SHIMANUKI, Yuko KOK ...2018 Volume 67 Issue 1 Pages 20-27
Published: 2018
Released on J-STAGE: June 23, 2018
JOURNAL FREE ACCESSThe objectives of this study were to investigate current conditions of home care in a depopulated agrarian region of Japan and identify issues that need to be addressed. An anonymous questionnaire survey was distributed, and responses obtained from 244 residents living in a region that has experienced population decline. Results demonstrated that 65.6% of respondents were certified as needing long-term care services, and 64.3% of respondents were receiving such services. More than half of care service users reported that they had used day care services or short-term institutionalization to help meet some of their needs. Satisfaction levels regarding these care services among users appeared to be high. Conversely, 20.5% of respondents reported that they had not used care services because of one or more of the following reasons: “Do not want to be taken care of by others,” “Do not have any need to use these services,” “Have adequate care from family members,” and “Unfamiliar with how to access them.” Female family caregivers reported that they needed the following to continue providing care: “Social welfare and health equipment rental,” “Access to facility-located rehabilitation services,” and “Support from cohabiting family members.” The results of this study suggest that professionals need to consider providing information that is easy to understand about the long-term care insurance system to care recipients in rural areas, including details of available care services and how best to access them.View full abstractDownload PDF (694K) -
Takashi YOSHIMURA2018 Volume 67 Issue 1 Pages 28-36
Published: 2018
Released on J-STAGE: June 23, 2018
JOURNAL FREE ACCESSIn this study, we focused on the dietary habits of residents living in rural areas and investigated the status of dietary habits 10 years after an intervention project. Questionnaires were distributed to 210 people who lived in rural areas. Among them, 109 (53 Seminar group, 56 Exercise group) returned the answer forms. The results showed that subjects in both the seminar group and the exercise group had reduced their frequency of fruit intake (Seminar group, p < .05; exercise group, p < .01) and their consideration of the types of carbohydrate ingested (Seminar group, p < .01; exercise group, p < .05). This was thought to be influenced by factors such as food availability, subjects' physical and psychological factors, living environment factors, and traditional food culture. Eight items that served to sustain desirable dietary habits all seemed to be related to being easy to achieve and easy to continue for the subjects. Individuals with desirable lifestyle habits might return to their original lifestyle eventually. Therefore, even if intervention has been effective, the effects are not necessarily maintained throughout their lifetime.View full abstractDownload PDF (755K) -
Hiroyuki FUJII2018 Volume 67 Issue 1 Pages 37-51
Published: 2018
Released on J-STAGE: June 23, 2018
JOURNAL FREE ACCESSInterprofessional education in the workplace is necessary for effective interprofessional collaboration. Various multi-professional training programs are conducted in hospitals, but their general features are not clear. In this study, we carried out a survey of staff in S Hospital to reveal the types of multi-professional training undertaken and participation rates. The study involved interviews held with 12 staff in the hospital and a questionnaire survey of all hospital staff. From the interview, we extracted 3 types of training (on-the-job training, off-thejob training, and informal activities) and 4 core skills to be learned and/or taught. The questionnaire survey (N = 1325, response rate 56.7%) revealed the main participation rates in training as care team activities 71.2%, freshman training 65.8%, other training in the institute 60.0%, training outside the institute 47.7%, and case discussion 42.9%. Around 90% of hospital staff participated in 1 or more of these trainings. Comparison for each attribute (Chi-square test and residual analysis) revealed that participation rates were as follows: (1) higher in freshman training and lower in the other types of training, the shorter the career of the participant (p < .01); (2) higher in social workers for all trainings, higher in nurses and care workers, healthcare technicians, and therapists for freshman training, care team activities, and training in the institute, and higher in physicians at case discussion and training in the institute (p < .01); (3) higher in chronic care units for all trainings except freshman training (p < .01, p < .05); and (4) lower in non-managerial staff for all trainings except freshman training (p < .01). Thus, multi-professional training can be used as a resource for interprofessional practice and education by determining the general features of these programs and setting common goals for 2 or more trainings. A future study to reveal the characteristics of each training, including informal activities, and the associations between them is warranted.View full abstractDownload PDF (853K) -
Makoto MOTOMIYA, Naoya WATANABE, Takuya KONNO, Keigo YASUI2018 Volume 67 Issue 1 Pages 52-57
Published: 2018
Released on J-STAGE: June 23, 2018
JOURNAL FREE ACCESSIn Hokkaido, the number of work-related deaths has been decreasing owing to increased safety measure implementation. However, safety measures for non-life-threatening injuries are considered to be insufficient. To reveal the status of non-life-threatening work-related injuries in Tokachi district, we investigated patients with work-related injuries who visited the Orthopaedic Surgery Department of our hospital, which has the only Emergency and Critical Care Center in the district, and examined in detail patients who needed multiple operations. All patients in the Department of Orthopaedic Surgery who had worker’s accident insurance were included in this study. We investigated age, sex, occupation, injury cause, injury site (upper extremity, lower extremity, and/or spine), diagnosis, and number of operations. There were 818 cases of work-related injuries and mean age was 47 (16-82) years. Regarding injury site, 482 patients had upper extremity injury, 273 had lower extremity injury, and 123 had spinal injury. Regarding number of operations, 371 patients had operations and 37 (28 upper extremity injuries and 11 lower extremity injuries) underwent operations more than 3 times. In 19 cases, injuries were caused by the primary industry of employment and 14 by a secondary industry; 19 cases were due to the patient being caught in an industrial machine, mostly agricultural harvesters. Severe injury requiring surgery occurred more than 3 times involved complex injury in the upper extremity or open fracture with soft tissue defect. In Tokachi district, severe limb injury is typically accompanied by soft tissue damage and requires long-term treatment including multiple operations. In future studies, it will be important to conduct detailed evaluation of non-life-threatening work-related injuries, including severe limb injury, and to establish relevant safety measures for such injuries especially those occurring in agricultural workers.View full abstractDownload PDF (826K) -
Momoko ARAKAWA, Kazuya HIURA, Tomoaki TANIGUCHI, Ryu KOBAYASHI, Hideha ...2018 Volume 67 Issue 1 Pages 58-64
Published: 2018
Released on J-STAGE: June 23, 2018
JOURNAL FREE ACCESSDirect-acting oral anticoagulants (DOAC) were approved for the prevention of cardiogenic embolism in non-valvular atrial fibrillation in recent years. However, the dosage of DOAC has to be reduced in patients with bleeding tendencies where the risk of hemorrhage is high, and dose reduction strategies differ depending on the type of DOAC. Therefore, we examined the dosage regimens of 4 DOACs (dabigatran, rivaroxaban, apixaban, edoxaban). Among 129 patients treated with DOACs, 85 received the standard dosage and 44 received non-standard dosage regimens. Among the non-standard dosage patients, 6 were taking a high dose (dose reduction was desirable) and 38 patients were taking a low dose (low dose is usually desirable). The low dosage group were significantly older and had a significantly lower CHADS2 score than that of the high dosage group. Hemorrhagic events occurred in 2 patients in the standard dosage group and in 3 patients in the low dosage group. Also, a thrombotic event occurred in only 1 patient in the standard dosage group. About 30% of the patients were on low dosage versus standard dosage. In practice, attending physicians tend to reduce the dose to avoid a hemorrhagic event particularly in elderly persons. However, a hemorrhagic event also occurred with low dosage in this survey. The validity and safety of dosages outside the limits of standard dosage have not been reported even though this dosage method is commonly used in clinical practice. Thus, more data should be accumulated from a large-scale cohort study to clarify this.View full abstractDownload PDF (746K) -
Ayumi SAWAKI, Hiroyuki NEMOTO, Tadahisa TAKIZAWA2018 Volume 67 Issue 1 Pages 65-75
Published: 2018
Released on J-STAGE: June 23, 2018
JOURNAL FREE ACCESSIn the 21st century, the notion that healthcare is a service business has become widespread in Japanese society. Patients now have the option of choosing hospitals. Consequently, many medical institutions implement enlightenment activities to improve the level of hospitality among staff. The Hospitality Improvement Committee at Ibaraki Seinan Medical Center Hospital, comprising members of varying professional backgrounds, has been established to improve healthcare services and hospitality skills as well as provide educational activities. As clinical radiologists, we have also established our own internal committee and incorporated a self-assessment system that individual staff use for routine self-assessment of hospitality skills. After approximately 2 years of engaging in these and other educational activities, hospitality skills among clinical radiologists have improved overall, suggesting the beneficial effect of the activities. However, some self-assessment items show no improvement above a certain level. In this study, we focused on this finding and evaluated the educational activities implemented so far.View full abstractDownload PDF (922K)
CASE REPORT
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Shinya SEKI, Takayoshi FUJIMATSU, Takuya KAKUTA2018 Volume 67 Issue 1 Pages 76-81
Published: 2018
Released on J-STAGE: June 23, 2018
JOURNAL FREE ACCESSEarly diagnosis and treatment of Legionella pneumonia is essential. We examined the clinical features of 9 patients with Legionella pneumonia in our hospital and here we report the characteristics of community-acquired pneumonia in this rural area to facilitate diagnoses of Legionella pneumonia. All patients were male, had low CO2 levels, hyponatremia, and a high creatine phosphokinase levels. Eight patients had high aspartate transaminase and alanine transaminase levels, and 7 had a low estimated glomerular filtration rate. The source of infection was determined in 6 patients: hot springs (n = 4), a refrigerated vehicle (n = 1), and well water (n = 1). Six patients were diagnosed using the urinary Legionella antigen test, and 3 were diagnosed using loop-mediated isothermal amplification (LAMP) of sputum samples. In such patients, it is therefore important to examine urine antigens and carry out polymerase chain reaction analysis (or LAMP) of sputum.View full abstractDownload PDF (672K) -
Akio YASUI, Shingo TAKEI, Akihito OTSUKA, Taeko OKAWA, Ryuichi FUKUYAM ...2018 Volume 67 Issue 1 Pages 82-86
Published: 2018
Released on J-STAGE: June 23, 2018
JOURNAL FREE ACCESSIt has been reported that mucosal defects in the oral cavity caused by resection at a surgical site can be successfully repaired using a polyglycolic acid sheet, an absorbable artificial biomaterial, and fibrin glue spray. We report our experience of a case where bone surface coverage with a polyglycolic acid sheet and fibrin glue after exposure following resection of maxillary gingival leukoplakia led to a good outcome. The patient was a 64-year-old man with a keratotic white lesion on the right maxillary gingiva measuring 22 × 10 mm. He underwent resection of the lesion, which was diagnosed as maxillary gingival leukoplakia. The bone surface was exposed because of the operative extent and was covered with a polyglycolic acid sheet and fibrin glue. Wound healing progressed, and normal mucous membrane was seen at 5 weeks postoperatively. No relapse has occurred, and his progress is satisfactory.View full abstractDownload PDF (5071K) -
Masatsugu ISHII, Junichi SANO, Yuki HIRANO, Hironobu KASHIWAGI, Michih ...2018 Volume 67 Issue 1 Pages 87-91
Published: 2018
Released on J-STAGE: June 23, 2018
JOURNAL FREE ACCESSA 74-year-old woman visited our hospital complaining of pain in the left lower quadrant of the abdomen. Physical examination revealed tenderness to palpation without peritoneal signs. Blood test results showed elevated inflammatory response. Both ultrasonography and computed tomography revealed an intra-abdominal abscess containing a foreign body (fish bone) immediately below the left inferior abdominal wall. Lower gastrointestinal endoscopy conducted under fluoroscopic guidance revealed no intraluminal lesion in the colon adjacent to the abscess, and contrast examination also revealed no communication between the colon and the abscess. Fasting and administration of antibiotics did not improve the symptoms. We planned surgical procedure. Partial resection of the sigmoid colon was performed because of the presence of strong adhesions between the colonic wall and abscess. The postoperative course was uneventful, and the patient was discharged on hospital day 12. Histological examination of the resected specimen showed chronic abscess formation, but no communication between the intestinal tract and abscess. Onset was thought to be chronic in this case, because of uncertainty about the history of ingestion of fish bone and failure to verify any communication with the intestinal tract.View full abstractDownload PDF (2026K)
REGIONAL MEETING
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2018 Volume 67 Issue 1 Pages 92-100
Published: 2018
Released on J-STAGE: June 23, 2018
JOURNAL FREE ACCESSDownload PDF (902K)
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