Awareness surveys on children with allergic diseases observed during infant medical examinations have been reported. However, there have been no such surveys on pregnant women with allergic diseases. Questionnaires were distributed to 255 pregnant women who participated in infant care training at our hospital between April 2005 and March 2016. We investigated food allergy (FA) and atopic dermatitis (AD) awareness among the women. They were separated into primigravida or multipara groups. Women who worked as medical personnel and those with incomplete responses were excluded. A total of 239 women responded, with a response rate of 94%. We enrolled 180 primigravidas and 42 multiparas in this study. No significant differences were observed in median age (interquartile range) between the groups: 30 years (26-34 years) and 30 years (20-41 years) in the primigravida and multipara groups, respectively. In the primipara group, 61% women responded that the diagnosis of allergy was made from blood examination, and 64% of the multiparas responded that the diagnosis was by oral food challenge and skin testing, which showed significantly greater immediate reaction (p < 0.001, respectively). Also, 55% of the multiparas reported that improved skin care without eczema prevented the development of AD, which was significantly less than the 71% of primigravidas (p = 0.02). Significantly fewer multiparas (17%) than primigravidas (36%) were unable to use steroid topical medication for eczema (p < 0.01). Our results suggest that it is important to provide pregnant women with accurate information on the diagnosis of FA and treatments for AD.

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　　Ibi Welfare Hospital covers a local town that has an aging population, and the development of a community-based integrated care system is an important issue. We have established and are operating a regional integrated NST system to maintain oral nutrition intake essential for daily life and prevention of pneumonia in this area, and here we report on outcomes and future issues. In this study, we investigated the regional integrated NST system (NST outpatient · NST hospitalization · NST visit) and examined dissemination of its service. Data was collected from February 2016 to March 2017. The investigation involved the following: (1) extraction of survey results of latent NST subjects and retrospective investigation of medical records; (2) expansion of NST outpatient services (examinations by surgeons, endoscopic evaluation of swallowing function, blood tests, dental examination, and evaluation by a dietician speech-language-hearing therapist, and return of a joint report created by the individual professionals to the introducing professional); and (3) introduction of NST hospitalization (2-week hospital stay for local inclusion sickbed care, introduction of swallowing passport, initiation of rehabilitation, oral care roundtrip, NST roundtrip, personnel care meetings with home staff, and introduction of visiting speechlanguage-hearing therapist rehabilitation to support home care after discharge). To increase awareness of this system, we visited the local nursing care insurance agency and welfare hospitals and tried to obtain cooperation through transparency. Introducing and initiating this regional integrated NST system “Ibi Model” revealed that the system is greatly needed in our region. We think that it has the potential to become a key supporting tool for the home-based medical care system within the regional comprehensive care system. Further verification is needed to assess real outcome changes such as a decrease in the incidence of pneumonia and improvement in quality of life.

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　　Knee swelling after total knee arthroplasty (TKA) is common and can lead to loss of functional performance. The aim of this study was to reveal the factors related to knee swelling after TKA. In total, 86 patients who underwent unilateral TKA were enrolled. Changes in thigh circumference at 0, 5, and 10 cm proximal from upper pole of the patella were evaluated. In addition, age, body mass index, operation time, blood loss volume, C-reactive protein, albumin, and D-dimer levels, and changes in knee flexion were also assessed preoperatively and at 7 days postoperatively. Thigh circumference at all sites increased postoperatively. Changes in thigh circumference at the superior edge of the patella correlated with changes in knee flexion (r =－0.33, p < 0.01). No significant correlation was found between the other factors. In conclusion, this study revealed a correlation between swelling and flexion after TKA, but no correlation between other factors pre-, intra-, or postoperatively. It is thus necessary to consider other factors in the future.

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　　The aim of this study was to determine the current situation in a rural community that is actively engaged in establishing a community-based integrated care system, especially for dementia, despite the community being at risk of becoming a marginal village. Six medical, longterm care, or welfare professionals in a rural area of City A, Gifu Prefecture were interviewed from May to September 2017 on the current status and challenges faced in establishing a community-based integrated care system for dementia. Qualitative data was structured by thematic analysis. Volunteer activities by long-term care facilities and an Osekkai (unsolicited) network comprising community specialists, social workers, and residents appeared to be foundational to the community-based integrated care system in the area. The key shared concept was that the intentional and proactive involvement of active elderly individuals as volunteers in community activities helps to prevent them from becoming dependent. Challenges to be addressed were providing these elderly individuals with opportunities to discuss their ideal final stage of life and to understand advanced care planning.

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　　Since fiscal year 2015, our hospital has conducted regular hospital inspections by a medical engineer (ME). About 1 year after the start of this inspection, fungi and common bacteria were detected, so we searched for the cause and report here successful cleanup of the incubator. When the incubator was cleaned during a periodic inspection, the ME discovered that dirt mainly adhered to the fan and the bed rest. Also, fungi were detected from the fans, so the ME cleaned and disinfected all the fans and then switched to a process of washing the central supply room. Following this process, bacteria were no longer detected from inside the incubator, but they have been consistently detected from the fans. We have no reported cases of patient infection, and we believe this is because the ME is responsible for periodic cleaning against bacteria and for conducting inspections. This demonstrates that successful cleaning of the incubator led to control of the spread of infectious diseases.

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　　Palonosetron, a second-generation 5-hydroxytryptamine 3 receptor antagonist (5-HT3RA), has a higher binding affinity for the 5-HT3 receptor and a longer half-life than the first-generation 5-HT3RAs. The efficacy of palonosetron as prophylaxis for chemotherapy-induced nausea and vomiting has been reported. However, there are no reports of efficacy in patients with failure of antiemetic prophylaxis. In this study, we retrospectively investigated the efficacy of palonosetron used in subsequent chemotherapy cycles in patients with failure of antiemetic prophylaxis. A total of 50 patients were included from August 2010 to January 2013; 27 patients received highly emetogenic chemotherapy and 23 received moderately emetogenic chemotherapy. Antiemetic was switched from granisetron to palonosetron for all patients. The proportion of patients who experienced reduced severity of nausea were 60% in the acute phase, and the proportion of patients with reduced severity of nausea and vomiting were 90% and 66% in the delayed phase, respectively. The proportion of patients who used rescue medications decreased from 48% to 24%. We confirmed improvement of chemotherapy-induced nausea and vomiting by switching from granisetron to palonosetron in patients with failure of antiemetic prophylaxis.

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　　The predicted rate of compliance with the Guidelines on the Management and Treatment of Glucocorticoid-induced Osteoporosis is around 20%. The notion that the occupational abilities of pharmacists could be useful in management and treatment of this iatrogenic disease led to a nationwide questionnaire survey of 102 Kosei Hospitals on the treatment of glucocorticoidinduced osteoporosis. In total, 67 hospitals responded (response rate, 65.7%). Analysis revealed that hospital pharmacies did not have a clear view on managing patients with a history of longterm steroid prescription. However, pharmacists had made proposed changes to prescriptions for preventing glucocorticoid-induced osteoporosis in approximately 30% of hospitals, and such proposals were usually acceptable to doctors. Also, 70% of chief pharmacists believed that pharmacists can play important roles in raising the rate of compliance with the guidelines.

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　　Interpretation of computerized tomography (CT) scans by a specialist is not readily available at the Emergency Department, Matsusaka-Chuo General Hospital. Thus, any CT findings that are missed on initial evaluation will subsequently be promptly reported to patients by a fulltime emergency doctor, so that they can be treated if necessary. This report describes an investigation of post-discharge follow-up reporting of CT findings in the last 3 years and details severe cases where radical treatment was required after the second diagnostic evaluation. Among 171 cases where findings were initially missed (1.1% of the total number of CT scans), many were neoplastic diseases (particularly lung neoplasms) or traumatic conditions (particularly intracranial hemorrhage). Several severe cases were aortic disease. Post-discharge aggravation was not confirmed in severe cases because of prompt follow-up reporting. The frequency of initially missed cases at our department tended to be lower than those previously reported. Based on our findings, CT images of suspected lung lesions, traumatic intracranial hemorrhage, and aortic diseases need to be carefully interpreted, with the causes of missed findings in severe cases being rare diseases, location of abnormalities (top/bottom edge of CT images), and minor findings. Overall, our post-discharge follow-up reporting system appears to be useful.

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　　A 68-year-old man presented with abdominal pain, vomiting, and diarrhea. He was admitted with a provisional diagnosis of acute gastroenteritis based on physical examination, blood tests, ultrasonography, and plain computed tomography. Despite treatment with fasting and fluid replacement, cardiopulmonary arrest occurred the following morning. All attempts at resuscitation failed and the patient died. Pathological autopsy revealed the presence of clots within the superior mesenteric vein, which was diagnosed as superior mesenteric vein thrombosis. This rare disease often manifests with only nonspecific symptoms and is typically difficult to diagnose. Because delayed diagnosis may lead to unfavorable outcomes, it is important to include this disease in the differential diagnosis of abdominal pain.

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　　We established the Technical Aids Support Office in our hospital to promote the introduction of and technical advice about assistive technology so as to enhance the quality of care and the functioning of patients and ensure staff safety. In this paper, we introduce two complicated cases that needed individual support. Case 1: A patient with amyotrophic lateral sclerosis. The amount of assistance required had gradually increased, but the patient still hoped to use a portable toilet. Because he could barely stand up, the height of the toilet needed adjustment. An elevated seat decreased the amount of assistance required. However, raising the bottom of the portable toilet turned out to be a challenge. Case 2: Multiple limb amputee. The patient and the caregiver experienced pain and distress during transfer between bed and chair. We tried using a lift assist device, but it the hardness of the sling worsened pain at the stump. A cushion with a sliding seat was then placed between the sling and the patient to reduce friction. The shape and hardness of cushion is a future challenge to solve. Timely individual support at each stage in their care for individual patients is indispensable for the provision of technical aid support.

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　　An 81-year-old man with complaints of dysphagia and weight loss was admitted to our hospital. Upper gastrointestinal endoscopy revealed advanced gastric cancer. Fever of unknown origin with leukocytosis persisted after admission. A granulocyte-colony stimulating factor (G-CSF)-producing gastric cancer was suspected because of elevated serum G-CSF levels. Surgery was performed in spite of the patient’s poor general condition. He went into acute respiratory distress from aspiration pneumonia after surgery and respiratory management with assisted ventilation was needed. Enteral feeding was difficult initially, but oral intake could eventually be resumed. The patient’s condition improved sufficiently to be discharged.

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　　Oral mucositis is reported to occurs in 40% of cancer patients on chemotherapy, suggesting the need for early oral care intervention in such patients. However, the oral care depends on each nurse and there has been no special document on the oral care for patients in the Respiratory Medicine and the Hematology/Oncology Ward, in which are managed around 100 regimens of chemotherapy per month. Here, to develop an oral care assessment sheet (OC sheet), we conducted a questionnaire survey of 24 ward nurses on oral care for chemotherapy patients and evaluated their assessment abilities using an oral care assessment test that was compliant with the items of the Eiler’s Oral Assessment Guide. The questionnaire survey revealed that nurses performed certain observations and/or interventions without basis and confidence, and that they did not always have patients’ cooperation while assessing their oral condition. They also tended to give inconsistent instructions. Use of the OC sheet enabled nurses to provide early oral care interventions and to confirm the utility of the chosen intervention. Test scores after the introduction of the OC sheet were significantly higher than before, indicating that use of the OC sheet improved nurses’ assessment and nursing care abilities.

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THE JAPANESE ASSOCIATION OF RURAL MEDICINE

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