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Volume 67, Issue 4
Displaying 1-14 of 14 articles from this issue
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ORIGINALS
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Toshiki KATSURA, Satoko KOMATA, Mai OGURA, Nobuhito ISHIKAWA, Akiko HO ...2018 Volume 67 Issue 4 Pages 457-
Published: 2018
Released on J-STAGE: December 18, 2018
JOURNAL FREE ACCESSThe purpose of this study is to elucidate the correlation between social capital and frailty of homebound community-dwelling elderly individuals without certification for long-term care. Subjects were 47 homebound and 47 age- and sex-matched, non-homebound elderly individuals evaluated from July to November, 2016. Variable parameters were physical, mental, and social frailty, Tilburg Frailty Indicator score, and social capital. The correlation between social capital and frailty in home-bounded elderlies was analyzed using the χ2 Test. Social capital was significantly correlated with mental frailty among homebound elderly individuals. In contrast, social capital was significantly correlated with all types of frailty among non-homebound elderly individuals. Among community-dwelling elderly individuals, social capital is related to prevention of comprehensive frailty and mental frailty. On the other hand, screening and intervention for prevention of long term-care are necessary for homebound elderly individuals.View full abstractDownload PDF (768K) -
Kensei GOTOH, Naoko NISHIMURA, Hiroki TAKAO, Yuto FUKUDA, Ayami YOSHIK ...2018 Volume 67 Issue 4 Pages 469-
Published: 2018
Released on J-STAGE: December 18, 2018
JOURNAL FREE ACCESSRibotestMycoplasma (Ribotest™), a rapid antigen detection assay for ribosomal protein L7/L12 for the diagnosis of Mycoplasma pneumoniae infection, has become available in Japan. However, the clinical utility of Ribotest remains controversial. We enrolled 1,140 children admitted to our hospital between January 2014 and March 2016 due to community-acquired pneumonia. We prospectively obtained two throat swabs during the acute phase; DNA detection using a loop-mediated isothermal amplification (LAMP) assay and antigen detection using Ribotest were performed for each sample. We also collected paired serum samples during the acute and convalescent phases for determining M. pneumoniae antibody titers using the particle agglutination test. M. pneumoniae pneumonia was diagnosed through either a positive LAMP assay or a 4-fold increase in antibody titers. Overall, 237 children (21%) were diagnosed with M. pneumoniae pneumonia. We evaluated the utility of Ribotest both in the non-epidemic period (January 2014–July 2015) and the epidemic period (August 2015–March 2016). Sensitivity of Ribotest for M. pneumoniae pneumonia was 23% in the non-epidemic period and 22% in the epidemic period, respectively. When serology was used as the standard, sensitivity of Ribotest was 25% in the non-epidemic period and 22% in the epidemic period, significantly lower than those of the LAMP assay (80% and 91%, respectively). Ribotest yielded false-positive results in 16 cases in the non-epidemic period and in 6 cases in the epidemic period. Thus, positive predictive values of Ribotest were significantly lower in the non-epidemic period (50%) than in the epidemic period (86%). Multivariate analysis showed that a shorter duration of fever before sampling (OR = 1.7) and a higher incidence of co-infection with other pathogens (OR = 29.4) were observed in children showing false-positive results of Ribotest. Thus, we conclude that Ribotest is unsuitable for rapid diagnosis of pediatric M. pneumoniae pneumonia.View full abstractDownload PDF (784K) -
Kumiko OGATA, Midori NISHIO, Sayori SAKANASHI, Kayoko KOGA2018 Volume 67 Issue 4 Pages 477-
Published: 2018
Released on J-STAGE: December 18, 2018
JOURNAL FREE ACCESSThis study investigated subjective health and its associated factors among community residents who participated in a meeting on nursing care and health held at a local commercial facility. An anonymous self-administered questionnaire was distributed to a total of 441 participants. Of these, 403 responded to the questionnaire. Respondents comprised 326 healthy individuals (80.9%) and 77 unhealthy individuals (19.1%). Mean age was 66.3 ± 11.6 years. Factors significantly associated with subjective health were age, non-smoking, regular exercise, need for daily living assistance, emotional support, and psychological status. Analysis according to age (elderly group vs. non-elderly) showed that the subjective health of the non-elderly group was not significantly associated with any of the factors, while that of the elderly group was significantly associated with non-smoking, need for daily living assistance, emotional support, and psychological status. Continuation of independent daily living through efforts to maintain or improve physical function is needed to promote subjective health, especially for the elderly. It is also important to establish a support system to facilitate communication with the family and community in order to maintain good psychological health even when these individuals become physically dependent.View full abstractDownload PDF (741K)
RESEARCH REPORTS
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Yuto SUZUKI, Makoto NAKAO, Hideki MURAMATSU, Sosuke ARAKAWA, Yusuke SA ...2018 Volume 67 Issue 4 Pages 485-
Published: 2018
Released on J-STAGE: December 18, 2018
JOURNAL FREE ACCESSIn patients with epidermal growth factor receptor (EGFR) mutation-positive lung cancer (LC) who have acquired resistance to first and/or second-generation EGFR-tyrosine kinase inhibitors (EGFR-TKIs), detection of EGFR T790M (T790M) mutation is essential before administration of osimertinib. Tissue sample is the main specimen used to detect the T790M mutation, and so cell block preparation using pleural or pericardial fluid should be considered. The utility of body cavity effusion cell block methods in T790M mutation detection have not yet been fully evaluated. This study aimed to evaluate the clinical background and treatment course of LC patients harboring the T790M mutation by using body cavity effusion cell block methods at our hospital. All patients were treated with first and/or second-generation EGFR-TKIs and had developed malignant pleural or pericardial fluid as a result of progressive disease. T790M mutation status was evaluated using body cavity effusion cell block method in 9 patients, from April 2016 to August 2017. We retrospectively evaluated the clinical characteristics and treatment course of these 9 patients (3 males and 6 females; median age 76 years). At the first diagnosis of LC, 7 patients had stage IV cancer; 4 patients were diagnosed by bronchial fibroscopy and 3 were diagnosed from pleural fluid examination. Regarding EGFR mutation, 3 and 6 patients carried the exon 19 deletion and L858R mutation, respectively. Median time interval between the first diagnosis of LC and T790M mutation evaluation was 30.8 months; 7 patients were diagnosed with positive T790M mutation by using body cavity effusion cell block methods. The T790M mutation was highly detected by examination of body cavity effusion cell blocks. Further evaluation is necessary with respect to variations in T790M detection rate based on the specimen collection site and/or progressive disease pattern in different patients.View full abstractDownload PDF (657K) -
Mami MIURA, Yuto YAMAZAKI, Sakumi YAITA, Takayuki ANNO, Nobuyuki KOBAY ...2018 Volume 67 Issue 4 Pages 492-
Published: 2018
Released on J-STAGE: December 18, 2018
JOURNAL FREE ACCESSOur hospital is responsible for acute care as part of a regional-based integral medical care center and uses Diagnosis Procedure Combination (DPC). We attempt to increase patient discharge rates within period II in the DPC / Per-Diem Payment System (DPC/PDPS). However, hospitalization of cerebrovascular disease patients tends to be prolonged by reduced activities of daily living caused by disease and patient background. Thus, we surveyed factors related to extended hospitalization of patients with cerebral infarction, who are among the largest number of patients with cerebrovascular disease. In this survey, we retrospectively analyzed 109 hospitalized patients who underwent medical treatment from May 2016 to March 2017. Patients were divided into two groups (within period II, and period III and above). We performed univariate and multivariate analysis on factors contributing to prolonged hospitalization. Multivariate logistic regression analysis revealed that place of residence (pre- and posthospitalization) affected the hospitalization period. Among them, patients who were admitted from their homes and discharged to facilities other than their homes had the longest hospital stay. Interestingly, univariate analysis showed a significant difference (P<0.001) between the two groups in the National Institute of Health Stroke Scale (NIHSS) score on admission, while there was no significant difference (P = 0.65) with multivariate analysis. It implied that NIHSS score affected the decision about recuperation location after discharge, but not the hospitalization period. Based on our study, we identified key issues that need to be addressed: 1) the time to determine appropriate medical care after the acute phase, and 2) the waiting period for proper transfer. Therefore, to promptly discharge patients from hospital, we believe it is important to provide early intervention by ward nurses at the time of hospitalization, and to review our ongoing efforts to strengthen the system and enhance collaboration within our medical center.View full abstractDownload PDF (826K) -
Naoki HIRABAYASHI, Osamu NISHIZAWA, Yuka YABANA, Mami WAKATA, Ryoko SA ...2018 Volume 67 Issue 4 Pages 500-
Published: 2018
Released on J-STAGE: December 18, 2018
JOURNAL FREE ACCESSPelvic organ prolapse (POP) is not regarded as life-threatening, and has been left undiagnosed on occasion. However, in some cases, the condition has resulted in hydronephrosis and renal failure. We have investigated the prevalence of hydronephrosis in patients with POP at the Female Pelvic Floor Medicine Center, and how it may be improved through surgery. Of the 555 patients examined between January 2016 and December 2017, 265 patients were diagnosed with POP. This study involved 192 of these cases diagnosed with POP as subjects. Using preoperative ultrasound scanning, hydronephrosis was classified into four categories depending on severity. At the time of surgery, the conditions of POP were classified into stages I to IV of the POP Quantification (POP-Q) system. Of these 192 patients, 20 (10.4%) had been evaluated as hydronephrosis (slight hydronephrosis 9, mild hydronephrosis 6, and severe hydronephrosis 5). It is known that as the staging of POP progresses, the likelihood of developing hydronephrosis also increases. In 20 cases with POP-Q stage IV, 7 were confirmed to have hydronephrosis; 3 of these were severe hydronephrosis. The 6 cases of mild, and 5 cases of severe hydronephrosis achieved cure after tension-free vaginal mesh TVM surgery. POP may cause hydronephrosis, so examination of the upper urinary tract is necessary. Ultrasound scans are useful in detecting hydronephrosis. There has been a case where it took 6 to 10 months for hydronephrosis to improve, so early diagnosis and management are crucial in order to prevent hydronephrosis. TVM surgery can be used for repair of not only anterior prolapse, but also uterine prolapse, which can be thus treated without hysterectomy, and this has the potential to improve hydronephrosis.View full abstractDownload PDF (2991K) -
Mitsuhiro MATSUO, Takashi TSUKISHIRO, Kiyohiro HIGUCHI2018 Volume 67 Issue 4 Pages 507-
Published: 2018
Released on J-STAGE: December 18, 2018
JOURNAL FREE ACCESSThis study was performed to assess the impact of sputum acid-fast bacilli (AFB) smear in predicting pulmonary tuberculosis (TB). We retrospectively identified sputum AFB smear specimens over a 6-year period in our hospital. A total of 1814 specimens were included: 26 were culture-positive for TB, and 116 were for nontuberculous mycobacterium (NTM). NTM were more frequently isolated than TB (odds ratio: 4.7, 95% confidence interval (95% CI); P <0.001). Sensitivity, specificity, and positive likelihood ratio of sputum AFB smear for TB were 42.3% (95% CI 23.4-63.1), 94.5% (95% CI 93.3-95.5), and 7.64 (95% CI 4.69-12.45), respectively. Although there was a statistical significance in the positive likelihood ratio, sputum smear test had a positive predictive value of 0.100 (95% CI 0.051-0.172). These data suggest that the diagnostic yield of sputum AFB smear for pulmonary TB might be substantially low in our clinical setting. Physicians should pay attention to interpretation of sputum smear results especially in areas with high prevalence of NTM.View full abstractDownload PDF (674K)
CASE REPORTS
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Masahide SUGIYAMA, Yutaka AOKI, Keisuke SHINOHARA, Tomoaki MIYATA, Hir ...2018 Volume 67 Issue 4 Pages 512-
Published: 2018
Released on J-STAGE: December 18, 2018
JOURNAL FREE ACCESSIt is suggested that in the use of tacrolimus for treatment of ulcerative colitis, it is important to achieve and maintain a high trough level as soon as possible. We examined two cases, with a starting initial dose higher than that recommended in the package insert, and adjusted the dose by daily therapeutic drug monitoring. Improvement of symptoms was observed by maintaining a high trough level of 10 to 15 ng/mL in these 2 cases. This improvement was observed from 9 days after achieving the high trough level, and it took the same number of days as stated in the mode of administration in the package insert.View full abstractDownload PDF (735K) -
Yasuo KOSUGI, Noboru FUKUHARA, Kunihiro IWATA, Taito ASAHINA2018 Volume 67 Issue 4 Pages 516-
Published: 2018
Released on J-STAGE: December 18, 2018
JOURNAL FREE ACCESSA 58-year-old woman who underwent surgery for breast cancer experienced recurrence in the ipsilateral breast during follow-up after postoperative radiotherapy and was scheduled for additional mastectomy. An 81-year-old man was found to have bilateral lung cancer during follow-up after coronary artery bypass grafting. Both patients underwent diffusion-weighted whole-body imaging with background suppression (DWIBS) for whole-body cancer screening, which led to incidental detection of bladder cancer that was adequately treated. In both cases, the lesions were unlikely to have been detected using positron emission tomography/computed tomography (PET/CT). This suggested that DWIBS might be more useful than PET/CT for whole-body cancer screening.View full abstractDownload PDF (1621K) -
Kenji HIRAU, Yutaka HIRANO, Kasumi TOZAWA, Kimito ORINO, Shinichi SASA ...2018 Volume 67 Issue 4 Pages 521-
Published: 2018
Released on J-STAGE: December 18, 2018
JOURNAL FREE ACCESSA 78-year-old man was diagnosed with adult T-cell leukemia/lymphoma (ATL) and was started on standard chemotherapy 1 year earlier. However, treatment was discontinued because of adverse drug reactions and worsening delirium. Thereafter, he remained stable and was followed up while receiving etoposide. He then visited our hospital because of acute abdominal pain and underwent surgery with a diagnosis of gastrointestinal perforation. Intraoperative observation showed a reddened, concentric wall thickening measuring 4 cm and a perforation site in the ileum, and thus partial resection of the small bowel was performed. The histological diagnosis was small bowel perforation due to tumor cell invasion. Two months postoperatively, he started a less intensive chemotherapy regimen along with palliative care, and died due to the primary disease approximately 5 months postoperatively. ATL involves systemic organs because of its high organ-affinity. Once it involves the gastrointestinal tract, various gastrointestinal symptoms can occur. Patients with ATL are at risk of developing gastrointestinal perforation at any time during the clinical course. Therefore, clinicians should be aware that once gastrointestinal perforation develops, the prognosis becomes extremely poor. Assessment of the disease state, early detection of gastrointestinal lesions, and prevention of opportunistic infections appear to be important in the management of patients with ATL.View full abstractDownload PDF (2473K) -
Hiromu KUBOTA, Hiroshi NAKAI, Masamitsu TAKAGI, Hidehisa HASHIMOTO, Sh ...2018 Volume 67 Issue 4 Pages 528-
Published: 2018
Released on J-STAGE: December 18, 2018
JOURNAL FREE ACCESSThe infrapatellar fat pad is functionally deformed with joint movement and is involved in adjusting the internal pressure of the knee joint. On the other hand, it can also become a source of anterior knee pain due to inflammation and degeneration. A young female handball player experienced anterior knee pain. No obvious abnormality was observed on basic X-ray and magnetic resonance images. Dynamic observation using ultrasonic diagnostic imaging showed poor kinetics with infiltration of the infrapatellar fat pad into the patellar ligament and the tibial condyle, with the knee joint in extension on the affected side compared with the normal side. Knee joint range of movement (affected side vs. normal side) was restricted to 140° p / 150° flexion and extension - 10° p / 5°, and there was infrapatellar tenderness in the affected region. Patella baja was confirmed compared with the normal side. In addition, the flexibility of the infrapatellar fat pad was reduced. From these findings, it was inferred that the cause of pain was restriction of knee joint extension due to reduced flexibility of the infrapatellar fat pad. Treatment of the infrapatellar fat pad, joint range training exercises, and muscle strengthening training exercises were carried out. Pain and restricted range of joint movements improved and the patient could returned to competitive sports.View full abstractDownload PDF (1995K)
NURSING RESEARCH REPORT
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Shinobu MIZUNO, Keiko OKUMURA, Michiko NAKANO2018 Volume 67 Issue 4 Pages 533-
Published: 2018
Released on J-STAGE: December 18, 2018
JOURNAL FREE ACCESSBoth nurses and clinical engineers are involved in training nurses who are new to the dialysis unit. Topics of instruction and prioritization differ depending on the profession of the instructor, often confusing the nurses and baffling the instructors. This suggests that the two professions may have different perspectives, so we administered a questionnaire to nurses and clinical engineers to find out. We found major differences in the topics of instruction that each profession considered important. For most nurses, basic machine operation and puncture site / shunt observation were important, but very few clinical engineers agreed. These differing perspectives on education between professions were the cause of differences in opinion. The major differences in perspectives on nursing education between professions were in terms of educational topics considered important, prioritization of educational topics, and strategies for addressing nurses’ confusion. A team-based medical care approach with collaboration between different professions is a unique system in the dialysis unit. Going forward, different professionals must work to gradually find a middle ground despite their differing ways of thinking and perspectives. We hope to collaborate and further enhance nursing education so that dialysis teams can have in depth discussions applying their unique professional perspectives and providing high-quality team-based medical care.View full abstractDownload PDF (627K)
MATERIAL
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Rie SUGIURA, Yuka TAKAHASHI, Shinobu SAKAMOTO, Miho INAMORI, Hiroaki Y ...2018 Volume 67 Issue 4 Pages 538-
Published: 2018
Released on J-STAGE: December 18, 2018
JOURNAL FREE ACCESSAt Anjo Kosei Hospital, all staff has been working concertedly on a project to establish a community hospital in line with our future vision. Hospital staff in charge of the Medical Affairs Division has been involved in measures aimed at achieving the slogan “health and happiness of local residents” as part of this project. To address this, three goals were set as follows: improvement of recoveries in accounts receivable management, a reduction of money held in trust, and a decrease in the number of outsourced transactions. To achieve the goals described above, the following specific measure were carried out: (1) collection of accounts receivable using convenience store settlement; (2) collection of high-cost medical expenses by wider use of Eligibility Certificates for Ceiling-Amount Applications and promotion of the Major Medical Cost Loan System for national health insurance holders; and (3) support in acquiring family registration for nonregistered family members and for health insurance benefits. Recoveries of accounts receivable through convenience store settlement was about 90,000 yen/month, and our support activities for family registration and health insurance benefits provided the recoveries of about 80,000 yen/month. Furthermore, the promoted use of the certificate and loan system resulted in recoveries of about 17 million yen/year. The average commission fee and number of outsourcing was 890,188 yen and 12 cases, respectively, from April to August 2016. However, in 2017, it was 305,615 yen and 10 cases, respectively. Our project aimed at achieving slogan-elicited patient voluntary payment of medical expenses, leading to improved recoveries, with reduced money held in trust and fewer outsourced transactions.View full abstractDownload PDF (919K)
REGIONAL MEETING
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2018 Volume 67 Issue 4 Pages 544-
Published: 2018
Released on J-STAGE: December 18, 2018
JOURNAL FREE ACCESSDownload PDF (640K)
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