In this study, we conducted text analysis to clarify the “feelings and considerations about the community (thoughts on the community)” of aged individuals in depopulated rural districts with low birth and high death rates, to identify a basis for public health nurse activities that contribute to improved functioning of aged individuals in rural areas. Quantitative text analysis was performed on free descriptive data collected from 362 aged individuals in rural districts; a co-occurrence network was created and correspondence analysis was performed. Six categories were extracted by analyzing the structure of the co-occurrence network: “loneliness because of the increasing number of unoccupied houses with few children and young people around”, “changes in the neighborhood and relationship with neighbors over time”, “continuous aging and depopulation of the village”, “preciousness of living with and spending time with family”, “maintaining good health and healthy aging”, and “difficulties and worries about inconvenient access to hospitals, public administrative offices, and shops”. Correspondence analysis of extracted words identified “inside the town”, “difficult”, “depopulation”, and “town” as factors strongly contributing to the principal component. The categories revealed by text analysis in this study may indicate an approach to develop the community, through objectively analyzing and then best utilizing self-care and mutual care in aged individuals in rural districts and social solidarity and governmental care (e.g., public health services).

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　　Occasionally, standard painkillers or triptans tend to be ineffective for treating pediatric patients with recurrent headache, leading to unavoidable absence and early departure from school, or even resulting in them becoming targets of bullying. Thirty children (19 male, 11 female; mean age 10.7 years, range 4–15 years) examined at my clinic in 2018, who presented with a chief complaint of intractable headache and exhibited abnormal electroencephalogram (EEG), were retrospectively studied. Their diagnosis, treatment, and treatment efficacy were analyzed. Although all participants showed abnormal brain waves on EEG, they did not demonstrate any other symptoms beside headache. Antiepileptic drug therapy proved efficacious in 24 of the 30 cases (80%). In all successfully treated cases, a definitive improvement in headaches was confirmed within 1–2 weeks.

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　　Physical function measurements were obtained and the 7-item Loco-Check questionnaire for evaluation of locomotive syndrome was administered to individuals who had given informed consent at a fall prevention seminar. In total, 49 of 113 middle-aged women (age 40-69 years) with no history of fragility fracture or gait disturbance responded positive to 1 or more Loco-Check items. Multiple logistic regression analysis revealed significant association with increased body mass index (BMI), Timed-Up-and-Go delay, decreased grip strength, and aging. These findings are consistent with reports from previous research and suggest that proper maintenance of BMI, dynamic trunk balance, and grip strength are important for extension of health and vitality of the musculoskeletal system. Also, early recognition of the risk of locomotive syndrome by the Loco-Check is considered essential.

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　　The aim of this study was to elucidate the current status of and problems with the in-service nursing education system at medical institutions in depopulated areas. Responses to a selfadministered questionnaire were requested from the director of the nursing service department at each of 29 national health insurance clinics and hospitals in Prefecture A. Completed questionnaires were returned by 18 medical facilities (5 hospitals and 13 clinics). Regarding educational methods for nurses, the largest number of responses concerned “participation in workshops held by the prefecture or municipalities”, followed by “training in external institutions or related facilities.” Thus, out-of-hospital education was predominant. The main reason for not dispatching nurses for out-of-hospital education was “difficulty securing time for the dispatch”. Problems with human resource development included “difficulty developing human resources because of human resource shortage” and “a loss of staff motivation”. In depopulated areas, the human resources pool includes nurses with various work experience; therefore, learning opportunities should be provided for nurses according to their practical abilities and in cooperation with many facilities. Educational methods that can connect out-of-hospital education with inhospital education should also be examined.

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　　Fees for comprehensive community-based care (CCC) wards were established as “CCC ward hospitalization fee and CCC hospitalization medical care fees: CCC wards” in the medical service fee revision of 2014. Since then, the number of hospitals submitting claims in this category has rapidly increased, from 114 in May 2014 to 2191 in June 2018. Although establishment of the CCC ward system and operational situation were previously described in featured articles and reports, the specific benefits of medical care provided in these wards remain unclear. In this study, we extracted descriptions from the Japanese literature of the benefits of medical care provided in CCC wards, organized this content using a qualitative approach, and examined the nursing roles revealed. In total, 25 papers were identified with information about the benefits of medical care in CCC wards. This content was abstracted into 50 codes and then grouped into 20 subcategories and 9 categories. These 9 categories were further classified into structure, process, and outcomes of medical care provided in CCC wards according to linguistic criteria developed based on the Donabedian model of health care quality, and the results were used to identify the nursing roles in CCC wards. Nurses appear to have diverse roles in the medical care provided in CCC wards, providing counseling on how to maintain basic service infrastructure (structure), supporting patients and families during their time in the wards (process), strengthening interdisciplinary collaboration (process), and improving nurses’ own professional competence (process). Through their roles in these structural and procedural dimensions, nurses support the intelligent operation of CCC wards and the expansion of community care support systems. Our results suggest that these activities may lead to outcomes in the form of enhanced community health.

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　　A questionnaire survey was conducted with 62 doctors from Itoigawa General Hospital to identify the content doctors would prefer in questions about prescriptions. A questionnaire was prepared based on the core pharmacy curriculum, and respondents were asked to choose the following ranked answers: “most welcomed”, “acceptable”, “unsure”, and “not welcomed”. The average rank was obtained for each of 32 items. The overall average rank was 989.5 ± 98.5. Items with a significantly lower average rank were “safety of drugs (adverse reactions and adverse events)” with an average rank of 711.3 and “actions of drugs (pharmacological action and drug interactions)” with an average rank of 754.8. In contrast, “medication and therapy policy” had the highest average rank (1194.7). These results reveal that doctors would greatly prefer to receive questions about prescriptions that are related to safety and pharmacological actions of drugs. It is anticipated that the results of this study will encourage pharmacists to ask doctors about prescription, thereby contributing to improved safety of medical care.

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　　We started a prophylactic rehabilitation class from fiscal year 2016 and 1 year later we identified 4 problems, namely, a small number of participants (mean, 4.6), a small male population (ratio of 1 male to 9 females), no follow up because only 1 session was given per area, and a low home exercise rate (42.5%). For the class in fiscal year 2017, discussions were held with the comprehensive regional support center. Accordingly, relevant information was disseminated via public relations magazines, neighborhood circulars, and the local government to address the problems with the number of participants and sex ratio, and a series of 4 sessions were held per area to address the problems with the lack of follow-up and continuation of home exercise. Objective assessments (grip strength, one-leg standing, and knee extension strength) were included in the physical assessment. Through these measures, based on questionnaire results, we found that there was an increase in the number of participants and that more participants continued the exercise at home after the class was increased.

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　　We conducted a questionnaire survey of 525 persons regarding end-of-life care (EoLC) between November and December 2017. A total of 495 individuals responded (response rate 94.3%). Respondents were grouped into either a medical staff (MS) group or community persons (CP) group. Significant differences were found between the MS and CP groups in implementing a family conference about EoLC (p＜0.05), but not in preparing documents about personal preferences for EoLC. There were significant differences between the groups in medical treatments in EoLC, for example, total parenteral nutrition, enteral nutrition via percutaneous endoscopic gastrostomy, and mechanical ventilation with intubation (p＜0.05). It is important that medical treatment in EoLC should meet the requirements of patients and their families. This study revealed differences in some aspects of EoLC between the MS and CP groups. Individuals should be supported in personally making decisions about their own EoLC.

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　　It has been reported that a comprehensive community support center cannot maintain boundaries between particular specialties (ie, public health nurses, social workers, and the chief care manager), resulting in excessive workload, staff shortages, and resignations. Nurses are beginning to acknowledge poor interprofessional interactions among themselves and are now concerned with improving nursing practice. In this study, we aimed to clearly specify the specialties of nurses in order to obtain relevant basic data for establishing an educational training system for community health nurses. We conducted text mining analysis using KH Coder open source software by targeting 8 community health nurses with over 3 years of experience in Prefecture A. The following 5 clusters of specialties were extracted: “Ability to provide consultation, maintain good relationships, and make good decisions”, “Good knowledge of medical care in general, care of the elderly with dementia and mental illness, and their situation at home”, “Services that prevent the elderly from becoming dependent”, “Collaboration with other professions by participating in home visits or community center visits”, and “Work that requires comprehensive guidance on health within the community”. To clarify the nursing specialty, it is desirable to comprehensively support a team approach by utilizing each specialty in 3 job types. In addition, we suggest that general community nursing roles can be better demonstrated by developing a vision, providing accessible consultation and supervision, and outlining a clear career path as part of the educational system.

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　　Central venous lesions are suspected in dialysis patients who present with increased venous pressure and severe swelling of the shunt arm. Here, we report a case where contrast computed tomography (CT) was useful for diagnosis. Iopamidol 300 (20 mL) was diluted 2-fold, 30 mL of which was injected into the vein in the shunt arm at 2.0 mL/s. Imaging was started 10 s later. Fixed stenosis caused by intimal proliferation can be assessed just as effectively using contrast CT and shunt angiography. However, contrast CT is more useful than shunt angiography in the assessment of stenosis due to compression by surrounding organs and lesions, because the position of vessels relative to surrounding organs can be depicted. Contrast CT allows for safer and shorter examination compared with shunt angiography, and the diagnostic performance of a single examination can be improved using 3-dimensional reconstruction (3D) and multiplanar reformation images. Precise information obtained using contrast CT will contribute to safe and effective percutaneous transluminal angioplasty.

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　　A 70-year-old man with continuous diarrhea for over 1 month consulted a primary care doctor. He was treated with oral antibiotics and probiotics but his condition worsened. He developed generalized edema and was referred to our hospital. Abdominal ultrasound and computed tomography (CT) scan findings were suggestive of colon cancer with accompanying liver metastasis. Total colonoscopy and endoscopy for pathological diagnosis led to a diagnosis of cancer of the sigmoid colon accompanied with liver metastasis or liver abscess. We planned to perform sigmoidectomy with simultaneous resection of the liver lesion. However, we considered that he was not particularly fit to undergo two concurrent surgeries. Therefore, based on his physical condition, we planned to first do a sigmoidectomy. Before surgery, the fever persisted and a repeat CT scan showed deterioration of the liver lesion. We diagnosed the liver lesion as abscess and performed percutaneous transhepatic abscess drainage (PTAD). Three days after PTAD, we then performed sigmoidectomy. Subsequently, the liver abscess resolved and gradually disappeared. At 5 years after surgery, there has been no recurrence of the cancer or abscess.

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　　The patient was a 64-years-old woman who while driving a light car was injured in a collision with another car. Chest X-ray and computed tomography (CT) revealed herniation of abdominal viscera into the left thoracic cavity for which we performed laparotomy based on a diagnosis of traumatic left diaphragmatic hernia. We performed a mini-laparotomy via a skin incision placed 10 cm caudal to the xiphoid process. Intraoperatively, we found an approximately 8-cm tear of the left leaflet of the central tendon of the diaphragm, through which the stomach was seen herniating into the thoracic cavity. There was no damage to intrapleural or intraperitoneal organs. The diaphragmatic tear was closed with continuous suturing, and the patient’s condition was stable postoperatively. In surgical repair of traumatic diaphragmatic hernia without organ damage, injury can be easily identified and repaired using a mini-laparotomy approach. This approach is additionally useful as it allows resection under direct vision.

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　　The purpose of this study was to identify issues with nursing administrator development in the Nursing Division of our hospital. In order to identify issues in the workshops, we conducted a questionnaire survey with chief nurses who participated in a competency workshop for them to become nursing administrators at the Nursing Division of Hospital A, and by reviewing their management behavior, we analyzed the insights they acquired. We used a qualitative, inductive research method that involved administering a written survey to 22 chief nurses who work at the hospital. The survey items were designed to find out what the participants learned, how they intended to put that knowledge to use, and what they felt during the workshop. Our analysis identified two categories of insights: those that would translate into behavior and those that represented new knowledge. The former comprised 22 subcategories and the latter 3 subcategories. Because the issues identified (maintaining conviction, customer orientation, and quality assurance) were limited to knowledge-based insights, these should be improved to become “insights that would translate into behavior” so that they can be put into practice in managing behaviors on the ward.

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