The objective of this study was to investigate associations between societal mutual assistance and vital functions among Aged People in rural Districts. This cross-sectional survey used questions based on the Anderson Behavioral Model, including relevant items such as “Individual characteristics (predisposing, enabling, and need factors)” and “Community characteristics (physical factors)”. We distributed questionnaires to 2,500 people and used 974 valid responses for study analyses. Our results showed that older adults in rural districts with lower levels of societal mutual assistance tended to have lower vital functions levels. Also, actual lower vital functions levels appear to be associated with lower levels of “Living in harmony with nature” and “No available social groups to participate in” at the group or community level, which define vital functions. It is necessary to objectively review self- and mutual-assistance roles of older adults living in rural areas as well as the mutual and public assistance functions that are typically involved in public health services.
This study aimed to clarify the factors influencing changes in activities of daily living (ADL) in patients receiving home rehabilitation. The study involved patients receiving home rehabilitation for 6 months between December 2017 and June 2018. There were no exclusion criteria for disease. For 35 patients (21 women; mean age, 77.4 ± 10.4 years), we investigated basic information and measured grip strength, Bedside Mobility Scale (BMS) score, and Functional Independence Measure (FIM) score at baseline and 6 months later. Changes in grip strength, BMS, and FIM between baseline and 6 months were calculated. Multiple regression analysis was used to identify factors influencing the change in FIM score. Multiple regression analysis extracted the factors of period from onset of main disease, amount of change in grip strength, and amount of change in BMS. The standardized partial regression coefficients were －0.331, 0.353, and 0.320, respectively. The adjusted coefficient of determination was 0.392. Thus, early intervention after onset of main disease, improvement of grip strength, and improvement of BMS score appear to be important to improving ADL after 6 months of home rehabilitation.
The purpose of this study was to ascertain the current status of the convalescent rehabilitation ward at our hospital and trends according to years of experience of staff by investigating the degree of achieving the “Ten Guidelines for Therapists,” which is a set of behavior guidelines for quality improvement in convalescent rehabilitation wards. We conducted a questionnaire survey of 26 physical therapists and 11 occupational therapists working in our convalescent rehabilitation ward. Items were rated using a 6-step Likert scale. Mean achievement of each item was calculated according to years of experience (1-2 years, 3-5 years, 6 years or more). A multiple comparisons test was then performed to compare the three experience groups. Results showed that, regardless of years of experience, items on the appropriateness of welfare equipment (Guideline 2), data management (Guideline 9), and staff education (Guideline 10) had low achievement levels. For Guidelines 9 and 10, which are related to organizational management, an education system was considered necessary for all experience groups. In addition, the degree of achievement differed significantly according to years of experience for items on collaboration with other professionals in case conferences (Guideline 5), environmental adjustment (Guideline 7), and staff education (Guideline 10). These findings suggest that the cause of the significant difference should be investigated and addressed.
The objective of this study was to investigate the knowledge physicians expect pharmacists to have when discussing the safety of medicines. Survey questionnaires were distributed to 81 physicians working at 2 general hospitals in the Jōetsu region of Niigata Prefecture, Japan. The survey instrument included 22 knowledge items, and for each item physicians were asked to select either “Necessary knowledge” or “Knowledge that should be understood” for pharmacists. We obtained 71 valid responses (response rate: 87.7%). Results showed that “Package inserts” were selected by most physicians: 95.8% for specialist-related inserts and 85.9% for non-specialist inserts, followed in order by “Guidelines in Japan”, “Interview forms”, “Blue letter and yellow letter”, and “Recent topics in academic meetings in Japan”. Knowledge of specialty-related fields was significantly more likely to be expected of pharmacists than non-specialty fields: 48.0% and 36.5%, respectively (p < 0.001). Overall, physicians in this study suggested that when pharmacists share information with physicians, their communications may be enhanced by referring to Japanese guidelines and relevant topics that have previously been discussed at academic meetings.
Diagnostic Procedure Combination (DPC) indices have substantial effects on revenue in Japanese medical institutions. There are a few indices in the DPC code system but this study focuses specifically on coverage rates. Results of an analysis of nationwide data on the number of beds and coverage rate indices showed that hospitals with more beds tended to have higher coverage rates. However, across hospitals with the same number of beds, coverage rate indices appeared to vary. Comparing our hospital’s selection rates of secondary disease names with national selection rates, we found some diagnosis categories with low selection rates. Therefore, in efforts to enhance the coverage rate indices, we sought to improve the selection rates of secondary disease names and optimize DPC coding. After initiating these measures, our coverage rate indices rose, but changes over the past 5 years have not been statistically significant. Therefore, it is necessary to continue these efforts to avoid a decline in coverage rate indices.
The purpose of this study was to compare the results of open surgery and laparoscopic surgery for acute appendicitis in adults. In 2013, we primarily selected open surgery for acute appendicitis, but in 2017 we opted to select mainly laparoscopic surgery. We compared between 92 patients who had undergone open surgery in 2013 and 88 patients who underwent laparoscopic surgery group in 2017. There was no difference in age, sex, body mass index, white blood cell count, C-reactive protein, or perforation rate on computed tomography between the two groups. The laparoscopic surgery group had significantly longer operation time but significantly lower blood loss and postoperative complication rate. In particular, laparoscopic surgery was advantageous in terms of hemostasis for moderate bleeding. The results suggest that laparoscopic surgery may be more useful in adult appendicitis than open surgery.
Pharmacists are required to work as specialists, but few studies have investigated the career paths available to certified/specialist pharmacists. Therefore, we surveyed hospital pharmacists on career formation, qualifications acquisition, and research activities. We administered an anonymous questionnaire using Google Forms to all 37 pharmacists at Sapporo-Kosei General Hospital and all responded. Responses to career path questions were compared between the current job and a job in the future. For the current job, there were more responses for acquiring a wide range of experience, knowledge, and skills and fewer responses for acquiring experience, knowledge, and skills in a specialized field and for acquiring certified/specialist pharmacist qualifications. This suggests that pharmacists intend to improve their expertise after acquiring a wide range of experience, knowledge, and skills. A high percentage of respondents cited interest in specialized fields as a reason to become qualified as a certified/specialist pharmacist. This suggests that interest in specialized fields is the greatest incentive to acquire further qualifications. In regard to research activity, items on daily workload, making time for research, and cooperation with research team members were often selected as problems. This suggests that time management and scheduling are important issues.
Currently in Japan, undernutrition is increasing among those aged 65 years or older and needs to be addressed. Energy intake also falls short of estimated energy requirements (physical activity level II) among individuals 20 years or older, except for women in their 70s. In order for these energy and nutrient intake requirements to be met, we believe it is necessary to advocate more moderate and appropriate consumption of Shikohin (pleasurable, non-essential food and beverages such as alcohol and coffee). Therefore, we have initiated dietary guidance group sessions focusing on appropriate amounts of Shikohin consumption in our long-term support health promotion programs, which are organized with the goal of care prevention. In our group sessions, we offer guidance to participants with excessive Shikohin consumption to moderate their consumption, and we offer guidance to those with appropriate levels of Shikohin consumption on nutritional intake and balancing meals. Results for those with excessive Shikohin consumption have shown declining amounts of Shikohin consumption and improvements in nutrition and balanced meal intake. Among participants with previously appropriate levels of Shikohin consumption we found moderately increased use of Shikohin products. Overall, our results suggest that interventions are appropriate and helpful for persons with excessive Shikohin consumption. Guidance is also necessary on adjusting, optimizing, or maintaining appropriate Shikohin consumption for all participants of such programs regardless of their Shikohin consumption levels.
Rehabilitative intervention led to some improvement in bodily function in a patient with amyotrophic lateral sclerosis (ALS) and aspiration pneumonia. By alleviating dyspnea and providing successful supportive care, he improved his sitting position in a wheelchair and reacquired transfer skills. Achieving this reduced burden on his primary caregiver. During rehabilitation, our multidisciplinary team considered the necessary support and care required for the patient to live at home in a sparsely populated area. As a result, we plan to improve his home life after discharge. This stimulated hope and motivation in both the patient and his caregiver to improve his home life, and their increased motivation led them to participate in ALS group meetings. Ultimately, the patient was discharged home.
We report on an apparently healthy woman in her 50s who noticed pain in the left side of her neck anteriorly and was prescribed an antimicrobial agent at a nearby clinic. However, she developed hypotension and hypoxemia and was brought to our hospital. Laboratory investigations revealed evidence of inflammation, and imaging findings showed low-density areas corresponding to the left lobe of the thyroid gland. The low-density areas extended to the superior mediastinum, raising suspicion of a thyroid gland mediastinal abscess. We performed inferior mediastinal drainage with video-assisted thoracoscopic surgery and resection of the left lobe of the thyroid gland. Culture of mediastinal aspirate yielded Streptococcus viridans. Based on these findings, the final diagnosis was descent-related mediastinitis secondary to acute suppurative thyroiditis.
A 52-year-old woman who had two episodes of cerebral hemorrhage due to cerebral arteriovenous malformation (AVM) had been treated with gamma knife radiosurgery twice. Complete obliteration of the AVM was confirmed after treatment and she was making steady progress. Twenty years after gamma knife radiosurgery, computed tomography showed cyst formation. The cyst grew larger with ensuing neurological signs and symptoms, so we performed surgery. Thereafter, it was possible to make a pathological assessment. Delayed cyst formation after gamma knife radiosurgery for AVM is known to be one of the late adverse effects of radiation but little is known beyond 10 years postoperatively. We report here on a case of cyst formation 20 years after gamma knife radiosurgery for AVM.
An 82 year-old-woman was referred to our hospital because of infiltrative shadow of the lingula in 201X. She was asymptomatic, so we followed up with imaging observation. After 1 year, the infiltrative shadow had progressed, so we performed bronchoscopy. Glandular epithelium with the mild aberrant type was detected, but did not lead to a definitive diagnosis. There was increased eosinophilic compartmentalization of immune response in the bronchoalveolar lavage, so we started treatment with corticosteroids for chronic eosinophilic pneumonia. However, there was no improvement of the shadow. Subsequent computed tomography-guided lung biopsy revealed evidence of papillary adenocarcinoma.
Few cases of experiences in discharge support in acute medicine have been reported. Here, we report a case in which an inexperienced nurse had a successful experience after participating in a discharge coordination conference. A qualitative approach was used to analyze a verbatim transcript of an interview with the nurse. Two top-level categories were extracted: “experience required for providing discharge support” and “experience acquired”. Six lower-level categories were extracted: “experience and images”, “knowledge of discharge support”, “lack of opportunities to provide discharge support”, “implementation of discharge support”, “opportunities to gather information”, and “coordination with other departments”. Acquiring and sharing information among multiple professions enabled the nurse to think about discharge support more practically and to clearly identify problems at discharge. The nurse had a sense of achievement and fulfillment from providing interventions to patients and their families from the early stage and thereby had a successful experience.
Asuke Hospital is located in the Eastern mesomountainous region of Toyota City. The aging rate in this medical care area is over 40% and it has become a typical depopulated area. Due to the shortage of care workers, we started accepting foreign care worker candidates under an Economic Partnership Agreement (EPA). To date, our institution accepted 1 EPA candidate in 2014 and 2 more candidates in 2016. We acted to provide support to EPA candidates mainly for “Coaching in care-giving techniques”, “Counterplan for passing the National Examination for Care Workers and Japanese language education”, and “Support for daily living”. It has been 3 years since we started accepting EPA candidates and in January 2018 our EPA candidate who joined in 2014 passed the 30th National Examination for care workers and became the first EPA care worker at our institution (JA Aichiken Kouseiren). We will continue to support EPA candidates in the future and work hard to create a good working environment for them to work on a long-term basis after they have become a certified care worker.