This study aimed to clarify factors that promote team care among nurses in comprehensive community-based care (CCC) wards. After the establishment of “CCC Ward Hospitalization Fees 1 and 2”, we conducted an anonymous, self-report survey at medical facilities affiliated with the Japanese Association of Hospitals for Community-based Care. The survey covered items related to the distinctive features of CCC wards including organization, types of conferences, and basic attributes of nurses. Other items examined were team care in CCC wards, including awareness of cooperation, goal and information sharing, and competency of interprofessional collaborative practice Data analysis included the t-test for comparison between variables, oneway analysis of variance, and the post hoc Tukey’s test for multiple comparisons. In the stepwise multiple regression model, scores for four “awareness of cooperation” factors and three “goal and information sharing” factors were used as independent variables and the total score for “competency of interprofessional collaborative practice” was used as the dependent variable. In total, 452 nurses returned the survey (response rate: 35.7%) and 309 provided valid responses (valid response rate: 68.3%). Results suggest that factors promoting team care for nurses in CCC wards predicted decision-making based on the following: patient conditions and lifestyles; clarification of team goals; proposal, consideration, and agreement regarding care methods and focus of care; and cooperation in team development. We believe that team care in CCC wards will be promoted by implementing the factors revealed in this study.

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　　The mandibular third molars are usually located near the inferior alveolar nerve, and surgical extraction may damage this nerve causing dysesthesia. Recently, cone-beam computed tomography (CBCT) has become more widespread, facilitating the diagnosis of various diseases of the oral maxillofacial region. This study investigated dysesthesia of the inferior alveolar nerve following mandibular third molar extraction and the relationship between this complication and preoperative imaging findings. A total of 401 mandibular third molars were extracted from 345 patients with a mean age 33.9 ± 14.6 years (range, 16-81 years). All patients were evaluated by panoramic radiography, and 89 mandibular third molars were evaluated by CBCT. We classified the shape of the mandibular canal into 4 types based on its shape at the point closest to the mandibular third molars. The rate of dysesthesia after mandibular third molar extraction was 5.7% among patients considered to be at high risk who underwent CBCT, and 0.64% among patients considered to be at low risk. The mandibular third molars were not in contact with the inferior alveolar nerve in 51 of the patients who underwent CBCT. These results suggest that deformation of the mandibular canal may lead to dysesthesia following mandibular third molar extraction and that CBCT was useful for predicting the risk of this complication.

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　　The objective of this study was to develop a scale that measures job satisfaction in public health nurses (PHNs) employed in the public sector and to test its reliability and validity. Results of semi-structured interviews with PHNs employed in the public sector and findings in literature review were assessed for content validity. A preliminary scale consisting of 74 items was thus developed, and its reliability and validity were tested in 1,030 PHNs employed in the public sector. Valid responses obtained from 422 PHNs (valid response rate, 41.0%) were subjected to item analysis followed by exploratory factor analysis using the principal factor method with promax rotation. Accordingly, 3 factors and 18 items were extracted, and the hypostatic factors were named “duties and responsibilities of PHNs”, “senior staff's understanding and environment facilitating personal development”, and “thoughts and trust in residents”. Confirmatory factor analysis confirmed the goodness of fit of the hypothetical model. Cronbach’s t was 0.907 (0.847-0.900 for subscales), confirming the reliability of the scale. The intraclass correlation coefficient (r) by the test-retest reliability method was .847 (.727-.830 for subscales), confirming stability. The criterion-related validity was confirmed by positive correlations of the draft scale with a general job satisfaction scale (r = .642, p.001), a self-esteem scale (r = .452, p.001), a self-efficacy scale (r =.411, p.001), an interpersonal support ability scale (r = .452, p.001), and a scale for ability to support and manage the community (r =.532, p.001). In sum, we developed a scale consisting of 3 factors and 18 items that measures job satisfaction in PHNs employed in the public sector. The contents of this scale will contribute to aspects of job satisfaction in diverse human resource development of the future. Thus, this scale is expected to be useful as a human resource development tool for PHNs employed in the public sector.

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　　Patients with cerebrovascular disease (CVD) were transferred to a recovery phase rehabilitation ward after the acute care phase after the new system establishing recovery-phase rehabilitation wards was started in April 2000. The patients received rehabilitative and nursing care in this ward. This study aimed to clarify the relationship between psychological adjustment and quality of life (QOL) in patients with CVD and to compare this relationship in patients with lateralized cerebral damage (right hemisphere, 19 patients; left hemisphere, 17 patients). Using the Japanese versions of the 36-item Short Form Health Survey for QOL and the Nottingham Adjustment Scale for psychological adjustment, we conducted a survey in three stages: on admission, hospitalization, and discharge. The results revealed that QOL in the group with right hemisphere cerebral damage (right group) and the group with left hemisphere cerebral damage (left group) did not worsen: physical health improved in the right group while physical and mental health in the left group showed rapid improved, despite being lower than in the right group on admission. QOL in both groups was almost the same o discharge. The results for psychological adjustment revealed that both groups showed adjustment in “anxiety/depression”, “disability attitude”, and “disability acceptance” during hospitalization, and psychological adjustment in both groups was similar on discharge.

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　　Prophylaxis is sometimes offered to inpatients who share a room with, or individuals who have been in close contact with, patients who have contracted influenza. In our hospital, 5-day prophylactic oseltamivir has been used as a standard procedure. Here, we investigated the effectiveness of this post-exposure prophylaxis for inpatients and healthcare professionals, as well as its effect on hospital management. The study period was 5 years from fiscal year 2013 to fiscal year 2017, and the effectiveness outcome was the secondary infection rate. Medication costs for this prophylaxis were compared with those for oseltamivir used according to the package insert. The secondary infection rates were 3.0% and 0.5% in 133 inpatients and 434 healthcare professionals who had received post-exposure oseltamivir, respectively. The medication costs were reduced by 50% compared with the estimated costs for 10-day oseltamivir administration. The effectiveness of 5-day prophylactic oseltamivir was similar to or higher than that reported previously, indicating that this prophylaxis was effective. Moreover, 5-day post-exposure prophylactic oseltamivir is expected to reduce the prolongation of hospital stay and influenza outbreaks and thus contribute to hospital management.

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　　This study aimed to elucidate nurses' interpretation of the feelings toward outings among patients with amyotrophic lateral sclerosis on home mechanical ventilation (ALS/HMV patients), as well as the support provided by nurses enabling these patients to go out. Semi-structured interviews were conducted with 5 nurses who had helped ALS/HMV patients make their first outing since starting HMV, and results were analyzed inductively. As interpreted by the nurses, there were 9 categories of feelings toward outings among ALS/HMV patients who had no prior experience of outings, such as “desire to go out”, “concerns about postural maintenance and physical pain”, and “concerns about mechanical troubles”. There were 7 categories of support provided by nurses to enable ALS/HMV patients to go out, such as “predicting and preparing for danger”, “persuading ALS/HMV patients to include outings in their lives”, and “finding the best timing for outings”. These results indicate that nurses grasped ALS/HMV patients' positive and negative feelings toward outings, and supported them to expand their lives by ensuring their safety, motivating them, alleviating their concerns, and enhancing their independence.

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　　Purpose: The self-expandable metallic stent (SEMS) for colorectal obstruction became covered by national health insurance in January 2012, and it has since become a standard treatment. Here we report the utility of SEMS for colorectal obstruction in our department.
　　Patients and Methods: We retrospectively reviewed 65 patients who underwent SEMS placement for colorectal obstruction in our department from May 2013 to December 2018. We examined age, sex, etiology of colorectal stenosis, purpose of stenting, and tumor location.
　　Results: The technical success rate was 98.5% (64/65) and the clinical success rate was 93.8% (61/65). Technical failure occurred in 1 case because the guidewire could not pass the stenosis. Adverse event rates were 1.6% within 7 days and 4.7% after 7 days.
　　Conclusion: SEMS placement had a high technical success rate and few adverse events. Clearly SEMS placement is a minimally invasive procedure that is effective for improving QOL. The safety and effectiveness of this procedure appeared to be excellent.

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　　Simultaneous creation of an enterostomy for enteral nutrition during esophagectomy has been useful in our experience, but bowel obstruction associated with intestinal fistula remains a problem. Therefore, in this study, we retrospectively reviewed 18 patients with esophageal cancer who underwent transdiaphragmatic transgastric tube enteral feeding catheter placement during gastric tube reconstruction via the mediastinal route after esophagectomy from November 2012 to March 2014. The catheter was guided from the gastric tube into the gastrointestinal tract, with the tip placed in the jejunum distal to the ligament of Treitz. From the gastric tube, the catheter was guided along the diaphragm to the anterior abdominal wall through the extraperitoneal route. No bowel obstruction associated with catheter placement has been observed in any of the patients from the time of surgery to this writing. Also, the procedure enabled jejunostomy use for more than 5 years, similar to conventional jejunostomy. We experienced 1 case of catheter deviation into the mediastinum. Overall, transgastric tube enteral feeding catheter placement for reconstruction of the posterior mediastinal gastric tube was useful for avoiding intestinal obstruction associated with jejunostomy. However, there may be a risk of catheter displacement into the mediastinum.

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　　Some patients requiring medical care wish to continue living at home, so the establishment of a collaborative healthcare system reflecting each community’s characteristics is urgently needed. Medical social workers (MSWs) are one of the professions in this collaborative system. Even though practice guidelines for MSWs include community practice, the main duty of MSWs to date is to support patients at hospital discharge. We, therefore, conduct this literature review to identify desirable MSW’s practice in the community. Based on Japanese studies on MSW's community practice we initially searched, MSW-led interventions were extracted from case reports, and inhibitory factors and promoting factors were extracted from research papers and survey reports. The finding indicates that practice MSWs implemented were “establishment of a collaborative system involves multiple institutions and professionals”, “establishment of a community network that supports patients’ life in the community”, “activation of the community through establishment of opportunities (e.g. gathering places) for residents to interact”, and “promotion for activities in the entire community (e.g., organizing educational classes)”. Data searched were summarized in 4 inhibitory factors and 4 promoting factors, respectively. The inhibitory factors were “activity restrictions due to the rules of institutions MSWs belong to”, “predominance of discharge support in the assigned jobs”, “shortage of allocated workers”, and “ambiguity of job responsibilities unique to MSW”. The promoting factors were “recognition within and outside the hospital, regarding the effectiveness of MSW’s practice”, “promotion of collaboration involving multiple institutions, multiple professionals, and non-professionals in the community”, “meeting the needs of MSW-specific roles”, and “establishment of MSWs' position in the community and their duties inside the hospitals”. As a result, the following points were important to address, which helps establish MSW's community practice: practice that utilizes social workers' perspectives and approaches; building better working environment within the hospital; and establishment of MSW's roles in the community collaboration inside and outside the hospital.

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　　Cases of Japanese spotted fever (JSF) have been reported mainly in the warm southwest region of Japan. A woman in her 40s developed a fever after being bitten by a tick attached to her pet dog in Hyogo Prefecture (west Japan). She then traveled to a vacation home in Yamanashi Prefecture (central Japan). Though she sought medical care in both prefectures, her symptoms did not improve, so she was admitted to our hospital, which is located in Nagano Prefecture near her vacation house. She had high fever and eruptions and had developed acute disseminated intravascular coagulation. From an interview, we suspected tick-borne disease and administered doxycycline and levofloxacin. She subsequently recovered. Nine months after discharge, a serological test performed at the National Institute of Infectious Diseases in Tokyo confirmed a diagnosis of JSF. JSF is a rare disease in Nagano Prefecture, with only 3 cases reported from 1999 to June 2020. As shown by this case, we should consider JSF in the differential diagnosis of patients with acute high fever and eruptions regardless of geographic region, because unlimited travel across Japan is now common.

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　　A 72-year-old woman was scheduled to undergo aortic valve replacement for aortic stenosis when she was diagnosed with heparin-induced thrombocytopenia type II after a decrease in platelets was detected. Although postponement was considered, the operation went ahead as scheduled because of unstable hemodynamics. Continuous intravenous infusion of argatroban (4 mg/kg/min) was initiated at the start of the operation, and nafamostat mesylate (30 mg/h) was initiated when cardiopulmonary bypass was started. Activated coagulation time was monitored, and the dose of argatroban was adjusted accordingly. Argatroban administration was terminated after removal of aortic cross-clamping, and cardiopulmonary bypass was stopped 1 h later. The operation was completed 7 h after stopping cardiopulmonary bypass due to difficulties in hemostasis. Operation time was 12 h 21 min, cardiopulmonary bypass time was 3 h 10 min, blood loss was 3444 mL, and blood transfusion volume was 6400 mL. The amount of argatroban administered was lower in our case than in previously reported cases, but blood loss after stopping cardiopulmonary bypass could not be reduced in our case.

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　　We investigated the relationship between neonatal blood hemoglobin (Hb) and period of oxygen administration in 4 cases of fetomaternal transfusion syndrome at our hospital. The hematological parameters were as follows. Case 1: Hb 7.0 g/dL, reticulocyte count 177‰, no blood transfusion, and oxygen administration for 3 days. Case 2: Hb 4.7 g/dL, reticulocyte count 132‰, blood transfusion given, and oxygen administration for 7 days. Case 3: Hb 4.1 g/dL, reticulocyte count 202‰, blood transfusion given, and oxygen administration for 12 days. Case 4: Hb 3.6 g/dL, reticulocyte count 48‰, and blood transfusion given. In Case 4, we started artificial respiration and oxygen administration for treatment of neonatal asphyxia. Oxygen administration was stopped at 50 days of age. Artificial respiration was continued, and tracheostomy was attempted at 198 days of age. Case 4 was classified as having acute blood loss based on the reticulocyte count and had a poorer prognosis than Cases 1-3, which were classified as having chronic blood loss. In Cases 1-3, peripheral blood Hb level was inversely related to the period of oxygen administration.

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　　The use of pharmaceuticals requires establishing a safe environment and securing a system to reduce risk. In our isotope inspections, the operational system for using radiopharmaceuticals was insufficient, which became a problem. For this reason, through cooperation between a radiological technologist responsible for radiation safety management and a pharmacist responsible for medicine safety management, we considered the operational system for the preparation and management of radiopharmaceuticals at our hospital. In accordance with the guidelines for handling radiopharmaceuticals, we established a system to reduce risks by reviewing pharmaceuticals, creating checklists, and improving the work environment. By reviewing and improving the system of safety management and safe use in cooperation with other disciplines, it became possible to reduce risk through double checks and to improve the work environment for routine operations. This report describes the efforts made in our hospital.

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