The main purpose of this retrospective cohort study was to examine the relationship between total walking distance on the first day of walking after surgery for hip fracture and walking status at discharge in the elderly. The inclusion criteria were age 65 years or older and ability to walk independently with or without a walking aid before the injury. Sex, age at admission, fracture type, type of surgical procedure, Revised Hasegawa Dementia Scale score, time from surgery to the first day of walking, total walking distance on the first day of walking, walking status at discharge, and length of hospitalization were investigated from the electronic medical records. We then examined the investigated the relationship between walking status at discharge and total walking distance on the first day of walking after surgery. Mean age of the patients was 79.5 years, and 6 patients had cognitive impairment. A total of 12 patients were able to walk 50m at discharge. In bivariate logistic regression analysis, total walking distance on the first day of walking was found to be a significant predictor of walking status. Therefore, total walking distance on the first day of walking after hip fracture surgery appears to be a useful predictor for the walking status at discharge in Japanese general hospitals.
It has been reported that 30% of deaths related to the Kumamoto Earthquakes were among those who had spent nights in the car. Spending nights in the car imposes heavy mental and physical burden, but it has been examined in only a few studies. At 1 year after the Kumamoto Earthquakes, this study examined the factors affecting the mental health of 460 disaster-affected workers at 13 companies who stayed in the car. It was found that 181 workers (72.7%) had spent nights in the car. They had significantly higher scores on the Athene Insomnia Scale, revised Impact of Event Scale (IES-R), and General Health Questionnaire (GHQ) 28 compared with workers who had not stayed overnight in the car. Multiple regression analysis showed that “physical functioning”, “social functioning”, “anxiety and insomnia”, and “staying in the car” were factors affecting the IES-R score, while “vitality”, “avoidance symptoms”, “staying in the car”, and “subjective symptoms” were factors affecting the GHQ 28 score. Mental burden on workers in a natural disaster are imposed in addition to accumulated work burden. Given that mental burden may not ease over a prolonged period, there appears to be a substantial need to urgently discuss how assistance measures should be provided.
The purpose of this study was to evaluate the effects of highly concentrated enteral nutrition (ENORAS®, Otsuka Pharmaceutical Factory, Tokushima, Japan; hereinafter, ED) on the maintenance of nutritional status and bodyweight in chemotherapy-treated patients with gastrointestinal cancer who received ED between July 2019 and January 2020. For 21 patients (15 men and 6 women, age range: 57-87 years old), we investigated serum albumin level, cholinesterase level, lymphocyte count, hemoglobin level, and bodyweight at baseline and after receiving ED. None of the patients showed any differences in albumin level, cholinesterase level, lymphocyte count, hemoglobin level, or bodyweight before and after receiving ED. Survivors had significantly favorable changes in cholinesterase level compared with non-survivors (p=0.0258). The group that received ED for 30 days or longer tended to show more favorable changes in bodyweight than the group that received ED for less than 30 days (p=0.0696). The group with stage I-III disease had more favorable changes in albumin level than the group with stage IV disease or recurrence (p=0.0932). Our results suggest that the ED is useful for helping to maintain nutritional status and bodyweight in chemotherapy-treated patients with gastrointestinal cancer.
The technology for processing and analyzing tangential X-ray images of intervertebral disc spaces is advancing rapidly with the development of medical imaging information technology. However, geometric measurements of the intervertebral disc space angle and the tangential X-ray incident angle have not yet been evaluated. This study examined these using a lumbar spine phantom and an X-ray flat panel detector. Depiction of the intervertebral disc spaces on frontal images of the lumbar spine was visually evaluated and compared in terms of deviation of the tangential X-ray incident angle in order to reveal whether there was an effective tangential X-ray incident angle index to improve the depiction accuracy. Tangential X-ray incident angle deviation was in the range of 0° to ±9.0°, and images were examined in ±2.0° increments of angle deviation (5 classes in total). Evaluation of the intervertebral disc spaces and the cartilage end plates revealed extremely clear depiction of the disc spaces with tangential depiction with angle deviation of ±2.0° or less and clear depiction of the disc spaces with a thin oval appearance of the cartilage end plates with angle deviation of ±3.0°-4.0°. However, there was unclear depiction of the disc spaces with a slightly thick oval appearance of the cartilage end plates with angle deviation of ±5.0°-6.0°, unclear depiction of the disc spaces and the cartilage end plates with angle deviation of ±7.0°-8.0°, and inadequate quality for observation of both the disc spaces and the cartilage end plates with deviation of ±9.0° or more. Therefore, it is considered that the allowable deviation of the tangential X-ray incident angle needs to be ±5.0°-6.0° or less. Setting of the tangential X-ray incident angle to the intervertebral disc space by geometric measurement can be achieved easily and accurately by use of the flat panel detector and the image processing function. It can also be a new index for improving the accuracy of image depiction ability.
The purpose of this study was to investigate the effects of energy of virtual monochromatic images (VMIs) and the strength of iterative reconstruction on computed tomography (CT) number, image noise, and visual evaluation. Low keV VMIs improve the CT number of the contrast agent but also increases image noise, making them difficult to use. However, the adoption of iterative reconstruction has made low keV VMIs possible to use. We scanned a phantom containing dilute contrast agent with single energy (SE) and dual energy (DE) scanned images, comparing CT number, image noise (SD), and the contrast-to-noise ratio (CNR). The CT number and SD of 40 keV VMIs were 2.8 and 2.4 times higher, respectively, than those of 120-kV CT images. VMIs showed an inferior CNR compared with SE images due to increased image noise. The higher the strength of iterative reconstruction, the higher the visual evaluation score. Visual evaluation scores were highest at 50 keV. Low-keV VMIs are greatly affected by increased image noise. But by taking into the effects of parameters such as tube voltage and strength of iterative reconstruction, low keV VMIs can improve the visualization of blood vessels and reduce the use of contrast agent.
An anonymous mail survey was conducted with 2000 elderly residents (≥ 70 years) of areas with heavy snowfall to assess differences in health and lifestyle between those with and without a driver’s license as well as the effects of voluntary license surrender. Responses from 1101 residents with complete demographic and license status data were analyzed. The survey showed that 63.7% had a driver's license, 15.4% had voluntarily surrendered their license, and 20.9% had never had a license. Compared with those who had surrendered their license or never had a license, those who had a license were younger, had higher scores on the Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence and a social capital scale, had better selfrated health and life satisfaction, and had participated in more activities over the past year. Among those who had surrendered their license, the women were younger than the men, and were more likely to be working and had better self-rated health and a higher score on the TMIG index of competence. Men who had surrendered their license more frequently reported “feeling calmer” than women, and women more frequently reported “spending more time working in the fields” than men. Over 60% of both men and women reported having fewer opportunities to leave their house. Among those who had a driver's license, about 40% reported that they wanted to keep driving as long as possible because not having a license would be inconvenient. These results suggest that it is important for people living in areas with heavy snowfall who have surrendered their license to secure another means of leaving their house due to the need to have a car for transportation in these areas.
An 83-year-old woman who vomited blood was taken to our hospital by ambulance. She was taking oral ticlopidine for chronic arterial occlusion of the lower extremities. Emergency upper gastrointestinal endoscopy revealed bleeding from a gastric polyp. Following endoscopic mucosal resection, the clinical course was uneventful and she was discharged 7 days after admission. Histopathology revealed that the resected gastric polyp was a hyperplastic polyp with no malignant findings.
A man in his 40s visited our hospital with a chief complaint of upper abdominal pain after defecation. His general and local conditions were good. Intraperitoneal free air was detected on an abdominal computed tomography (CT) scan, and laboratory tests revealed leukocytosis. Esophagogastroduodenoscopy showed no abnormalities. Emergent laparotomy was performed because of the suspected intestinal perforation, but neither perforation nor peritonitis was observed. Bacterial culture of intraperitoneal lavage fluid was negative. The postoperative course was uneventful and he was discharged. Because the cause of pneumoperitoneum was unknown, the diagnosis was idiopathic pneumoperitoneum. However, we had the opportunity to evaluate abdominal CT images taken with the lung window setting 4 years before the operation, which showed pneumatosis intestinalis in the ileocecal region. It has been reported that metachronous pneumatosis intestinalis is sometimes detected in cases of pneumoperitoneum with pneumatosis intestinalis. Thus, pneumatosis intestinalis was suspected as the cause of pneumoperitoneum in this case.
A 65-year-old man visited our department because of 3 nodules that had appeared 6 months earlier in the lower jaw and left lower leg. One month before presentation, papules appeared and spread across his body. Palpation revealed a soft nodule in the lower jaw and relatively hard nodules in the left lower leg. Biopsy of the nodules showed moderate-sized cell infiltration in the middle to lower dermis and mononuclear cells (mainly lymphocytes) with many eosinophils in the adipose tissue. Histochemistry confirmed CD4-positive and CD8-positive cells, but not CD30-positive larger lymphocytes. Accordingly, psuedolymphoma was diagnosed. Two months later, prurigo pigmentosa appeared on the trunk, and minocycline (200 mg/day; p.o.) was effective to some degree. Both eruptions were thought to be induced by land leech bites.
A 14-year-old girl (Case 1) with respiratory distress during exercise was referred to our department after a pancreatic mass was detected by computed tomography (CT). Contrastenhanced CT scan showed a low-density mass measuring 2.5 × 2 cm in the body of the pancreas. Low signal intensity was seen on T1-weighted magnetic resonance imaging (MRI) and high signal intensity on T2-weighted MRI. We suspected solid-pseudopapillary neoplasm (SPN) of the pancreas and performed laparoscopy-assisted spleen-preserving distal pancreatectomy. The postoperative course was uneventful, and she was discharged on postoperative day 13. A 15-yearold girl (Case 2) with abdominal pain and fever was referred to our department after an abdominal cystic mass was detected by ultrasound examination. Contrast-enhanced CT showed a 4-cm well-circumscribed mass. Higher signal intensity was seen on T2-weighted MRI. We suspected SPN of the pancreas and performed laparoscopic spleen-preserving distal pancreatectomy. The postoperative course was uneventful, and she was discharged on postoperative day 8. Laparoscopic or laparoscopy-assisted surgery should be considered for SPN of the pancreas.
The purpose of this study was to verify whether emotional intelligence-based leadership behaviors among nursing administrators were enhanced by using a 38-item Leadership Self-Evaluation Checklist, which was developed by the author in 2017 and included emotional intelligence items. Participants in this study were 17 nursing administrators at Hospital A. Each participant was interviewed after they completed the self-evaluation checklist 4 times at 3-month intervals. Changes in the scores of checklist items on emotional intelligence-based leadership behaviors and changes in what they said during interviews were analyzed. The results were then analyzed to look for changes in the items on emotional intelligence-based leadership behaviors, increases in participant awareness, and other behavioral changes. The average subscale score for the emotional intelligence-based leadership behavior items was increased significantly in 2 participants, and findings of their interviews were further investigated. Participant 11 who showed a 2-point increase in the average subscale score of emotional intelligence-based leadership behavior items was aware that being unable to effectively communicate with staff was their weakness and was consciously taking steps to overcome this weakness. Participant 14 showed a 2.85-point improvement and recognized the need to identify their own shortcomings and change their behaviors, which led to behaviors such as creating an environment where staff felt comfortable expressing themselves. In short, it was confirmed that repeated self-evaluation using the checklist by nursing administrators increased their emotional intelligence-based leadership behavior score.
Medical technologists at our hospital have begun to conduct tests before outpatient appointments for memory loss and dementia. They administer the Mini-Mental State Examination (MMSE) and the Geriatric Depression Scale (GDS-15), take patients' medical history, and perform auxiliary diagnostic tests for cognitive function. Technologists at our hospital assessed 365 patients (mean age 80 years; 172 men and 193 women) in this way between May 2018 and May 2019. We determined a cutoff value for the MMSE and tested the validity of the technologists’ assessments of these patients by comparing them against physicians' clinical diagnosis. Our hospital sees many patients with Alzheimer’s disease, and 85% of patients diagnosed with dementia had an MMSE score of 23 or lower. The MMSE is a highly reliable screening test for dementia, and technologists scored it similarly to physicians. Addition of the GDS-15 showed that outpatients with dementia had underlying anxiety symptoms and depression. It is important that technologists continue their involvement in outpatient care as certified dementia specialists while also continuing to consider which tests they should conduct.