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ORIGINALS
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Yuki NAGATA, Mikiyasu SAKAI, Hiroko KOMAI, Toshitaka WATARIGUCHI, Koui ...2024 Volume 72 Issue 5 Pages 367-373
Published: 2024
Released on J-STAGE: March 17, 2024
JOURNAL FREE ACCESSEarly detection of third-generation cephalosporin-resistant bacteria in blood culture tests influences the choice of antimicrobial agents. We report on our hospital’s system for early reporting of third-generation cephalosporin-resistant bacteria and its utility. The hospital operates a 24-h simple cefpodoxime (CPDX) testing system, where the content of a sample container with a positive blood culture result is smeared on a CA Sheep Blood Agar/VCM Chocolate EX II fractionation medium, and an antibiotic susceptibility test (AST) disk (Sensi-Disk CPDX) is placed at the center of the medium and incubated. The presence or absence of third-generation cephalosporin-resistant bacteria is estimated from the diameter of the growth inhibition zone. The physician in charge of AST makes comments on the chart based on the simple CPDX test results. The sensitivity of the simple CPDX test for detecting third-generation cephalosporin-resistant bacteria, based on AST results, was 95.5%. Among patients with failed antimicrobial therapy, the rate of switching antimicrobials before the AST results were known was 57.9% in cases where there were comments made by the physicians in charge of AST, compared with 42.9% in cases without comments. These results suggest that the simple CPDX test enables early and accurate detection of third-generation cephalosporin-resistant bacteria, facilitating early switching of antimicrobial agents through collaboration with physicians in charge of AST.View full abstractDownload PDF (726K) -
Hiromi KIMURA, Kayoko KOGA, Midori NISHIO, Hiroko KUKIHARA2024 Volume 72 Issue 5 Pages 374-384
Published: 2024
Released on J-STAGE: March 17, 2024
JOURNAL FREE ACCESSThis study aimed to develop a scale for identifying care needs to enable family caregivers to provide appropriate care to community-dwelling elderly people with early cognitive dysfunction. We developed a draft scale taking into account 32 items of care needs for elderly people with early cognitive dysfunction based on previous studies, and we conducted a questionnaire survey with 86 primary caregivers of elderly people who attended memory loss consultations at Regional Comprehensive Support Center A and the Outpatient Memory Loss Clinic in the Department of Neurology at University Hospital B. Exploratory factor analysis revealed 3 factors consisting of 14 items: (1) family's lack of understanding of early cognitive dysfunction and caregiving, (2) confusion about caregiving and consultations, and (3) caregiving methods and prevention of deterioration with early cognitive dysfunction. Cronbach’s alpha was calculated to be 0.83 for all items, confirming the reliability of the results. In the results of confirmatory factor analysis, the model fit was goodness of fit index (GFI) = 0.89, adjusted GFI = 0.88, comparative fit index = 0.90, and root mean square error of approximation = 0.08. The Care Needs Scale for Elderly People with Early Cognitive Dysfunction consists of 14 items, and this study suggests that the scale can be used to help caregivers of elderly people with early cognitive dysfunction provide appropriate care.View full abstractDownload PDF (813K)
RESEARCH REPORTS
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Ayaka WAKAMATSU, Aya TANAKA, Ryosuke WAKAMATSU, Yuki YAMASHITA, Akio S ...2024 Volume 72 Issue 5 Pages 385-393
Published: 2024
Released on J-STAGE: March 17, 2024
JOURNAL FREE ACCESSWe investigated the relationship between renal function assessment based on cystatin C (CsyC) and serum creatinine levels and the status of chemotherapy use in patients with gynecological cancer undergoing paclitaxel and carboplatin therapy. A significant positive correlation was found between estimated glomerular filtration rate from creatinine (eGFRcre) and eGFR from CsyC (eGFRcys) in the 98 patients included in the study. When eGFRcre and eGFRcys values were grouped according to GFR categories in the CKD severity classification, severe cases (eGFRcys < eGFRcre) were of more advanced age (P < 0.05) and had lower albumin levels (P < 0.01) than matched cases. Although no clear relationship was found between renal function assessment and chemotherapy status, the CysC and eGFRcys values tended to be higher and lower, respectively, in patients whose chemotherapy was deferred (P < 0.01 for CysC, P = 0.07 for eGFRcys). These results suggest that eGFRcre-based renal function assessment is overestimated compared with eGFRcys-based assessment in patients with gynecological cancer and may lead to carboplatin overdose or treatment deferral in elderly patients and patients with hypoalbuminemia.View full abstractDownload PDF (2167K) -
Utako IWAKIRI, Towako MORIYAMA2024 Volume 72 Issue 5 Pages 394-401
Published: 2024
Released on J-STAGE: March 17, 2024
JOURNAL FREE ACCESSIn line with the reform of the national medical remuneration system, an additional remuneration for pharmacists was set for their coordinating operations with local pharmacies to promote outpatient chemotherapy. In our hospital, we introduced this system in June 2020 in order to raise the level of regional cooperation. Although an independent specialized pharmacist is essential for performing this task, it is generally assumed that hospital organizations cannot afford to assign such specialists in clinical practice due to the lack of regular staff. This study aimed to examine effective personnel assignment and profitability for pharmacists in our pharmacy department. The pharmacist working in the outpatient chemotherapy room and concurrently in the ward was changed to work concurrently in the dispensing room, thereby increasing the time spent in the outpatient chemotherapy room from 4 to 6 h. As a result, this personnel assignment substantially increased the amount of additional remuneration and economic profits, but consultations from inpatients decreased. In conclusion, a planned allocation of pharmacists would contribute not only to safe and secure medical service, but also to an increase in medical profits.View full abstractDownload PDF (3282K)
CASE REPORTS
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Takuro KUMAGAI, Manami NAITO, Ken SAITO2024 Volume 72 Issue 5 Pages 402-407
Published: 2024
Released on J-STAGE: March 17, 2024
JOURNAL FREE ACCESSA 71-year-old woman underwent gastrostomy due to malnutrition resulting from impaired esophageal peristalsis due to scleroderma. However, the gastrostomy tube was removed due to worsening of difficult-to-treat dermatitis around the gastrostomy. An intractable gastrocutaneous fistula with persistent gastric juice leakage and peri-gastrostomy dermatitis was treated with fistulotomy and local negative pressure closure therapy under local anesthesia. Spontaneous closure of an intractable fistula after gastrostomy removal can be difficult due to underlying malnutrition and exposure to leaking gastric juice, among other factors. The present case suggests that fistulectomy followed by local negative pressure closure therapy for an intractable fistula after gastrostomy removal can enable oral intake in the early postoperative period and also facilitate wound management.View full abstractDownload PDF (1619K) -
Hidenori OJIO, Yasuharu TOKUYAMA, Naoki OKUMURA, Jin TAKANO, Emiri SUG ...2024 Volume 72 Issue 5 Pages 408-414
Published: 2024
Released on J-STAGE: March 17, 2024
JOURNAL FREE ACCESSA woman in her 70s was referred to our hospital for epigastric pain. CT showed a 3-cm mass slightly below the cardia. At her request, we adopted a strategy of watchful waiting, but 2 years later CT and endoscopy revealed that the mass had grown to 3.5 cm, and single-incision laparoscopic intragastric resection was performed. The day after surgery, hematemesis was observed. Upper gastrointestinal endoscopy revealed oozing from the staple line at the tumor resection site, and hemostasis was performed. Oral intake was started on postoperative day 4, and the patient was discharged from the hospital on postoperative day 10. The final pathology results showed a low-risk gastrointestinal stromal tumor (GIST). Three years after surgery, there has been no evidence of passage obstruction or recurrence. We discuss the indications and techniques for single-incision laparoscopic intragastric resection and review the literature.View full abstractDownload PDF (2522K)
NURSING RESEARCH REPORT
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Emi MAEDA, Yukie KODAMA, Kouichi YABUKI2024 Volume 72 Issue 5 Pages 415-420
Published: 2024
Released on J-STAGE: March 17, 2024
JOURNAL FREE ACCESSThe aim of this study was to identify factors that enable discharge to home after surgery for proximal femoral fracture in elderly patients aged 90 years or older and to effectively provide post-discharge support for maintaining and improving their quality of life. The items significantly associated with discharge to home were the ability to walk at discharge, independence in activities such as toileting, and the family’s desire for the patient to return home. Even patients with dementia and those requiring caregiving could be discharged home if they lived with a son or daughter who was present during the daytime. Furthermore, ambulation on postoperative day 7 was associated with subsequent walking ability.View full abstractDownload PDF (793K)
SHORT REPORT
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Takahiko KATO2024 Volume 72 Issue 5 Pages 421-425
Published: 2024
Released on J-STAGE: March 17, 2024
JOURNAL FREE ACCESSIn the 42 years since our hospital's founding, its building had become aged and overcrowded. To solve these issues, a new hospital was planned and opened in January 2021. Previously in Samihara, about 6,000 ambulances a year could not be accommodated in the city hospitals and had to be redirected to other municipalities. Because of this, a working group was established based on the concept of “strengthening emergency medical care” and examined the design and operational plans for the new hospital. In terms of physical facilities, the interventional radiology room, endoscopy room, and radiology room were designed to be adjacent to the emergency outpatient department on the first floor. On the organizational side, we established an emergency center and a stroke center to strengthen our emergency medical system. The new hospital has actively accepted emergency patients since it opened, and the number of ambulances accepted has increased by 1,600 per year compared with before it opened. By promoting the clear concept of “strengthening emergency medical care”, the new hospital centered on emergency medical care was successfully completed and has led to an increase in the acceptance of emergency patients.View full abstractDownload PDF (1205K)
MATERIAL
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QIJUN YAN, Mitsuko USHIKUBO2024 Volume 72 Issue 5 Pages 426-433
Published: 2024
Released on J-STAGE: March 17, 2024
JOURNAL FREE ACCESSMore than 90% of Chinese returnees who returned permanently to Japan after the normalization of diplomatic relations between Japan and China in 1972 are over 70 years old, and their care needs are increasing. In order to clarify the support needs of Chinese returnees whose caregiving problems are becoming more serious, this study organized and analyzed the literature on care for first-generation Chinese returnees and their caregiving problems and suggested solutions. We searched the Ichushi-Web (Japan Central Revuo Medicina Web, ver. 5), CiNii, and PubMed databases for journal articles focusing on home care for returnees from China published since the enactment of long-term care insurance in 2000. Five articles were selected for analysis. As a result, there were few papers on home care and the studies included not only first-generation Chinese returnees but also second-generation returnees. Data collection required Chinese translators and interpreters. Three types of problems were identified: problems arising from cultural differences, problems related to the care system, and problems related to support in the local community. Four suggestions are made for each of these three issues, and there is a need for future research.View full abstractDownload PDF (1386K)
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