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Volume 73, Issue 4
Displaying 1-6 of 6 articles from this issue
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ORIGINALS
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Toshikazu ICHIE, Noriko KUBOTA, Chise HONDA, Megumi YOKODE, Mayu MINAM ...2024 Volume 73 Issue 4 Pages 347-355
Published: 2024
Released on J-STAGE: December 15, 2024
JOURNAL FREE ACCESSUse of benzodiazepine (BZD) receptor agonists for delirious or elderly patients has occasionally been found as a result of inappropriate instructions for insomnia or restlessness, according to research of the dementia and delirium support team (DDST), which manages instructions on admission and during hospital rounds. We believe that one reason for this is the lack of hospital guidelines for managing insomnia and restlessness. When changing electronic medical record vendors, we took the opportunity to establish proper drug usage instructions. The percentage of available instructions for insomnia and restlessness at the time of admission and the prescribed medications were surveyed and compared before and after the vendor change. The prescription rate for insomnia was 88.6% (1,779/2,007) before and 91.9% (1,902/2,069) after the change, showing a significant increase. The prescription rate of benzodiazepine receptor agonist use was 47.7% (848/1,779) before and 41.6% (792/1,902) after the change, showing a significant decrease. The prescription rate for restlessness was 71.2% (1,429/2,007) before and 85.6% (1,771/2,069) after the change, showing a significant increase. The recommended drug usage instructions affected prescriptions for insomnia and restlessness at admission and prescriptions of BZD receptor agonist usage at admission. Our findings seem to suggest that setting drug usage instructions for insomnia and restlessness when changing the electronic medical record vendor will be useful for promoting proper medication use.View full abstractDownload PDF (769K) -
Mitsuki HAYASHI, Yasushi MATSUKAWA, Mina INOUE, Masahiko SODA, Yuta KA ...2024 Volume 73 Issue 4 Pages 356-362
Published: 2024
Released on J-STAGE: December 15, 2024
JOURNAL FREE ACCESSCongenital fetal abnormalities, typically structural abnormalities, are found about 3-5% of all pregnancies. The prenatal detection of these abnormalities are especially important in providing optimal perinatal management for neonates. In many obstetric hospitals and clinics in Japan, fetal ultrasound screening is provided by obstetricians at regular pregnancy checkups. There were few reports on fetal ultrasound performed by medical technologists. Therefore, we conducted a retrospective investigation to determine the efficacy and accuracy of fetal ultrasound performed by medical technologists in our hospital. In total, 2,289 pregnancy women underwent fetal ultrasound screening. We excluded cases that were a second or subsequent scan, had gestational age of <22 weeks at the time of ultrasound screening, or had missing perinatal and neonatal outcomes. The remaining of 2,186 cases, including 65 cases of twins, were investigated. Abnormal findings were noted in 79 cases (3.6%): 31 for the heart, 14 for head, and 11 for urogenital organs. In those cases, congenital abnormalities were found in 39 neonates (1.8%). There were 95 cases (4.3%) in which abnormal finding were absent in fetal ultrasound screening but congenital abnormalities were diagnosed in neonates, including ventricular aneurysm, interruption of the vena cava, cerebellar medulloblastoma, atrial septal defect, and cleft palate. In conclusion, for detecting structural abnormalities, fetal ultrasound screening performed by medical technologists is an important alternative to ultrasound screenings performed by obstetricians. To increase the accuracy of fetal ultrasound screening, continuous improvement of fetal ultrasound skills is important.View full abstractDownload PDF (750K) -
Kumiko OGATA, Emiko NAKASHIMA, Shinichiro MIURA, Sayori SAKANASHI, Yuk ...2024 Volume 73 Issue 4 Pages 363-371
Published: 2024
Released on J-STAGE: December 15, 2024
JOURNAL FREE ACCESSThis study aimed to elucidate lifestyle, frailty status, and factors associated with frailty among community-dwelling older adults with heart disease. An anonymous self-administered questionnaire-based survey was sent by mail to 1,277 patients aged 65 or older who were attending an outpatient cardiology department. Survey items covered basic attributes, health and heart disease information, lifestyle, and frailty status. Descriptive statistics, t-tests, and Pearson's product-moment correlations were used to analyze the data. A total of 362 respondents who completed the survey with minimal missing data were included in the analysis. While less than 30% of the respondents maintained a socially engaged lifestyle, over 80% practiced health habits, such as diet and blood pressure management. At least one in four respondents exhibited frailty in motor skills or oral function. The study identified several factors significantly associated with frailty: female sex, poor economic and health status, and lack of healthy dietary or exercise habits. For older adults with heart disease to maintain independent living, it is crucial to manage disease symptoms, maintain oral health, practice dietary habits that prevent malnutrition, and engage in regular exercise aligned with their interests.View full abstractDownload PDF (821K) -
: Comparison of the Standard Syringe Changeover Method Versus the On-Off Method or Double Pumping MethodHiroshi NOMURA, Kenzo SHIBAYAMA2024 Volume 73 Issue 4 Pages 372-381
Published: 2024
Released on J-STAGE: December 15, 2024
JOURNAL FREE ACCESSObjective: When dopamine is administered using a syringe pump, the reduction in drug infusion volume due to syringe replacement can cause hemodynamic instability. To address this, several changeover methods have been developed. This study aimed to investigate the optimal syringe changeover method by comparing the time required for syringe replacement and the drug infusion volume during replacement across different methods.
Methods: Experiment I. The time required for syringe replacement using the standard syringe changeover method and the flushing method was compared using the Mann-Whitney U test, and the volume of dopamine solution not infused during syringe replacement was estimated. Experiment II. At dopamine infusion rates of 3.6 ml/h (general initial rate) and 6.0 ml/h (standard rate), the dopamine infusion volume over 60 min after syringe replacement was compared between the on-off method or double pumping method and standard syringe changeover method.
Results and Discussion: There was no significant difference in syringe replacement time between the standard syringe changeover method and the flushing method. The volume of uninfused dopamine solution during the syringe replacement period was less than 0.1 ml for both flow rates. At a flow rate of 3.6 ml/h, the volume of dopamine infused 10 min after the start of infusion was significantly larger with both the double pumping method and the on-off method compared with the standard method. At 30 min and between 50 to 60 min, only the on-off method showed a significantly larger infusion volume compared with the standard method. At a flow rate of 6.0 ml/h, no significant differences were observed at any time point. These findings suggest that higher flow rates may reduce the impact of frictional resistance.View full abstractDownload PDF (1865K)
CASE REPORTS
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Hiroya SUZUKI, Hiroshi NAKANO, Sohei HAYASHISHITA, Mei SAKUMA, Masashi ...2024 Volume 73 Issue 4 Pages 382-389
Published: 2024
Released on J-STAGE: December 15, 2024
JOURNAL FREE ACCESSThe patient was a 66-year-old man who presented to our hospital with intermittent abdominal pain. Abdominal ultrasound showed a mass presenting as a target sign in the right abdomen, suggesting intussusception. Subsequent computed tomography (CT) and lower gastrointestinal endoscopy revealed a 5 cm lipoma in the ascending colon. The intussusception had resolved spontaneously, so the patient was followed up on an outpatient basis. Although endoscopic treatment was considered for the lipoma, due to its large size, the patient was referred to our department for surgery 1 month later. A follow-up CT scan revealed a recurrence of the intussusception. Because the patient tolerated oral intake, had normal bowel movements without symptoms of bowel obstruction, and experienced only mild abdominal pain, conservative outpatient observation was continued until laparoscopic-assisted ileocecal resection was performed. The postoperative course was uneventful, and the patient was discharged on postoperative day 8 without any complications. Colonic lipoma causing intussusception is relatively rare. Since lipoma is a benign disease, it is a good candidate for laparoscopic surgery, which offers excellent cosmetic outcomes and rapid postoperative recovery. Even in cases with intussusception, when there is no bowel obstruction and the abdominal pain is mild, elective surgery within 1-3 months can be considered a viable option.View full abstractDownload PDF (2744K) -
Ryo KANODA, Hiroshi NAKANO, Hiroya SUZUKI, Sohei HAYASHISHITA, Mei SAK ...2024 Volume 73 Issue 4 Pages 390-396
Published: 2024
Released on J-STAGE: December 15, 2024
JOURNAL FREE ACCESSMetronidazole is an effective antibacterial agent against anaerobic bacteria, and its use in the gastrointestinal field, particularly in patients with intra-abdominal infections, has increased with the availability of injectable formulations. However, a known side effect of metronidazole is central nervous system impairment, namely, metronidazole-induced encephalopathy. Here, we present a case of a 68-year-old man who underwent laparoscopic abdominoperineal resection for rectal cancer in March of year X. Postoperatively, metronidazole was administered for pelvic dead space infection and perineal wound infection, and the patient continued the oral medication after discharge. In May of year X, the patient was referred to our institution near his home for postoperative adjuvant chemotherapy. In February of year X+1, the patient developed dysarthria, and a FLAIR (fluid-attenuated inversion recovery) image on head magnetic resonance imaging revealed bilaterally symmetric hyperintense lesions in the dentate nuclei of the cerebellum. Suspecting metronidazole-induced encephalopathy based on the medication history, metronidazole was discontinued, leading to symptom improvement within approximately 3 days. We diagnosed metronidazole-induced encephalopathy based on the imaging findings and clinical observations. When using metronidazole, we should pay attention to the dosage and duration of administration and make efforts to detect side effects early.View full abstractDownload PDF (1749K)
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