We established a General Management Office of Health Insurance and Medical Practice in Showa University to achieve more optimization of the system of Health Insurance & Medical. This office manages the comprehensive administration of the medical services under the health insurance system in each Showa University affiliated hospital. We can confirm that the contents of the medical service under health insurance actually performed in each hospital are the same as the one conducted by the social health insurance administrator of the surveillance and inspection throughout Japan regarding structure and quality, because some of our members had personnel interchange with Ministry of Health, Labour and Welfare as associate members. This time, we would like to report on our activities aiming at wide dissemination of this “Health Insurance & Medical Practice” in the university and the questionnaire survey result which was conducted in order to confirm the effectiveness of our activities. As a result from our activity, physicians have come to understand the calculation requirements necessary to claim medical fees and they have started to carefully make note of disease names for themselves in the medical records. Also, it is thought that our activities contribute to conduct of an appropriate Health Insurance & Medical Practice as it makes it possible to share information on unresolved problems and on rule compliance in order to conduct it properly.

View full abstract

In recent years the increasing number of workers with depression and workers on leave due to depression has become a problem. Various efforts have been made to address this problem. One such effort is group cognitive therapy serving as reinstatement support. Although an assessment of effects has been undertaken, few studies have examined the factors related to the effect. In this study, factors related to depression symptoms, such as social function, nonfunctional cognition, and improvement of returning to the work situation were examined. In this study, male patients who satisfy the diagnostic criteria of major depressive disorder, dysthymia, bipolar Ⅱ disorder （presently depressed state）, between the ages of 30 and 55 years old, who was unlikely to retire or who is on leave within 1 month of reinstatement, were targeted. In the previous study, DAS representing schema and nonfunctional attitude did not improve, but this study showed improvement. The following improvement factors were extracted: the“what you learned what impression is given to the other people”, “satisfaction level”, “to obtain information” of the collective psychotherapeutic healing factor. Individual spirit was used to correct the attitude. This suggests the possibility that a unique healing factor was important in group cognitive behavioral therapy which is not in therapy.

View full abstract

We extracted and analyzed characteristics and issues of accidents related to pediatric care at Showa University Hospital. Of the incident reports related to pediatric care in the past 11 years input via the entry system of the Medical Safety Management Department in our hospital, 17 accidents which were classified as more serious than category 3b （required major medical or surgical intervention） were enrolled in this study. These accidents were analyzed and classified according to each written report. The male to female ratio of patients was 11：6. The age range of the patients was 0〜18 years; 12 cases （71％） were aged 0〜3 years and 11 （65％） of these had neither development delay nor malformation. Of all events, 15 cases （88％） were inpatient cases and five （29％） of these occurred at the neonatal intensive care unit （NICU） or intensive care unit （ICU）. Five events （29％） were related to nursing care, four （24％） to treatment/procedure, four （24％） to drainage tube of other tube, one （6％） to examination, two （12％） to others with unexpected sudden changes classified into category 5 （death）. Regarding the background of accidents, only two cases （12％） had neither development delay nor malformation, except for NICU and ICU cases. Of all accidents, 13 events （76％） were due to clinical practices or nursing by health-care professionals. In conclusion, effective measures can be taken to improve the quality of clinical practice and the medical system in approximately 80％ of all events at our hospital. However, approximately 10％ of accidents were due to underlying diseases or difficulty with response to an unexpected sudden change, indicating that there are limits to intervention in pediatric care safety management.

View full abstract

Fracture treatment including an external fixator and leg lengthening by the Ilizarov method uses the ring type external fixator; it is applied for the treatment of closed fractures, deformation correction, and bone defects. When treating pseudarthrosis and fixing at a docking site, a pressing and fixing procedure utilizing shortening by an Ilizarov external fixator is applied. In animal experiments, when compression is applied to the bone contact area, it is reported that it is advantageous for callus formation if the strain generated is from 100 to 2,000µStrain. However, the mechanical properties in the bone contact area in external fixation have yet to be clarified. We investigated the load and strain generated when pressing and fixing using a telescopic rod （hereinafter, an extender）. A ring fixation system equipped with an extender was mounted to a simulated bone. A load cell, for load measurement, and a strain gauge were attached to the bone fracture surface to measure the load and strain generated when shortened 0.25mm at a time. The ring fixation system used was a standard four-ring frame system. The load with 5-5.5mm shortening on the simulated bone was 148-164N. Through this study, it was possible to clarify the load and strain in the contact area in the standard four-ring frame system.

View full abstract

Meniscus reconstruction using an autologous tendon graft is recently performed for patients with progressive knee osteoarthritis who underwent subtotal lateral menisectomy, because meniscus allograft transplantation, the standard treatment throughout the world, is not allowed in Japan. However, the posterior body of meniscus is intact in some cases at the time of surgery, and thus it may reasonable to reconstruct only the absent part of the meniscus. The purpose of this study was to evaluate the influence of bone tunnel position on postoperative change of grafts as well as articular cartilage in a rabbit model. We made partial defects of medial meniscus in both knees of fifteen Japanese white rabbits, then reconstructed the defect using autologous tendons secured through the bone tunnels. The aperture of bone tunnels were created in two different positions for comparison. The bone tunnel aperture was positioned at the articular surface of tibia in the right knee （articular group） and at the medial outer edge of tibia in the left knee （extra-articular group）. The tendon grafts and surrounding cartilage were evaluated histologically and morphologically at 2, 4, 8, 12, and 18 weeks after surgery （n＝3）. Tendon grafts became degenerated and osteophyte was seen in medial femoral condyle from 4 weeks in the articular group. Articular cartilage of the tibia in the extra-articular group was maintained until 18 weeks, however that in the articular group was progressively damaged. Creating a bone tunnel on the articular surface may lead to exessive mechanical stress for the graft, hence degenerative change of the graft and progressive damage of the cartilage were observed in the articular group. Our result suggested that the bone tunnel aperture should be created at the extra-articular edge of the tibia when performing partial meniscus reconstruction to avoid mechanical stress to the graft.

View full abstract

Surgical orthodontic treatment is performed in adults with malocclusion due to skeletal jaw deformity and left-right asymmetry, and to address the chief complaint. However, obtaining the consent of patients and their family is often difficult because surgical orthodontic treatment has the disadvantages of the negative perception associated with surgery, duration of hospitalization, etc. When a patient with skeletal deformity does not consent to surgical orthodontic treatment, camouflage treatment and compensatory alignment for the skeletal deformity become necessary. The present patient, a woman, was 22 years old at the time of examination. She underwent orthodontic camouflage treatment at another hospital, through which retention was achieved. However, the deviation of the mandible to the left and soft tissue asymmetry had not improved; hence, she visited this hospital for surgical orthodontic treatment. After the tests and diagnosis at the department, the patient underwent double-jaw orthognathic surgery. Morphological imbalance, which was the chief complaint of the patient, improved, and functional occlusion was achieved. Herein, we report the skeletal and occlusal changes after the treatment.

View full abstract

This case was a 12 years and 4 months girl who complained her teeth do not bite properly and upper teeth hide the lower teeth. Overjet was＋8.5mm, overbite was＋6.0mm. Angle Cl. Ⅱand midline of lower dental arch shifted to the right side. Lateral and postero-anterior cephalometric analysis revealed skeletal Class Ⅱ with mesofacial type, right Ramus height was 5.5mm shorter than the other side, and Menton was 4.5mm shifted to the right side with occlusal plane inclination. Objectives of 1^st phase treatment were to accelerate mandibular growth of the right side more than the other side and correct the midline by using functional appliance （FKO）, and at 2^nd phase treatment, to establish proper molar relation and tooth axis using a multi bracket system. By 15months of 1^st phase treatment, remarkable mandibular growth was obtained with good patient cooperation. After 31months of 2^nd phase treatment, proper occlusion was achieved. This case suggested that FKO can correct imbalanced mandibular growth and prevent actualization of mandibular deformity in adolescents.

View full abstract

The patient was an 83-year-old paraplegic male with a history of ischial pressure ulcer at our department. In June 2018 he was hospitalized in our department for relapse of a pressure ulcer at the same site. Exposure of the ischial tuberosity and an extensive subcutaneous pocket were found, and thus we debrided the wound and injected a dermal micrograft using the RIGENERA^® system under general anesthesia. After negative pressure wound therapy, the ulcerated area was covered with a gluteus maximus flap two weeks after surgery, and the sutures were removed 20 days later. The clinical course was satisfactory with no relapse 6 months after surgery. Since the RIGENERA^® system was developed in Italy in 2013, treatment with micrograft has attracted attention abroad, but there are few reports of use in Japan. As a pioneer of micrograft treatment in Japan, we used it in conjunction with negative pressure wound therapy and surgical operation and report good results.

View full abstract