This study aims to elucidate the difficulties that nurses experience in providing care for elderly patients with dementia in acute care hospitals in Japan. A self-rating questionnaire survey was completed by 115 nurses working in acute care hospitals with more than 200 beds. A content analysis based on Krippendorffs method was conducted. We performed an analysis by dividing the data into semantic contents, with the emphasis on the context, then organized the data according to similarities in the semantic contents, and categorized these into categories and subcategories. We collected 105 （91.3％） valid responses. The mean age of the participants was 34.4 years and the mean length of experience of providing dementia care was 7.4 years. The analysis yielded 69 contexts, 3 categories, and 11 subcategories, including the following three categories: 1） difficulties related to the symptoms of dementia, 2） conflicts with responsibilities as a nurse, and 3） difficulties caused by the wards not specialized in dementia care. It is necessary to help nurses overcome the difficulties they experience in providing care for elderly patients with dementia in acute care hospitals by developing educational programs suitable for the nursing care of the elderly with dementia while investigating factors related to the difficulties. In this study nurses working in acute care hospitals experienced difficulties in responding to core symptoms and behavioral and psychological symptoms of dementia （BPSD）. Nurses faced a dilemma because they had to restrain patients due to the importance of safety although they wished to provide nursing that places greater importance on the dignity of patients. The findings suggest that nurses experience difficulties because they are in charge of many severely ill and dementia afflicted patients and they must provide for the safety of these patients, and this is complex because the disturbed behavior of elderly people with dementia affect other inpatients. It is necessary to create questions from the categories and subcategories identified in this study, conduct a questionnaire survey for nurses who provide care for elderly patients with dementia in acute care hospitals to elucidate details of the difficulties of dementia nursing, and examine the factors related to the difficulties.
This study clarifies the trend of evaluation scales for clinical practice by nursing students. This study will be used as material to evaluate both, the educational abilities of professors and the practical nursing abilities of students, in clinical practice. The search method was based on the Medical Journal （ICHUSHI） Web Ver. 5, with the search period from January 2005 to September 2015. The search was limited to original articles with the terms "clinical practice," "nursing students, " and "evaluation." Among the articles, those that used scales to evaluate nursing practice were included in the analysis. Those that used only original questionnaires were excluded. As a result, 1,132 articles were extracted. Of these, 73 were applicable to the conditions of this study. There were 55 types of evaluation scales used, and a wide variety of scales from 1 to 11 per article. The evaluators were classified into three categories: teachers, instructors, and students. The evaluation targets were classified into five categories: teachers, instructors, students, practice processes （general practice）, and practice environment. Among the literature that assessed people, the four references that assessed teachers were the fewest, and all of them were identified after 2011. There were 20 references that evaluated instructors and 45 references that evaluated students, which were confirmed in 2005. Of the documents that evaluated instructors, three used the Japanese version of the Effective Clinical Teaching Behaviors （ECTB） for students and one used the Scale of Clinical Teaching Behaviors （SCTB） for nursing practice for instructors （self-evaluation）. As for the raters and rating scales in the literature that assessed instructors, 11 of the 14 student evaluations were ECTB, three were SCTB, and six instructors （self-assessment） were ECTB. In recent studies on educational evaluation in nursing practice, the commonality of the SCTB and ECTB was confirmed as a scale for evaluating the educational practice ability of professors. However, only a few studies have evaluated teachers. In addition, those evaluations were conducted at two or three points in time; for instance, after basic practice and before and after domain practice. There were no studies on student evaluations throughout the entire process, which could have been conducted from basic nursing practice to after the completion of all practices. Finally, it was found that the students evaluated their practical training by combining the evaluation scales for each component of their practical nursing skills.
Considering the growing trends of globalization and team medical care in current clinical settings in Japan, it is necessary to educate medical university students, regardless of their specialty, in common English vocabulary for communication with other medical personnel and their patients. Operating on the assumption that students should be taught different types of vocabulary before and after entering courses for their specialization, we present an appropriate method for exposing medical university freshmen to English medical terms in their required English courses. To identify words specifically suited for first-year medical students, we constructed vocabulary lists based on a 780,126-word corpus, which we created from English language academic journals of medicine, dentistry, pharmacy, and nursing and rehabilitation sciences. The lists consist of five groups of words, four of which should be taught before students enter courses for their specializations. In this paper, we present those vocabulary lists and contend that the word groups should be learned in a specific order. We hope that these lists and the method described in our paper will be adopted for uniform use in English language education in medical schools, and that this might serve as a step toward creating a standard for medical English education to facilitate the communication between all relevant parties which is so crucial to successful medical treatment.
Cervical adenopathy is frequently treated in daily medical practice, but its specific diagnosis is inconsistent. In this study, we retrospectively examined the details of cervical adenopathy, including age, medical treatment department, disease period, symptoms, results of blood tests, image analysis, cytodiagnosis, and definite diagnosis in 84 patients who underwent evaluation for cervical adenopathy at our department from January 2015 to December 2017. Among the 84 patients, inflammatory disease was confirmed in 74 patients and malignant disease was confirmed in 10 patients. The mean age of the patients with malignant disease was significantly higher than that of the patients with inflammatory disease （p＜0.001）. In addition, the disease period in the patients with malignant disease tended to be longer than that in the patients with inflammatory disease. Tenderness was confirmed in 61％ and 10％ of the patients with inflammatory disease and malignant disease, respectively. The soluble interleukin-2 receptor level was significantly higher in the patients with malignant disease than in the patients with inflammatory disease （p＝0.0014）. On ultrasound, the lymph nodes had a significantly larger size （p＜0.001） and significantly smaller aspect ratio （p＝0.015） in the patients with malignant disease than in the patients with inflammatory disease. Aspiration biopsy cytology was performed in 9 patients with malignant disease and 47 patients with inflammatory disease. No false-positive and false-negative data were found for both diseases. We found that the disease period among the patients with malignant disease was long because many of them were elderly and did not experience tenderness. In addition, the soluble interleukin-2 receptor was non-specific, but considered to be useful for the differential diagnosis of benign and malignant disease. When malignant disease is suspected based on an ultrasound examination, aspiration biopsy cytology is useful.
Vitamin D （VD） deficiency in pregnant women results in fetal VD deficiency, which leads to the risk of low birth weight, reduced bone density, and infectious susceptibility in their offspring. We determined the number of pregnant women with VD deficiency and investigated if VD status is related to anthropometric data and infectious susceptibility in their offspring. The subjects were 30 women and their neonates. VD levels were measured after 32 weeks of gestation. VD deficiency was diagnosed based on a serum 25（OH）VD concentration ＜20ng/dl. The mothers were divided into VD deficiency and normal groups, and their infants’ outcomes were checked at 1, 3, and 6 months. As a result, fourteen of the 30 subjects were diagnosed with VD deficiency. According to the questionnaire survey, anti-ultraviolet measures during pregnancy; intake of foods rich in VD such as fish, eggs, and mushrooms; and knowledge of VD were not related to serum VD levels in pregnant women. The median gestational age and birth weight of the neonates were 39.5 weeks and 3,031g, respectively. There were no significant differences between VD deficiency and non-deficiency in the presence of respiratory tract infections and eczema at 1, 3, and 6 months. Our results did not reveal a relationship between VD deficiency and offspring’s anthropometric data or infectious susceptibility later in life. Larger epidemiological studies of VD levels in pregnant women are necessary to determine the issues related to VD deficiency in pregnancy.
In Japan, an increasing number of inbound tourists require emergency hospital visits; however, the cost associated with these visits has not been previously evaluated. Therefore, we researched the costs incurred for emergency visits by inbound tourists. This study retrospectively focused on medical costs incurred by international tourists who visited the Yamanashi Red Cross Hospital between January 2013 and March 2018. A total of 625 patient cases （291 males and 334 females） were included in this analysis. The mean age of the patient cohort was 36.4 years （range＝0-89 years）. The median fee was 10,420 JPY （range＝1,160-2,080,096 JPY）; at the 90th percentile, expenditures totaled 38,334 JPY. Six patients incurred costs of＞500,000 JPY; these patients spent up to 2,080,096 JPY on medical care. Thus, we conclude that traveler’s insurance is both recommended and desirable to ensure safe and cost-effective travels.
To begin with, to date, there is no study on the rehabilitation effect of the gynecologic cancer perioperative period. Therefore, our study aimed to treat perioperative gynecologic cancer patients in groups with and without rehabilitation until the surgical retreatment. Muscle strength, exercise tolerance, anxiety, and health-related quality of life （HRQOL） were studied. A total of 44 patients with gynecologic cancer were operated in a hospital from April 1, 2018, to December 31, 2019. We compared the group with 22 subjects who did not undergo rehabilitation until they were discharged from the surgery department and the group with 22 subjects in the intervention group who underwent rehabilitation. The result shows muscular strength （knee extension muscle strength）, exercise tolerance （6-minute walk）, anxiety （STAI）, and HRQOL （EORTC QLQ-C30）. We evaluated the intervention group, a target group at the time of in front of operation and a discharge together and weighed these items. Muscular strength, exercise tolerance, and many items of HRQOL of both the control and intervention groups displayed a significant decrease compared with that of the preoperation. Under the influence of operation and hospitalization, it was suggested that performing rehabilitation minimizes the decline. There are several studies on postoperative rehabilitation of gastrointestinal cancer. For a gynecologic cancer patient, muscle strength, exercise tolerance, pain, and weakness may be significantly improved by performing rehabilitation.
Verification of the effectiveness in “Questionnaire for extracting intentions of presentation options for organ donation” for organ donation-related behavior at emergency medical centers. The subject is a family member of a patient who was transported by a tertiary emergency and died within a week. The intervention in this study is the provision of organ donation options using a questionnaire. We randomized the families of patients transported to the emergency medical center and presented the intervention group with organ donation options. The patient was followed up for one week, and the families of the deceased patients were mailed a self-administered questionnaire 8 weeks after death. Responses were received from 111 （36.3％）. There were no changes in organ donation-related behaviors in 51 intervention groups （45.9％） who received the option. When the subjects were stratified, patients were of Working-age population between 15 and 65 （Working age: 66.7％ vs. Dependent age: 12.5％, p＝0.04）, families were women （women: 24.1％ vs. men: 3.1％, p＝0.02）, and families were confused （was confused: 40.0％ vs. wasn’t confused: 0.0％, p＝0.004）, there was an increase in “family discussions” an action related to organ donation. When presenting Organ donation options, 17.4％ felt distrust and 28.3％ felt stress. Although the effect of option presentation via a questionnaire on the related behavior of organ donation is limited, it is considered an effective strategy at the initial stage of option presentation. This strategy makes it possible to present the option without the attending physician and is a versatile approach in many facilities.
The patient was a girl delivered by cesarean section at 36 weeks of gestation. Polyhydramnios was detected in the fetal period, and she had severe muscular hypotonia, a weak cry, and akinesia immediately after delivery. She was treated with non-invasive positive-pressure ventilation, although oxygen was not required. She had feeding problems owing to the absence of a swallowing reflex. Hence, she required tube feeding. She was a floppy infant, and her symptoms suggested a neuromuscular disease initially. Although she required mechanical ventilation and tube feeding for a long time, her hypotonia improved in a time-dependent manner, and it was a clue for suspecting Prader-Willi syndrome （PWS）. In the genetic examination, DNA methylation testing was useful for diagnosis in our patient. Considering the improvement of hypotonia in a time-dependent manner, a final diagnosis of PWS in early infancy was made.
Gitelman syndrome （GS） is a genetic disorder caused by mutations in the gene, which codes for the Na-Cl cotransporter on the distal convoluted tubule. GS leads to hypokalemia, metabolic acidosis, hyperreninemia, hyperaldosteronemia, short stature, seizure, and tetany. We describe two siblings in whom incidental hypokalemia detection was a clue towards GS diagnosis. 【Patient 1 （elder brother）】 A generally healthy 10-year-old boy presented to his primary care physician with a cough, which subsequently worsened, necessitating admission to our hospital. Examination revealed pneumonia, hypokalemia, and long QT. His blood pressure was normal; however, plasma renin activity and aldosterone concentrations were increased. Oral potassium was administered, which improved his hypokalemia and long QT. 【Patient 2 （younger brother）】 A generally healthy 9-year-old boy presented with fever and cough. Antibiotics were administered for Mycoplasma pneumonia, and blood tests revealed hypokalemia. The patient’s condition did not improve with the aforementioned treatment, and he was admitted to our hospital. He received oral potassium therapy and improved thereafter. The patients described in this report were siblings and both presented with hypokalemia, suggesting GS. Genetic analysis of revealed two heterozygous mutations （c.179C＞T and c.781C＞T） in both patients. Incidentally detected blood test abnormalities may provide useful clues to diagnose GS. Clinicians should consider GS in the differential diagnosis of patients presenting with hypokalemia.
Adenomatoid odontogenic tumor （AOT） is classified as a rare, benign odontogenic tumor. AOT is more commonly developed in the maxilla with an impacted tooth. In this study, we described a rare case of AOT developed in the mandible without an impacted tooth. A 25-year-old Japanese female had been aware of gum swelling affecting the mandibular premolar region. Due to the development of the gum swelling, she was referred to our hospital for clinical attention. At the initial visit to our hospital, the swelling in the buccal gingiva at the left lower canine and first premolar region was not associated with any pain. Panoramic X-ray and CT exhibited absence of any impacted tooth and a 12×10×10mm-well-circumscribed radiolucent mass with points like radiopacity at the inter-radicular area between the left mandibular canine and the first premolar. Initial clinical diagnosis of the case was a mandibular benign tumor, and it was conservatively treated by surgical enucleation and curettage. Moreover, histopathological findings showed nodules with a columnar epithelium with variably sized rosette- or duct-like spaces. Around these duct-like spaces are small foci of calcification. Thus, we finally diagnosed this lesion as adenomatoid odontogenic tumor. There were no signs of recurrence for 2 years after the procedure. Cases of AOT with no impacted tooth are defined as extrafollicular variant, and only few cases have been reported of this variant. More knowledge about extrafollicular variant of AOT needs to be explored. Although recurrence rates of AOT are exceedingly low, careful and sustained follow-up is still highly recommended.
For the treatment of adult malocclusion patients with facial asymmetry, surgical orthodontic treatment is highly recommended mainly to establish functional occlusion and improve aesthetic facial appearance. However, surgical orthodontic treatment is obtaining the consent of patients together with their family due to the restrictions this method entails, such as invasion and hospitalization associated with surgery. Improvement with orthodontic treatment alone requires “camouflage treatment,” which requires a compensatory arrangement in consideration with the inconsistency of the maxilla and mandible. The patient, woman aged 41 years and 11 months at the time of the first visit was admitted to our hospital due to a developed bad biting habit resulting in facial distortion. Standard tests and diagnoses were performed at the department, and surgical orthodontic treatment was considered. However, improvement of facial asymmetry was not desired at the request of the patient, so malocclusion ameliorated by orthodontic treatment alone was chosen as the approach. Hence, the deviation of the mandible to the right and soft tissue asymmetry was not improved. However, we report the skeletal and occlusal changes after the treatment. A change in the jaw position and occlusal position of the mandible before and after treatment was achieved, because a functional occlusion, which is the patient’s chief concern, was obtained despite the right lateral deviation. Stable occlusion and mandibular movement in the long term is also worth noting for this approach.
Given our experience of peritoneal endometriosis, a relatively rare condition, we report this case along with a literature discussion. Cases of peritoneal endometriosis in a surgical scar account for 0.03％-3.5％ of all cases of endometriosis. However, in Japan, both the frequency of endometriosis and the rate of cesarean section have increased. In the future, it is likely that we will encounter more patients with this condition. This disease must be considered in the differential diagnosis of a mass developing in abdominal scars in women along with swelling and pain that are similar to those in menstruation. For preoperative diagnosis, magnetic resonance imaging is effective in identifying the mass.