In April 2019, Showa University reformed its Emergency Medical Center at Showa University Hospital into a Department of Emergency Medicine as part of a project to revitalize the emergency medical care provided by the university. This paper aims to show how the reformation of the Emergency Medical Center has influenced the number of ambulance admissions and ambulance response rates. We tabulated and compared the following figures between the periods from April 2019 to March 2020 and from April 2016 to March 2019: the number of ambulance calls placed to Showa University Hospital, the rate of ambulance admissions in response, the number of calls not resulting in ambulance response, and the rate of nonresponse （based on that number）. Showa University Hospital received 7,516 ambulance requests and dispatched 7,228 ambulances （response rate of 96.2％） from April 2019 to March 2020. The results of the interrupted time-series analysis showed that the response rate over this period increased by 6.8％ （95％ CI, 2.4％-11.2％） compared to that from April 2016 to March 2019. There were multiple reasons for the improved response rate. Once the department was reformed, its purpose was more clearly understood. From April 2019, three important reforms were carried out altogether: more personnel were allocated during busier hours, a North American style of emergency medicine was adopted, and an emergency care system manual was introduced. As a result, these reforms in combination led to a significant increase in the number of ambulance calls. The Emergency Medical Center reformation increased the number of ambulances received by Showa University Hospital, which in turn improved healthcare in the community. We propose that similar reforms could be applied to other Showa University Hospitals.

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In Japan, every Kaifukuki Rehabilitation Ward （KRW） uses the Functional Independence Measure （FIM） to measure clinical outcomes. However, patients who are discharged with an adequate FIM score do not always accomplish satisfactory activities of daily living. Acquiring the ability to recognize one’s own potential and resolve problems, defined as empowerment, is imperative for life. However, there are currently no measurements to assess empowerment intervention outcomes in KRWs. This study aims to create a prototype empowerment scale for KRWs and to establish its validity, reliability, and correlation with the FIM scale. This includes 17 questions based on several items from earlier studies that were translated into Japanese. We verified the item, validity, and reliability of the scale by analyzing the responses of 98 inpatients in KRWs. We also assessed the correlation between the empowerment scale scores and the FIM scores. Although some items exhibited a floor effect, a good discriminative power for all items has been demonstrated in the good-poor analysis, and all items correlated with the total score. Several fit indices for the five-factor structural model in the confirmatory factor analysis and the correlation between the subscale and the total score demonstrated conformable values. The reliability was generally good. The empowerment scale scores and the FIM scores demonstrated little correlation. Although some modifications are necessary, the prototype empowerment scale exhibited validity and reliability. This scale will assess the abilities of patients in a different manner than the FIM construct and may help evaluate the abilities required for daily living after discharge from a more diversified perspective.

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Image quality assurance refers to the activities of radiological technologists of checking the images before confirmation, editing the images as necessary, and deleting unnecessary images to support the physician’s diagnosis and interpretation. Whether image information corresponding to the order has been obtained and associated information is correctly entered are the points to be confirmed before fixing the images. Moreover, associated information, image density, image direction, and image order should be corrected as necessary. Thus, this study investigated whether image quality assurance affects education to improve the techniques in taking images and whether this contributes to medical safety. Contents and retake rates including the difference in the years of experience were examined and analyzed according to the site （chest, abdomen, cervical vertebra, shoulder joint, knee joint, lumbar spine, and hip joint） based on the retaken simple radiographic images in 5 years （between 2012 and 2016）. In addition, frequencies by cause of retakes were investigated according to site. The results showed that the retake rate was increased by new technicians and fluctuated due to changes in rotation timing. Moreover, the retake study meeting helped prevent the increase in retake rate by those factors. Furthermore, enhancing image quality assurance contributed to medical safety.

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Associations of the change of department among nurses working in the university hospital between the sense of coherence and the job stress. This study evaluated the sense of coherence （SOC） and job stress of 2,763 nurses from six university hospitals who were subjected to a change of department. The participants of the study were instructed to answer an online SOC questionnaire and questionnaire about the nursing job stressor scale （NJSS）. Showa University School of Nursing and Rehabilitation Science Ethics Committee approved this study （approval number 468）. Results from 1,013 nurses （36.6％ of effective response rate） were analyzed. There was no significant difference in SOC scores between post-transfer experience and non-experience groups. Participants in the post-transfer experience group had a significantly higher NJSS score and lower standard four items than those in the non-experience group （p＜0.001）. In terms of transfer affirmation and non-affirmation, most participants who transferred departments had significantly higher SOC and NJSS scores than those who did not transfer. In the Clause 2 logistic-regression analysis, age and SOC 【OR：1.034（95％Cl：1.022-1.046）】 became independent factors of a feeling of affirmation. Participants who with agreed to change departments had significantly higher levels of feeling of affirmation than those who did not agree. Based on the SOC scores, the stress level due to the experience of change of department was not a significant factor to relieve stress while feeling various stress by making use of conventional experience. Because the participants who do not agree with the change of departments find it difficult to adjust in a different environment, efforts such as periodical interview and support by the hospital manager are necessary. Therefore, a support program is particularly important for nurses who could not adjust after a change of department.

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Little evidence is available that positively suggests the vertical transmission of severe acute respiratory syndrome coronavirus 2 （SARS-CoV-2）, which became a pandemic beginning the end of 2019, from mothers to neonates. However, a neonate is considered to be possibly infected with coronavirus disease 2019 （COVID-19） when a mother is suspected to be infected with or is undergoing a test for SARS-CoV-2 polymerase chain reaction （PCR） at delivery, necessitating infection measures immediately upon his/her birth to prevent nosocomial infection. This study aims to clarify the current situation and changes made in the management of neonatal intensive care unit （NICU） wards during the spread of infection to utilize this information for future infection measures. This study retrospectively investigated the changes made in NICU ward management and the inpatient breakdown over a 1 month （approximate） from the introduction of PCR testing for all patients until the declaration of the state of emergency was lifted. Consequently, seven neonates were admitted to the negative-pressure private room during the investigation period. Neonatal resuscitation, with personal protective equipment attached, was performed with an open incubator at least 2m away from the mother to prevent nosocomial infections. After resuscitation, the neonate was immediately placed in a waiting incubator and transferred to the NICU. The nurse who worked in a negative-pressure private room was exclusively assigned. Moreover, the number of beds in the negative-pressure private room was reduced from two to one due to the change in staffing. Moreover, the visit of the parents was forced to change to a shift system and time limit. Infection measures were implemented at the NICU ward during the spread of COVID-19. The changes in the management of the NICU ward that was experienced during this time should be clarified so that the information can be utilized for future infection measures with the assumption of measures that are in place during normal situations.

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Fish-mouth incision on a fingertip is one method for preventing blood congestion after surgical reattachment of an amputated finger. Moreover, it is also reported to be useful for evaluating the patency of the finger arteries. In this case, the right index and the middle fingers were fully amputated due to injuries by a press machine, classified as Tamai zoneⅢ. Suturing the finger nerves was a challenge although replantation was possible. Temporary insufficient blood circulation in the index finger was observed during secondary reconstruction using the sural nerve. The fish-mouth incision was performed immediately after the operation. Consequently, direct continuous infusion of sodium heparin was started to evaluate postoperative blood flow, achieving finger survival. Thus, insufficient blood circulation was caused due to the use of a pneumatic tourniquet which resulted in temporary occlusion and ischemia of the finger arteries. Moreover, the use of an air tourniquet during surgery should be kept to a minimum. However, the fish-mouth incision and direct continuous administration of sodium heparin allow continuous direct observation and were useful for blood flow evaluation.

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Pleomorphic adenoma is the most common type of salivary gland tumor, frequently occurring in the parotid gland. Here, we report a case of pleomorphic adenoma of the minor salivary gland of the upper lip of a 29-year-old male. He noticed the tumor a year ago, and it gradually increased in size over the past six months. The tumor was painless and movable, with an elastic consistency. The tumor surface was normal, and computed tomography, magnetic resonance imaging, and ultrasound imaging showed that the tumor had clear boundaries. It was approximately 20×20×20mm in size. Tumor excision was performed under general anesthesia, following a clinical diagnosis of left upper lip tumor. The histopathological diagnosis was pleomorphic adenoma. The postoperative course of the patient was uneventful, and there was no evidence of recurrence.

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