Ward patients may deteriorate to the point of unexpected admission to the intensive care unit or even cardiac arrest and death. Almost all hospitals have established systems for responding to such in-hospital emergencies. Numerous hospitals broadcast such emergencies through a public address system, termed the “Code Blue” system. Other hospitals have medical emergency teams (MET) specializing in response to such emergencies. Recently, the Rapid Response System (RRS) has also been introduced. The purpose of the RRS is to prevent in-hospital emergencies based on the presence of preliminary signs prior to the development of the in-hospital emergency. It is estimated that approximately half of the serious adverse events may be preventable. Patients often exhibit signs of physiological deterioration several hours (median: 6 hours) prior to cardiac arrest. Theoretically, this short period may be sufficient to perform interventions that prevent severe deterioration.
In introducing RRS for in-hospital emergencies, the function of hospitals and the number of physicians should be considered. There are numerous hospitals in Gunma Prefecture implementing the “Code Blue” system. Moreover, hospitals staffed with a larger number of physicians providing acute care have MET and RRS.

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Aims: This study aims to 1) characterize how counseling and support specialists (CSSs) support families of technology-dependent children living at home and 2) discusses how collaboration between CSSs and health care providers such as nurses can further improve support for these families.
Methods: A qualitative descriptive study design was used. Data were collected using semi-structured interviews with ten CSSs who had experience supporting technology-dependent children in A prefecture.
Results: Family support practices of CSSs were classified into seven categories. They were 1) gaining understanding of the needs of each family 2) being aware of parents' feelings 3) assuming an active role in adjusting family relationships 4) connecting families with appropriate health care services 5) providing support and adjusting care plans taking the whole family into consideration 6) being aware of security and safety issues and 7) supporting families through interdisciplinary collaboration.
Conclusions: Practices of CSSs, such as connecting families with appropriate health care services and improving awareness of security and safety issues, were characterized. The expertise of CSSs as well as of home visiting nurses on health management and medical care should be utilized in mutual collaboration to support families.

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Objective: To clarify the concept of management of stress in mothers raising young children.
Method: Analysis of thirty-four articles from Japan and other countries using Rodgers concept analysis.
Findings: The concept attribute was “devising behaviors to deal with stressful situations during child-rearing.” Prerequisites were “presence of stress during child-rearing,” “acknowledgment of stress during child-rearing,” and “recognizing the possibilities of dealing with the stress of child-rearing.” These led to conclusions of “reducing stress of child-rearing,” “maintaining and improving psychological health of mothers,” and “improving self-efficacy related to child-rearing.”
Conclusions: Concept analysis uncovered a concept for managing the stress of child-rearing. The concept itself consisted of mothers of young children acknowledging stress from child-rearing, recognizing that they could take action to deal with the stress, and then choosing and enacting methods that suited them, reviewing action taken, and making adjustments as they went along, choosing different behaviors depending on the situation and devising new ones as necessary. Using this concept, the author defined child-rearing stress management as “acknowledging the stress of child-rearing, recognizing it as potentially manageable, and devising behaviors to deal with stressful situations.” Changes in society mean mothers feel a greater burden in caring for their children. Supporting them so they can manage the stress will therefore be increasingly important. This concept can be used to support mothers and in further research on managing the stress of child-rearing.

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Objectives: This study was aimed to develop a preliminary version of nursing algorithms covering the entire nursing process of balancing social roles and medical treatment in cancer survivors. Methods: 1. Establishing the base of the preliminary algorithms. 2. Evaluation and revision of the initial algorithms in two steps (step 1: review of entries regarding support of social roles of survivors; step 2: creating a Primary Flow Chart (PFC)). Results: Preliminary versions of nursing algorithms were developed to include measures to provide concrete support for continuing social roles. Algorithms were developed for 1) the pre-treatment period and first day of treatment; 2) follow-up visits; 3) changes in treatment; 4) exacerbation of symptoms. Conclusions: Preliminary version nursing algorithms for balancing social roles and medical treatment in cancer survivors were developed through a comprehensive assessment of survivors. The preliminary version algorithms include concrete measure to support cancer survivors, and are designed to provide rapid support through cooperation with professionals in other specialties.

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Malignant pleural mesothelioma (MPM) is a rare disease causing chest pain and dyspnea when the tumor invades the pleura, and pleural effusion. MPM frequently compromises activity levels (particularly in the elderly) unless radically treated. The Japanese guidelines state that the definitive therapy is trimodal (extrapleural pneumonectomy [EPP], systemic chemotherapy, and hemithoracic irradiation). However, EPP is highly invasive, and postoperative complications may develop in the elderly. Recent studies have shown that pleurectomy/decortication (P/D) (lung-preserving radical surgery) affords outcomes similar to EPP. We performed P/D to treat MPM in an octogenarian with intractable pleural effusion. The surgical procedure was completed in 440 min, with hemorrhage of 2,095g. The postoperative pathological diagnosis was biphasic MPM. No major postoperative complication developed, and the patient was discharged 14 days after surgery. The patient survives without pleural effusion more than 2 months after discharge.

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Objective: To report a case of aplastic anemia in a patient treated with cyanamide.
Case summary: A 65years old man was admitted to our hospital because of dysarthria and weakness of left leg. He had taken cyanamide (70mg/day) for 6weeks as an alcohol deterrent. His blood count showed pancytopenia and the result of bone marrow aspiration showed severe aplastic anemia. Cyanamide was discontinued and the patient was kept on antibiotics and G-CSF. After 6days blood count was recovered with no need of G-CSF.
Discussion: Reports of cyanamide induced aplastic anemia are rare. We could find only 3 reports. These reports showed the interval between the beginning of cyanamide and the onset of aplastic anemia (20days to 6months), recovery period after discontinuation (2-4weeks) and dose of cyanamide (50-120mg/day). These are consistent with our case. We report this as a rare case that recovered with appropriate treatment.

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An 87-year-old female patient who developed epigastric pain was diagnosed with perforated duodenal diverticulum. Her hemodynamic status was stable, and no signs of peritoneal irritation were observed. Inflammation was localized. Therefore, she received conservative treatment. The patient uneventfully improved and started oral intake at 16 days post admission and was discharged after 28 days.

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We report a case of laparoscopy-assisted distal gastrectomy (LADG) for a gastric cancer patient with complete situs inversus (SIT). The patient was a female in her 70s, and she was diagnosed with SIT in her childhood when she underwent an appendectomy. She visited us complaining of epigastric discomfort and was diagnosed as having gastric cancer by gastrointestinal endoscopy. Preoperative CT revealed a perfect mirroring of the usual vascular anatomy without other anatomical abnormalities. LADG with D2 lymph node dissection and Roux-en-Y reconstruction were performed safely, without complications. During surgery, the operator stood on the side opposite to the usual side of the patient. The postoperative course was uneventful. There are few reports on LADG for SIT, and it is important to perform sufficient simulation before surgery.

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A 52-year-old woman was referred for treatment of an umbilical hernia. On initial presentation, she denied abdominal pain. Physical examination demonstrated mild lower abdominal tenderness, and laboratory data revealed slightly elevated inflammatory response. However, abdominal computed tomography (CT) scan showed intraperitoneal free air and an abscess in the pelvis. She was admitted with suspected gastrointestinal perforation, and antibiotic treatment was performed. She had no symptoms after discharge. Follow-up abdominal CT scan 4 months later showed a persistent abscess cavity with a large air collection in the right lower quadrant. We performed an operation with the preoperative diagnosis of intraabdominal abscess caused by sigmoid diverticulitis. An abscess with a thick wall adhering firmly to the right ovary and fimbriae of the fallopian tube was found and a fistula between a sigmoid diverticulum and the right fallopian tube was detected. A right tuboovarian abscess due to sigmoid diverticulitis was suspected and right salpingo-oophorectomy and partial resection of the sigmoid colon were performed. We must consider the possibility of fistula formation to adnexa when investigating and treating colonic diverticulosis with a pelvic abscess.

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