Background & Aims: Medical safety measures for nurses are an important issue. The present study aimed to clarify the human factors affecting the frequency of incidents by years of experience.

Methods: The participants were 1,489 nurses working in acute care hospitals with more than 400 beds. An anonymous, self-administered questionnaire survey was conducted. The survey included the frequency of incidents in the last six months and a “Questionnaire on Work Situations Commonly Associated with Nursing-Related Incidents.” Multiple logistic regression analysis was performed. Explanatory variables were extracted from the questionnaire items through principal component analysis. The objective variable was incident frequency. The analysis was conducted by years of experience.

Results: Valid responses were obtained from 716 nurses. Extracted variables were: unsafe execution of work, psychological stress, physical stress, busy work environment. Significant associations with incident frequency was found for busy work environment, psychological stress, and unsafe execution of work for nurses with up to 1 year, 4-10 years, and 11 or more years of experience, respectively.

Conclusion: The human factors affecting incident frequency were shown to differ depending on the nurses’ years of experience. Thus, preventive measures based on nursing experience are necessary: improving support systems to reduce busyness, improve psychological support, and address role familiarity for nurses with up to 1 year, 4-10 years, and 11 or more years of experience, respectively.

Background and aims: Recently, genome-wide analyses have revealed mutations in spliceosome machinery associated with myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML). Single-nucleotide polymorphisms (SNPs) of serine/arginine-rich splicing factor 2 (SRSF2) and splicing factor 3a subunit 1 (SF3A1) were investigated in a Japanese population of patients and healthy control group. We aimed to find associations with prognosis and pathology.

Methods: We obtained genomic DNA from 99 patients with MDS, 92 patients with AML, and 172 healthy controls and detected SRSF2 (rs237057) and SF3A1 (rs2074733) genotypes using polymerase chain reaction–restriction fragment length polymorphism.

Results: There was no statistical significance to associate these polymorphisms with susceptibility to MDS/AML. However, the SF3A1 rs2074733 TC was significantly associated with higher hemoglobin level, compared to the TT genotype (mean±standard deviation, 10.6±1.63 vs 9.09±2.19 g/dL; P＝0.022). In addition, patients with rs2074733 TC showed a significantly lower frequency of chromosomal abnormality [2 (18.2%) vs. 46 (53.5%), P＝0.027]. We observed no statistical significance between these polymorphisms and clinical variables for AML, or the prognosis of MDS and AML.

Conclusions: Our study indicates that the SF3A1 rs2074733 TC genotype is associated with some clinical features of MDS.

Purpose: To investigate newspaper coverage related to the cases due to insufficient confirmation of radiology diagnostic imaging reports, and examine the characteristics of the medical facilities and cases.

Methods: A total of 7,607 reports included in a newspaper database (Oct. 2015 - Jan. 2020) were evaluated.

Results: There were 28 newspaper reports (47 patients from 19 facilities).　The number of reports increased year by year.　15/19 facilities had 400 beds or more.　Thirty-one accidents were related to CT, 27 were related to the organs which were not primary targets of the examinations, and in 37 accidents the referring physicians did not open the reports.　In four accidents, the report was opened, but was not responded to appropriately.

Conclusion: Many reported cases were from large-scale hospitals considered to have a relatively well-established medical safety systems, and it was speculated that there may potentially be many additional cases.

Background/objective: The teaching behaviors of teachers in clinical practicums are important for nursing care and learning. In this study, we clarified the type of information teachers pay attention to and teachers’ decision making and teaching behaviors during the instruction implemented before the students practice daily living support skills in a Fundamental nursing practice.

Subjects and methods: Ten nursing teachers were interviewed after video recording in a simulated instruction setting in which the teachers instructed students before they perform daily living support in a clinical practicum. From video-recorded behaviors and verbatim transcripts, points of focused information, contents of decision making, and teaching behaviors to simulated students during the instruction were extracted and categorized.

Results: Three points of focused information ,such as “contents of support plans prepared by students,” five contents of decision making, such as “decision making about instruction to facilitate reviewing the necessity of support and appropriateness of selected activities to support,” and six teaching behaviors, such as “teaching behaviors related to goal setting and reasons for selecting particular activities to support” were extracted.

Conclusion: The teachers paid attention to many things so that the student could provide care, and guidance was given based on the decision making at the time of teaching. In addition, instructions were provided while considering the opinions of the students.

Purpose: We present the outcome of surgical revascularization for internal carotid artery stenosis in the acute stage of cerebral infarction, and verify the effectiveness and safety of the treatment strategy.

Materials and Methods: The study included patients treated with carotid endarterectomy (CEA) or carotid angioplasty and stenting (CAS) for carotid artery stenosis in the past 3 years.　We defined the acute stage as within 14 days of last cerebral ischemic event, and compared the acute stage with the non-acute stage with regards to patient background, complications, and outcomes.

Results: Nine cases were acute stage (CEA: 4 cases; CAS: 5 cases), and 21 cases were non-acute stage (CEA: 10 cases; CAS: 11 cases).　There were no permanent complications, no recurrence of ipsilateral stroke within 30 days of treatment, and no onset of ischemic heart disease in both groups.　Among all 30 cases, the plaque volume was significantly greater in the CEA-treated group than in the CAS-treated group (CEA: 1090㎣; CAS: 612㎣) (P<0.01), and the same tendency was observed between acute CEA and CAS.

Conclusion: There were no serious complications, including hyperperfusion syndrome or hemorrhagic infarction, in the acute phase of CEA and CAS.

　　We report the case of a 60-year-old man with pneumaturia due to gas production by Klebsiella pneumoniae in the bladder. Diabetes mellitus is a major risk factor, and K. pneumoniae produces carbon dioxide by fermenting glucose under anaerobic conditions. Antibiotic therapy successfully improved cystitis and pneumaturia. However, in the presence of urinary tract obstruction and/or emphysematous upper urinary tract infections, other interventions may be needed.

　　A 49-year-old man was referred to our hospital with acute lower gastrointestinal bleeding. Blood tests showed anemia; however, computed tomography did not reveal extravasation into the intestine. Moreover, colonoscopy on admission did not reveal bleeding. However, hematochezia recurred on the 3rd day of hospitalization, and repeat colonoscopy revealed bleeding from the appendiceal orifice. Emergency laparoscopic appendectomy was performed. Histopathological examination of the resected specimen showed multiple appendiceal diverticula, which were considered to be the sites of bleeding. Appendiceal diverticular bleeding is rare in patients with lower gastrointestinal bleeding. Until 2019, appendiceal bleeding was reported in 13 cases in Japan. All 14 patients （including the patient described in our report） underwent an uneventful operation. Therefore, surgical intervention is a useful therapeutic approach for appendiceal bleeding.

　　A left upper lobectomy was performed in an 80-year-old man with lung cancer. There was no air leakage after surgery, but on the evening of the next day severe subcutaneous emphysema and a massive air leakage developed after he had suffered bouts of coughing. In response to his worsening symptoms, he underwent surgery, which identified a subpleural pocket-like tear on the remaining lower lobe. There had been no evidence of emphysematous changes in his preoperative findings. This case demonstrates the need to consider reinforcing the pulmonary surface facing a large dead space to avoid coughing-induced pulmonary barotrauma.

　　A woman in her 30s ingested 12 leaves of Nerium oleander to commit suicide, and was transferred to our hospital by ambulance 19 hours later because of worsening nausea. On arrival at the emergency room (ER), we detected drowsiness, limb weakness, tremor, and sinus bradycardia with a heart rate of 50/min; however, her general condition was stable. Her serum potassium level (4.1 mEq/l) was within the normal range. She was admitted to the intensive care unit (ICU) after administration of activated charcoal and laxative in the ER. Her general condition was stabilized, and she was moved from the ICU to a general inpatient ward on the 2nd hospital day. Finally, she was uneventfully discharged on the 5th hospital day.

　　Nerium oleander is poisonous because it contains cardiac glycosides. Early identification of the poisoning substance and aggressive intervention with medical treatment are important.

　　A man in his sixties visited our hospital complaining of left groin pain. Following clinical examination, he was diagnosed with the spermatic cord tumor with left inguinal hernia.　Inguinal hernia repair was performed with complete excision of the spermatic cord tumor. Pathological findings revealed that the spermatic cord tumor was a lipoma, and there was no evidence of malignancy. This report describes a case of spermatic cord lipoma with inguinal hernia in details.

Summary : A 67-year-old man had suffered an asymptomatic left carotid artery stenosis 2 years previously, but the stenosis had aggravated during the follow-up period although surgery was not necessary. N-isopropyl-p[¹²³I] iodoamphetamine single photon emission computed tomography (SPECT) showed cerebral blood flow in the left hemisphere reduced by 10% compared with the normal side, suggesting hemodynamic cerebral ischemia. He underwent carotid endarterectomy (CEA). Postoperative magnetic resonance imaging and SPECT suggested hyperperfusion. Intensive antihypertensive therapy was administered. He left hospital with no subjective complaints on postoperative day 17. Outpatient antihypertensive therapy was continued, but he developed general convulsions with severe hypertension on postoperative day 29. Delayed cerebral hyperperfusion syndrome was diagnosed and intensive antihypertensive therapy restarted. The symptoms improved in a few days, but intensive antihypertensive therapy was continued until discharge. He left the hospital without complications on postoperative day 44. Patients who have had long-term exposure to chronic hemodynamic cerebral ischemia need intensive care, because of the risk of hyperperfusion syndrome continues for 4 weeks or more, even if hyperperfusion has improved after CEA followed by antihypertensive therapy.

　　We had previously experienced a case involving prolonged cardiopulmonary resuscitation (CPR) on Mt. Fuji (3,776 m), demanding strenuous work by the rescuers. The objective of this study was to examine the effectiveness of a wearable electrocardiogram (ECG) with 10 electrodes for the assessment of cardiac condition during exercise at hypobaric hypoxic environment. The traces of ECG during CPR action were obtained in a hypobaric chamber with barometric pressure adjusted to be equivalent to 3,700 m above sea level (630-640 hPa). Two volunteers performed CPR with or without breaths using a CPR mannequin. In a 3,700-m-equivalent environment, the percentage of recordings with clear signal qualities were 26% at V1 position, and 31% at V4 position, respectively. Although wearable ECG monitoring is still under development, removing electromyogram artefact may improve the signal quality and make the wearable 12-lead ECG monitoring useful in preventing cardiac problems at high altitudes and in wilderness environments.

Background & Aims: With the development of radiology, the demand for medical physicists is increasing, and the training of new medical physicists is becoming a necessity. Although a few questionnaire surveys regarding medical physicists and medical physicist training courses have been conducted, no survey reports have yet been conducted on examinees. This study is the first survey of general examinees.

Methods: Gunma University has a webpage for test preparation, and we conducted a survey on examinees using this page, through a questionnaire and access analyses.

Results: Approximately 80% of the users qualified as technologists. Considering the percentage of users by region, the number of medical physicists and accredited facilities were strongly correlated. The proportion of females was extremely low. Exam papers on “science and technology” and “radiation physics” were accessed more than those on “medical and biology” field. Thus, physics may be a shortcoming of many examinees; science and engineering majors were less likely to take exams and have lower pass rates.

Conclusion: Recruitment and provision of learning environments for science and engineering graduates are required. To increase the number of students, while improving the quality of medical physicists, it is necessary to investigate current conditions of students in greater detail.