Background/Purpose: In 2012, the intensive care unit (ICU) of Hospital A introduced a gastric residual volume (GRV) enteral nutrition protocol. In 2016, the number of measurements and flow velocity were revised. The purpose of this study was to investigate and compare the protocol implementation status before and after the revision, and to examine the effectiveness of the revised protocol.

Method: We collected data retrospectively in 48 and 71 patients before and after revision.

RESULTS: There were no significant differences in the rate of GRV≥150 ml, discontinuing the protocol due to an adverse event, reaching the target dose before and after the revision. In addition, the time taken to reach the target dose was significantly increased (p<0.01) , while the daily fluctuation range in blood glucose levels and the deviating doctor’s instruction change were significantly decreased (p<0.01).

CONCLUSIONS: It is suggested that the revised protocol is not harmful and allows for more unified enteral nutrition management. In addition, excessive increases in blood glucose may be suppressed. We would like to continue to manage enteral nutrition according to the physical symptoms of patients, centering on the protocol.

Objective: To survey the status of plain radiography in Gunma Prefecture, and estimate radiation dose to residents in this area.

Methods: We conducted a questionnaire survey in 14 hospitals in Gunma Prefecture.　We asked radiology departments in these hospitals about the number of examinations by anatomical region and the number of radiographs during a one month period (from July 1 to July 31, 2018).　The radiation dose was estimated from the effective dose from each radiograph, the number of examinations, and the number of radiographs.　We calculated the collective effective dose from the number of examinations and the number of radiographs.

Results: The total number of examinations during the survey period was 51,771.　By anatomical location, the number of chest radiographs was the highest at 31,338, followed by abdominal radiographs at 8,523.　The collective effective dose was estimated to be 31.352 man Sv.　Abdominal radiographs were highest, at 16.40 man Sv.　Based on the collective effective dose and the population of Gunma Prefecture, the annual dose per person in Gunma was estimated to be 0.74 mSv.

Conclusions: We estimated the radiation dose in Gunma Prefecture by surveying the status of plain radiography.　The annual dose per person in Gunma was estimated to be 0.74 mSv.

Purpose: To estimate the annual effective dose per person in Gunma Prefecture by calculating average effective dose from computed tomography (CT) examinations in the area.

Methods: We collected data on age, gender, anatomical region, and dose-length product (DLP) on patients who underwent CT examinations during a specific two-week period in July 2016 from 95 facilities in Gunma Prefecture.

Result: We used data from 12,878 (7,014 males; 5,864 females) CT examinations on patients 10 years old and older (age 66.9+/-17.5 years, 10-104 years).　The effective doses were 2.4 mSv for head examinations (2,664 cases), 9.3 mSv for chest examinations (2,192 cases), 19.9 mSv for chest and abdomen examinations (3,906 cases), 16.5 mSv for abdomen examinations (1,611 cases), 14.5 mSv for coronary artery CT examinations (retrospective) (144 cases), 8.6 mSv for coronary artery CT examinations (prospective) (129 cases), 34.2 mSv for dynamic liver examinations (749 cases), with an average of 13.5 mSv overall.　According to the National Database (from April, 2016 to March, 2017) of the Ministry of Health, Labour and Welfare, the annual number of CT examinations in Gunma prefecture was 430,000; thus the annual effective dose by CT examination per resident was calculated as 2.95 mSv.

Conclusion: The effective dose per CT examination was 13.5 mSv.　The annual effective dose per resident increased by about 28% from that of 2.3 mSv in 2000.

Aim: This study investigated the use of the Mother and Child Health (MCH) Handbook and the association between the knowledge of disaster preparedness and utilization of the self-recording sections of the MCH Handbook.

Methods: In this cross-sectional study, self-reporting questionnaires were distributed to 1,009 puerperal women, and 662 complete responses were analyzed.

Results: Overall, 42.0% used the self-recording sections in the MCH Handbook during pregnancy, and 29.8% shared the MCH Handbook with family. Additionally, 78.1% participants recorded their weight changes during pregnancy, 54.5% recorded the development of their fetus in the MCH Handbook, and 66.6% had read information for pregnant women. Fisher’s exact test showed a significantly different rate of knowledge of disaster preparedness regarding Disaster Emergency Dengon Dial 171, the cellular phone disaster message board, and a hazard map among pregnant women who used the self-recording sections and those who did not.

Conclusions: This study demonstrated the rate of each function in the MCH Handbook. Pregnant women who used the self-recording sections in the MCH Handbook had disaster preparedness knowledge about the recognition of the Disaster Emergency Dengon Dial 171, the cellular phone disaster message board, and a hazard map.

Background & Aim: Road accident injuries and fatalities are an ongoing world-wide problem. Thus, this study examined the prevalence of front seatbelt use among Mongolian hospital workers and explored the factors associated with this behavior.

Methods: Self-administered questionnaires were distributed to 750 people who worked in a tertiary hospital; 681 agreed to participate and, among them, 521 (76.5%) provided complete responses. Participants were asked about their personal seatbelt use in the front passenger seat and their demographic characteristics. SPSS version 26 was used for all statistical analyses. Chi-squared and Fisher’s exact tests were used to analyze categorical values, with Mann-Whitney U tests being used to analyze ordinal and numeric values.

Results: Approximately five-sevenths (drivers: 73.3%, non-drivers: 71.9%) of participating passengers “always” used seatbelts while in a front passenger seat, according to the self-questionnaires. A multivariate analysis revealed that the timing of seatbelt use while one is in the driver’s seat before starting the engine and experiences of traffic accidents while riding in a car were associated with drivers using the front passenger seatbelt.

Conclusions: We suggest that educational programs on seatbelt use should be developed and delivered for interventions concerning, and promoting seatbelt use before starting the engine.

Background and objective: Gender diversity is widely recognized in the international society.　In Japan, on the other hand, the lack of understanding of LGBT limits care quality provided by healthcare professionals for this group of people.　The objective of this study was to investigate how LGBT is perceived by nursing students and to clarify the issues to promote the students’ understanding of LGBT.

Method: An anonymous questionnaire about LGBT was conducted on approximately 320 1st-year to 4th-year nursing students.　The questionnaire consisted of (1) interest level, (2) opportunity for interaction, (3) source of information, (4) knowledge, (5) consideration in health care settings, and (6) social distance in regards to LGBT.　Regarding social distance, four cases of lesbian, gay, bisexual and transgender were presented to ask the students if they were for or against five items including “to work with them as a colleague, to hire them, to become their teacher, to have a friend who is in romantic relationship with them, and to have children who marries them.”

Results: 225 (73.8%) valid responses were analyzed.　The average interest level was 6.7±1.8 points on a 10-point visual analog scale.　The most common opportunity for students to interact with LGBT was “on television and the Internet,” i.e., 42.9%.　The most common source of information was “school,” i.e., 66.2%.　Regarding social distance, the approval rate of “colleagues,” “employment,” and “teachers” was high, i.e., 95% or higher, while it was slightly low in the case of “romantic relationship” and “marriage,” i.e., 60～90%.　The approval rate was related to the high interest level in LGBT (p<.001─p<.05).

Discussion: The importance for nursing students to increase the interest level in gender diversity was suggested in order to deepen their understanding of LGBT.

An 85-year-old men with a past history of locally advanced and high Gleason grade (4＋5) prostate cancer died suddenly. The autopsy confirmed that his direct cause of death was suffocation following aspiration pneumonia. He underwent definitive heavy ion radiotherapy in combination with one-year neoadjuvant and 1.5-year adjuvant combination androgen blockade (CAB) between 9 and 7 years before the sudden death and his PSA was stable at 0.04 ng/ml at one year before the death. Pathological findings confirmed that his prostate cancer was completely cured including surrounding tissues outside the prostate and there were no adverse pathological changes due to heavy ion radiation in the rectum and bladder neck. Many clinical studies have already confirmed heavy ion radiation therapy to be an effective and less invasive treatment for localized and locally advanced prostate cancer. This initial case report may further demonstrate both microscopic curability and safety of heavy ion radiation therapy.

A 77-year-old woman was admitted to our emergency department with nausea and upper abdominal pain for 3 days.　An abdominal plain radiograph showed ileus. Computed tomography revealed closed loop sign, whirl sign, and ascites, so an emergency laparotomy was performed with a diagnosis of strangulated ileus. The surgical findings showed a defect in the right diaphragm, and the small intestine was herniated. Therefore, the patient was diagnosed with an incarcerated right sided Bochdalek hernia. The hernia foramen was repaired by direct suture closure and she had an uneventful postoperative course. She was discharged to her home 10 days after the operation and had no recurrence. Right sided Bochdalek hernia of the adult is rare, and we reviewed our experience in light of some literature.

Oral administration of Methotrexate (MTX) for rheumatoid arthritis caused Methotrexate-associated lymphoproliferative disorders (MTX-LPD), although just only drug withdrawal has a possibility to cure MTX-LPD rapidly.　The purpose of consulting to the ear-nose-throat doctor (ENT doctor) is a biopsy from the lesion, and getting pathological diagnosis, whereas some patients stopped taking MTX drugs before visiting to the ENT doctor. As a result, MTX-LPD lesion disappeared rapidly, and it could not be diagnosed any more. During a follow-up examination in that case, some MTX-LPD suspected lesions developed to the malignant lymphoma. Biopsy before withdrawal of MTX is important.　Moreover, carefully watching of lesions, and frequently examination of patients are really needed to MTX-LPD.