Drastic reforms in healthcare are required in Japan. "Healthcare 2035" has been proposed to further develop healthcare and lead the world as a maturing nation. We introduced the following two policy recommendations to contribute to the new vision, 1) “Disability Registry” construction as a prognosis ⁄ outcome indicator in medical database, and 2) "Definition of Health for a Care–focused Mature Society": in a care–focused mature society such as Japan, the notion that "despite ‘social, physical, and mental challenges’ such as the disabilities acquired from trauma or disease, quality of life can be maintained and that one ‘is able to’ self–manage and aim for "self–actualization" should be added to the future "definition of health"." Japanese healthcare policies and present situation which become background reasons requiring construction of “Disability Registry”, which is "Injuries ⁄ Diseases Medical Treatment, Nursing, Health, and Welfare Database" were reviewed. A system, established by collaboration among medical institutions, nursing–care facilities, administrative officials, etc. for the purpose of sharing patient information throughout the region and conducting medical treatment based on continuous information in the Yamaguchi Prefecture areas of Ube, Sanyo Onoda, and Miya, seemed to be useful for building the database construction as an example of regional advanced initiatives. It was thought that construction of the Disability Database will contribute to health promotion for the "Definition of Health for a Care–focused Mature Society" from the viewpoint of improving of information accessibility for all: including "people with disabilities".
Background: Chronic subdural hematoma is one of the most common diseases encountered in neurosurgical practice. Although treatment methods are well established, factor leading to recurrence remain unclear.
Methods: To identify recurrence factors, we compared the clinical features of recurrent and non–recurrent hematomas in patients with bilateral chronic subdural hematoma. We retrospectively analyzed data for 23 patients (46 hematomas) who had undergone burr–hole surgery between January 2000 and December 2016. Recurrence was defined as the time at which hematoma recurrence warranted re–drainage.
Results: The recurrence factors identified were post–operative hematoma volume and density. These bilateral surgical hematoma patients had same patient backgrounds and histories. No significant difference in degree of paralysis, and volume and density of hematoma pre–operatively in those with recurrent hematoma was observed.
Conclusions: In recurrent hematoma, the density of the hematoma increased, and the hematoma volume showed an increasing trend one week post–operatively. In order to prevent the recurrence of chronic subdural hematoma, it is necessary to improve the return of the brain the next day after the operation by removing the hematoma as much as possible with surgery and postoperative drainage. In addition, within one week after surgery, taking measures against elevation of hematoma and increase of hematoma density are required. Especially, it is necessary for intervention in cases where return of the brain is not good with the head CT of the next day after surgery.
Ankylosing spondylitis (AS) is an inflammatory disease that can cause some of vertebrae to fuse together. This fusing makes the spine less flexible and pain in lower back and hips. AS has a thinning of a bone and weakened vertebrae, which occur vertebral fractures. Here we present a case of AS in multiple vertebral fractures by traffic accident.
Traffic accidents are the cause of traumatic brain injuries in 83% of children. Sometimes, patients and their families have to live with a feeling of inconvenience due to the after–effects. Therefore, medical institutional support must be provided from the acute phase until after discharge. We performed rehabilitation from the acute phase to restoration in an 8–year–old boy with severe head injury caused by a traffic accident. During hospitalization, in addition to motor paralysis, aphasia, attention deficit, visual disapproval, and visual spatial cognitive impairment were observed. The symptoms improved by evaluation and training and higher brain function was observed on developmental examination. However, after discharge, we needed additional advice and guidance in school because problems such as forgetting to take things to school and increase in mistakes during tests were observed. These problems were solved and the rehabilitation ended 6 months after injury. The notable characteristic of this case is that the physical and brain function returned to the mean normal range about 1 month after injury and further improvement was seen after cranioplasty. Therefore, data on the physical and cerebral function of children with severe head injury after cranioplasty are useful for returning to the pre–injury functional levels and leading normal school life. Moreover, very few higher brain function tests are available for children; therefore, it is important to evaluate brain function through observation and interview. In conclusion, we should conduct developmental examination and practice in a simulated school classroom while the patient is in the hospital as well as evaluate and consider academic aspects while providing treatment from hospitalization to outpatient care in such cases.