Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
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Volume 57, Issue 1
Displaying 1-18 of 18 articles from this issue
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Contents
  • Effects of introducing the electronic incident reporting system
    RIKIO KAWABATA, HIROYUKI KOBAYASHI, HIDEKO AIDA, TAKAO TASHIRO, EIJI M ...
    2011 Volume 57 Issue 1 Pages 31-37
    Published: February 28, 2011
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.57.31
    JOURNAL FREE ACCESS
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    Objective : It is desirable to collect a detailed incident reports as soon as possible after the occurrence of any incident. Against this background, Juntendo University Hospital introduced an electronic data entry system in June 2008, replacing the paper-based system for incident management. Here, we compared the status of incident entries before and after the introduction of the electronic data entry system. Materials and methods : The status of incident entry by occupation and incident level in a three-year period before the introduction of the electronic data entry system was compared to that in a one-year period after introduction of the electronic system. Moreover, questionnaires completed by 213 nurses were analyzed to evaluate the usability of the new entry procedure. Results : The number of incident entries in a one-year period after the introduction of the electronic data entry system was increased by 21.5% (501 reports) from that in a one-year period before the electronic system was introduced within the university hospital. Similarly, the number of entries by nurses who reported a large number of incidents and/or reported incidents at high rates was increased by 29.3% (481 reports). The ratio of low level (levels 0 and 1) incident entries to overall incident entries within the university hospital and the proportion reported by individual nurses were significantly higher in the one-year period after introduction of the system than in the three-year period before the introduction (p=0.000). Similarly, the ratios of entries made at other levels were also significantly increased (p-0.000). According to the questionnaire results, 165 nurses (77.5%) indicated that the new data entry procedure is easier to understand than the previous procedure, and 126 nurses (59.2%) indicated that the new procedure is timesaving. These findings suggest that the electronic data entry system simplified incident reporting procedures. Conclusions : The introduction of the electronic data entry system facilitated the collection of information on low level (levels 0 and 1) incidents. Furthermore, the new data entry procedure is considered easy and timesaving, and has therefore been well received by nurses. The introduction of the electronic data entry system has been effective in increasing the number of reports, and consequently helps in reducing the risk of medical incidents occurring.
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  • Forty cases of active tuberculosis diagnosed after hospital admission
    from Juntendo Tokyo Koto Geriatric Medical Center
    AKIHIKO IWASE, AKIHIDE KAWAMURA, KEI INAMI, EMI ONUMA, NORIYUKI HONMA, ...
    2011 Volume 57 Issue 1 Pages 38-42
    Published: February 28, 2011
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.57.38
    JOURNAL FREE ACCESS
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    Objective : Tuberculosis is a very important problem for infection control in hospitals. We analyzed active tuberculous patients who were diagnosed after hospital admission in order to clarify the issues in tuberculosis management. Patients and methods : We analyzed the backgrounds of 40 inpatients with active tuberculosis, who were correctly diagnosed after admission to Juntendo Tokyo Koto Geriatric Medical Center. Results : The subjects were 35 patients (87.5%) who were 65 years or older (average 76.1 yr-old). The male to female ratio was 30 : 10. The major underlying diseases consisted of diabetes mellitus, cerebrovascular disease/dementia and malignant tumors. There were 24 (60.0%) cases of pulmonary tuberculosis and 11 (27.5%) cases of tuberculous pleurisy comprising main types detected in these 40 tuberculosis patients. Two patients developed pulmonary tuberculosis during long-term hospitalization in the psychosomatic wards. Many patients with pulmonary tuberculosis were infectious and initially treated as having pneumonia at admission. Conclusions : In the aging society of Japan, we encountered elderly tuberculous patients who were difficult to diagnose due to underlying diseases. In elderly patients demonstrating chest x-ray shadow and suspected of pneumonia, tuberculosis must be always differentiated. Some elderly inpatients may develop active tuberculosis during long-term hospitalization. Tuberculosis should be always considered in daily practice.
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  • The efficacy of estrogen replacement therapy for vascular dysfunction induced by a maternal low protein diet
    MIHO MIYAKAWA, YUKA MUSHA, MAREKI OHTSUJI, SHIGERU ITOH, SATORU TAKEDA
    2011 Volume 57 Issue 1 Pages 43-51
    Published: February 28, 2011
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.57.43
    JOURNAL FREE ACCESS
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    Objectives : Our previous study showed that estrogen played an important role in limiting cardiovascular dysfunction induced by maternal protein restriction. Therefore, we hypothesized that estrogen replacement therapy (ERT) would improve the cardiovascular dysfunction of ovariectomized offspring following maternal protein restriction. Methods : Wistar rats were fed a diet containing either 18% (control group;C) or 9% casein (protein restriction group : R) throughout pregnancy only. On day 50, the offspring in the C and R groups were divided into 3 groups each, and the indicated surgery was performed in each group (sham group (CO, RO), ovariectomized group (CX, RX), ovariectomized and ERT group (CE, RE). On day 50, 75,100,125,150,175, blood pressure was measured in all groups. On day 175, the offspring were killed and the mesenteric arteries dissected. Endothelial function in the mesenteric artery was investigated with a wire myograph in all groups. Vascular contraction to cumulative dose-responses to phenylephrine (PE) and the thromboxane A2 mimetic, U46619 were carried out under isometric conditions. Endothelium-dependent relaxation was assessed by acetylcholine (ACh), and bradykinin (BK) -induced relaxation in the PE pre-contracted arteries. Endothelium-independent relaxation was determined by sodium nitroprusside (SNP). Results : There was no difference in blood pressure at any time point among the groups. There were no differences among groups in contractile responses to PE, U46619. The relaxant response to ACh and SNP did not differ among groups. The vasodilatory response to bradykinin (BK) was significantly attenuated in RX, and ERT improved this attenuation. Conclusions : It was demonstrated that NO production through BK in endothelial cells was attenuated in mesenteric arteries by maternal protein restriction. ERT appears to improve endothelial dysfunction induced by maternal low protein diet.
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  • Effects of providing training in living skills to patients with Alzheimer's disease during long-term hospitalization in a psychiatric ward
    RYO KUMAGAI, YUKIKO SAITO, AKIRA NAGASAWA, KENJI TAKANO, MARI SHINOMIY ...
    2011 Volume 57 Issue 1 Pages 52-58
    Published: February 28, 2011
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.57.52
    JOURNAL FREE ACCESS
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    Objective : In Japan, training on improvement of the living skills for 4 hours a day/5 days a week is required in psychiatric wards for demented elderly. Patients admitted to the ward of Juntendo Tokyo Koto Geriatric Medical Center perform radio exercises and receive training to improve swallowing function and learn to manufacture handicraft products. We previously established the efficacy of training on improvement of living skills for patients with Alzheimer's disease during long-term hospitalization. Materials and Methods : The subjects were 12 demented elderly inpatients with Alzheimer's disease who were admitted to the psychiatric ward of Juntendo Tokyo Koto Geriatric Medical Center between April 2009 and March 2010 and hospitalized for more than 90 days. The following information on these patients was obtained : clinical data, degree of Activity of Daily Living (ADL), cognitive functions, Behavioral and Psychological Symptoms of Dementia (BPSD) and dosage of drugs at the time of admission and 90 days after admission. Results : The degree of ADL and cognitive functions observed 90 days after admission did not significantly differ from observed at the time of admission. With regard to the BPSD, the degree of delusions, agitation, and anxiety significantly decreased 90 days after admission. The dosage of antidepressants was significantly increased;however, there were no differences with regard to the dosages of antipsychotic drugs and benzodiazepines. Conclusions : It was shown that ADL and cognitive functions of patients were preserved for 90 days after admission. Nevertheless, the dosages of antidepressants were increased, and the symptoms that influenced ADL and BPSD, such as dysphoria and apathy, remained unchanged;moreover, the dosages of other drugs remained constant. These findings suggest that training to improve living skills is effective for the preservation of ADL and cognitive functions in demented patients.
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