For the purpose of improving home visiting skills for mental health services, a new report format was developed. This study was designed to examine the effectiveness of the new report format through the use of case study sessions.

Four case study sessions were implemented with the new report format, which is composed of six factors and 36 items of home visiting skills. The“Public Health Nurses’Home Visiting Skills for Mental Health Services”were used for evaluation on a scale of one to four（1-4 points for each item）．

The evaluation scores all significantly improved after each case study session compared to those before the session. The scores improved by 12.6 points from the beginning of entire case study session until the end（p<0.05）．Of all the home visiting factors,“Determining Needs”and“Understanding Family Relationships”were most significantly improved（p<0.05）．Although not so significant, the other four factors, including“Managing the Home Visiting”were also improved.

The case study sessions with the new report formats was proven to be effective for improving home visiting skills for mental health services.

Background

The lipid-lowering therapy by statins may stabilize and reduce coronary plaques. We compare the effect of strong or moderate statins on the coronary plaque characteristics by using 64-slice multidetector computed tomography （MDCT）．

Methods and Results

We analyzed 13 subjects with non-calcified coronary plaques（NCP）as determined by MDCT. Pitavastatin（PTV：2mg/day）or pravastatin（PRA：10mg/day）were randomly administered. MDCT were performed at 0, 6 and 12 months after lipid-lowering therapy. In PTV group（n=6），CT density of NCP increased by 35.6 ± 28.8 HU after 6 months（p=0.037）and by 30.6 ± 29.8 HU after 12 months（NS）．NCP area was decreased by 35.9 ± 15.2 % after 6 months and by 41.0 ± 16.5 % after 12 months（both P=0.001）．In PRA group（n=7），CT density of NCP did not significantly increased after 6 months（NS）and after 12 months（NS）．NCP area was not significantly decreased at 6 months（NS），but decreased by 23.1 ± 16.7 % at 12 months（P=0.001）．

Conclusions

Serial CT angiography revealed that the regression of NCP occurs rapidly by strong lipid lowering therapy compared to the moderate statin therapy.

Older patients commonly have delirium-like symptoms after endoscopy with sedation. We investigated influencing factors for the onset of these symptoms by retrospective review of 230 nursing records of patients aged 65 and over.

Records were sorted by the presence or absence of delirium-like symptoms, and extracted factors were compared between the groups by a Chi-square test. Additionally, logistic regression analysis was performed using the factors as explanatory variables and presence/absence of delirium-like symptoms as objective variables.

Chi-square test results showed that those using medications which are at high risk of causing delirium tended to have delirium ? like episodes（p=0.052）．Logistic regression analysis extracted three variables as influencing factors of delirium：age（OR=1.27）sex（male）（OR=2.88），and high risk medicine（OR=3.44）．

The results suggest that older males taking high risk medicines are more likely to develop delirium-like symptom after endoscopy with sedation.

Monte Carlo simulation method was used to examine optimal administration method of Tazobactam / Piperacillin（TAZ/PIPC）against Pseudomonas aeruginosa（P. aeruginosa）．The dose to obtain?50% Time above MIC（%T>MIC）by renal functions and target attainment rates（TA%）?80% ware calculated for 12 administration methods. Pharmacokinetic parameters were established according to population pharmacokinetic analyses in Japanese patients with pneumonia, whereas MIC was determined using the MIC90 from the antibiogram of P. aeruginosa isolated at the Yamaguchi University Hospital in a 5-year period starting in 2011. Our recommended criteria for optimum administration was TA ?80% with 50%T＞MIC, and prioritizing facility for the patient（low-dose, lower frequencies and shorter infusion time）．The results obtained in 2015 suggest a recommendation of 2.25g × 4doses/day for patients with creatinine clearance（CLcr）<20mL/min, 4.5g × 3doses/day for patients with CLcr 20-29 mL/min, 4.5g × 4doses/day in patients of CLcr 30-79 mL/min（1hour infusion），and 4.5g × 4doses/day in patients of CLcr?80mL/min（3hours infusion）. However, there was variation in MIC90 levels between periods：some cases have much higher MIC90 value, in which case the optimal dosage could not be recommended within the indicated dose.

Nursing students are required to realize the importance of active learning and to identify their own agenda and goals in learning basic clinical skills. This study used post-class self-review reports to clarify how critically students review their practice in order to improve their performance.

Review reports from 78 second-year nursing students who had undergone 13 basic clinical skills classes were analyzed in the light of review characteristics and depth of review. Of 2,386 descriptions about self-review, 1,748 were used to categorize into“techniques”（1,564；89.5%），“knowledge”（137；7.8%），and“attitudes”（47；2.7%）．A total of 34 students（43.6%）set their own agenda whilst 44（56.4%）did not. Depth of review was categorized into “remaining superficial”（49；62.8%），“gradually deepening”（18；23.1%），and“becoming profound”（11；14.1%）．Of 49 students with superficial reviews, 32（65.3%）had no agenda or goals for themselves, which indicated that they tended to be unable to clarify what was important for their improvement and to learn actively or think critically. Of those who had conducted more profound reviews only 50-60% of them set their own agenda and goal suggesting that even these students were not always good at effectively setting goals.

The findings suggest that student reflection on their performance of basic nursing skills is an area that requires improvement.

The aim of the present study was to clarify the current circumstances related to the use of stenting for cervical internal carotid artery stenosis in neurosurgical facilities where there are no full-time neuroendovascular specialists．A total of 82 patients（68 men and 14 women；mean age of 72.4 years）with cervical internal carotid artery stenosis treated surgically during a 13-year period from April 2002 to March 2015 at Kanmon Medical Center were identified, and their medical records were reviewed. Seventy-six carotid endarterectomies（47 symptomatic lesions and 29 asymptomatic lesions）and 16 carotid artery stentings（9 symptomatic lesions and 7 asymptomatic lesions）were performed in 68 and 15 patients, respectively. The main reasons for performing stenting were a high location of the stenotic lesion and serious previous disease. Cerebral ischemia as a complication occurred in 4 patients who had undergone stenting and had an adverse influence on outcome in none of them. Although currently few patients undergo stenting for carotid artery stenosis, this results support its validity and safety in neurosurgical facilities where there are no full-time neuroendovascular specialists. In view of its relative simplicity, the proportion of stenting relative to endarterectomy will likely increase in future, especially in neurosurgical facilities lacking manpower.

The patient was a 68-year-old man who was underwent laparoscopic resection with D2 lymph node dissection for the early sigmoid colon cancer（Ⅱa+Ⅱc type）in December 2007.

The pathological diagnosis was moderate-differentiated adenocarcinoma with invasion to submucosa（SM），slight lymphatic invasion（ly1）and no venous invasion（v0）in the colonic wall and no lymphoid metastases（n0），which were categorized in curative A resection.

In February 2016, an abdominal ultra-sonography detected multiple tumorous lesions of the liver. As pathological examinations of percutaneous liver biopsy demonstrated the same pathological image as the primary sigmoid colon cancer, they were diagnosed as hepatic metastases. Six courses of bevacizumab and SOX were administered and these lesions disappeared. After that, S-1 only was performed for this patient and his disease remained stable and no new metastasis has occurred. Rarely but liver metastases from the SM colon cancer can occur. So it is necessary to accumulate more cases to elucidate the risk factors for recurrence and establish a surveillance system.

Background

We present a case in which remained swallowing dysfunction improved by adequate rehabilitation after treatment of a deep neck abscess.

Case presentation

A 68-year-old male presented to the emergency department of our hospital with appetite loss and chest pain and was diagnosed as having a deep neck abscess. While antibiotic treatment was effective, swallowing disorder became apparent after treatment. Thus, he was referred to our department for rehabilitation.

Clinical course

Videofluoroscopic（VF）examination of swallowing function revealed decreased hyoid movement and pharyngeal residue in the right piriform recess. Indirect therapy to treat the upward movement disorder of the hyoid and training to clear the pharyngeal residue were started. One month later, repeated VF showed improved hyoid movement and decreased residue in the piriform recess.

Discussion

The main cause of swallowing disorder of this patient was considered to be the limited upward movement of the pharynx due to severe cicatrix formation after massive inflammation. When swallowing dysfunction appears after development of a deep neck abscess, adequate therapy and/or training based on detailed evaluation is necessary.

We present a surgical case of locally advanced colorectal cancer after neoadjuvant chemotherapy. The case was a man in him 60s, he had sigmoid colon cancer. The tumor was large mass and spread from the urinary bladder to abdominal wall. He had few symptom of ileus, so we performd neoadjuvant chemotherapy with S-1 and oxaliplatin（SOX）plus Bevacizumab for four cycles to him.

After neoadjuvant chemotherapy, objective tumor shrinkage was observed with this case, and treatment resulted in a partial response by Response Evaluation Criteria in Solid Tumors（RECIST）．

The case was underwent safety surgery with no residual margin.

In conclusion, neoadjuvant chemotherapy with SOX or mFOLFOX6+ B-mab may safe and improve surgical rate with no residual margin. Further studies on neoadjuvant chemotherapy for locally advanced colorectal cancer will be need about survival data such as PFS and OS.