Today, the patient's needs for medical care and services have become diversified and medical information spreads widely and swiftly at that. In these circumstances, nurses are strongly expected to further develop their faculties of nursing and appropriately responding to the patient's emotional state. To nurture capable nurses, it is neccessary to establish an adequate training and performance evaluation system.
 In 2002, we had a chance to participate in the planning of “the Mie prefectural enterprise for continuous nurse education and appropriate nursing staff arrangement”. Based on this experience, we made a guideline for continuous nurse education, practice manual and an appraisal table for each rank.
 Meanwhile, The Mie Prefectural Federation of Agricultural Cooperatives for Health and Welfare, was studying a faculty appraisal system for all staffs. We started our nurse education program incorporating this system.
 Our nurse education program is made up of five ability-areas, that is, (1) nursing practice, (2) education to the lower class nurse and research, (3) human-relationship achievement, (4) nursing team management and (5) risk management.
 The outcome of this program was examined by the appraisal committee according to the improvement level in nursing abilities (including both skills and sensibility).

Today, the patient's needs for medical care and services have become diversified and medical information spreads widely and swiftly at that. In these circumstances, nurses are strongly expected to further develop their faculties of nursing and appropriately responding to the patient's emotional state. To nurture capable nurses, it is neccessary to establish an adequate training and performance evaluation system.In 2002, we had a chance to participate in the planning of “the Mie prefectural enterprise for continuous nurse education and appropriate nursing staff arrangement”. Based on this experience, we made a guideline for continuous nurse education, practice manual and an appraisal table for each rank.Meanwhile, The Mie Prefectural Federation of Agricultural Cooperatives for Health and Welfare, was studying a faculty appraisal system for all staffs. We started our nurse education program incorporating this system.Our nurse education program is made up of five ability-areas, that is, (1) nursing practice, (2) education to the lower class nurse and research, (3) human-relationship achievement, (4) nursing team management and (5) risk management.The outcome of this program was examined by the appraisal committee according to the improvement level in nursing abilities (including both skills and sensibility).
Nurses ; nursing therapy ; educational ; Career Development ; seconds

The present experiment aimed to determine what kinds of afferent nerve fibers in dorsal roots are stimulated during manual stimulation with an acupuncture needle by using single nerve unit recording techniques in bullfrogs. An acupuncture needle was inserted into a hind limb via the skin to the muscles, and was manually twisted right and left at a frequency of about 1Hz. Dorsal roots of the 8th and 9th spinal nerves were cut close to their entrance into the spinal cord and dissected to record single unitary afferent activity. The conduction velocity of the single nerve fiber was measured. A total of 30 units were successfully dissected, and all of those responded to manual twisting stimulation of the acupuncture needle in a hind limb. All of the dissected fibers had their receptive fields only at the unilateral side ipsilateral, to the recording site never contralateral. The conduction velocities of all 30 units ranged between 5.3 - 40.7 m/s. The reports by Erlanger et al.^{1, 2)} which showed the maximum conduction velocities of Aa, β, δand C afferent fibers in bullfregs to be about 48.2m/s, 28.7m/s, 13.6m/s and 0.7m/s, respectively, indicated that all 30 units dissected at the dorsal roots and responding to manual acupuncture stimulation were Aα, β, δ fibers. We could not record single nerve unitary activity of C fibers, probably because of technical difficulties. We conclude that manual acupuncture needle stimulation to the hind limbs excites single unitary afferent fibers of Aα, β, and δ fibers in the dorsal roots of bull frogs.

In August 1995, a committee was inaugurated in our hospital to improve hospital-patient relationship. Under the auspices of the committee, a series of lecture meetings were held with professional consultants and teachers invited. From September to December in that year, the on-the-job training was started and all the staff and part-time workers participated. The second training was carried out exclusively for people in managerial positions and the committee members from January to February in 1996. From March to June the third training was done for all the staff. The fourth and final training was given to the committee members from July to August in 1996. These on-the-job training and meetings resulted in marked improvements in communication between patients and hospital members. Moreover, the reform image of our hospital has been known widely. From now, we should continue our efforts to improve the hospital-patient relationship through various projects.

Objective: This study aimed to elucidate the electro-clinical characteristics of epilepsy and immunological markers in patients with epilepsy after infl uenza-associated encephalopathy/encephalitis (IAE). Methods: Eighteen patients with epilepsy after IAE (8 males, 10 females; mean age of onset 6.4±6.4 years) were studied. Antibodies to glutamate receptor (GluR) ε2 (NR2B) were examined by immunoblot and ELISA. Cytokines were measured by BioPlex. Results: Mean interval between IAE and epilepsy onset was 63.2 ± 95.0 days (mean ± SD). In 16 of 18 patients, complex partial seizures were observed. Most complex partial seizures were of short durations and showed few lateralizing signs. Interictal discharges were seen in the frontal area in 7 of 14 patients. Ictal EEG showed rapid propagation to bilateral hemispheres. Patients with higher cerebrospinal fl uid levels of anti-GluRε2 antibodies, higher cerebrospinal fl uid levels of IL-1β, soluble tumor necrosis factor receptor 1 and IFN-γ during chronic stage, had higher frequency of epileptic seizures. Conclusion: This study indicates that the frontal lobes are susceptible to rapid epileptogenesis after IAE, and that epileptic partial seizures after IAE had characteristics resembling generalized seizures. Presence of anti-GluRε2 antibodies and elevated IL-1β, TNFα, and IFN-γ in cerebrospinal fl uid may be associated with intractability of epileptic seizures.

Object: A multicenter survey was conducted to investigate the status of use of supplements and related problems in patients with diabetes mellitus.
Methods: A questionnaire was mailed to institutions where members of the Drug Information Section, Tokyo Hospital Pharmacists Association, worked, and hospitalized patients with diabetes mellitus were surveyed with a questionnaire.
Results: The response rate of the questionnaire was 85%, and 22 patients reported taking supplements.  The most common motivation to purchase supplements was a recommendation from an acquaintance, followed by a recommendation from a family member and TV. Only 9.1% of the patients consulted healthcare professionals when purchasing supplements.  The patients who did not follow the dosage and administration instructions and those who were not aware of precautions regarding proper use accounted for 31.8% and 63.6%, respectively.  The proportion of patients who did not inform their physicians about the use of supplements was 65.2%, and 4.5% reported some health damage (rash).
Conclusion: Our results revealed that supplements were used without careful consideration and were not administered properly, suggesting that scientific evaluation of efficacy and safety was warranted in future studies.  It is important for pharmacists to actively collect information on patient use of supplements and share the information within the medical team.

　　Capnocytophaga canimorsus is a spindle-shaped facultatively anaerobic Gram-negative rod in the oral cavity of dogs and cats. C. canimorsus rarely infects humans through an animal bite or scratch. However, it leads to severe sepsis once infection occurs, and the fatality rate is estimated to be up to 30%. The patient was a 56-year-old man with fatigue and fever. Sepsis with thrombocytopenia was suspected from the blood examination results. We decided to conduct microscopic examination of a non-stained peripheral blood smear and identified bacteria; therefore, Gram stain was immediately performed and spindle-shaped Gram-negative bacilli were detected. Additionally, the patient had a history of a bite and scratch by his cat. We suspected C. canimorsus infection from the microscopic examination findings and history. Moreover, we determined early that the pathogenic bacterium was C. canimorsus by blood culture. With immediate and proper treatment based on these results, we could rescue this septic patient with disseminated intravascular coagulation. Microscopic examination of non-stained peripheral blood smear is helpful for the early diagnosis of C. canimorsus infection.

Recent progress in chemotherapy has prolonged the survival of patients with malignant biliary strictures, leading to increased rates of stent occlusion. Even we employed metallic stents which contributed to higher rates and longer durations of patency, and occlusion of covered metallic stents now occurs in about half of all patients during their survival. We investigated the complication and patency rate for the removal of covered metallic stents, and found that the durations were similar for initial stent placement and re-intervention. In order to preserve patient quality of life, we currently recommend the use of covered metallic stents for patients with malignant biliary obstruction because of their removability and longest patency duration, even though uncovered metallic stents have similar patency durations.
Biliary Tract Diseases/*surgery ; Coated Materials, Biocompatible ; Device Removal ; Drainage/methods ; Endoscopy ; Foreign-Body Migration/surgery ; Humans ; Metals ; Postoperative Complications/surgery ; *Stents/adverse effects

Background/Aims: No screening test for esophageal motility disorder (EMD) has been established, the objective of this study is to examine the potential usefulness of our newly developed “Onigiri esophagography” combined with an obstruction level (OL) classification system in screening for EMD. Methods: A total of 102 patients with suspected EMDs who underwent both high-resolution manometry (HRM) and Onigiri esophagography between April 2017 and January 2019 were examined. The EMD diagnosis was performed based on the Chicago classification version 3.0 by HRM. Onigiri esophagography was performed using a liquid medium (barium sulfate) followed by a solid medium, which consisted of an Onigiri (a Japanese rice ball) with barium powder. The extent of medium obstruction was assessed by the OL classification, which was defined in a stepwise fashion from OL0 (no obstruction) to OL4 (severe obstruction). Results: The patients with OL0 (32.3%), OL1 (50.0%), OL2 (88.0%), OL3 (100.0%), and OL4 (100.0%) were diagnosed EMDs by HRM. The area under the curve, as determined by a receiver operating characteristic analysis, for the OL classification was 0.86. Using the cutoff value of OL1, the sensitivity and specificity were 87.3% and 61.3%, respectively, while using a cutoff value of OL2, the sensitivity and specificity were 73.2% and 90.3%, respectively. Conclusion In conclusion, Onigiri esophagography combined with the OL classification system can be used as a screening test for EMDs with a cutoff value of OL1.