We performed gamma knife treatment for multiple brain metastases including a left frontal lobe lesion in a patient in his 60s who had renal cell carcinoma. After treatment, the left frontal lobe lesion initially shrank but then began to grow again, resulting in extensive edema, right hemiparesis, impaired activities of daily living (ADL), and decreased motivation. Although the renal cell carcinoma was in the terminal stage, we judged that recovery of ADL could be expected by removing the left frontal lobe lesion and therefore performed craniotomy tumor removal. As a result, the patient’s motivation and right hemiplegia markedly improved and ADL dramatically improved. Although the period from craniotomy tumor removal to death was as short as 2 months, significant improvement of ADL during this time was achieved by removing the tumor. Tumor resection for metastatic brain tumors is rarely performed in the setting of end-stage cancer. However, this case highlights the potential of brain tumor resection as palliative treatment that can be considered for improving ADL even in patients with terminal cancer.

JA Omagari Kosei Medical Center is an acute hospital located in Daisen City, Akita Prefecture, and we have two comprehensive community-based care wards. Falls and fall incidents are always ranked high in acute hospitals. Injuries caused by falls such as fracture, may lead to decline in activities of daily living / quality of life in patients and / or their families, which may then prolong the hospitalization period. Therefore, prevention of falls and falling is beneficial. Previous studies have reported that the activities of the ‘falls and falling’ teams contribute to reducing the fall rate. However, few studies have been conducted in acute hospital settings. Therefore, in this study we summarized the characteristics and current status of hospitalized patients in terms of falls and falling incidents in our hospital from medical records and incident accident reports. 　　Among 230 patients, 291 falls and falling incidents were reported in 1 year; falls and falling accounted for 32.9％ of all incidents. In addition, the fall rate was 2.1 cases / 1,000 patients / day, average age was 77 years, and there was a higher tendency in men. Furthermore, falls and falling occurred on a median 13 days from hospitalization; in 124 cases (42.6％) within 10 days after hospitalization and in 60 cases (20.6％) from 10 days to 20 days. A similar tendency was seen in patients who were moved to the comprehensive community-based care ward. Therefore, we considered that the patient would require continuous attention after moving to that ward. Ultimately, falls and falling occurred in the late-night period (from midnight to 8 a.m.), and many were at the bedside (58.4％), and the purpose of movement was bowel motion (54.3％).

At Anjo Kosei Hospital, all staff has been working concertedly on a project to establish a community hospital in line with our future vision. Hospital staff in charge of the Medical Affairs Division has been involved in measures aimed at achieving the slogan “health and happiness of local residents” as part of this project. To address this, three goals were set as follows: improvement of recoveries in accounts receivable management, a reduction of money held in trust, and a decrease in the number of outsourced transactions. To achieve the goals described above, the following specific measure were carried out: (1) collection of accounts receivable using convenience store settlement; (2) collection of high-cost medical expenses by wider use of Eligibility Certificates for Ceiling-Amount Applications and promotion of the Major Medical Cost Loan System for national health insurance holders; and (3) support in acquiring family registration for nonregistered family members and for health insurance benefits. Recoveries of accounts receivable through convenience store settlement was about 90,000 yen/month, and our support activities for family registration and health insurance benefits provided the recoveries of about 80,000 yen/month. Furthermore, the promoted use of the certificate and loan system resulted in recoveries of about 17 million yen/year. The average commission fee and number of outsourcing was 890,188 yen and 12 cases, respectively, from April to August 2016. However, in 2017, it was 305,615 yen and 10 cases, respectively. Our project aimed at achieving slogan-elicited patient voluntary payment of medical expenses, leading to improved recoveries, with reduced money held in trust and fewer outsourced transactions.