We report a 74-year-old woman who developed right-sided Hunt syndrome on July 3, XXXX, and who received stellate ganglion block and an infusion of aciclovir while hospitalized. Steroids were not used due to her diabetes. After discharge, she continued taking vitamin B₁₂, and received stellate ganglion block three times a week, but the paralysis did not show a tendency toward recovery. Following a combination of acupuncture and rehabilitation starting on October 6 (post-onset day 95), the paralysis score, which was 4 points on day 95, showed a tendency toward recovery : 32 points on day 186, and 36 points or more (within the normal range) on day 246. No apparent synkinesis was seen one year after the onset. Although Hunt syndrome appeared to be refractory due to her advanced age, presence of diabetes, unused steroids, complete paralysis with a paralysis score of 8 points or less, and no tendency to recover for three months or more, the results suggested that she responded to the combination of acupuncture and rehabilitation.

Objective: This study aimed to clarify the circumstances and challenges in home care-oriented hospital nurse training on the basis of results of hospital nurse self-evaluations of nursing activities implemented in preparation for home care.

Methods: Group interviews were conducted with 13 nurses at 9 different hospitals, and the results were qualitatively and inductively analyzed.

Results and Discussion: Six categories for actual nursing activities implemented in preparation for home care were extracted. These categories were "I leave home care to other medical professionals," "No form of inter-hospital cooperation has been established," "There is disparity in cooperation with home-visiting nurses," "Social resources are not being used due to a lack of knowledge," "Able to develop a perspective of home care through workshop participation, years of experience, and interest," and "Competency is lacking despite knowledge of home care." Home care was apparently not being utilized by hospital nurses due to a lack of knowledge of social resources and a lack of interdisciplinary cooperation.

Conclusions: Challenges in nurse training implemented in preparation for home care included compensating for the lack of practical knowledge of social resources and devising a duty system and inter-facility exchanges to allow nurses to build experience in other areas and departments. The results of this study suggested the need for organizational training initiatives and for improvement of the quality of individuals in order to put acquired knowledge into practice.

We retrospectively investigated the effects of acupuncture on refractory peripheral facial paralysis. Among patients with Bell's palsy or Ramsay Hunt syndrome (type II) who underwent acupuncture between August 1996 and June 2004, were 29 patients with a minimum electroneuronography (ENoG) percent response of 0%, and NET scale-out (14 patients with Bell's palsy, 15 with Ramsay Hunt syndrome). Demographically, they 21 males and 8 females, with a mean age of 44.3±12.8 years. Their disease duration, and paralysis score assessed using the 40-point method (Yanagihara's method) were 43.2±23.9 days and 10.2±2.7 points, respectively. To evaluate treatment response, we employed the paralysis score, and a sequela score assessed using a modification of the sequela evaluation method designed by Nishimoto and Murata et al. The paralysis score exceeded 36 points within 6 months after onset. Five patients (17.2%) without sequelae were regarded as having achieved complete recovery, and 24 (82.8%) as having achieved incomplete recovery. When the minimum ENoG is 0%, recovery within 6 months beyond onset is considered impossible. The results suggest, however, the efficacy of acupuncture.
seconds ; Paralysis ; Acupuncture ; Sequela ; month

We retrospectively compared the treatment effects of electro-acupuncture against in situ acupuncture, in 15 Hunt's Syndrome patients who underwent acupuncture therapy in our institution between August 1996, and June 2004, and who had fulfilled 3 electroneurography (ENoG) criteria with a value of 0% within 90 days after onset, had a paralysis score of <20, and could be followed up for 6 months after onset. Electroacupuncture therapy was performed on the paralysis side of the faces of 8 patients (the electro-acupuncture group), while in situ acupuncture therapy was performed on the remaining 7 (the in situ acupuncture group). No significant differences were observed in the background factors between the two groups. Treatment results were evaluated using the 40-point paralysis score described by Yanagihara, as well as a sequela score, which was a modified method of the sequela assessment developed by Nishimoto and Murata et al. Changes in paralysis scores from first acupuncture therapy, out to 6 months post-onset were compared using repeated ANOVA measures, and Mann-Whitney U tests respectively. Recovery of paralysis scores did not significantly differ between the two groups (p=0.0507), although slightly better recovery was observed in the electroacupuncture group, as compared with the in situ acupuncture group. Additionally, sequelae scores did not significantly differ between the two groups (p=0.51). In recent years, many have been of the opinion that lowfrequency stimulation is contraindicated. In this study, however, the incidence of sequelae did not differ significantly between the electro-acupuncture therapy and the in situ acupuncture therapy groups, although slightly better paralysis recovery was observed in the former.