Akita has the fastest aging community in Japan. Increasing demand for emergency care and subsequent hospital care for elderly patients is placing excessive pressure on community hospitals because of the chronic shortage of doctors and other medical staff. The characteristic features of these patients are comorbidities, high incidence of cognitive disorders of varying degrees, and physical frailty. To address these urgent problems in a comprehensive manner, the creation of a special department, the ER and GP (general practitioners) department, might be an effective solution. The absence of a GP section in the hospital and lack of family physicians is a major problem in the Japanese medical system. In this context, Akita prefectural government established a training institute for general practitioners and family physicians in Akita Kousei Medical Center in 2012. Only 6 trainees have joined the program in 4 years, so major problems remain. One is the limited human resources available: young doctors and students are still not familiar with the specific area of GP. This is because of the long history of Japanese postgraduate training that is focused on cultivating specialist physicians. The second major problem is the differences that often exist between these doctors─generalists include both hospitalists and family physicians─and these two groups sometimes have completely different mentalities. More time is needed to establish a new style of hospital medicine.

A 72-year-old woman on dialysis acutely developed disturbed consciousness and severe hypertension. Head computed tomography (CT) demonstrated only ventriculomegaly without bleeding. Her consciousness level further deteriorated after dialysis using heparin, and subsequent head CT revealed a new, minor intraventricular hemorrhage. Hemorrhage-associated hydrocephalus was diagnosed, and the installation of a ventriculoperitoneal shunt resulted in good recovery. The patient might have experienced minor repeated bleeding and developed latent post-hemorrhagic hydrocephalus. Even minor bleeding could cause acute exacerbation of hydrocephalus; therefore, clinicians should be alert to hydrocephalus when a dialysis patient develops disturbed consciousness without any evidence of stroke on head CT.

No abstract available.
Aged ; Drug Resistance, Bacterial ; Humans ; Imipenem/pharmacology/therapeutic use ; Klebsiella Infections/diagnosis/drug therapy/*microbiology ; Klebsiella pneumoniae/drug effects/isolation & purification/*physiology ; Male ; Microbial Sensitivity Tests ; Phenotype ; Sepsis/diagnosis/drug therapy/*microbiology ; Thienamycins/pharmacology/therapeutic use

Since the discovery of the first strain in 1961 in England, MRSA, the most notorious multidrug-resistant hospital pathogen, has spread all over the world. MRSA repeatedly turned down the challenges by number of chemotherapeutics, the fruits of modern organic chemistry. Now, we are in short of effective therapeutic agents against MRSA prevailing among immuno-compromised patients in the hospital. On top of this, we recently became aware of the rise of diverse clones of MRSA, some of which have increased pathogenic potential compared to the classical hospital-associated MRSA, and the others from veterinary sources. They increased rapidly in the community, and started menacing otherwise healthy individuals by causing unexpected acute infection. This review is intended to provide a whole picture of MRSA based on its genetic makeup as a versatile pathogen and our tenacious colonizer.
Adenosine ; Chemistry, Organic ; Chromatography, Micellar Electrokinetic Capillary ; Clone Cells ; Colon ; England ; Fruit ; Humans ; Methicillin ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Sprains and Strains ; Staphylococcus ; Staphylococcus aureus