Two years have passed since a patient who started to use the respirator for a tuberculosis sequela and chronic respiratory failure at home. During this period, the patient got several short-term admissions into the hospital. After his first discharge, the patient and his family felt anxiety about recupration at home. It was the first time for us to provide home care services to a respirator wearing patient. However, the shift to recuperation at home was realized as an understanding was reached between physicians who decided upon care home and the patient's wife who wished “to live with the husband together”. The patient is now playing a role as a father and as a husband, and he is leading a full life. In this study, the personal and familial circumstances of the patient, decision-making about home care and community support were analized. We coucluded that there were several important factors for successful recuperation at home:specification of contents of concrete medical support to a patient and a family;an immediate suitable action at the time of change of a patient's condition;taking periodic rests of a patient and a family;and a good family relationship.
Patients ; Ventilators, Mechanical ; seconds ; Family ; Home

The clinical competence needed by every beginning resident and the present status of such competencewere examined in August 1998 through questionnaires distributed to clinical educators and the nursing staff of university hospitals and clinical training hospitals designated by the Ministry of Health and Welfare. Completed questionnaires were returned by 576 (65.9%) of clinical educators and nursing staff. With a cluster analysis of the necessity and the present status of clinical competence, 21 items for clinical competence were identified as those most requiring evaluation by the national examination. These 21 items included 11 items for clinical competence in the cognitive domain, 8 items in the psychomotor domain, and 2 in the affective domain. In about half of the direct answers obtained from clinical educators, evaluations were considered necessary for 15 items of clinical competence, of which 13 belonged to the cognitive domain. These results were consistent with the present status. However, practical examinations have also attracted increasing attention, as the results included strong demands that the national examination evaluate some basic clinical skills, such as physical examination and measurement of vital signs. However, about 30 % of authorities governing the national examination thought no changes are needed in the national examination.

BACKGROUND/AIMS: In Japan, it is customary to take a daily bath during which the body is immersed in water to the neck. During full-body immersion, hydrostatic pressure is thought to compress the chest and abdomen, which might influence esophageal motor function and intra-gastric pressure. However, whether water immersion has a significant influence on esophageal motor function or intragastric pressure has not been shown. The aim of this study was to clarify the influence of full-body water immersion on esophageal motor function and intragastric pressure. METHODS: Nine healthy male volunteers (mean age 40.1 +/- 2.8 years) were enrolled in this study. Esophageal motor function and intragastric pressure were investigated using a high-resolution 36-channel manometry device. RESULTS: All subjects completed the study protocol. Intragastric pressure increased significantly from 4.2 +/- 1.1 to 20.6 +/- 1.4 mmHg with full-body water immersion, while the lower esophageal high pressure zone (LEHPZ) value also increased from 20.5 +/- 2.2 to 40.4 +/- 3.6 mmHg, with the latter being observed regardless of dietary condition. In addition, peak esophageal peristaltic pressure was higher when immersed as compared to standing out of water. CONCLUSIONS: Esophageal motor function and intragastric pressure were altered by full-body water immersion. Furthermore, the pressure gradient between LEHPZ and intragastric pressures was maintained at a high level, and esophageal peristaltic pressure was elevated with immersion.
Abdomen ; Baths ; Esophageal Sphincter, Lower ; Gastroesophageal Reflux ; Humans ; Hydrostatic Pressure ; Immersion ; Japan ; Male ; Manometry ; Neck ; Peristalsis ; Thorax ; Water

This study investigated the characteristics of emergency patients, including walk-in patients and those brought in by ambulance, who visited Akita Kousei Medical Center in the 6 months from April 2019, and the clinical features of elderly patients with heart failure. Elderly patients above 70 years of age accounted for 38.7% of emergency cases and up to 61.7% of ambulance cases. The most common diseases and disorders were orthopedic, digestive, otorhinolaryngeal, respiratory, neurological, dermatological, and cardiovascular disease, in that order. In total, 56 patients with heart failure were admitted during this period (age 83.5±8.3 years, male: female ratio, 1:1.67). Hospitalization from homes accounted for 66.1% of admissions, with the remainder from nursing homes. After treatment, 35.7% of patients moved to nursing homes and 19.6% died despite in-hospital care. Because heart failure is one of the most common conditions in elderly patients, it is pertinent to recognize the importance of quality of outpatient care to prevent hospitalization and also to preserve quality of life by focusing on alleviating overall pain and discomfort.