An 8-year-old girl was admitted with vision loss. She had no history of amblyopia or other eye diseases. On examination, both eyes showed vision loss and uncorrected myopia, regardless of visual acuity correction by glasses. Her symptoms were considered exacerbated by fatigue. We diagnosed tonic accommodation because a regulatory paralysis agent provided relief. The patient had been treated with tropicamide methyl sulfate and neostigmine, but her visual acuity did not change. Based on a Kampo diagnosis, she was prescribed Shokenchuto. After 4 months' administration, her uncorrected vision improved by 1.2 in both eyes, and her visual acuity was maintained even when fatigued. Kampo medicine can be a treatment option for tonic accommodation in cases where standard treatments are ineffective.

A 54-year-old female had cesarean sections at ages 26 and 29, a left salpingophrectomy for left ovarian cyst at age 31, and a total abdominal hysterectomy for fibroids at age 41. After total abdominal hysterectomy, she had repeated bouts of ileus and started taking daikenchuto (DKT), which is commonly used to prevent ileus. At age 54, she visited our hospital when DKT failed to relieve her constipation and lower abdominal pain and had occasional heat flash above her neck. Tongue examination revealed pale red tongue and fissured tongue signs with yellow fur and dilation of the sublingual collateral vessels. Kampo diagnosis was blood stasis and excess heat, for which keishibukuryogan was prescribed to be taken daily and with which her symptoms dissipated after 7 days. Despite the popular use of DKT, its potential to cause excess heat after long-term use is not as well known. It is extremely important to warn clinicians who prescribe Kampo not to focus solely on a disease-to-prescription model but also to be learned of the discipline and to take measures to prevent adverse long-term effects and complications.

Based on the assessment of the home health care services provided by our hospital over the past five years and the results of a survey of the people concerned, we studied the problems of home care and dwelt on what it should be in the future. An alarming fact was brought to light: Many of those who look after patients in their homes are stress-ridden. Even among those who said they are satisfied with the present care system, not a few expressed uncertainty about the future. Many were of the opinion that without option of putting the patients in hospitals or nursing homes if need be, the home health care system would not hold water.
Our hospital admits only those patients who are badly in need of hospital treatment, and technically many cases cannot be referred to general practitioners. To add to the development of home health care, it is necessary to establish a coll aborative system between hospitals and neighborhood clinics. Under the system, patients will be screened according to the degree of their need for medical care, and visiting nurses will be able to show their skill fully and provide care confidently while keeping close contact with physicians.

Objective: Similarity of drug names is one factor of dispensing incidents.  The aim of this study was to survey the relation between sensual similarities of drug names and the occurrence of taking errors for pharmacists who actually prepare medicine.
Methods: A pair of drugs (15 incident pairs and 104 control pairs) was displayed on a computer screen at random.  The subject’s task was to determine the sensual similarity of them.  Thirteen pharmacists who prepared these pairs and caused their incidents participated in the experiment.
Results: The result showed that the sensual similarity of drug names of incident pairs was found to be highly significant in comparison to one of the control pairs [p=0.026].  However, the similarity in incident pairs is not necessarily high.  It was suggested that the similarity of drug name was not the only factor of taking error.  Multiple linear regression analyses of the sensual similarity in control pairs were performed, in which 10 variables were reported as quantitative indicators of similarity of drug name and were able to be measured on the internet.  The correlation was good [R²=0.828].  However, this regression model was not useful when adjusting to incident pairs.  In incident pairs, the similarity value calculated by the regression model was lower than the measured sensual similarity.
Conclusion: The result suggested that measured sensual similarity includes other risk factors of taking error, such as appearance similarity and/or efficacy similarity and/or short distance arrangement.  It seemed that the pharmacist’s ability complicated the factor of taking error.

In order to examine the attitudes of medical students toward oriental medicine before and after lecture course, self-administered questionnaires were given the medical students of Kyoto Prefectural University of Medicine. Eighteen percent of the students had some experience with the prescription of Kampo medicine by doctors; 53% had used Kampo medicine purchased in pharmacies, and 13% had been treated with acupuncture and moxibustion. Eighty-four percent of the students were interested in oriental medicine; 82% thought that oriental medicine was worth learning; 76% thought that oriental medicine was essential in contemporary medicine and 54% wanted to introduce oriental medicine into their clinical practice in the future. These percentages increased after the lecture course to 92%, 85%, 87% and 62%, respectively.

With aging of inpatients, the prevention of falls in old people is an important task nurses have to take upon themselves. In our hospital, we have been tackling the task in earnest by utilizing a fall prevention assessment score sheet. Our efforts have resulted in changes in the attitude of nurses as shown by a survey. (1) By working on the nursing plan with use of the fall prevention assessment score sheet, nurses have become alert to risk factors for falling. (2) They have realized that assistance suited to the needs of each patient is vital and that collaboration between patients, their families and hospital staff contributes to the prevention of falls greatly. (3) The use of an intervention manual has made it easy for nurses to cope with falls and consequent injury. (4) To share information of every factor for falling among the nursing staff has added greatly to the prevention of the recurrence of the fall.
Prevention ; Fall, NOS ; Surveys ; Attitude ; Knowledge acquisition using a method of assessment

  A 4–year trial of an undergraduate medical care education program for smoking cessation with the participation of simulated patients is described. Simulated medical care with the participation of simulated patients is thought to motivate medical students to learn clinical skills for smoking cessation. However, simulated medical care for smoking cessation is difficult to plan when both the medical students and the simulated patients are nonsmokers.

OBJECTIVES: Sarcopenia, decreased muscle volume and muscle weakness in the elderly is a serious risk of various adverse outcomes. Current diagnostic procedure for sarcopenia includes gait speed, grip strength, and percentage of skeletal muscle volume. However, lower leg muscle strength decreases much faster than grasp power, and we have evaluated the usefulness of its measurement using a recently developed instrument (Locomoscan). METHODS: Forty-three institutionalized elderly subjects were evaluated for their anthropometrical parameters, body composition, grasp and lower leg muscle strength, and gait speed. They were categorized into 2 groups; gait speed equal to or higher than 0.8 m/s and that below 0.8 m/s. RESULTS: Leg muscle strength per body weight was significantly greater in those with their gait speed equal to or higher than 0.8 m/s, whereas there was no significant difference in other parameters. Receiver operator characteristics analysis has shown that leg muscle alone significantly predicted the greater gait speed. CONCLUSIONS: Lower leg muscle strength can be useful for predicting gait speed.
Aged* ; Body Composition ; Body Weight ; Gait* ; Hand Strength* ; Humans ; Leg* ; Muscle Strength* ; Muscle Weakness ; Muscle, Skeletal ; Sarcopenia

BACKGROUND/OBJECTIVES: The level of serum albumin is an index of nourishment care and management. However, the distribution and correlates of serum albumin levels among individuals with motor disorders have not been reported until now. Therefore, we examined the distribution and correlates of serum albumin levels among individuals with motor disorders. SUBJECTS/METHODS: A cross-sectional study on 249 individuals with motor disabilities (144 men, mean age: 51.4 years; 105 women, mean age: 51.4 years) was conducted at five institutions in Ibaraki Prefecture, Japan in 2008. The results were compared with data from the National Health and Nutrition Survey. RESULTS: The mean serum albumin levels were 4.0 ± 0.4 g/dL for men and 3.8 ± 0.5 g/dL for women. Overall, 17 (11.8%) men and 25 (23.8%) women had hypoalbuminemia (serum albumin level ≤ 3.5 g/dL); these proportions were greater than those among healthy Japanese adults (≤ 1%). Low serum albumin level was related with female sex, older age, low calf circumference, low relative daily energy intake, low hemoglobin (Hb), low blood platelet count, low high-density lipoprotein cholesterol (HDL-C), low HbA1c, and high C-reactive protein (CRP) levels. The strongest correlates, based on standardized betas, were Hb (0.321), CRP (-0.279), and HDL-C (0.279) levels. CONCLUSIONS: These results indicate that the prevalence of hypoalbuminemia is higher in individuals with motor disabilities than in healthy individuals and that inflammation is a strong negative correlate of serum albumin levels. Therefore, inflammation should be examined for the assessment of hypoalbuminemia among institutionalized individuals with motor disabilities.
Adult ; Asian Continental Ancestry Group ; C-Reactive Protein ; Cholesterol ; Cross-Sectional Studies ; Energy Intake ; Female ; Humans ; Hypoalbuminemia ; Inflammation ; Japan* ; Lipoproteins ; Male ; Motor Disorders* ; Nutrition Surveys ; Nutritional Status ; Platelet Count ; Prevalence ; Serum Albumin*