Purpose: Although a late-evening snack (LES) has been recommended to patients with chronic liver disease, the effects of long-term carbohydrate-enriched LES still remain debatable. The purpose of this study was to clarify the usefulness of the LES in outpatients with liver cirrhosis.　　Materials and Methods: A nutritional education using LES was given once every month during six months by registered dietitians and pharmacists to 23 outpatients with liver cirrhosis. Seventeen patients were graded A in light of Child classification, and six were graded B. The LES consisted of health foods such as rice balls and bread with 100-200 kcal carbohydrate. Serum AST, ALT, total bilirubin, total protein and albumin levels were evaluated before the nutritional education and 12 months after the start of the education.　　Results: The nutritional education was finished by 19 patients (82.9%). No significant differences were observed in AST, ALT, total bilirubin and total protein values between before and after the education. In 14 patients who were graded Child A and B after the education, with the exception of two patients graded Child C after the education, serum albumin concentrations after the education were significantly higher than those before the education.　　Conclusions: The long-term nutritional therapy with carbohydrate-enriched LES can be performed in the most efficient way on a large percentage of outpatients with liver cirrhosis. This nutritional therapy may be useful for liver cirrhosis patients so long as the liver functions fairly well.

　　With the revision of the Medical Service Law in April 2005, it has become incumbent on clinical engineers to take charge of medical equipment in their hospital and to run a maintenance check on the equipment at regular intervals.　　However, it is difficult to show what clinical engineers have done as visualized achievements, for no insurance mark to the maintenance and management business itself.　　By using the accumulated maintenance records and a new medical equipment management system - the Arcadia company’s “CEIA system” installed in April 2010. We considered the cost performance of the medical equipment could be enhanced through the efforts of clinical engineers.　　For this purpose, we made the list of technical fees to be paid if a clinical engineer should entrust temporarily the maintenance management to an equipment maker and calculated the cost item by item.　　Moreover, the items which were checked and repaired were divided into those “outsourced” and those taken care of by hospital clinical engineers. When trial calculations were made using “in-house processing-outsourcing＝achievements” formula, we had about 50 million yen or more.

　　The establishment of a sustainable healthcare system based on residents’ needs is an urgent issue in a rural region. For this purpose, considering the structure of a healthcare system, such as the numbers of beds, doctors, and nurses is important. In addition, the study of healthcare utilization using the date gathered through geographic information systems (GIS) would be very helpful in building such a healthcare system. In Japan, however, there are few published studies available on how health services are utilized. The aim of this paper was to review articles of GIS research on healthcare utilization. We conducted a systematic search of published peer-reviewed literature on PubMed. We found 38 articles that satisfied our inclusions criteria for review. Of them, 12 articles had a map for understanding health needs or demands, 23 articles carried analyses of distance and time for health utilizations, and seven articles had a buffer or database for analyses of healthcare utilization. Most of these articles have dealt with pediatric care and emergency care. Given the aging population in a rural region, we concluded that a more evidence-based approach should be taken to rural health focussing on lifestyle-related diseases.

　　The purpose of this study was to clarify the effectiveness the score of the family’s ability to care to determine the discharge destination in patients with hip fractures.　　The subjects were 73 patients with hip fractures, who were admitted to the subacute care ward. They were classified into two groups: 48 patients who were discharged to home and 25, who were transferred to some other hospital or nursing home. 　　The following parameters were compared between the two groups: sex, age, preinjury level of independence in daily living for the disabled elderly, level of independence in daily living for the demented elderly during hospitalization, FIM (Functional Independence Measure) at the time of discharge from hospital, number of family caregivers, familial care ability score, and length of hospitalization. The parameters presenting significant differences were used as independent variables in multiple logistic regression analysis, with discharge outcome as the dependent variable.　　The parameters presenting significant differences between the two groups were “FIM at hospital discharge” and “familial care ability score”. In addition, multiple logistic regression analysis revealed that “FIM at hospital discharge” and “familial care ability score” were significantly related to discharge outcome. Results of receiver operating characteristic analysis (area under the curve) for &ldqup;FIM at hospital discharge,” “familial care ability score,” and “FIM at hospital discharge＋familial care ability score” were 0.763, 0.681, and 0.786, respectively. Furthermore, the area under the curve for “FIM at discharge＋familial care ability score” was higher compared with those for the other parameters.　　Thus, we demonstrated that familial care ability score was effective in determining the discharge destination in patients with hip fractures.

　　Introduction: Reimbursement for breathing care services was started with the revision of the nation's medical service fee system in 2010. Our hospital was not properly equipped in the light of certain standards governing facilities. Nonetheless, we started giving instructions to nurses on how to check the respirator at work. In addition to the on-the-job training, we are engaged in educational activity and information gathering. Out team comprises clinical engineers, physical therapists and registered nurses. They are all certified respiratory therapists. We hereby report our activities and refer to future problems.　　Activities: 1. Safety checks of respirators while in use. 2. Respiratory rehabilitation during hemodialysis. 3. Respirator-related workshops. 4. Review of accidents.　　Results: 1. It has become easier to discover potential problems and meet them at once. This is because our team is made up of different specialists, each used to looking at things differently. 2. Being constantly on the alert for any indication of a trouble ensures safety during breathing rehabilitation. 3. The number of accidents during 2012 decreased from 2011.　　Future: We think that since “safety management” is the center piece of our activity, our team ought to be recognized as an official organization of the hospital.

　　A 71-year-old woman was admitted to our hospital as heatstroke was suspected. Although of no obvious central nerve system disorder was found, magnetic reasonance angiography of brain blood vessels showed left middle cerebral artery occlusion. SPECT revealed a reduction in left cerebral blood flow. To supply the blood flow, superficial temporal artery - middle cerebral artery anastomosis was done. The result was satisfactory. Any other neurological symptoms were not observed. Asymptomatic occlusion of the middle cerebral artery might contribute to heatstroke. This case demonstrated the importance of the assessment for brain artery dynamics on heatstroke.

　　We encountered with a rare case of intraductal apocrine carcinoma of the breast. The patient was a 62-year-old woman who had undergone right mastectomy for invasive ductal carcinoma of the right breast two years previously. This time, she was diagnosed with the left breast cancer (Category4) because left mammography showed pleomorphic and segmental calcifications. Ultrasonography (US) revealed an irregular and low echoic mass. Histopathological examination by US-guided core needle biopsy showed apocrine carcinoma. Mastectomy with sentinel lymph node biopsy for breast cancer of the left breast was performed. Post operative histopathological examination revealed intraductal apocrine carcinoma without lymph node metastasis. Estrogen and progesterone receptors were negative, while androgen receptors were positive, HER2 score was 2+. Adjuvant therapy was not performed. She is under observation as an outpatient now.

　　Along with the accumulation of evidence to support the use of an oral rehydration solution before surgery, there is a strong tendency for the period of fasting before the induction of general anesthesia to become shorter and shorter. In this study, we compared hunger, thirst, psychology and onset of pneumonia as a sequela in between two groups of surgical patients-one with preoperative rehydration and the other without. The results showed that stress did not build up in the patients given a preoperative oral rehydration solution even after they returned to their rooms and did not have an intravenous drip. No one in either group developed pneumonia after surgery.

　　The platelet counts documented in most of the studies using the fully automated hematology analyzer XE-5000 are values measured by impedance technology (PLT-I). If blood specimens showing an anomalous particle-size distribution curve in the area where platelet counts are low are used (exceptionally low platelet count samples), the counting method is automatically switched over to an optical method (PLT-O). In the present study, we examined the usefulness of the XE-5000 by comparing PLT-I with PLT-O, using blood samples with low platelet counts collected from patients who visited our hospital between January 1 and March 31, 2012. Dilution linearity left nothing to be desired in either of the two, but simultaneous reproducibility was higher in PLT-O than in PLT-I. The correlations of PLT-I and PLT-O with visual counts were high, working out at r＝0.889～0.984. In the exceptionally low platelet count samples, the correlation coefficient was high in PLT-O than in PLT-I. The cases showing low platelet counts frequently presented giant platelets and/or red cell fragments. Therefore, measuring the samples with low platelet counts requires a high degree of precision. In the samples with exceptionally low platelet counts, PLT-O exceeded PLT-I in simultaneous reproducibility and correlation with visual counts. Thus, our study demonstrated the usefulness of the XE-5000 that could enumerate PLT-O automatically and speedily.

　　The subjects were aged inhabitants in a rural area in the southern part of Akita Prefecture. The purpose of this study was to collect and provide fundamental information instrumental in grasping the candidates for institutional care under the secondary prevention program. Toward this end, we examined the items of the checklist for preventing or delaying institutionalization relative to blood-sugar levels in the subjects.　　Since we found that elevated fasting blood-sugar levels and high HbA1c values had some associations with depression, it was concluded that those old people with elevated blood-sugar levels should be taken care of with depression in mind.