Following the revision of nursing care remuneration in FY 2015, our health service facility for the elderly made improved support available based on the outcomes of rehabilitation case conferences (RCCs) we convened for users of visiting rehabilitation services. In this study, we conducted a survey to investigate the implementation status of the RCC outcomes by respondents,including service users, their family members, and healthcare professionals,at our facility and the changes observed in service users who participated in the RCCs.Survey items inquired about the basic attributes of service users, RCC topics discussed, status of participation in the RCCs by occupation,and independence in activities of daily living (ADL) of elderly disabled people.The topics covered in the RCCs were classified using the International Classification of Functioning,Disability,and Health.In total,85 of 108 people who needed nursing care (34 men, 51 women; mean age 81.4±9.4 years;mean duration of service use 16.3 months) participated in the RCCs.The majority of topics covered in the RCCs concerned ADL and environmental factors,and more than half of the respondents participated in RCCs several times.Because ADL and environmental factors were discussed most,it can be said that the RCC concerning visiting rehabilitation services for users living at home is an effective means of expanding ADL and instrumental ADL. An advantage of holding RCCs is that the users themselves can clarify the current status and future goals. Also, from the service provider perspective, multidisciplinary cooperation becomes easier and helps to further improve support for users.

Restrictions on the use of antimicrobial agents are reported to lead to a reduction in the use of carbepanem (CP) antiobiotics and in the detection of resistant bacteria. Our hospital began monitoring the use of specific antimicrobial agents in June 2014. In the present study, we examined changes in the use of injectable broad-spectum antibiotics and in the susceptibility of Pseudomonas aeruginosa before and after introducing our antimicrobial use monitoring system (pre-and post-monitoring). We obtained a total of 301 specimens taken before the introduction of the system (January 2012-May 2014,143 specimens) and after after the introduction (June 2014-December 2016, 158 specimens). We then examined antimicrobial use density (AUD) and P. aeruginosa sensitivity per 100 patient-days.Comparisons of pre-monitoring results (2012) and post-monitoring results (2016) show that AUD decreased for imipenem/cilastatin (IPM/CS;0.26 to 0.1), meropenem (0.46 to 0.19), CAZ(0.52 to 0.16), and CZOP (0.17 to 0.09) and increased for tazobactam/piperacillin (0.67 to 1.16). Susceptibility of P. aeruginosa tended toward recovery (IPM/CS:0.8 to 0.87, piperacillin: 0.89 to 0.92, ceftazidime: 0.87 to 0.93,and cefozopran: 0.8 to 0.94). Our antimicrobial use monitoring system reduced the use of CP antibiotics and helped to restore the susceptibility of P. aeruginosa.

This study sought to determine factors related to sex differences in satisfaction with home care services among caregivers in a depopulated agrarian region. An anonymous questionnaire was administered to caregivers with experience providing home care to individuals aged ≥ 65 years. The questionnaire asked about the basic characteristics of the respondents, the nature of the care services they provided, and their satisfaction and responses after the care services. Valid responses for care service satisfaction were received from 130 individuals (78 women and 52 men), 71.6% of whom were aged ≥ 60 years. Overall, 52.3% of respondents were satisfied with their care services. We did not observe any association between the sex of the caregiver and care service satisfaction. Based on the qualitative analysis of their responses about satisfaction, we abstracted categories that demonstrated the particular characteristics of female and male caregivers.The results of this study indicate that professionals involved in providing care services should base their support on sex-based differences in characteristics.

Several highly specific gene mutations have been discovered in malignant lymphoma. Mutations of the MYD88 gene have been detected in lymphoplasmacytic lymphoma and in some cases of diffuse large B-cell lymphoma. We report here a case in which detection of such mutation led to a definitive diagnosis. A 76-year-old woman developed a fever of unknown origin. Physical findings revealed no evident signs of infection or lymphadenopathy. Although serum sIL-2R levels were high, computed tomography revealed only mild hepatosplenomegaly with no lesions from which a biopsy could be taken. We performed a bone marrow examination, which initially did not lead to a diagnosis. However, due to progressive worsening of the patient’s systemic condition and noted increased splenomegaly on computed tomography, we performed genetic testing which included the above. This testing detected mutation of the MYD88 gene in bone marrow cells. We strongly suspected malignant lymphoma and conducted further detailed examination, which led to the diagnosis of intravascular large B-cell lymphoma. Genetic testing may be an extremely useful method that can serve as a decisive factor in diagnosing malignant lymphoma that is otherwise difficult to diagnose.

In many patients with pulmonary cryptococcosis, chest radiographs show solitary or multiple nodular shadows, but pulmonary cryptococcosis with a large mass is rare. A previously healthy 45-year-old man presented to the hospital complaining of fever and cough. Contrast-enhanced computed tomography showed a tumor shadow with a long diameter of 64 mm in the lower lobe of the right lung. We considered the possibility of a lung abscess, but because it was refractory to antibiotics, we suspected the possibility of a malignant tumor. Transbronchial biopsy was performed, and Cryptococcus neoformans was detected. There were no complications of meningitis or immune deficiency, including acquired immune deficiency syndrome. He was administered antifungal drugs, and shrinkage of the shadow was achieved. Pulmonary cryptococcosis should also be considered when a large lung mass is observed.

We report the case of a 3-year-old boy with a history of repeated neutropenia and infection along with a significant family medical history. The diagnosis was cyclic neutropenia based on genetic testing. He had experienced frequent repeated episodes of fever since age 8 months, and he was found to have neutropenia when hospitalized due to acute otitis media at age 13 months. We obtained serial data of complete blood cell counts for 6 weeks when he was 3 years and 4 months old, which confirmed a cyclic increase and decrease in the number of neutrophils. ELANE gene testing was performed after obtaining written informed consent from the parents. A missense mutation was identified. At the parents’ request, we ran further testing and identified the same mutation in the father and paternal grandmother. Thus, 3 generations of kindred had the ELANE gene mutation. Because of repeated infections, prophylactic sulfamethoxazole trimethoprim was started from age 3 years and 10 months, resulting in a considerable decrease in the frequency of infections. Since age 4 years and 11 months, cyclic neutrophil over about 3 weeks has persisted, but there have been no serious infections requiring hospitalization.

In this study, we implemented a health education course, comprising lectures, cooking lessons, and group discussions for household cooks, that addressed the need for continued reduction of table salt intake and evaluated the effects from participants’ narratives. After the health education course, participants reported continuing to make the following efforts: planning dishes that have a milder yet still delicious taste, evaluating the amount of salt, refraining from highly salty dishes, and continuing to reduce salt use when cooking. The reasons participants continued to reduce table salt use included wanting to live a healthy life, understanding how to reduce salt in dishes, learning to reduce salt consumption, learning to check the amount of salt in dishes, learning that low-salt cooking is easy, learning that unseasoned dishes can be delicious, and feeling the benefits of reduced salt intake. Participants learned that low-salt cooking is easy and how to determine the amount of salt from set values, which were effective for their continued reduction of salt intake. Moreover, our study shows that continuous support is important until individuals become accustomed to milder tastes.

Conventional footplates place physical burden on helpers due to various incidents with the footplates and the need to bend over to operate the footplate. Therefore, we examined the introduction of a semi-automated retractable footplate with a ratchet mechanism (hereafter, semi-automated retractable footrest) and investigated its safety and convenience. Both patients and staff reported that the semi-automated retractable footrest was useful. We also found that the semi-automated retractable footrest was free of incidents, reduced physical burden, and enabled helpers to avoid contamination of their hands. However, we also found aspects of the semi-automated retractable footrest that need to be improved.

Five years have passed since the Japan Nursing Association started the Diagnostic Service for Improving Labor and Nursing Quality (DiNQL). We have participated in DiNQL data input support analysis activities since 2013, and the DiNQL Promotion Committee was launched in 2015. Here, we report on the activities of the DiNQL Promotion Committee and evaluate the results of these activities. The DiNQL Promotion Committee's four main activities involve being in charge of the floor at meetings, clarifying the input method aimed at shortening data collection time, supporting analysis of the DiNQL data input, and holding workshops for analysis and utilization. A self-administered questionnaire was administered to 43 ward nursing managers (including section chiefs and managers) to evaluate these committee activities. Both section chiefs and clerical staff responded that DiNQL data input time was shortened by more than 90%. Section chiefs comprised 64% and managers 79% of those who responded that DiNQL data could be utilized for determining annual departmental goals. In total, 71% of managers and 50% of section chiefs responded that DiNQL data is useful for nursing management. Based on these results, we confirmed that setting up the DiNQL Promotion Committee and its activities has led to nursing management support.

Accidents involving metals brought into the MRI room are occurring with increasing frequency. The Japan Council for Quality Health Care has released medical safety information about bringing magnetic materials into the MRI room, showing that this is an important safety issue. In our hospital, there were 4 accidents involving metal brought into the MRI room between April 2012 and March 2016. One serious incident was a projectile accident involving scissors carried by a nurse. In response, we have adopted new preventive measures, including specialized uniforms and a color-coding scheme for indicating MRI-safe and MRI-unsafe items (using colored tape, etc.). Here we report on the effect of these accident prevention efforts.