The World Health Organization (WHO) recommends antimicrobial use density (AUD) as an indicator for evaluating the amount of antimicrobials used, an index that is now widely employed in many facilities. Defined daily doses (DDD) set by WHO are used for calculating AUD. However, discrepancies have been noted between other countries and Japan in the standard dosage of antimicrobials, which may cause a problem evaluating antimicrobial use with the DDD. Therefore, in this study, we calculated AUD (modified antimicrobial use density: mAUD) with the DDD (modified defined daily dose: mDDD) of our hospital for the carbapenem antimicrobial meropenem (MEPM), mAUD, and resistance rate of Pseudomonas aeruginosa. From 2010 through fiscal year 2016 (ending in March), AUD was 5.9±1.4, 7.0±2.9, 8.2±2.3, 6.8±2.1, 7.3±2.2, 7.0±2.1, and 8.0±3.0 and mAUD was 11.7±2.7, 12.0±4.9, 11.3±3.1, 11.0± 3.4, 11.4±3.5, 11.5±3.5, and 11.2±4.2, respectively. The corresponding resistance rate of P. aeruginosa was 35.1%, 37.9%, 10.0%, 6.0%, 22.6%, 10.6%, and 10.0%. A significant positive correlation was found between mAUD and the resistance rate of Pseudomonas aeruginosa (P < 0.01, r = 0.88). Our results confirm that the mAUD is an effective index for controlling resistance of P. aeruginosa.

Purpose: A report of effective occupational therapy for delirium patients with cancer is uncommon. We report a patient of carcinomatous meningitis, in whom her daily activity is improved by occupational therapy. Case: Firstly, we supported her meals and then started occupational therapy accepting her interest. Although degree of confusion and her performance status was not varied from beginning to end, she could concentrate our programmed works and change her way of feelings. Also occupational therapy promotes reminiscence about her life review and friendship among other patients even in delirium condition. Conclusion: Occupational therapy can reduce cancer patients' impatience, anxiety and solitary feelings and improve quality of life.

STUDY DESIGN: A retrospective comparative study. PURPOSE: To compare perioperative medical complications after posterior approach spinal instrumentation surgery for osteoporotic vertebral collapse (OVC) between patients with primary osteoporosis and those with secondary osteoporosis. OVERVIEW OF LITERATURE: With increased aging of society, the demand for instrumentation surgery for an osteoporotic spine has been increasing. However, no studies have compared the rates or severities of perioperative complications after spinal instrumentation surgery between patients with primary osteoporosis and those with secondary osteoporosis. METHODS: Ninety-one patients with OVC aged ≥50 years (23 males and 68 females) who underwent posterior approach vertebral replacement with cages or posterior spinal fusion combined with vertebroplasty were divided into primary (n=56) and secondary (n=35) osteoporosis groups. Bone mineral density (BMD), osteoporosis treatment prior to OVC, operative invasiveness, and perioperative medical complications were compared. RESULTS: Diabetes mellitus (51.4%) was the most common cause of secondary osteoporosis, followed by glucocorticoid use (22.9%). No significant differences were seen in terms of age, gender, BMD, osteoporosis treatment, or operative invasiveness, including the number of levels fused, estimated blood loss, and number of patients requiring transfusion. No significant difference in the incidence of perioperative complications were observed between the primary and secondary osteoporosis groups (16.1% vs. 22.9%). However, surgical site infection (SSI) was significantly more frequently seen in the secondary osteoporosis group (11.4%) than in the primary osteoporosis group (1.8%; p<0.05). One patient in the secondary osteoporosis group developed methicillin-resistant Staphylococcus aureus infection that ultimately required instrument removal. CONCLUSIONS: The overall incidence of perioperative medical complications after posterior approach spinal instrumentation surgery for OVC was comparable between the primary and secondary osteoporosis groups under conditions of similar background characteristics and operative invasiveness. However, SSI (particularly more severe cases) occurred more frequently in patients with secondary osteoporosis.
Aging ; Bone Density ; Diabetes Mellitus ; Humans ; Incidence ; Male ; Methicillin-Resistant Staphylococcus aureus ; Osteoporosis* ; Retrospective Studies ; Spinal Fusion ; Spine ; Surgical Wound Infection ; Vertebroplasty

1)The Keio ACLS Popularizing and Promoting Association (KAPPA) is an official student organization that promotes advanced life support techniques.
2)KAPPA has provided 29 advanced cardiac life support courses, including 20 official ICLS (immediate cardiac life support) courses of the Japanese Association for Acute Medicine, which have trained 314 ICLS providers and 61 ICLS instructors during the past 8 years.
3)Peer–led training among students to maintain the quality of the courses has contributed to the activities of KAPPA.

STUDY DESIGN: A retrospective study. PURPOSE: To examine the efficacy and safety for a posterior-approach circumferential decompression and shortening reconstruction with a titanium mesh cage for lumbar burst fractures. OVERVIEW OF LITERATURE: Surgical decompression and reconstruction for severely unstable lumbar burst fractures requires an anterior or combined anteroposterior approach. Furthermore, anterior instrumentation for the lower lumbar is restricted through the presence of major vessels. METHODS: Three patients with an L1 burst fracture, one with an L3 and three with an L4 (5 men, 2 women; mean age, 65.0 years) who underwent circumferential decompression and shortening reconstruction with a titanium mesh cage through a posterior approach alone and a 4-year follow-up were evaluated regarding the clinical and radiological course. RESULTS: Mean operative time was 277 minutes. Mean blood loss was 471 ml. In 6 patients, the Frankel score improved more than one grade after surgery, and the remaining patient was at Frankel E both before and after surgery. Mean preoperative visual analogue scale was 7.0, improving to 0.7 postoperatively. Local kyphosis improved from 15.7degrees before surgery to -11.0degrees after surgery. In 3 cases regarding the mid to lower lumbar patients, local kyphosis increased more than 10degrees by 3 months following surgery, due to subsidence of the cages. One patient developed severe tilting and subsidence of the cage, requiring additional surgery. CONCLUSIONS: The results concerning this small series suggest the feasibility, efficacy, and safety of this treatment for unstable lumbar burst fractures. This technique from a posterior approach alone offers several advantages over traditional anterior or combined anteroposterior approaches.
Decompression ; Decompression, Surgical ; Follow-Up Studies ; Humans ; Kyphosis ; Male ; Operative Time ; Retrospective Studies ; Titanium

Pneumonia is common among elderly patients and the incidence among older adults is increasing in aging societies. If pulmonologists were to treat all cases of pneumonia, their work volume would be immense and the risk of burnout would increase. We reviewed cases of consecutive patients 70 years of age or older who were treated for pneumonia between November 2017 and October 2018 at Akita Kousei Medical Center. Of a total of 372 patients recruited for this study (214 men, mean age 85.6 years), 288 patients recovered and 84 (29.2%) died. The duration of admission differed significantly between the cardiovascular department and surgery department (p=0.03), between the renal unit of the internal medicine department and the neurosurgery department (p=0.01), and the renal unit of the internal medicine department and the surgery department (p=0.0005). Outcome was not significantly different among departments. It is crucial that pulmonologists and non-pulmonologists collaborate to treat pneumonia in old adults.