A 68-year-old woman received aortic valve replacement (AVR) with a Freestyle stentless valve using a subcoronary technique for aortic stenosis and regurgitation in September 2000. She complained of chest pain, had low grade fever and findings of inflammation and was admitted to our hospital with a diagnosis of acute myocardial infarction in December 2000. She suffered from repetitive or recurrent myocardial infarction. Transesophageal echocardiogram revealed no abnormal findings of the Freestyle stentless valve, but her blood culture was positive for methicillin-resistant coagulase negative Staphylococcus aureus (MRCNS) and she underwent an emergency operation. The Freestyle stentless valve was removed and replaced with a mechanical valve. The patient's intraoperative tissue grew MRCNS and parenteral antibiotics were administered for 8 weeks after surgery. Her condition was complicated with multiple cerebral infarction, however she was discharged on the 113th postoperative day and is doing well without recurrence of infection 12 months after the operation.

Objective: As part of the revision on remuneration for medical services in 2012, a new system has been implemented to allow an additional fee for inpatient pharmaceutical services to be added to the basic hospitalization fee.
Methods: We at Kitasato University Kitasato Institute Hospital satisfied all institutional requirements for the new system and were preparing to introduce it from April 2012; however, there was concern about the increased workload due to the additional work of preparing diaries for pharmaceutical services used in calculating the additional fee.
Results: We therefore developed a database titled Diary System for Inpatient Pharmaceutical Services for the preparation and management of diaries.  This system allows pharmacists from various divisions to enter data simultaneously and realizes the unified management of records of services performed at various places in the pharmacy.
Conclusions: Since entered data are automatically reflected in the inpatient pharmaceutical service diary and the monthly summary, an advantage compared to paper diaries in terms of efficiency may be expected.  Furthermore, the monthly summary of the number of service hours by ward and service type may also be used for service analysis.

Purpose: Distress screening is mandated by Ministry of Health, Labor and Welfare of Japan, however there is few data available on its effect in actual practice. We examined the impact of distress screening on palliative care referral at Hyogo Prefectural Amagasaki General Medical Center in Japan. Materials and Methods: We implemented distress screening on cancer patients who were given chemotherapy from February 2018. Patients were referred to the palliative care team when the physicians judged the need on the basis of the screening results or when the patients themselves wanted to receive the palliative care service. We examined the number of the patients referred to the palliative care team, then we researched the changes of the number after implementation of the screening, using the regression discontinuity analysis. Results: The distress screening didn’t increase the number of the patients who were referred to the palliative care team: the estimated difference of the number was 3.32 (95% confidence interval: −3.19〜9.82). Conclusion: We implemented distress screening at our hospital but it didn’t increase palliative care referral. Only a few studies have examined how routine screening impacts clinical outcomes. We expect our study helps to research the effectiveness of screening in each healthcare facility.

BACKGROUND: To examine changes in psychological distress prevalence among pregnant women in Miyagi Prefecture, which was directly affected by the Great East Japan Earthquake and tsunami, and compare it with the other, less damaged areas of Japan. METHODS: This study was conducted in conjunction with the Japan Environment and Children`s Study. We examined 76,152 pregnant women including 8270 in Miyagi Regional Center and 67,882 in 13 other regional centers from the all-birth fixed data of the Japan Environment and Children's Study. We then compared the prevalence and risk of distress in women in Miyagi Regional Center and women in the 13 regional centers for 3 years after the disaster. RESULTS: Women in the Miyagi Regional Center suffered more psychological distress than those in the 13 regional centers: OR 1.38 (95% CI, 1.03-1.87) to 1.92 (95% CI, 1.42-2.60). Additionally, women in the inland area had a consistently higher prevalence of psychological distress compared to those from the 13 regional centers: OR 1.67 (95% CI, 1.18-2.38) to 2.19 (95% CI, 1.60-2.99). CONCLUSIONS The lack of pre-disaster data in the Japan Environment and Children's Study made it impossible to compare the incidence of psychological distress before and after the March 2011 Great East Japan Earthquake. However, 3 years after the Great East Japan Earthquake, the prevalence of pregnant women with psychological distress did not improve in Miyagi Regional Center. Further, the prevalence of mental illness in inland areas was consistently higher than that in the 13 regional centers after the disaster.
Adolescent ; Adult ; Disasters ; Earthquakes ; Female ; Humans ; Japan/epidemiology* ; Pregnancy ; Pregnancy Complications/psychology* ; Pregnant Women/psychology* ; Prevalence ; Psychological Distress ; Tsunamis ; Young Adult