1.Prevention of Delirium by Introducing Modified HELP (Hospital Elder Life Program) in Acute Medical Wards
Kota OCHIAI ; Hiroshi FUKUSHIMA ; Hitoshi NAKATA ; Noriko TAKAMATSU ; Miwako HONDA
An Official Journal of the Japan Primary Care Association 2020;43(3):105-111
Introduction: This study examined the effectiveness of the modified Hospital Elder Life Program (HELP) for preventing delirium, which was adjusted to be used in acute internal medicine wards at general community hospitals in Japan.Methods: The pre-intervention group consisted of 751 patients aged 70 years or older hospitalized at Nishiyodo Hospital and Amagasaki Medical Co-op Hospital between January and July 2013. The post-intervention group consisted of 775 patients aged 70 years or older hospitalized between March and July 2017 and between October and December 2017. To address risk factors for delirium, a multicomponent intervention (modified HELP) consisting of the following was implemented: handing out pamphlets, orientation to maintain activity levels, sleep improvement, early initiation of rehabilitation, provision of glasses, hearing aids, and dentures, and the termination of continuous intravenous infusion. The Delirium Screening Tool was used to calculate the percentage of inpatients who developed delirium.Results: Of the 751 patients in the pre-intervention group, 108 (14.4%) developed delirium and 88 (11.4%) of the 775 patients in the post-intervention group exhibited delirium (odds ratio: 0.70; 95% confidence interval: 0.48-1.01; p=0.06).Conclusion: The modified HELP, adjusted for use in Japan, did not significantly reduce the rate of delirium during hospitalization. Therefore, a more universal intervention method is needed in the future.
2.Gastric Adenocarcinoma of Fundic Gland Type with Aggressive Transformation and Lymph Node Metastasis: a Case Report.
Yasuhiro OKUMURA ; Manabu TAKAMATSU ; Manabu OHASHI ; Yorimasa YAMAMOTO ; Noriko YAMAMOTO ; Hiroshi KAWACHI ; Satoshi IDA ; Koshi KUMAGAI ; Souya NUNOBE ; Naoki HIKI ; Takeshi SANO
Journal of Gastric Cancer 2018;18(4):409-416
A 55-year-old man visited our hospital for a detailed examination of a gastric submucosal tumor that was first detected 10 years prior. The tumor continued to grow and had developed a depressed area in its center. A histopathological examination of biopsy specimens revealed gastric adenocarcinoma of the fundic gland type (GA-FG). It was diagnosed as T2 based on the invasion depth as determined by white-light endoscopy and endoscopic ultrasonography. A total gastrectomy with lymphadenectomy was performed and a GA-FG in the mucosa and submucosa was confirmed histopathologically. However, there was a gradual transition to an infiltrative tubular adenocarcinoma with poorly differentiated components in the muscular and subserosal layers. Metastasis was identified in a dissected lymph node (LN). This is the first report of a GA-FG progressing to an aggressive cancer with LN metastasis. These findings modify our understanding of the pathophysiology of GA-FG.
Adenocarcinoma*
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Biopsy
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Endoscopy
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Endosonography
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Gastrectomy
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Gastric Mucosa
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Humans
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Lymph Node Excision
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Lymph Nodes*
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Middle Aged
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Mucous Membrane
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Neoplasm Metastasis*