Introduction: The purpose of this study was to clarify the awareness and difficulties of home care support in outpatient nursing at an advanced acute care hospital.Methods: An anonymous questionnaire survey of outpatient nurses at a university hospital was conducted using a detention method.Results: In total, 195 questionnaires were analyzed (effective response rate: 89.9%). The number of years of outpatient nursing experience was within 1 to 3 years for 40%, being the highest. Regarding the importance of outpatient care in supporting home care, approximately 97% of the subjects answered that they 'always think' or 'sometimes think' that it is important. On the other hand, approximately 50% of subjects answered that they 'always' or 'sometimes' perform home care support. Eight difficulties in outpatient home care support were identified: [insufficient manpower], [shortage of time], [difficulties in understanding which patients need home care support], [lack of knowledge], [difficulties in in-hospital and community collaboration], [support not keeping up with current medical change], [number of outpatients], and [time-consuming support].Conclusion: It is necessary to improve the individual skills of outpatient nurses in order to provide seamless medical care and systematically improve the outpatient nursing system, including streamlining work, and facilitating in-hospital and community collaboration.

From November 1976 to December 1991, we performed extra anatomic bypass procedures (EAB) in 100 cases with aortoiliac occlusive disease. The operative procedures included 26 axillo-femoral bypasses (Ax-F), 27 femoro-femoral bypasses (F-F) and 47 aorto-femoro-femoral bypasses (Ao-F-F). The average age was 75.8 years in Ax-F and 73.8 years in F-F. These were significantly higher than that of Ao-F-F (70.8 years). In addition, the rate of limb salvage in Ax-F was 85%, and this group had more critical cases than the other two groups. The cumulative primary patency rate and survival rate at 5 years were 64.4%, 20.8% (Ax-F), 65.9%, 51.1% (F-F) and 96.5%, 70.4% (Ao-F-F) respectively. The late results of Ao-F-F were comparable to direct aorto-femoral bypass procedures performed in our institution during the same period. On the contrary, the results of Ax-F and F-F were discouraging. We suggest that EAB should be selected for high risk, limb salvage cases and in particular, Ax-F and F-F should be limited to patients with nonphysical acting. We are opposed to appealing for an extended indications of EAB and it should not be regarded simply as a low-risk substitute for aorto-femoral bypass.

Vascular trauma of the upper extremities is rare. We have successfully treated a case of laceration of the right subclavian artery induced by chest injury. A 45-year-old man with blunt trauma was admitted and angiography revealed laceration of the right subclavian artery. The injured area was exposed by a median sternal approach. The right common carotid-subclavian artery bypass was successfully performed with autogenous vein graft in less than three hours from admission. He recovered without any neurological deficit or functional disability and returned to his former occupation.