Today, the circumstances surrounding the medical economy are severer than ever. Therefore, it is vitally important for a hospital to rationalize management and implement a labor-saving system drastically.In October 2000, Atsumi Hospital moved to a newly built complex. At that time, those sections and departments which do not have any direct relation to medical treatment and care were restructured and established a supply center in order to use human resources effectivily.Before the establishment of the supply center, we had reviewd simple, routine tasks such as ward nursing assistant services, office work and management itself. While introducing our hospital supply center in this paper, we compare efficiencies before and after the move to the new building and dwell on advantages of centralization of ward nursing services.The rearrangement of the personnel, materials and information has made it possible to increase the efficiency of simple work and reduce the number of nursing assistants by 20%. Henceforth, it would be necessary to educate the staff, work on proper personnel changes, carefully make a plan for outsourcing, and choose trustworthy dealers.
Human Resources ; Work ; Economic supply ; Effective ; Central

A 2-year-old boy was admitted to our service with a diagnosis of double-outlet right ventricle (DORV) complicated by mitral valve stenosis. On echocardiographic measurement, the mitral annulus was 11mm (69% of normal) in diameter and 1.67cm²/m² in annular area. He underwent intraventricular tunnel repair and patch reconstruction of the right ventricular outflow tract under cardiopulmonary bypass. No attempt was made to operate on the mitral valve. DORV with mitral stenosis is a rare cardiac anomaly, the last 20 years only 21 cases have been reported, of which only 4 were cases with hypoplastic mitral rings. Although the patient made an uneventful recovery and remains well 5 months after surgery, a close observation is required for the mitral valve stenosis.

With the advent of a society in which the number of elderly people is increasing and the number of babies a woman gives birth to in her lifetime is decreasing, how to address to the future financial broblem of the nation's health insurance schemes has come up for discussion. Against the backdrop of quantitative repletion of medical care, the government has come pu with a policy calling for the containment of medical costs. Under the circumstances, it is expected that the proceeds from medical treatment will level off in years to come. To cope with the situation, the Federation of Agricultural Cooperatives for Welfare in Aichi Prefecture has planned to install a department-wise cost control system in its member hospitals with eht aim of making all staff members cost-conscious, profit-minded and futrure-oriented in every department. In this paper, the authors will present the system in outline and show the target number of patients set on the basis of the break-even point, financial analyses of departments where revenues are below the break-even point and measures to deal with deficits case by case. In addition, as a task to be tackled with, the need for the omprovement of the accuracy and the standardization of the system will be discussed.

Scimitar syndrome is a rare congenital cardiac anomaly with anomalous right pulmonary veins draining to the inferior caval vein. Currently, it is widely accepted that there are 2 forms of presentation with either an infantile manifestation or an adult form. Patients in the latter category are usually less severely affected and frequently asymptomatic on diagnosis. A 16-year-old boy who had been given a diagnosis of scimitar syndrome was observed for years because of his unwillingness to undergo surgery. However, since the latest catheter examination demonstrated an elevated pulmonary-to-systemic flow ratio of 2.39, he consented to undergo surgical treatment. Preoperative studies demonstrated an intact atrial septum and abnormal bronchial arborization of the right lung. Pulmonary angiography demonstrated abnormal right pulmonary veins that converged to a single venous trunk, the so-called scimitar vein, and drained into the inferior caval vein at the level of diaphragma. Because of the morphological abnormalities including a wide distance between the pulmonary veno-caval junction and interatrial septum, counterclockwise rotation of the heart, and a small left atrium, surgical management was performed with a novel approach, consisting of relocation of the scimitar vein to the anterolateral wall of the right atrium, total excision of the oval fossa, and intra-atrial baffle rerouting with the pulmonary venous blood being conveyed to the left atrium through the atrial septal defect. During the cardiopulmonary bypass vacuum assisted venous drainage through a femoral venous cannula was highly effective to secure a clear operative field without occlusion of the inferior caval vein. Postoperative recovery was uneventful and the repeat Doppler echocardiography demonstrated an unobstructed flow through the baffle. This experience indicates that the above novel approach is a promising surgical option for the management of scimitar syndrome.

Older adults tend to lose the opportunities and abilities to pursue hobbies and perform various activities. Club activities provided in the community for old people seem to be beneficial in that the activities prevent them from becoming housebound, and improve overall QOL. In the present study, we conducted a survey by sending out self-answered questionnaire to 424 elder residents in rural areas. We collected information about their life circumstances, the presence or absence of physical pain, activities of Daily Living (ADLs), the degree of enjoyment from activities on the list, the frequency of going out, PGC morale scale and so on. The activities enjoyed frequently by the elderly were bathing, eating and watching TV. The degrees of enjoying eating and bathing showed positive correlations with the PGC morale scale, but the degree of enjoying gambling correlated negatively with the scale. A regression analysis was performed with the PGC morale scale as dependent variables. As a result, a significant model was structured to predict the life sati of the aged by making interpersonal distress, enjoyment derived from gambling, basic ADLs, physical pain and dwelling alone as indepeudent variables. These results will assist us in providing adequate health care to pelple of advanced age.
Morale ; pleasurable emotion ; Academic degree ; Bathing self care ; Activities

Spinal cord injury is a dreaded and serious complication of operative procedures on the descending aorta. To avoid this serious complication, 53 patients underwent somatosensory evoked potential (SEP) monitoring during operations on the aorta which required cross-clamping of the descending aorta. 38 patients whose SEPs were kept normal during and after operations did not develop spinal cord injury. Among the 14 patients who developed both abnormal decrease in amplitude and elongation of peak latency, 13 lost their SEPs during aortic cross-clamping. Peripheral nerve ischemia seemed to be the cause of those abnormalities in 8 to whom cross-clamping was given to the abdominal aorta. Inadequate perfusion of the distal aorta was suspected in 6 to whom cross-clamping was given to the descending thoracic aorta. In these cases, however, SEP monitoring was not specific in differentiating spinal cord ischemia from peripheral nerve ischemia. Spinal cord injury was noted in only one of the 6 patients. The remaining one patient developed complete loss of SEP and spinal cord injury on the first postoperative day despite the well preserved SEP during the operation. Since this patient underwent flow reversal and thromboexclusion method for the dissecting aneurysm, gradual thrombotic occlusion of the important radicular arteries draining to spinal cord might have resulted delayed appearance of the spinal cord injury. In conclusion, SEP monitoring is the reliable method to detect the spinal cord ischemia which might be developed during cross-clamping of the descending aorta. However, this method bears limitation in its clinical application due to the following reasons. First, intraoperative SEP monitoring cannot predict delayed occurence of spinal cord injury. Secondly, this method cannot detect the qualitative extent of ischemia of spinal cord and the safe range of the cross-clamp time.

Background: This study examined the bidirectional and temporal-ordinal relationship between loneliness and back pain. Methods: Data from 7,730 participants in waves 6 (2012–2013), 7 (2014–2015), and 8 (2016–2017) of the national English Longitudinal Study of Ageing were analyzed. Back pain was graded on a scale of 0–10 (0, no discomfort; 10, unbearable pain). Loneliness was measured using the Revised University of California Los Angeles Loneliness Scale. A targeted minimum loss-based estimator was used to examine the bidirectional longitudinal associations between back pain and loneliness. Results: No loneliness in waves 6 and 7 (relative risk [RR]=0.76; 95% confidence interval [CI], 0.61–0.94), no loneliness in wave 6 but loneliness in wave 7 (RR=0.58; 95% CI, 0.50–0.68), and loneliness in wave 6 but not in wave 7 (RR=0.69; 95% CI, 0.57–0.86) were associated with significant risk reductions of back pain in wave 8 compared with the scenario of loneliness in waves 6 and 7. Mild back pain in wave 6 but moderate back pain (RR=0.55; 95% CI, 0.35–0.86) or severe back pain in wave 7 (RR=0.49; 95% CI, 0.34–0.72) showed a significant risk reduction of loneliness in wave 8 compared with severe back pain in waves 6 and 7. Conclusion Loneliness may be a risk factor for back pain, and back pain may be a risk factor for loneliness. The results of this study will inform the development of more effective interventions for loneliness and back pain.

Background: This study examined the bidirectional and temporal-ordinal relationship between loneliness and back pain. Methods: Data from 7,730 participants in waves 6 (2012–2013), 7 (2014–2015), and 8 (2016–2017) of the national English Longitudinal Study of Ageing were analyzed. Back pain was graded on a scale of 0–10 (0, no discomfort; 10, unbearable pain). Loneliness was measured using the Revised University of California Los Angeles Loneliness Scale. A targeted minimum loss-based estimator was used to examine the bidirectional longitudinal associations between back pain and loneliness. Results: No loneliness in waves 6 and 7 (relative risk [RR]=0.76; 95% confidence interval [CI], 0.61–0.94), no loneliness in wave 6 but loneliness in wave 7 (RR=0.58; 95% CI, 0.50–0.68), and loneliness in wave 6 but not in wave 7 (RR=0.69; 95% CI, 0.57–0.86) were associated with significant risk reductions of back pain in wave 8 compared with the scenario of loneliness in waves 6 and 7. Mild back pain in wave 6 but moderate back pain (RR=0.55; 95% CI, 0.35–0.86) or severe back pain in wave 7 (RR=0.49; 95% CI, 0.34–0.72) showed a significant risk reduction of loneliness in wave 8 compared with severe back pain in waves 6 and 7. Conclusion Loneliness may be a risk factor for back pain, and back pain may be a risk factor for loneliness. The results of this study will inform the development of more effective interventions for loneliness and back pain.

Background: This study examined the bidirectional and temporal-ordinal relationship between loneliness and back pain. Methods: Data from 7,730 participants in waves 6 (2012–2013), 7 (2014–2015), and 8 (2016–2017) of the national English Longitudinal Study of Ageing were analyzed. Back pain was graded on a scale of 0–10 (0, no discomfort; 10, unbearable pain). Loneliness was measured using the Revised University of California Los Angeles Loneliness Scale. A targeted minimum loss-based estimator was used to examine the bidirectional longitudinal associations between back pain and loneliness. Results: No loneliness in waves 6 and 7 (relative risk [RR]=0.76; 95% confidence interval [CI], 0.61–0.94), no loneliness in wave 6 but loneliness in wave 7 (RR=0.58; 95% CI, 0.50–0.68), and loneliness in wave 6 but not in wave 7 (RR=0.69; 95% CI, 0.57–0.86) were associated with significant risk reductions of back pain in wave 8 compared with the scenario of loneliness in waves 6 and 7. Mild back pain in wave 6 but moderate back pain (RR=0.55; 95% CI, 0.35–0.86) or severe back pain in wave 7 (RR=0.49; 95% CI, 0.34–0.72) showed a significant risk reduction of loneliness in wave 8 compared with severe back pain in waves 6 and 7. Conclusion Loneliness may be a risk factor for back pain, and back pain may be a risk factor for loneliness. The results of this study will inform the development of more effective interventions for loneliness and back pain.